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BT 15.000 718.042 Td /F2 21.0 Tf  [(The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Recommendations from a Review of the Literature)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(May 30, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 78.638 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
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BT 82.605 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 88.026 663.247 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
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BT 158.996 663.247 Td /F1 9.8 Tf  [(Richard Aml�t)] TJ ET
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BT 220.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 225.637 663.247 Td /F1 9.8 Tf  [(Dr Jo Nurse)] TJ ET
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BT 277.644 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 283.065 663.247 Td /F1 9.8 Tf  [(Professor Richard Williams)] TJ ET
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BT 26.250 651.342 Td /F1 9.8 Tf  [(Stanke C, Murray V, Aml�t R, Nurse J, Williams R. The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 495.498 651.342 Td /F1 9.8 Tf  [(Recommendations )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(from a Review of the Literature. PLOS Currents Disasters. 2012 May 30 . Edition 1. doi: 10.1371/4f9f1fa9c3cae.)] TJ ET
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BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(Introduction)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects )] TJ ET
BT 565.435 578.476 Td /F1 9.8 Tf  [(on )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(some people�s health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(the hardiest of people who are affected.)] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(Methods)] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(The Health Protection Agency \(HPA\) undertook a review of the literature published from 2004 to 2010. It is intended to: assess )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on )] TJ ET
BT 26.250 475.738 Td /F1 9.8 Tf  [(practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can )] TJ ET
BT 26.250 463.833 Td /F1 9.8 Tf  [(support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and )] TJ ET
BT 26.250 451.929 Td /F1 9.8 Tf  [(discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes )] TJ ET
BT 26.250 440.024 Td /F1 9.8 Tf  [(and recommendations from this review of the literature.)] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(Results)] TJ ET
BT 26.250 408.714 Td /F1 9.8 Tf  [(The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights )] TJ ET
BT 26.250 396.810 Td /F1 9.8 Tf  [(the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the )] TJ ET
BT 26.250 384.905 Td /F1 9.8 Tf  [(majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of )] TJ ET
BT 26.250 373.000 Td /F1 9.8 Tf  [(common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people )] TJ ET
BT 26.250 361.095 Td /F1 9.8 Tf  [(affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the )] TJ ET
BT 26.250 349.191 Td /F1 9.8 Tf  [(literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are )] TJ ET
BT 26.250 337.286 Td /F1 9.8 Tf  [(under-represented in the published data. Most people�s psychosocial needs are met through their close relationships with their )] TJ ET
BT 26.250 325.381 Td /F1 9.8 Tf  [(families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, )] TJ ET
BT 26.250 313.476 Td /F1 9.8 Tf  [(there are a number of methodological challenges that arise when conducting research and when analysing and comparing data )] TJ ET
BT 26.250 301.572 Td /F1 9.8 Tf  [(on the psychosocial and mental health impacts of floods.)] TJ ET
BT 26.250 282.167 Td /F1 9.8 Tf  [(Conclusions)] TJ ET
BT 26.250 270.262 Td /F1 9.8 Tf  [(The HPA�s findings showed that a multi-sector approach that involves communities as well as agencies is the best way to )] TJ ET
BT 26.250 258.357 Td /F1 9.8 Tf  [(promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate )] TJ ET
BT 26.250 246.453 Td /F1 9.8 Tf  [(distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research )] TJ ET
BT 26.250 234.548 Td /F1 9.8 Tf  [(findings. Further research is needed on the longitudinal effects of flooding on people�s mental health, the effects of successive )] TJ ET
BT 26.250 222.643 Td /F1 9.8 Tf  [(flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people )] TJ ET
BT 26.250 210.738 Td /F1 9.8 Tf  [(who respond to the needs of other persons in the aftermath of disasters.)] TJ ET
BT 26.250 191.334 Td /F1 9.8 Tf  [(Corresponding author: Carla Stanke)] TJ ET
BT 26.250 179.429 Td /F1 9.8 Tf  [(Address: Health Protection Agency)] TJ ET
BT 26.250 167.524 Td /F1 9.8 Tf  [(151 Buckingham Palace Road)] TJ ET
BT 26.250 155.619 Td /F1 9.8 Tf  [(London SW1W 9SZ)] TJ ET
BT 26.250 143.715 Td /F1 9.8 Tf  [(E-mail: carla.stanke@hpa.org.uk)] TJ ET
BT 26.250 131.810 Td /F1 9.8 Tf  [(Fax: 020 7811 7759)] TJ ET
BT 26.250 119.905 Td /F1 9.8 Tf  [(Telephone: 020 7811 7161)] TJ ET
BT 26.250 83.303 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 63.348 Td /F1 9.8 Tf  [(Flooding is now the most frequent type of major disaster. Over the last 10 years, floods in Europe have killed more than 1,000 )] TJ ET
BT 26.250 51.444 Td /F1 9.8 Tf  [(people and affected over 3.4 million others)] TJ ET
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BT 209.969 52.951 Td /F4 8.7 Tf  [(1)] TJ ET
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BT 214.788 51.444 Td /F1 9.8 Tf  [(. In common with other types of major incidents or disasters, the effects on people�s )] TJ ET
BT 26.250 39.539 Td /F1 9.8 Tf  [(health, relationships and welfare can be extensive. However, flooding also stands out from some other types of disasters )] TJ ET
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BT 15.000 718.042 Td /F2 21.0 Tf  [(The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Recommendations from a Review of the Literature)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(May 30, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 78.638 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
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BT 82.605 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 88.026 663.247 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
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BT 153.575 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 158.996 663.247 Td /F1 9.8 Tf  [(Richard Aml�t)] TJ ET
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BT 220.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 225.637 663.247 Td /F1 9.8 Tf  [(Dr Jo Nurse)] TJ ET
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BT 277.644 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 283.065 663.247 Td /F1 9.8 Tf  [(Professor Richard Williams)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Stanke C, Murray V, Aml�t R, Nurse J, Williams R. The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 495.498 651.342 Td /F1 9.8 Tf  [(Recommendations )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(from a Review of the Literature. PLOS Currents Disasters. 2012 May 30 . Edition 1. doi: 10.1371/4f9f1fa9c3cae.)] TJ ET
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BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(Introduction)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects )] TJ ET
BT 565.435 578.476 Td /F1 9.8 Tf  [(on )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(some people�s health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(the hardiest of people who are affected.)] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(Methods)] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(The Health Protection Agency \(HPA\) undertook a review of the literature published from 2004 to 2010. It is intended to: assess )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on )] TJ ET
BT 26.250 475.738 Td /F1 9.8 Tf  [(practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can )] TJ ET
BT 26.250 463.833 Td /F1 9.8 Tf  [(support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and )] TJ ET
BT 26.250 451.929 Td /F1 9.8 Tf  [(discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes )] TJ ET
BT 26.250 440.024 Td /F1 9.8 Tf  [(and recommendations from this review of the literature.)] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(Results)] TJ ET
BT 26.250 408.714 Td /F1 9.8 Tf  [(The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights )] TJ ET
BT 26.250 396.810 Td /F1 9.8 Tf  [(the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the )] TJ ET
BT 26.250 384.905 Td /F1 9.8 Tf  [(majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of )] TJ ET
BT 26.250 373.000 Td /F1 9.8 Tf  [(common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people )] TJ ET
BT 26.250 361.095 Td /F1 9.8 Tf  [(affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the )] TJ ET
BT 26.250 349.191 Td /F1 9.8 Tf  [(literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are )] TJ ET
BT 26.250 337.286 Td /F1 9.8 Tf  [(under-represented in the published data. Most people�s psychosocial needs are met through their close relationships with their )] TJ ET
BT 26.250 325.381 Td /F1 9.8 Tf  [(families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, )] TJ ET
BT 26.250 313.476 Td /F1 9.8 Tf  [(there are a number of methodological challenges that arise when conducting research and when analysing and comparing data )] TJ ET
BT 26.250 301.572 Td /F1 9.8 Tf  [(on the psychosocial and mental health impacts of floods.)] TJ ET
BT 26.250 282.167 Td /F1 9.8 Tf  [(Conclusions)] TJ ET
BT 26.250 270.262 Td /F1 9.8 Tf  [(The HPA�s findings showed that a multi-sector approach that involves communities as well as agencies is the best way to )] TJ ET
BT 26.250 258.357 Td /F1 9.8 Tf  [(promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate )] TJ ET
BT 26.250 246.453 Td /F1 9.8 Tf  [(distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research )] TJ ET
BT 26.250 234.548 Td /F1 9.8 Tf  [(findings. Further research is needed on the longitudinal effects of flooding on people�s mental health, the effects of successive )] TJ ET
BT 26.250 222.643 Td /F1 9.8 Tf  [(flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people )] TJ ET
BT 26.250 210.738 Td /F1 9.8 Tf  [(who respond to the needs of other persons in the aftermath of disasters.)] TJ ET
BT 26.250 191.334 Td /F1 9.8 Tf  [(Corresponding author: Carla Stanke)] TJ ET
BT 26.250 179.429 Td /F1 9.8 Tf  [(Address: Health Protection Agency)] TJ ET
BT 26.250 167.524 Td /F1 9.8 Tf  [(151 Buckingham Palace Road)] TJ ET
BT 26.250 155.619 Td /F1 9.8 Tf  [(London SW1W 9SZ)] TJ ET
BT 26.250 143.715 Td /F1 9.8 Tf  [(E-mail: carla.stanke@hpa.org.uk)] TJ ET
BT 26.250 131.810 Td /F1 9.8 Tf  [(Fax: 020 7811 7759)] TJ ET
BT 26.250 119.905 Td /F1 9.8 Tf  [(Telephone: 020 7811 7161)] TJ ET
BT 26.250 83.303 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 63.348 Td /F1 9.8 Tf  [(Flooding is now the most frequent type of major disaster. Over the last 10 years, floods in Europe have killed more than 1,000 )] TJ ET
BT 26.250 51.444 Td /F1 9.8 Tf  [(people and affected over 3.4 million others)] TJ ET
0.267 0.267 0.267 rg
BT 209.969 52.951 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 214.788 51.444 Td /F1 9.8 Tf  [(. In common with other types of major incidents or disasters, the effects on people�s )] TJ ET
BT 26.250 39.539 Td /F1 9.8 Tf  [(health, relationships and welfare can be extensive. However, flooding also stands out from some other types of disasters )] TJ ET
Q
q
15.000 684.354 577.500 53.646 re W n
0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Recommendations from a Review of the Literature)] TJ ET
Q
0.271 0.267 0.267 rg
BT 15.000 675.088 Td /F3 9.8 Tf  [(May 30, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 78.638 675.088 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
0.271 0.267 0.267 rg
BT 82.605 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 88.026 663.247 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
0.271 0.267 0.267 rg
BT 153.575 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 158.996 663.247 Td /F1 9.8 Tf  [(Richard Aml�t)] TJ ET
0.271 0.267 0.267 rg
BT 220.216 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 225.637 663.247 Td /F1 9.8 Tf  [(Dr Jo Nurse)] TJ ET
0.271 0.267 0.267 rg
BT 277.644 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 283.065 663.247 Td /F1 9.8 Tf  [(Professor Richard Williams)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Stanke C, Murray V, Aml�t R, Nurse J, Williams R. The Effects of Flooding on Mental Health: Outcomes and )] TJ ET
BT 495.498 651.342 Td /F1 9.8 Tf  [(Recommendations )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(from a Review of the Literature. PLOS Currents Disasters. 2012 May 30 . Edition 1. doi: 10.1371/4f9f1fa9c3cae.)] TJ ET
q
15.000 25.253 577.500 611.804 re W n
0.271 0.267 0.267 rg
BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(Introduction)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects )] TJ ET
BT 565.435 578.476 Td /F1 9.8 Tf  [(on )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(some people�s health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(the hardiest of people who are affected.)] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(Methods)] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(The Health Protection Agency \(HPA\) undertook a review of the literature published from 2004 to 2010. It is intended to: assess )] TJ ET
BT 26.250 499.548 Td /F1 9.8 Tf  [(and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning )] TJ ET
BT 26.250 487.643 Td /F1 9.8 Tf  [(for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on )] TJ ET
BT 26.250 475.738 Td /F1 9.8 Tf  [(practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can )] TJ ET
BT 26.250 463.833 Td /F1 9.8 Tf  [(support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and )] TJ ET
BT 26.250 451.929 Td /F1 9.8 Tf  [(discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes )] TJ ET
BT 26.250 440.024 Td /F1 9.8 Tf  [(and recommendations from this review of the literature.)] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(Results)] TJ ET
BT 26.250 408.714 Td /F1 9.8 Tf  [(The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights )] TJ ET
BT 26.250 396.810 Td /F1 9.8 Tf  [(the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the )] TJ ET
BT 26.250 384.905 Td /F1 9.8 Tf  [(majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of )] TJ ET
BT 26.250 373.000 Td /F1 9.8 Tf  [(common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people )] TJ ET
BT 26.250 361.095 Td /F1 9.8 Tf  [(affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the )] TJ ET
BT 26.250 349.191 Td /F1 9.8 Tf  [(literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are )] TJ ET
BT 26.250 337.286 Td /F1 9.8 Tf  [(under-represented in the published data. Most people�s psychosocial needs are met through their close relationships with their )] TJ ET
BT 26.250 325.381 Td /F1 9.8 Tf  [(families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, )] TJ ET
BT 26.250 313.476 Td /F1 9.8 Tf  [(there are a number of methodological challenges that arise when conducting research and when analysing and comparing data )] TJ ET
BT 26.250 301.572 Td /F1 9.8 Tf  [(on the psychosocial and mental health impacts of floods.)] TJ ET
BT 26.250 282.167 Td /F1 9.8 Tf  [(Conclusions)] TJ ET
BT 26.250 270.262 Td /F1 9.8 Tf  [(The HPA�s findings showed that a multi-sector approach that involves communities as well as agencies is the best way to )] TJ ET
BT 26.250 258.357 Td /F1 9.8 Tf  [(promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate )] TJ ET
BT 26.250 246.453 Td /F1 9.8 Tf  [(distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research )] TJ ET
BT 26.250 234.548 Td /F1 9.8 Tf  [(findings. Further research is needed on the longitudinal effects of flooding on people�s mental health, the effects of successive )] TJ ET
BT 26.250 222.643 Td /F1 9.8 Tf  [(flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people )] TJ ET
BT 26.250 210.738 Td /F1 9.8 Tf  [(who respond to the needs of other persons in the aftermath of disasters.)] TJ ET
BT 26.250 191.334 Td /F1 9.8 Tf  [(Corresponding author: Carla Stanke)] TJ ET
BT 26.250 179.429 Td /F1 9.8 Tf  [(Address: Health Protection Agency)] TJ ET
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BT 26.250 554.500 Td /F1 9.8 Tf  [(adults; relatively few studies examined the effects of flooding on children, but those that did revealed increases in aggression, )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(bedwetting and moderate to severe stress symptoms. Studies showing increases in PTSD following flooding came from Europe )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(and North America, with limited evidence reported about suicide in relation to flooding.)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(This paper provides a summary of the outcomes and recommendations from a recent literature review entitled )] TJ ET
BT 502.557 511.286 Td /F5 9.8 Tf  [(The effects of )] TJ ET
BT 26.250 499.381 Td /F5 9.8 Tf  [(flooding on mental health)] TJ ET
0.267 0.267 0.267 rg
BT 135.187 500.888 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 140.005 499.381 Td /F1 9.8 Tf  [(. Access to the full report can be gained at: )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 487.476 Td /F1 9.8 Tf  [(https://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317131788841)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 468.072 Td /F1 9.8 Tf  [(Importantly, this paper offers a short version of the critique that appears in the HPA�s report concerning recent peer-reviewed )] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(literature and authoritative guidance for delivering responses to peoples� needs for psychosocial and mental health care. It also )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(offers an overview of the HPA�s recommendations to the responsible authorities and agencies about developments to the )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(research agenda and service developments that are informed by the messages from recent research and expert opinion.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(In 2009-2010, the Department of Health for England asked the HPA to contribute to its )] TJ ET
BT 400.748 412.953 Td /F5 9.8 Tf  [(New Horizons: A shared vision for )] TJ ET
BT 26.250 401.048 Td /F5 9.8 Tf  [(mental health policy)] TJ ET
0.267 0.267 0.267 rg
BT 112.411 402.555 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 117.229 401.048 Td /F1 9.8 Tf  [(. The New Horizons policy states that mental health problems are common as are mental disorders that )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(spring from environmental as well as physical and social risks. Since then, a new government has been elected in the UK and )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(health policy for public mental health matters has been taken forward by the strategy titled No Health Without Mental Health)] TJ ET
0.267 0.267 0.267 rg
BT 558.405 378.746 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 563.224 377.238 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(That policy sustains the general approach in New Horizons and affords prominence to developing people�s resilience and )] TJ ET
BT 26.250 353.429 Td /F1 9.8 Tf  [(preventing people from developing mental disorders. One of the environmental risks that may threaten people�s mental health is )] TJ ET
BT 26.250 341.524 Td /F1 9.8 Tf  [(posed by disasters, which include flooding. The HPA responded by:)] TJ ET
0.271 0.267 0.267 RG
40.337 325.087 m 
40.337 325.534 40.154 325.978 39.838 326.294 c
39.522 326.609 39.078 326.793 38.631 326.793 c
38.185 326.793 37.741 326.609 37.425 326.294 c
37.109 325.978 36.925 325.534 36.925 325.087 c
36.925 324.640 37.109 324.196 37.425 323.880 c
37.741 323.565 38.185 323.381 38.631 323.381 c
39.078 323.381 39.522 323.565 39.838 323.880 c
40.154 324.196 40.337 324.640 40.337 325.087 c f
BT 45.750 322.119 Td /F1 9.8 Tf  [(Assessing and appraising the epidemiological evidence on flooding and mental health;)] TJ ET
40.337 301.932 m 
40.337 302.379 40.154 302.823 39.838 303.139 c
39.522 303.455 39.078 303.639 38.631 303.639 c
38.185 303.639 37.741 303.455 37.425 303.139 c
37.109 302.823 36.925 302.379 36.925 301.932 c
36.925 301.486 37.109 301.042 37.425 300.726 c
37.741 300.410 38.185 300.226 38.631 300.226 c
39.078 300.226 39.522 300.410 39.838 300.726 c
40.154 301.042 40.337 301.486 40.337 301.932 c f
BT 45.750 298.965 Td /F1 9.8 Tf  [(Assessing the existing guidance on emergency planning for the mental health needs of people who are affected by flooding;)] TJ ET
40.337 278.778 m 
40.337 279.224 40.154 279.668 39.838 279.984 c
39.522 280.300 39.078 280.484 38.631 280.484 c
38.185 280.484 37.741 280.300 37.425 279.984 c
37.109 279.668 36.925 279.224 36.925 278.778 c
36.925 278.331 37.109 277.887 37.425 277.571 c
37.741 277.255 38.185 277.071 38.631 277.071 c
39.078 277.071 39.522 277.255 39.838 277.571 c
40.154 277.887 40.337 278.331 40.337 278.778 c f
BT 45.750 275.810 Td /F1 9.8 Tf  [(Providing a more detailed report for policymakers and services, which highlights the evidence about the impact of flooding )] TJ ET
BT 45.750 263.905 Td /F1 9.8 Tf  [(on people�s mental health, and which provides a summary of such information as is available about practical methods to )] TJ ET
BT 45.750 252.000 Td /F1 9.8 Tf  [(reduce these impacts through the work of public sector services and by their collaboration with other non-governmental )] TJ ET
BT 45.750 240.096 Td /F1 9.8 Tf  [(agencies; and)] TJ ET
40.337 219.909 m 
40.337 220.355 40.154 220.799 39.838 221.115 c
39.522 221.431 39.078 221.615 38.631 221.615 c
38.185 221.615 37.741 221.431 37.425 221.115 c
37.109 220.799 36.925 220.355 36.925 219.909 c
36.925 219.462 37.109 219.018 37.425 218.702 c
37.741 218.386 38.185 218.202 38.631 218.202 c
39.078 218.202 39.522 218.386 39.838 218.702 c
40.154 219.018 40.337 219.462 40.337 219.909 c f
BT 45.750 216.941 Td /F1 9.8 Tf  [(Identifying where and how research can support development of future evidence-based guidance.)] TJ ET
BT 26.250 193.786 Td /F1 9.8 Tf  [(This paper summarises the methodology used in that review, and sets the findings into the context framed by: current and )] TJ ET
BT 26.250 181.881 Td /F1 9.8 Tf  [(immediate past policy in England; guidance offered by international governing bodies \(the World Health Organization and )] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(NATO\) and non-governmental authorities; and a selection of recent advice from academic and other sources. The discussion )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(identifies the challenges faced by the researchers in this area. It also draws together key themes and recommendations that )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(emerge in the HPA�s report.)] TJ ET
BT 26.250 109.565 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 89.610 Td /F1 9.8 Tf  [(Two main types of source were used to examine the effects of flooding on people�s mental health. First, a review of the )] TJ ET
BT 26.250 77.706 Td /F1 9.8 Tf  [(published academic literature and, second, guidance from governmental, non-governmental and other authoritative sources and )] TJ ET
BT 26.250 65.801 Td /F1 9.8 Tf  [(selected papers that describe how services might be mounted in response to people�s psychosocial and mental health needs )] TJ ET
BT 26.250 53.896 Td /F1 9.8 Tf  [(after flooding.)] TJ ET
Q
q
15.000 24.610 577.500 752.390 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(because, often, it is possible to prevent flooding by using flood-prevention measures, and because of the lengthy recovery )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(period afterwards, which increases the risks of secondary stressors arising and the impact of worry about recurrence on people )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(who are affected by floods.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Furthermore, the impacts of climate change are likely to increase the occurrence of flooding. Projected climate-related increases )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(in precipitation are likely to make floods more frequent and severe. Coastal flooding is likely to threaten up to 1.6 million more )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(people every year in the European Union)] TJ ET
0.267 0.267 0.267 rg
BT 203.466 701.960 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 208.285 700.452 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Accounts of the psychosocial impacts of flood events suggest that they can have significant effects on people�s wellbeing, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(relationships and mental health. Flooding can pose substantial social and welfare problems that may continue over extended )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(periods of time because of not only being flooded \(the primary stressor\), but also because of the secondary stressors \(those )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(stressors that are indirectly related to the initial extreme event, i.e., economic stress associated with re-building\) that arise as )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(people try to recover their lives, property and relationships. Flooding can challenge the psychosocial resilience of the hardiest of )] TJ ET
BT 26.250 621.524 Td /F1 9.8 Tf  [(people who are affected.)] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(In their 2005 review on the global health impacts of flooding, Ahern et al)] TJ ET
0.267 0.267 0.267 rg
BT 335.705 603.626 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 340.524 602.119 Td /F1 9.8 Tf  [( report a number of epidemiological studies which )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(examined the effects of flooding on common mental disorders \(including anxiety and depression\), post-traumatic stress disorder )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(\(PTSD\) and suicide. Most studies exploring the effects of flooding on common mental disorders came from high or middle-)] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(income countries, and results revealed significant increases in depression, anxiety and psychological distress among flooded )] TJ ET
BT 26.250 554.500 Td /F1 9.8 Tf  [(adults; relatively few studies examined the effects of flooding on children, but those that did revealed increases in aggression, )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(bedwetting and moderate to severe stress symptoms. Studies showing increases in PTSD following flooding came from Europe )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(and North America, with limited evidence reported about suicide in relation to flooding.)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(This paper provides a summary of the outcomes and recommendations from a recent literature review entitled )] TJ ET
BT 502.557 511.286 Td /F5 9.8 Tf  [(The effects of )] TJ ET
BT 26.250 499.381 Td /F5 9.8 Tf  [(flooding on mental health)] TJ ET
0.267 0.267 0.267 rg
BT 135.187 500.888 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 140.005 499.381 Td /F1 9.8 Tf  [(. Access to the full report can be gained at: )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 487.476 Td /F1 9.8 Tf  [(https://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317131788841)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 468.072 Td /F1 9.8 Tf  [(Importantly, this paper offers a short version of the critique that appears in the HPA�s report concerning recent peer-reviewed )] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(literature and authoritative guidance for delivering responses to peoples� needs for psychosocial and mental health care. It also )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(offers an overview of the HPA�s recommendations to the responsible authorities and agencies about developments to the )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(research agenda and service developments that are informed by the messages from recent research and expert opinion.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(In 2009-2010, the Department of Health for England asked the HPA to contribute to its )] TJ ET
BT 400.748 412.953 Td /F5 9.8 Tf  [(New Horizons: A shared vision for )] TJ ET
BT 26.250 401.048 Td /F5 9.8 Tf  [(mental health policy)] TJ ET
0.267 0.267 0.267 rg
BT 112.411 402.555 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 117.229 401.048 Td /F1 9.8 Tf  [(. The New Horizons policy states that mental health problems are common as are mental disorders that )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(spring from environmental as well as physical and social risks. Since then, a new government has been elected in the UK and )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(health policy for public mental health matters has been taken forward by the strategy titled No Health Without Mental Health)] TJ ET
0.267 0.267 0.267 rg
BT 558.405 378.746 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 563.224 377.238 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(That policy sustains the general approach in New Horizons and affords prominence to developing people�s resilience and )] TJ ET
BT 26.250 353.429 Td /F1 9.8 Tf  [(preventing people from developing mental disorders. One of the environmental risks that may threaten people�s mental health is )] TJ ET
BT 26.250 341.524 Td /F1 9.8 Tf  [(posed by disasters, which include flooding. The HPA responded by:)] TJ ET
0.271 0.267 0.267 RG
40.337 325.087 m 
40.337 325.534 40.154 325.978 39.838 326.294 c
39.522 326.609 39.078 326.793 38.631 326.793 c
38.185 326.793 37.741 326.609 37.425 326.294 c
37.109 325.978 36.925 325.534 36.925 325.087 c
36.925 324.640 37.109 324.196 37.425 323.880 c
37.741 323.565 38.185 323.381 38.631 323.381 c
39.078 323.381 39.522 323.565 39.838 323.880 c
40.154 324.196 40.337 324.640 40.337 325.087 c f
BT 45.750 322.119 Td /F1 9.8 Tf  [(Assessing and appraising the epidemiological evidence on flooding and mental health;)] TJ ET
40.337 301.932 m 
40.337 302.379 40.154 302.823 39.838 303.139 c
39.522 303.455 39.078 303.639 38.631 303.639 c
38.185 303.639 37.741 303.455 37.425 303.139 c
37.109 302.823 36.925 302.379 36.925 301.932 c
36.925 301.486 37.109 301.042 37.425 300.726 c
37.741 300.410 38.185 300.226 38.631 300.226 c
39.078 300.226 39.522 300.410 39.838 300.726 c
40.154 301.042 40.337 301.486 40.337 301.932 c f
BT 45.750 298.965 Td /F1 9.8 Tf  [(Assessing the existing guidance on emergency planning for the mental health needs of people who are affected by flooding;)] TJ ET
40.337 278.778 m 
40.337 279.224 40.154 279.668 39.838 279.984 c
39.522 280.300 39.078 280.484 38.631 280.484 c
38.185 280.484 37.741 280.300 37.425 279.984 c
37.109 279.668 36.925 279.224 36.925 278.778 c
36.925 278.331 37.109 277.887 37.425 277.571 c
37.741 277.255 38.185 277.071 38.631 277.071 c
39.078 277.071 39.522 277.255 39.838 277.571 c
40.154 277.887 40.337 278.331 40.337 278.778 c f
BT 45.750 275.810 Td /F1 9.8 Tf  [(Providing a more detailed report for policymakers and services, which highlights the evidence about the impact of flooding )] TJ ET
BT 45.750 263.905 Td /F1 9.8 Tf  [(on people�s mental health, and which provides a summary of such information as is available about practical methods to )] TJ ET
BT 45.750 252.000 Td /F1 9.8 Tf  [(reduce these impacts through the work of public sector services and by their collaboration with other non-governmental )] TJ ET
BT 45.750 240.096 Td /F1 9.8 Tf  [(agencies; and)] TJ ET
40.337 219.909 m 
40.337 220.355 40.154 220.799 39.838 221.115 c
39.522 221.431 39.078 221.615 38.631 221.615 c
38.185 221.615 37.741 221.431 37.425 221.115 c
37.109 220.799 36.925 220.355 36.925 219.909 c
36.925 219.462 37.109 219.018 37.425 218.702 c
37.741 218.386 38.185 218.202 38.631 218.202 c
39.078 218.202 39.522 218.386 39.838 218.702 c
40.154 219.018 40.337 219.462 40.337 219.909 c f
BT 45.750 216.941 Td /F1 9.8 Tf  [(Identifying where and how research can support development of future evidence-based guidance.)] TJ ET
BT 26.250 193.786 Td /F1 9.8 Tf  [(This paper summarises the methodology used in that review, and sets the findings into the context framed by: current and )] TJ ET
BT 26.250 181.881 Td /F1 9.8 Tf  [(immediate past policy in England; guidance offered by international governing bodies \(the World Health Organization and )] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(NATO\) and non-governmental authorities; and a selection of recent advice from academic and other sources. The discussion )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(identifies the challenges faced by the researchers in this area. It also draws together key themes and recommendations that )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(emerge in the HPA�s report.)] TJ ET
BT 26.250 109.565 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 89.610 Td /F1 9.8 Tf  [(Two main types of source were used to examine the effects of flooding on people�s mental health. First, a review of the )] TJ ET
BT 26.250 77.706 Td /F1 9.8 Tf  [(published academic literature and, second, guidance from governmental, non-governmental and other authoritative sources and )] TJ ET
BT 26.250 65.801 Td /F1 9.8 Tf  [(selected papers that describe how services might be mounted in response to people�s psychosocial and mental health needs )] TJ ET
BT 26.250 53.896 Td /F1 9.8 Tf  [(after flooding.)] TJ ET
Q
q
15.000 24.610 577.500 752.390 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(because, often, it is possible to prevent flooding by using flood-prevention measures, and because of the lengthy recovery )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(period afterwards, which increases the risks of secondary stressors arising and the impact of worry about recurrence on people )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(who are affected by floods.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Furthermore, the impacts of climate change are likely to increase the occurrence of flooding. Projected climate-related increases )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(in precipitation are likely to make floods more frequent and severe. Coastal flooding is likely to threaten up to 1.6 million more )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(people every year in the European Union)] TJ ET
0.267 0.267 0.267 rg
BT 203.466 701.960 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 208.285 700.452 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Accounts of the psychosocial impacts of flood events suggest that they can have significant effects on people�s wellbeing, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(relationships and mental health. Flooding can pose substantial social and welfare problems that may continue over extended )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(periods of time because of not only being flooded \(the primary stressor\), but also because of the secondary stressors \(those )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(stressors that are indirectly related to the initial extreme event, i.e., economic stress associated with re-building\) that arise as )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(people try to recover their lives, property and relationships. Flooding can challenge the psychosocial resilience of the hardiest of )] TJ ET
BT 26.250 621.524 Td /F1 9.8 Tf  [(people who are affected.)] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(In their 2005 review on the global health impacts of flooding, Ahern et al)] TJ ET
0.267 0.267 0.267 rg
BT 335.705 603.626 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 340.524 602.119 Td /F1 9.8 Tf  [( report a number of epidemiological studies which )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(examined the effects of flooding on common mental disorders \(including anxiety and depression\), post-traumatic stress disorder )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(\(PTSD\) and suicide. Most studies exploring the effects of flooding on common mental disorders came from high or middle-)] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(income countries, and results revealed significant increases in depression, anxiety and psychological distress among flooded )] TJ ET
BT 26.250 554.500 Td /F1 9.8 Tf  [(adults; relatively few studies examined the effects of flooding on children, but those that did revealed increases in aggression, )] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(bedwetting and moderate to severe stress symptoms. Studies showing increases in PTSD following flooding came from Europe )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(and North America, with limited evidence reported about suicide in relation to flooding.)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(This paper provides a summary of the outcomes and recommendations from a recent literature review entitled )] TJ ET
BT 502.557 511.286 Td /F5 9.8 Tf  [(The effects of )] TJ ET
BT 26.250 499.381 Td /F5 9.8 Tf  [(flooding on mental health)] TJ ET
0.267 0.267 0.267 rg
BT 135.187 500.888 Td /F4 8.7 Tf  [(4)] TJ ET
0.271 0.267 0.267 rg
BT 140.005 499.381 Td /F1 9.8 Tf  [(. Access to the full report can be gained at: )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 487.476 Td /F1 9.8 Tf  [(https://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317131788841)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 468.072 Td /F1 9.8 Tf  [(Importantly, this paper offers a short version of the critique that appears in the HPA�s report concerning recent peer-reviewed )] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(literature and authoritative guidance for delivering responses to peoples� needs for psychosocial and mental health care. It also )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(offers an overview of the HPA�s recommendations to the responsible authorities and agencies about developments to the )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(research agenda and service developments that are informed by the messages from recent research and expert opinion.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(In 2009-2010, the Department of Health for England asked the HPA to contribute to its )] TJ ET
BT 400.748 412.953 Td /F5 9.8 Tf  [(New Horizons: A shared vision for )] TJ ET
BT 26.250 401.048 Td /F5 9.8 Tf  [(mental health policy)] TJ ET
0.267 0.267 0.267 rg
BT 112.411 402.555 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 117.229 401.048 Td /F1 9.8 Tf  [(. The New Horizons policy states that mental health problems are common as are mental disorders that )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(spring from environmental as well as physical and social risks. Since then, a new government has been elected in the UK and )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(health policy for public mental health matters has been taken forward by the strategy titled No Health Without Mental Health)] TJ ET
0.267 0.267 0.267 rg
BT 558.405 378.746 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 563.224 377.238 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 365.334 Td /F1 9.8 Tf  [(That policy sustains the general approach in New Horizons and affords prominence to developing people�s resilience and )] TJ ET
BT 26.250 353.429 Td /F1 9.8 Tf  [(preventing people from developing mental disorders. One of the environmental risks that may threaten people�s mental health is )] TJ ET
BT 26.250 341.524 Td /F1 9.8 Tf  [(posed by disasters, which include flooding. The HPA responded by:)] TJ ET
0.271 0.267 0.267 RG
40.337 325.087 m 
40.337 325.534 40.154 325.978 39.838 326.294 c
39.522 326.609 39.078 326.793 38.631 326.793 c
38.185 326.793 37.741 326.609 37.425 326.294 c
37.109 325.978 36.925 325.534 36.925 325.087 c
36.925 324.640 37.109 324.196 37.425 323.880 c
37.741 323.565 38.185 323.381 38.631 323.381 c
39.078 323.381 39.522 323.565 39.838 323.880 c
40.154 324.196 40.337 324.640 40.337 325.087 c f
BT 45.750 322.119 Td /F1 9.8 Tf  [(Assessing and appraising the epidemiological evidence on flooding and mental health;)] TJ ET
40.337 301.932 m 
40.337 302.379 40.154 302.823 39.838 303.139 c
39.522 303.455 39.078 303.639 38.631 303.639 c
38.185 303.639 37.741 303.455 37.425 303.139 c
37.109 302.823 36.925 302.379 36.925 301.932 c
36.925 301.486 37.109 301.042 37.425 300.726 c
37.741 300.410 38.185 300.226 38.631 300.226 c
39.078 300.226 39.522 300.410 39.838 300.726 c
40.154 301.042 40.337 301.486 40.337 301.932 c f
BT 45.750 298.965 Td /F1 9.8 Tf  [(Assessing the existing guidance on emergency planning for the mental health needs of people who are affected by flooding;)] TJ ET
40.337 278.778 m 
40.337 279.224 40.154 279.668 39.838 279.984 c
39.522 280.300 39.078 280.484 38.631 280.484 c
38.185 280.484 37.741 280.300 37.425 279.984 c
37.109 279.668 36.925 279.224 36.925 278.778 c
36.925 278.331 37.109 277.887 37.425 277.571 c
37.741 277.255 38.185 277.071 38.631 277.071 c
39.078 277.071 39.522 277.255 39.838 277.571 c
40.154 277.887 40.337 278.331 40.337 278.778 c f
BT 45.750 275.810 Td /F1 9.8 Tf  [(Providing a more detailed report for policymakers and services, which highlights the evidence about the impact of flooding )] TJ ET
BT 45.750 263.905 Td /F1 9.8 Tf  [(on people�s mental health, and which provides a summary of such information as is available about practical methods to )] TJ ET
BT 45.750 252.000 Td /F1 9.8 Tf  [(reduce these impacts through the work of public sector services and by their collaboration with other non-governmental )] TJ ET
BT 45.750 240.096 Td /F1 9.8 Tf  [(agencies; and)] TJ ET
40.337 219.909 m 
40.337 220.355 40.154 220.799 39.838 221.115 c
39.522 221.431 39.078 221.615 38.631 221.615 c
38.185 221.615 37.741 221.431 37.425 221.115 c
37.109 220.799 36.925 220.355 36.925 219.909 c
36.925 219.462 37.109 219.018 37.425 218.702 c
37.741 218.386 38.185 218.202 38.631 218.202 c
39.078 218.202 39.522 218.386 39.838 218.702 c
40.154 219.018 40.337 219.462 40.337 219.909 c f
BT 45.750 216.941 Td /F1 9.8 Tf  [(Identifying where and how research can support development of future evidence-based guidance.)] TJ ET
BT 26.250 193.786 Td /F1 9.8 Tf  [(This paper summarises the methodology used in that review, and sets the findings into the context framed by: current and )] TJ ET
BT 26.250 181.881 Td /F1 9.8 Tf  [(immediate past policy in England; guidance offered by international governing bodies \(the World Health Organization and )] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(NATO\) and non-governmental authorities; and a selection of recent advice from academic and other sources. The discussion )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(identifies the challenges faced by the researchers in this area. It also draws together key themes and recommendations that )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(emerge in the HPA�s report.)] TJ ET
BT 26.250 109.565 Td /F4 12.0 Tf  [(Methods)] TJ ET
BT 26.250 89.610 Td /F1 9.8 Tf  [(Two main types of source were used to examine the effects of flooding on people�s mental health. First, a review of the )] TJ ET
BT 26.250 77.706 Td /F1 9.8 Tf  [(published academic literature and, second, guidance from governmental, non-governmental and other authoritative sources and )] TJ ET
BT 26.250 65.801 Td /F1 9.8 Tf  [(selected papers that describe how services might be mounted in response to people�s psychosocial and mental health needs )] TJ ET
BT 26.250 53.896 Td /F1 9.8 Tf  [(after flooding.)] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F5 9.8 Tf  [(THE OBJECTIVES OF THE LITERATURE REVIEW)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The specific objectives of the literature review were:)] TJ ET
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40.337 731.634 m 
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36.925 731.188 37.109 730.744 37.425 730.428 c
37.741 730.112 38.185 729.928 38.631 729.928 c
39.078 729.928 39.522 730.112 39.838 730.428 c
40.154 730.744 40.337 731.188 40.337 731.634 c f
BT 45.750 728.667 Td /F1 9.8 Tf  [(To review the epidemiological evidence about the mental health impacts on people who have been affected by flooding by )] TJ ET
BT 45.750 716.762 Td /F1 9.8 Tf  [(critically appraising published studies of floods that have occurred world-wide; and)] TJ ET
40.337 696.575 m 
40.337 697.021 40.154 697.465 39.838 697.781 c
39.522 698.097 39.078 698.281 38.631 698.281 c
38.185 698.281 37.741 698.097 37.425 697.781 c
37.109 697.465 36.925 697.021 36.925 696.575 c
36.925 696.128 37.109 695.684 37.425 695.368 c
37.741 695.052 38.185 694.869 38.631 694.869 c
39.078 694.869 39.522 695.052 39.838 695.368 c
40.154 695.684 40.337 696.128 40.337 696.575 c f
BT 45.750 693.607 Td /F1 9.8 Tf  [(To identify gaps in current knowledge about reducing the psychosocial and mental health impacts of flooding, its effects on )] TJ ET
BT 45.750 681.702 Td /F1 9.8 Tf  [(public mental health, and people�s needs for mental healthcare.)] TJ ET
BT 26.250 658.548 Td /F5 9.8 Tf  [(LITERATURE SEARCH STRATEGY)] TJ ET
BT 26.250 639.143 Td /F1 9.8 Tf  [(The authors collected evidence through a systematic review of the literature that was published between 2004 and 2010. The )] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(methodology used was similar to that used in a global epidemiological review that was published in 2005 on the health impacts )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(of flooding)] TJ ET
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BT 71.237 616.841 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 76.055 615.333 Td /F1 9.8 Tf  [(. The 2005 epidemiological review included a section on the mental health effects of flooding; searching the )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(literature from 2004 onwards allowed the authors to review the results of more recent studies which were not included in the )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(epidemiological review published in 2005, building upon what was already established with new studies. The authors developed )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(an algorithm and used the Scopus search engine to search for all papers with the specified search terms in their titles, abstracts )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(or as keywords \(Scopus is a search tool that scans and has access to many large academic databases including Medline )] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(\(pubmed\), Embase, Psychinfo, and covers 15,000 peer-reviewed journals as well as conference proceedings and book series\).)] TJ ET
BT 26.250 536.405 Td /F5 9.8 Tf  [(INCLUSION CRITERIA)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(The inclusion criteria were that the epidemiological papers selected should have been published in peer-reviewed journals in the )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(subject areas of: medicine, nursing, psychology, pharmacology and toxicology. The authors also sought data that is available )] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(from government and non-governmental organisations and took advice from experts in the field on what research was in press )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(or in process as well as seeking their knowledge of what other sources of information they knew.)] TJ ET
BT 26.250 461.881 Td /F5 9.8 Tf  [(EXCLUSION CRITERIA)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(The authors excluded papers if they were:)] TJ ET
40.337 426.039 m 
40.337 426.486 40.154 426.930 39.838 427.246 c
39.522 427.562 39.078 427.746 38.631 427.746 c
38.185 427.746 37.741 427.562 37.425 427.246 c
37.109 426.930 36.925 426.486 36.925 426.039 c
36.925 425.593 37.109 425.149 37.425 424.833 c
37.741 424.517 38.185 424.333 38.631 424.333 c
39.078 424.333 39.522 424.517 39.838 424.833 c
40.154 425.149 40.337 425.593 40.337 426.039 c f
BT 45.750 423.072 Td /F1 9.8 Tf  [(Irrelevant to the search such as use of the words �flood� and �flooding� to mean inundation; biochemistry, genetics and )] TJ ET
BT 45.750 411.167 Td /F1 9.8 Tf  [(molecular biology;)] TJ ET
40.337 390.980 m 
40.337 391.426 40.154 391.870 39.838 392.186 c
39.522 392.502 39.078 392.686 38.631 392.686 c
38.185 392.686 37.741 392.502 37.425 392.186 c
37.109 391.870 36.925 391.426 36.925 390.980 c
36.925 390.533 37.109 390.089 37.425 389.773 c
37.741 389.457 38.185 389.274 38.631 389.274 c
39.078 389.274 39.522 389.457 39.838 389.773 c
40.154 390.089 40.337 390.533 40.337 390.980 c f
BT 45.750 388.012 Td /F1 9.8 Tf  [(Conference papers, dissertations, older papers, editorials, commentaries, meta-analyses and unpublished manuscripts; or)] TJ ET
40.337 367.825 m 
40.337 368.272 40.154 368.716 39.838 369.032 c
39.522 369.347 39.078 369.531 38.631 369.531 c
38.185 369.531 37.741 369.347 37.425 369.032 c
37.109 368.716 36.925 368.272 36.925 367.825 c
36.925 367.378 37.109 366.934 37.425 366.618 c
37.741 366.303 38.185 366.119 38.631 366.119 c
39.078 366.119 39.522 366.303 39.838 366.618 c
40.154 366.934 40.337 367.378 40.337 367.825 c f
BT 45.750 364.857 Td /F1 9.8 Tf  [(Not published in English, and not published between 2004 and 2010.)] TJ ET
BT 26.250 341.703 Td /F1 9.8 Tf  [(The authors manually reviewed references from full text papers in order to identify additional articles that met the inclusion )] TJ ET
BT 26.250 329.798 Td /F1 9.8 Tf  [(criteria. In addition, the authors searched the databases listed here in order to identify other recent epidemiological reviews:)] TJ ET
40.337 313.361 m 
40.337 313.807 40.154 314.251 39.838 314.567 c
39.522 314.883 39.078 315.067 38.631 315.067 c
38.185 315.067 37.741 314.883 37.425 314.567 c
37.109 314.251 36.925 313.807 36.925 313.361 c
36.925 312.914 37.109 312.470 37.425 312.154 c
37.741 311.838 38.185 311.655 38.631 311.655 c
39.078 311.655 39.522 311.838 39.838 312.154 c
40.154 312.470 40.337 312.914 40.337 313.361 c f
BT 45.750 310.393 Td /F1 9.8 Tf  [(DARE \(Database of Abstracts of Reviews of Effects\);)] TJ ET
40.337 290.206 m 
40.337 290.653 40.154 291.097 39.838 291.413 c
39.522 291.728 39.078 291.912 38.631 291.912 c
38.185 291.912 37.741 291.728 37.425 291.413 c
37.109 291.097 36.925 290.653 36.925 290.206 c
36.925 289.759 37.109 289.315 37.425 288.999 c
37.741 288.684 38.185 288.500 38.631 288.500 c
39.078 288.500 39.522 288.684 39.838 288.999 c
40.154 289.315 40.337 289.759 40.337 290.206 c f
BT 45.750 287.238 Td /F1 9.8 Tf  [(CDSR \(Cochrane Database of Systematic Reviews\);)] TJ ET
40.337 267.051 m 
40.337 267.498 40.154 267.942 39.838 268.258 c
39.522 268.574 39.078 268.758 38.631 268.758 c
38.185 268.758 37.741 268.574 37.425 268.258 c
37.109 267.942 36.925 267.498 36.925 267.051 c
36.925 266.605 37.109 266.161 37.425 265.845 c
37.741 265.529 38.185 265.345 38.631 265.345 c
39.078 265.345 39.522 265.529 39.838 265.845 c
40.154 266.161 40.337 266.605 40.337 267.051 c f
BT 45.750 264.084 Td /F1 9.8 Tf  [(EPPI \(Evidence for Policy and Practice Information Centre\); and)] TJ ET
40.337 243.897 m 
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39.522 245.419 39.078 245.603 38.631 245.603 c
38.185 245.603 37.741 245.419 37.425 245.103 c
37.109 244.787 36.925 244.343 36.925 243.897 c
36.925 243.450 37.109 243.006 37.425 242.690 c
37.741 242.374 38.185 242.190 38.631 242.190 c
39.078 242.190 39.522 242.374 39.838 242.690 c
40.154 243.006 40.337 243.450 40.337 243.897 c f
BT 45.750 240.929 Td /F1 9.8 Tf  [(DoPHER \(Database of providing health effectiveness reviews\).)] TJ ET
BT 26.250 217.774 Td /F1 9.8 Tf  [(The search generated 3,585 references and this number was reduced to 827 papers when the authors applied their exclusion )] TJ ET
BT 26.250 205.869 Td /F1 9.8 Tf  [(criteria. The authors assessed all of the papers for their suitability for inclusion in the review by applying the strict )] TJ ET
BT 26.250 193.965 Td /F1 9.8 Tf  [(epidemiological criteria that are cited in Ahern et al)] TJ ET
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BT 244.631 195.472 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 249.449 193.965 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 174.560 Td /F5 9.8 Tf  [(THE PAPERS REVIEWED)] TJ ET
BT 26.250 155.155 Td /F1 9.8 Tf  [(The HPA found 48 papers on mental health that fit the strict criteria. The authors included all of them in the review, but gave )] TJ ET
BT 26.250 143.250 Td /F1 9.8 Tf  [(greatest weight to studies that were based on epidemiological designs with controlled comparisons.)] TJ ET
BT 26.250 123.846 Td /F1 9.8 Tf  [(Table 1 summarises the epidemiological papers that are assessed in the HPA�s report \(reference numbers in parenthesis\).)] TJ ET
BT 26.250 104.441 Td /F4 9.8 Tf  [(Table 1: Distribution of research papers by flood event \(reference numbers in parentheses\))] TJ ET
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BT 45.750 728.667 Td /F1 9.8 Tf  [(To review the epidemiological evidence about the mental health impacts on people who have been affected by flooding by )] TJ ET
BT 45.750 716.762 Td /F1 9.8 Tf  [(critically appraising published studies of floods that have occurred world-wide; and)] TJ ET
40.337 696.575 m 
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38.185 698.281 37.741 698.097 37.425 697.781 c
37.109 697.465 36.925 697.021 36.925 696.575 c
36.925 696.128 37.109 695.684 37.425 695.368 c
37.741 695.052 38.185 694.869 38.631 694.869 c
39.078 694.869 39.522 695.052 39.838 695.368 c
40.154 695.684 40.337 696.128 40.337 696.575 c f
BT 45.750 693.607 Td /F1 9.8 Tf  [(To identify gaps in current knowledge about reducing the psychosocial and mental health impacts of flooding, its effects on )] TJ ET
BT 45.750 681.702 Td /F1 9.8 Tf  [(public mental health, and people�s needs for mental healthcare.)] TJ ET
BT 26.250 658.548 Td /F5 9.8 Tf  [(LITERATURE SEARCH STRATEGY)] TJ ET
BT 26.250 639.143 Td /F1 9.8 Tf  [(The authors collected evidence through a systematic review of the literature that was published between 2004 and 2010. The )] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(methodology used was similar to that used in a global epidemiological review that was published in 2005 on the health impacts )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(of flooding)] TJ ET
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BT 71.237 616.841 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 76.055 615.333 Td /F1 9.8 Tf  [(. The 2005 epidemiological review included a section on the mental health effects of flooding; searching the )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(literature from 2004 onwards allowed the authors to review the results of more recent studies which were not included in the )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(epidemiological review published in 2005, building upon what was already established with new studies. The authors developed )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(an algorithm and used the Scopus search engine to search for all papers with the specified search terms in their titles, abstracts )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(or as keywords \(Scopus is a search tool that scans and has access to many large academic databases including Medline )] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(\(pubmed\), Embase, Psychinfo, and covers 15,000 peer-reviewed journals as well as conference proceedings and book series\).)] TJ ET
BT 26.250 536.405 Td /F5 9.8 Tf  [(INCLUSION CRITERIA)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(The inclusion criteria were that the epidemiological papers selected should have been published in peer-reviewed journals in the )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(subject areas of: medicine, nursing, psychology, pharmacology and toxicology. The authors also sought data that is available )] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(from government and non-governmental organisations and took advice from experts in the field on what research was in press )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(or in process as well as seeking their knowledge of what other sources of information they knew.)] TJ ET
BT 26.250 461.881 Td /F5 9.8 Tf  [(EXCLUSION CRITERIA)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(The authors excluded papers if they were:)] TJ ET
40.337 426.039 m 
40.337 426.486 40.154 426.930 39.838 427.246 c
39.522 427.562 39.078 427.746 38.631 427.746 c
38.185 427.746 37.741 427.562 37.425 427.246 c
37.109 426.930 36.925 426.486 36.925 426.039 c
36.925 425.593 37.109 425.149 37.425 424.833 c
37.741 424.517 38.185 424.333 38.631 424.333 c
39.078 424.333 39.522 424.517 39.838 424.833 c
40.154 425.149 40.337 425.593 40.337 426.039 c f
BT 45.750 423.072 Td /F1 9.8 Tf  [(Irrelevant to the search such as use of the words �flood� and �flooding� to mean inundation; biochemistry, genetics and )] TJ ET
BT 45.750 411.167 Td /F1 9.8 Tf  [(molecular biology;)] TJ ET
40.337 390.980 m 
40.337 391.426 40.154 391.870 39.838 392.186 c
39.522 392.502 39.078 392.686 38.631 392.686 c
38.185 392.686 37.741 392.502 37.425 392.186 c
37.109 391.870 36.925 391.426 36.925 390.980 c
36.925 390.533 37.109 390.089 37.425 389.773 c
37.741 389.457 38.185 389.274 38.631 389.274 c
39.078 389.274 39.522 389.457 39.838 389.773 c
40.154 390.089 40.337 390.533 40.337 390.980 c f
BT 45.750 388.012 Td /F1 9.8 Tf  [(Conference papers, dissertations, older papers, editorials, commentaries, meta-analyses and unpublished manuscripts; or)] TJ ET
40.337 367.825 m 
40.337 368.272 40.154 368.716 39.838 369.032 c
39.522 369.347 39.078 369.531 38.631 369.531 c
38.185 369.531 37.741 369.347 37.425 369.032 c
37.109 368.716 36.925 368.272 36.925 367.825 c
36.925 367.378 37.109 366.934 37.425 366.618 c
37.741 366.303 38.185 366.119 38.631 366.119 c
39.078 366.119 39.522 366.303 39.838 366.618 c
40.154 366.934 40.337 367.378 40.337 367.825 c f
BT 45.750 364.857 Td /F1 9.8 Tf  [(Not published in English, and not published between 2004 and 2010.)] TJ ET
BT 26.250 341.703 Td /F1 9.8 Tf  [(The authors manually reviewed references from full text papers in order to identify additional articles that met the inclusion )] TJ ET
BT 26.250 329.798 Td /F1 9.8 Tf  [(criteria. In addition, the authors searched the databases listed here in order to identify other recent epidemiological reviews:)] TJ ET
40.337 313.361 m 
40.337 313.807 40.154 314.251 39.838 314.567 c
39.522 314.883 39.078 315.067 38.631 315.067 c
38.185 315.067 37.741 314.883 37.425 314.567 c
37.109 314.251 36.925 313.807 36.925 313.361 c
36.925 312.914 37.109 312.470 37.425 312.154 c
37.741 311.838 38.185 311.655 38.631 311.655 c
39.078 311.655 39.522 311.838 39.838 312.154 c
40.154 312.470 40.337 312.914 40.337 313.361 c f
BT 45.750 310.393 Td /F1 9.8 Tf  [(DARE \(Database of Abstracts of Reviews of Effects\);)] TJ ET
40.337 290.206 m 
40.337 290.653 40.154 291.097 39.838 291.413 c
39.522 291.728 39.078 291.912 38.631 291.912 c
38.185 291.912 37.741 291.728 37.425 291.413 c
37.109 291.097 36.925 290.653 36.925 290.206 c
36.925 289.759 37.109 289.315 37.425 288.999 c
37.741 288.684 38.185 288.500 38.631 288.500 c
39.078 288.500 39.522 288.684 39.838 288.999 c
40.154 289.315 40.337 289.759 40.337 290.206 c f
BT 45.750 287.238 Td /F1 9.8 Tf  [(CDSR \(Cochrane Database of Systematic Reviews\);)] TJ ET
40.337 267.051 m 
40.337 267.498 40.154 267.942 39.838 268.258 c
39.522 268.574 39.078 268.758 38.631 268.758 c
38.185 268.758 37.741 268.574 37.425 268.258 c
37.109 267.942 36.925 267.498 36.925 267.051 c
36.925 266.605 37.109 266.161 37.425 265.845 c
37.741 265.529 38.185 265.345 38.631 265.345 c
39.078 265.345 39.522 265.529 39.838 265.845 c
40.154 266.161 40.337 266.605 40.337 267.051 c f
BT 45.750 264.084 Td /F1 9.8 Tf  [(EPPI \(Evidence for Policy and Practice Information Centre\); and)] TJ ET
40.337 243.897 m 
40.337 244.343 40.154 244.787 39.838 245.103 c
39.522 245.419 39.078 245.603 38.631 245.603 c
38.185 245.603 37.741 245.419 37.425 245.103 c
37.109 244.787 36.925 244.343 36.925 243.897 c
36.925 243.450 37.109 243.006 37.425 242.690 c
37.741 242.374 38.185 242.190 38.631 242.190 c
39.078 242.190 39.522 242.374 39.838 242.690 c
40.154 243.006 40.337 243.450 40.337 243.897 c f
BT 45.750 240.929 Td /F1 9.8 Tf  [(DoPHER \(Database of providing health effectiveness reviews\).)] TJ ET
BT 26.250 217.774 Td /F1 9.8 Tf  [(The search generated 3,585 references and this number was reduced to 827 papers when the authors applied their exclusion )] TJ ET
BT 26.250 205.869 Td /F1 9.8 Tf  [(criteria. The authors assessed all of the papers for their suitability for inclusion in the review by applying the strict )] TJ ET
BT 26.250 193.965 Td /F1 9.8 Tf  [(epidemiological criteria that are cited in Ahern et al)] TJ ET
0.267 0.267 0.267 rg
BT 244.631 195.472 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 249.449 193.965 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 174.560 Td /F5 9.8 Tf  [(THE PAPERS REVIEWED)] TJ ET
BT 26.250 155.155 Td /F1 9.8 Tf  [(The HPA found 48 papers on mental health that fit the strict criteria. The authors included all of them in the review, but gave )] TJ ET
BT 26.250 143.250 Td /F1 9.8 Tf  [(greatest weight to studies that were based on epidemiological designs with controlled comparisons.)] TJ ET
BT 26.250 123.846 Td /F1 9.8 Tf  [(Table 1 summarises the epidemiological papers that are assessed in the HPA�s report \(reference numbers in parenthesis\).)] TJ ET
BT 26.250 104.441 Td /F4 9.8 Tf  [(Table 1: Distribution of research papers by flood event \(reference numbers in parentheses\))] TJ ET
Q
q
15.000 94.560 577.500 682.440 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F5 9.8 Tf  [(THE OBJECTIVES OF THE LITERATURE REVIEW)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The specific objectives of the literature review were:)] TJ ET
0.271 0.267 0.267 RG
40.337 731.634 m 
40.337 732.081 40.154 732.525 39.838 732.841 c
39.522 733.157 39.078 733.340 38.631 733.340 c
38.185 733.340 37.741 733.157 37.425 732.841 c
37.109 732.525 36.925 732.081 36.925 731.634 c
36.925 731.188 37.109 730.744 37.425 730.428 c
37.741 730.112 38.185 729.928 38.631 729.928 c
39.078 729.928 39.522 730.112 39.838 730.428 c
40.154 730.744 40.337 731.188 40.337 731.634 c f
BT 45.750 728.667 Td /F1 9.8 Tf  [(To review the epidemiological evidence about the mental health impacts on people who have been affected by flooding by )] TJ ET
BT 45.750 716.762 Td /F1 9.8 Tf  [(critically appraising published studies of floods that have occurred world-wide; and)] TJ ET
40.337 696.575 m 
40.337 697.021 40.154 697.465 39.838 697.781 c
39.522 698.097 39.078 698.281 38.631 698.281 c
38.185 698.281 37.741 698.097 37.425 697.781 c
37.109 697.465 36.925 697.021 36.925 696.575 c
36.925 696.128 37.109 695.684 37.425 695.368 c
37.741 695.052 38.185 694.869 38.631 694.869 c
39.078 694.869 39.522 695.052 39.838 695.368 c
40.154 695.684 40.337 696.128 40.337 696.575 c f
BT 45.750 693.607 Td /F1 9.8 Tf  [(To identify gaps in current knowledge about reducing the psychosocial and mental health impacts of flooding, its effects on )] TJ ET
BT 45.750 681.702 Td /F1 9.8 Tf  [(public mental health, and people�s needs for mental healthcare.)] TJ ET
BT 26.250 658.548 Td /F5 9.8 Tf  [(LITERATURE SEARCH STRATEGY)] TJ ET
BT 26.250 639.143 Td /F1 9.8 Tf  [(The authors collected evidence through a systematic review of the literature that was published between 2004 and 2010. The )] TJ ET
BT 26.250 627.238 Td /F1 9.8 Tf  [(methodology used was similar to that used in a global epidemiological review that was published in 2005 on the health impacts )] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(of flooding)] TJ ET
0.267 0.267 0.267 rg
BT 71.237 616.841 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 76.055 615.333 Td /F1 9.8 Tf  [(. The 2005 epidemiological review included a section on the mental health effects of flooding; searching the )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(literature from 2004 onwards allowed the authors to review the results of more recent studies which were not included in the )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(epidemiological review published in 2005, building upon what was already established with new studies. The authors developed )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(an algorithm and used the Scopus search engine to search for all papers with the specified search terms in their titles, abstracts )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(or as keywords \(Scopus is a search tool that scans and has access to many large academic databases including Medline )] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(\(pubmed\), Embase, Psychinfo, and covers 15,000 peer-reviewed journals as well as conference proceedings and book series\).)] TJ ET
BT 26.250 536.405 Td /F5 9.8 Tf  [(INCLUSION CRITERIA)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(The inclusion criteria were that the epidemiological papers selected should have been published in peer-reviewed journals in the )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(subject areas of: medicine, nursing, psychology, pharmacology and toxicology. The authors also sought data that is available )] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(from government and non-governmental organisations and took advice from experts in the field on what research was in press )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(or in process as well as seeking their knowledge of what other sources of information they knew.)] TJ ET
BT 26.250 461.881 Td /F5 9.8 Tf  [(EXCLUSION CRITERIA)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(The authors excluded papers if they were:)] TJ ET
40.337 426.039 m 
40.337 426.486 40.154 426.930 39.838 427.246 c
39.522 427.562 39.078 427.746 38.631 427.746 c
38.185 427.746 37.741 427.562 37.425 427.246 c
37.109 426.930 36.925 426.486 36.925 426.039 c
36.925 425.593 37.109 425.149 37.425 424.833 c
37.741 424.517 38.185 424.333 38.631 424.333 c
39.078 424.333 39.522 424.517 39.838 424.833 c
40.154 425.149 40.337 425.593 40.337 426.039 c f
BT 45.750 423.072 Td /F1 9.8 Tf  [(Irrelevant to the search such as use of the words �flood� and �flooding� to mean inundation; biochemistry, genetics and )] TJ ET
BT 45.750 411.167 Td /F1 9.8 Tf  [(molecular biology;)] TJ ET
40.337 390.980 m 
40.337 391.426 40.154 391.870 39.838 392.186 c
39.522 392.502 39.078 392.686 38.631 392.686 c
38.185 392.686 37.741 392.502 37.425 392.186 c
37.109 391.870 36.925 391.426 36.925 390.980 c
36.925 390.533 37.109 390.089 37.425 389.773 c
37.741 389.457 38.185 389.274 38.631 389.274 c
39.078 389.274 39.522 389.457 39.838 389.773 c
40.154 390.089 40.337 390.533 40.337 390.980 c f
BT 45.750 388.012 Td /F1 9.8 Tf  [(Conference papers, dissertations, older papers, editorials, commentaries, meta-analyses and unpublished manuscripts; or)] TJ ET
40.337 367.825 m 
40.337 368.272 40.154 368.716 39.838 369.032 c
39.522 369.347 39.078 369.531 38.631 369.531 c
38.185 369.531 37.741 369.347 37.425 369.032 c
37.109 368.716 36.925 368.272 36.925 367.825 c
36.925 367.378 37.109 366.934 37.425 366.618 c
37.741 366.303 38.185 366.119 38.631 366.119 c
39.078 366.119 39.522 366.303 39.838 366.618 c
40.154 366.934 40.337 367.378 40.337 367.825 c f
BT 45.750 364.857 Td /F1 9.8 Tf  [(Not published in English, and not published between 2004 and 2010.)] TJ ET
BT 26.250 341.703 Td /F1 9.8 Tf  [(The authors manually reviewed references from full text papers in order to identify additional articles that met the inclusion )] TJ ET
BT 26.250 329.798 Td /F1 9.8 Tf  [(criteria. In addition, the authors searched the databases listed here in order to identify other recent epidemiological reviews:)] TJ ET
40.337 313.361 m 
40.337 313.807 40.154 314.251 39.838 314.567 c
39.522 314.883 39.078 315.067 38.631 315.067 c
38.185 315.067 37.741 314.883 37.425 314.567 c
37.109 314.251 36.925 313.807 36.925 313.361 c
36.925 312.914 37.109 312.470 37.425 312.154 c
37.741 311.838 38.185 311.655 38.631 311.655 c
39.078 311.655 39.522 311.838 39.838 312.154 c
40.154 312.470 40.337 312.914 40.337 313.361 c f
BT 45.750 310.393 Td /F1 9.8 Tf  [(DARE \(Database of Abstracts of Reviews of Effects\);)] TJ ET
40.337 290.206 m 
40.337 290.653 40.154 291.097 39.838 291.413 c
39.522 291.728 39.078 291.912 38.631 291.912 c
38.185 291.912 37.741 291.728 37.425 291.413 c
37.109 291.097 36.925 290.653 36.925 290.206 c
36.925 289.759 37.109 289.315 37.425 288.999 c
37.741 288.684 38.185 288.500 38.631 288.500 c
39.078 288.500 39.522 288.684 39.838 288.999 c
40.154 289.315 40.337 289.759 40.337 290.206 c f
BT 45.750 287.238 Td /F1 9.8 Tf  [(CDSR \(Cochrane Database of Systematic Reviews\);)] TJ ET
40.337 267.051 m 
40.337 267.498 40.154 267.942 39.838 268.258 c
39.522 268.574 39.078 268.758 38.631 268.758 c
38.185 268.758 37.741 268.574 37.425 268.258 c
37.109 267.942 36.925 267.498 36.925 267.051 c
36.925 266.605 37.109 266.161 37.425 265.845 c
37.741 265.529 38.185 265.345 38.631 265.345 c
39.078 265.345 39.522 265.529 39.838 265.845 c
40.154 266.161 40.337 266.605 40.337 267.051 c f
BT 45.750 264.084 Td /F1 9.8 Tf  [(EPPI \(Evidence for Policy and Practice Information Centre\); and)] TJ ET
40.337 243.897 m 
40.337 244.343 40.154 244.787 39.838 245.103 c
39.522 245.419 39.078 245.603 38.631 245.603 c
38.185 245.603 37.741 245.419 37.425 245.103 c
37.109 244.787 36.925 244.343 36.925 243.897 c
36.925 243.450 37.109 243.006 37.425 242.690 c
37.741 242.374 38.185 242.190 38.631 242.190 c
39.078 242.190 39.522 242.374 39.838 242.690 c
40.154 243.006 40.337 243.450 40.337 243.897 c f
BT 45.750 240.929 Td /F1 9.8 Tf  [(DoPHER \(Database of providing health effectiveness reviews\).)] TJ ET
BT 26.250 217.774 Td /F1 9.8 Tf  [(The search generated 3,585 references and this number was reduced to 827 papers when the authors applied their exclusion )] TJ ET
BT 26.250 205.869 Td /F1 9.8 Tf  [(criteria. The authors assessed all of the papers for their suitability for inclusion in the review by applying the strict )] TJ ET
BT 26.250 193.965 Td /F1 9.8 Tf  [(epidemiological criteria that are cited in Ahern et al)] TJ ET
0.267 0.267 0.267 rg
BT 244.631 195.472 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 249.449 193.965 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 174.560 Td /F5 9.8 Tf  [(THE PAPERS REVIEWED)] TJ ET
BT 26.250 155.155 Td /F1 9.8 Tf  [(The HPA found 48 papers on mental health that fit the strict criteria. The authors included all of them in the review, but gave )] TJ ET
BT 26.250 143.250 Td /F1 9.8 Tf  [(greatest weight to studies that were based on epidemiological designs with controlled comparisons.)] TJ ET
BT 26.250 123.846 Td /F1 9.8 Tf  [(Table 1 summarises the epidemiological papers that are assessed in the HPA�s report \(reference numbers in parenthesis\).)] TJ ET
BT 26.250 104.441 Td /F4 9.8 Tf  [(Table 1: Distribution of research papers by flood event \(reference numbers in parentheses\))] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 31.875 750.139 Td /F1 9.8 Tf  [(American Hurricanes 2004/5 \(7-34\))] TJ ET
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415.396 712.106 0.750 48.638 re f
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BT 420.646 750.139 Td /F1 9.8 Tf  [(28)] TJ ET
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26.625 696.225 0.750 16.631 re f
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BT 31.875 702.251 Td /F1 9.8 Tf  [(Poland 1997 \(35;36\))] TJ ET
0.267 0.267 0.267 rg
415.396 712.106 165.479 0.750 re f
415.396 696.225 0.750 16.631 re f
580.125 696.225 0.750 16.631 re f
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BT 420.646 702.251 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
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26.625 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 686.370 Td /F1 9.8 Tf  [(Mexico 1999 \(37;38\))] TJ ET
0.267 0.267 0.267 rg
415.396 696.225 165.479 0.750 re f
415.396 680.344 0.750 16.631 re f
580.125 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 686.370 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 680.344 389.521 0.750 re f
26.625 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 670.489 Td /F1 9.8 Tf  [(China, Hunan province 1998 \(39-41\))] TJ ET
0.267 0.267 0.267 rg
415.396 680.344 165.479 0.750 re f
415.396 664.462 0.750 16.631 re f
580.125 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 670.489 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 664.462 389.521 0.750 re f
26.625 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 654.608 Td /F1 9.8 Tf  [(Vietnam, Xangsane Typhoon 2006 \(42\))] TJ ET
0.267 0.267 0.267 rg
415.396 664.462 165.479 0.750 re f
415.396 648.581 0.750 16.631 re f
580.125 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 654.608 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 648.581 389.521 0.750 re f
26.625 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 638.726 Td /F1 9.8 Tf  [(Sri Lanka, Tsunami 2004 \(43\))] TJ ET
0.267 0.267 0.267 rg
415.396 648.581 165.479 0.750 re f
415.396 632.700 0.750 16.631 re f
580.125 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 638.726 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 632.700 389.521 0.750 re f
26.625 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 622.845 Td /F1 9.8 Tf  [(Germany 2002 \(44\))] TJ ET
0.267 0.267 0.267 rg
415.396 632.700 165.479 0.750 re f
415.396 616.819 0.750 16.631 re f
580.125 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 622.845 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 616.819 389.521 0.750 re f
26.625 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 606.964 Td /F1 9.8 Tf  [(Korea 2006 \(45\))] TJ ET
0.267 0.267 0.267 rg
415.396 616.819 165.479 0.750 re f
415.396 600.938 0.750 16.631 re f
580.125 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 606.964 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 600.938 389.521 0.750 re f
26.625 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 591.083 Td /F1 9.8 Tf  [(Carlisle, UK 2005 \(46\))] TJ ET
0.267 0.267 0.267 rg
415.396 600.938 165.479 0.750 re f
415.396 585.056 0.750 16.631 re f
580.125 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 591.083 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 585.056 389.521 0.750 re f
26.625 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 575.201 Td /F1 9.8 Tf  [(Iowa, US 1993 \(47;48\))] TJ ET
0.267 0.267 0.267 rg
415.396 585.056 165.479 0.750 re f
415.396 569.175 0.750 16.631 re f
580.125 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 575.201 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 569.175 389.521 0.750 re f
26.625 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 559.320 Td /F1 9.8 Tf  [(Mississippi River \(Illinois and Missouri\)1993 \(49;50\))] TJ ET
0.267 0.267 0.267 rg
415.396 569.175 165.479 0.750 re f
415.396 553.294 0.750 16.631 re f
580.125 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 559.320 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 553.294 389.521 0.750 re f
26.625 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 543.439 Td /F1 9.8 Tf  [(Italy 1996 \(51\))] TJ ET
0.267 0.267 0.267 rg
415.396 553.294 165.479 0.750 re f
415.396 537.413 0.750 16.631 re f
580.125 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 543.439 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 537.413 389.521 0.750 re f
26.625 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.558 Td /F1 9.8 Tf  [(UK 2007 \(52;53\))] TJ ET
0.267 0.267 0.267 rg
415.396 537.413 165.479 0.750 re f
415.396 521.531 0.750 16.631 re f
580.125 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 527.558 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 521.531 389.521 0.750 re f
26.625 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 511.676 Td /F1 9.8 Tf  [(UK 1998-2002 \(54\))] TJ ET
0.267 0.267 0.267 rg
415.396 521.531 165.479 0.750 re f
415.396 505.650 0.750 16.631 re f
580.125 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 511.676 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 505.650 389.521 0.750 re f
26.625 489.769 389.521 0.750 re f
26.625 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 495.795 Td /F1 9.8 Tf  [(Total)] TJ ET
0.267 0.267 0.267 rg
415.396 505.650 165.479 0.750 re f
415.396 489.769 165.479 0.750 re f
415.396 489.769 0.750 16.631 re f
580.125 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 495.795 Td /F1 9.8 Tf  [(48)] TJ ET
BT 26.250 434.870 Td /F1 9.8 Tf  [(Twenty-eight \(28\) of the papers assessed people�s mental health after hurricanes in America and 20 after floods. The authors )] TJ ET
BT 26.250 422.965 Td /F1 9.8 Tf  [(made the decision to include hurricanes leading to flooding because of the difficulties in classifying disasters. We concluded that )] TJ ET
BT 26.250 411.060 Td /F1 9.8 Tf  [(it was important to include the extensive data on the mental health of people affected by hurricanes because of the health )] TJ ET
BT 26.250 399.156 Td /F1 9.8 Tf  [(impacts of the floods immediately following Hurricane Katrina.)] TJ ET
BT 26.250 379.751 Td /F1 9.8 Tf  [(The majority of papers that the authors reviewed consider population samples of adults who are affected by a particular flood. A )] TJ ET
BT 26.250 367.846 Td /F1 9.8 Tf  [(number of papers report research on samples taken from specific populations: six relate to people aged under 18 )] TJ ET
0.267 0.267 0.267 rg
BT 516.149 369.353 Td /F4 8.7 Tf  [(9)] TJ ET
BT 520.967 369.353 Td /F4 8.7 Tf  [(12)] TJ ET
BT 530.605 369.353 Td /F4 8.7 Tf  [(13)] TJ ET
BT 540.242 369.353 Td /F4 8.7 Tf  [(16)] TJ ET
BT 549.879 369.353 Td /F4 8.7 Tf  [(40)] TJ ET
BT 559.517 369.353 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 569.154 367.846 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 355.941 Td /F1 9.8 Tf  [(two studies were conducted in evacuation shelters after Hurricane Katrina )] TJ ET
0.267 0.267 0.267 rg
BT 347.054 357.449 Td /F4 8.7 Tf  [(17)] TJ ET
BT 356.692 357.449 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 366.329 355.941 Td /F1 9.8 Tf  [(; one specifically sampled ethnic minorities )] TJ ET
0.267 0.267 0.267 rg
BT 553.266 357.449 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 562.903 355.941 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 344.037 Td /F1 9.8 Tf  [(one assessed patients evacuated from a heart centre)] TJ ET
0.267 0.267 0.267 rg
BT 256.038 345.544 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 265.675 344.037 Td /F1 9.8 Tf  [(; and one study was of pregnant women )] TJ ET
0.267 0.267 0.267 rg
BT 441.273 345.544 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 450.910 344.037 Td /F1 9.8 Tf  [(. The majority of the studies )] TJ ET
BT 26.250 332.132 Td /F1 9.8 Tf  [(were cross-sectional.)] TJ ET
BT 26.250 312.727 Td /F1 9.8 Tf  [(The timing of the studies, relative to the flood considered by the research, varied from data collected pre-event, to data collected )] TJ ET
BT 26.250 300.822 Td /F1 9.8 Tf  [(after zero to two weeks, and up to eight years after flooding. However, the vast majority of the studies took place between six )] TJ ET
BT 26.250 288.918 Td /F1 9.8 Tf  [(months and 24 months after the index event. The size of the population samples was also very diverse, ranging from 50 to )] TJ ET
BT 26.250 277.013 Td /F1 9.8 Tf  [(33,000 people.)] TJ ET
BT 26.250 257.608 Td /F5 9.8 Tf  [(THE REVIEW OF RECENT GUIDANCE DOCUMENTS)] TJ ET
BT 26.250 238.203 Td /F1 9.8 Tf  [(The authors reviewed recent government policy in England and other governmental and non-governmental guidance )] TJ ET
BT 26.250 226.299 Td /F1 9.8 Tf  [(documents of international standing as well as relevant papers which offer theoretical standpoints)] TJ ET
0.267 0.267 0.267 rg
BT 445.695 227.806 Td /F4 8.7 Tf  [(55)] TJ ET
BT 455.332 227.806 Td /F4 8.7 Tf  [(56)] TJ ET
BT 464.970 227.806 Td /F4 8.7 Tf  [(57)] TJ ET
BT 474.607 227.806 Td /F4 8.7 Tf  [(58)] TJ ET
BT 484.244 227.806 Td /F4 8.7 Tf  [(59)] TJ ET
BT 493.882 227.806 Td /F4 8.7 Tf  [(60)] TJ ET
BT 503.519 227.806 Td /F4 8.7 Tf  [(61)] TJ ET
BT 513.156 227.806 Td /F4 8.7 Tf  [(62)] TJ ET
BT 522.794 227.806 Td /F4 8.7 Tf  [(63)] TJ ET
BT 532.431 227.806 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 542.068 226.299 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 214.394 Td /F1 9.8 Tf  [(intention was to identify documents in the public domain that outline, directly or by implication, models of care for responding to )] TJ ET
BT 26.250 202.489 Td /F1 9.8 Tf  [(the psychosocial and mental health impacts of disasters in general and, if possible, flooding in particular. In this regard, we were )] TJ ET
BT 26.250 190.584 Td /F1 9.8 Tf  [(greatly assisted by advice from experts.)] TJ ET
BT 26.250 171.180 Td /F1 9.8 Tf  [(As a result, the authors analysed the content of guidance documents, research reports, and other papers. They include the )] TJ ET
BT 26.250 159.275 Td /F1 9.8 Tf  [(current policy on psychosocial and mental health care in the set of contemporary emergency preparedness guidance published )] TJ ET
BT 26.250 147.370 Td /F1 9.8 Tf  [(by the Department of Health for England)] TJ ET
0.267 0.267 0.267 rg
BT 200.756 148.877 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 210.393 147.370 Td /F1 9.8 Tf  [( and a report on the research conducted by the University of Lancaster on the )] TJ ET
BT 26.250 135.465 Td /F1 9.8 Tf  [(psychosocial and welfare impacts of the floods that occurred in England in 2007)] TJ ET
0.267 0.267 0.267 rg
BT 370.376 136.973 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 380.014 135.465 Td /F1 9.8 Tf  [(. Each of the documents that the HPA )] TJ ET
BT 26.250 123.561 Td /F1 9.8 Tf  [(reviewed offers practical guidance for policymakers, strategic and operational managers, public health services and clinical )] TJ ET
BT 26.250 111.656 Td /F1 9.8 Tf  [(services. Importantly, their advice fits well with the evidence that emerged from the literature review and which is reviewed in the )] TJ ET
BT 26.250 99.751 Td /F1 9.8 Tf  [(HPA�s report.)] TJ ET
BT 26.250 63.149 Td /F4 12.0 Tf  [(Results)] TJ ET
Q
q
15.000 33.313 577.500 743.687 re W n
q
26.250 777.000 555.000 0.000 re W n
Q
1.000 1.000 1.000 rg
26.250 489.394 555.000 287.606 re f
0.267 0.267 0.267 rg
26.625 775.875 389.521 0.750 re f
26.625 759.994 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 766.020 Td /F1 9.8 Tf  [(Flood event)] TJ ET
0.267 0.267 0.267 rg
415.396 775.875 165.479 0.750 re f
415.396 759.994 0.750 16.631 re f
580.125 759.994 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 766.020 Td /F1 9.8 Tf  [(Number of papers)] TJ ET
0.267 0.267 0.267 rg
26.625 759.994 389.521 0.750 re f
26.625 712.106 0.750 48.638 re f
0.271 0.267 0.267 rg
BT 31.875 750.139 Td /F1 9.8 Tf  [(American Hurricanes 2004/5 \(7-34\))] TJ ET
0.267 0.267 0.267 rg
415.396 759.994 165.479 0.750 re f
415.396 712.106 0.750 48.638 re f
580.125 712.106 0.750 48.638 re f
0.271 0.267 0.267 rg
BT 420.646 750.139 Td /F1 9.8 Tf  [(28)] TJ ET
0.267 0.267 0.267 rg
26.625 712.106 389.521 0.750 re f
26.625 696.225 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 702.251 Td /F1 9.8 Tf  [(Poland 1997 \(35;36\))] TJ ET
0.267 0.267 0.267 rg
415.396 712.106 165.479 0.750 re f
415.396 696.225 0.750 16.631 re f
580.125 696.225 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 702.251 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 696.225 389.521 0.750 re f
26.625 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 686.370 Td /F1 9.8 Tf  [(Mexico 1999 \(37;38\))] TJ ET
0.267 0.267 0.267 rg
415.396 696.225 165.479 0.750 re f
415.396 680.344 0.750 16.631 re f
580.125 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 686.370 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 680.344 389.521 0.750 re f
26.625 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 670.489 Td /F1 9.8 Tf  [(China, Hunan province 1998 \(39-41\))] TJ ET
0.267 0.267 0.267 rg
415.396 680.344 165.479 0.750 re f
415.396 664.462 0.750 16.631 re f
580.125 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 670.489 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 664.462 389.521 0.750 re f
26.625 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 654.608 Td /F1 9.8 Tf  [(Vietnam, Xangsane Typhoon 2006 \(42\))] TJ ET
0.267 0.267 0.267 rg
415.396 664.462 165.479 0.750 re f
415.396 648.581 0.750 16.631 re f
580.125 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 654.608 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 648.581 389.521 0.750 re f
26.625 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 638.726 Td /F1 9.8 Tf  [(Sri Lanka, Tsunami 2004 \(43\))] TJ ET
0.267 0.267 0.267 rg
415.396 648.581 165.479 0.750 re f
415.396 632.700 0.750 16.631 re f
580.125 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 638.726 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 632.700 389.521 0.750 re f
26.625 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 622.845 Td /F1 9.8 Tf  [(Germany 2002 \(44\))] TJ ET
0.267 0.267 0.267 rg
415.396 632.700 165.479 0.750 re f
415.396 616.819 0.750 16.631 re f
580.125 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 622.845 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 616.819 389.521 0.750 re f
26.625 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 606.964 Td /F1 9.8 Tf  [(Korea 2006 \(45\))] TJ ET
0.267 0.267 0.267 rg
415.396 616.819 165.479 0.750 re f
415.396 600.938 0.750 16.631 re f
580.125 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 606.964 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 600.938 389.521 0.750 re f
26.625 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 591.083 Td /F1 9.8 Tf  [(Carlisle, UK 2005 \(46\))] TJ ET
0.267 0.267 0.267 rg
415.396 600.938 165.479 0.750 re f
415.396 585.056 0.750 16.631 re f
580.125 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 591.083 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 585.056 389.521 0.750 re f
26.625 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 575.201 Td /F1 9.8 Tf  [(Iowa, US 1993 \(47;48\))] TJ ET
0.267 0.267 0.267 rg
415.396 585.056 165.479 0.750 re f
415.396 569.175 0.750 16.631 re f
580.125 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 575.201 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 569.175 389.521 0.750 re f
26.625 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 559.320 Td /F1 9.8 Tf  [(Mississippi River \(Illinois and Missouri\)1993 \(49;50\))] TJ ET
0.267 0.267 0.267 rg
415.396 569.175 165.479 0.750 re f
415.396 553.294 0.750 16.631 re f
580.125 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 559.320 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 553.294 389.521 0.750 re f
26.625 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 543.439 Td /F1 9.8 Tf  [(Italy 1996 \(51\))] TJ ET
0.267 0.267 0.267 rg
415.396 553.294 165.479 0.750 re f
415.396 537.413 0.750 16.631 re f
580.125 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 543.439 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 537.413 389.521 0.750 re f
26.625 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.558 Td /F1 9.8 Tf  [(UK 2007 \(52;53\))] TJ ET
0.267 0.267 0.267 rg
415.396 537.413 165.479 0.750 re f
415.396 521.531 0.750 16.631 re f
580.125 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 527.558 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 521.531 389.521 0.750 re f
26.625 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 511.676 Td /F1 9.8 Tf  [(UK 1998-2002 \(54\))] TJ ET
0.267 0.267 0.267 rg
415.396 521.531 165.479 0.750 re f
415.396 505.650 0.750 16.631 re f
580.125 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 511.676 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 505.650 389.521 0.750 re f
26.625 489.769 389.521 0.750 re f
26.625 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 495.795 Td /F1 9.8 Tf  [(Total)] TJ ET
0.267 0.267 0.267 rg
415.396 505.650 165.479 0.750 re f
415.396 489.769 165.479 0.750 re f
415.396 489.769 0.750 16.631 re f
580.125 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 495.795 Td /F1 9.8 Tf  [(48)] TJ ET
BT 26.250 434.870 Td /F1 9.8 Tf  [(Twenty-eight \(28\) of the papers assessed people�s mental health after hurricanes in America and 20 after floods. The authors )] TJ ET
BT 26.250 422.965 Td /F1 9.8 Tf  [(made the decision to include hurricanes leading to flooding because of the difficulties in classifying disasters. We concluded that )] TJ ET
BT 26.250 411.060 Td /F1 9.8 Tf  [(it was important to include the extensive data on the mental health of people affected by hurricanes because of the health )] TJ ET
BT 26.250 399.156 Td /F1 9.8 Tf  [(impacts of the floods immediately following Hurricane Katrina.)] TJ ET
BT 26.250 379.751 Td /F1 9.8 Tf  [(The majority of papers that the authors reviewed consider population samples of adults who are affected by a particular flood. A )] TJ ET
BT 26.250 367.846 Td /F1 9.8 Tf  [(number of papers report research on samples taken from specific populations: six relate to people aged under 18 )] TJ ET
0.267 0.267 0.267 rg
BT 516.149 369.353 Td /F4 8.7 Tf  [(9)] TJ ET
BT 520.967 369.353 Td /F4 8.7 Tf  [(12)] TJ ET
BT 530.605 369.353 Td /F4 8.7 Tf  [(13)] TJ ET
BT 540.242 369.353 Td /F4 8.7 Tf  [(16)] TJ ET
BT 549.879 369.353 Td /F4 8.7 Tf  [(40)] TJ ET
BT 559.517 369.353 Td /F4 8.7 Tf  [(41)] TJ ET
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BT 569.154 367.846 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 355.941 Td /F1 9.8 Tf  [(two studies were conducted in evacuation shelters after Hurricane Katrina )] TJ ET
0.267 0.267 0.267 rg
BT 347.054 357.449 Td /F4 8.7 Tf  [(17)] TJ ET
BT 356.692 357.449 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 366.329 355.941 Td /F1 9.8 Tf  [(; one specifically sampled ethnic minorities )] TJ ET
0.267 0.267 0.267 rg
BT 553.266 357.449 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 562.903 355.941 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 344.037 Td /F1 9.8 Tf  [(one assessed patients evacuated from a heart centre)] TJ ET
0.267 0.267 0.267 rg
BT 256.038 345.544 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 265.675 344.037 Td /F1 9.8 Tf  [(; and one study was of pregnant women )] TJ ET
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BT 441.273 345.544 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 450.910 344.037 Td /F1 9.8 Tf  [(. The majority of the studies )] TJ ET
BT 26.250 332.132 Td /F1 9.8 Tf  [(were cross-sectional.)] TJ ET
BT 26.250 312.727 Td /F1 9.8 Tf  [(The timing of the studies, relative to the flood considered by the research, varied from data collected pre-event, to data collected )] TJ ET
BT 26.250 300.822 Td /F1 9.8 Tf  [(after zero to two weeks, and up to eight years after flooding. However, the vast majority of the studies took place between six )] TJ ET
BT 26.250 288.918 Td /F1 9.8 Tf  [(months and 24 months after the index event. The size of the population samples was also very diverse, ranging from 50 to )] TJ ET
BT 26.250 277.013 Td /F1 9.8 Tf  [(33,000 people.)] TJ ET
BT 26.250 257.608 Td /F5 9.8 Tf  [(THE REVIEW OF RECENT GUIDANCE DOCUMENTS)] TJ ET
BT 26.250 238.203 Td /F1 9.8 Tf  [(The authors reviewed recent government policy in England and other governmental and non-governmental guidance )] TJ ET
BT 26.250 226.299 Td /F1 9.8 Tf  [(documents of international standing as well as relevant papers which offer theoretical standpoints)] TJ ET
0.267 0.267 0.267 rg
BT 445.695 227.806 Td /F4 8.7 Tf  [(55)] TJ ET
BT 455.332 227.806 Td /F4 8.7 Tf  [(56)] TJ ET
BT 464.970 227.806 Td /F4 8.7 Tf  [(57)] TJ ET
BT 474.607 227.806 Td /F4 8.7 Tf  [(58)] TJ ET
BT 484.244 227.806 Td /F4 8.7 Tf  [(59)] TJ ET
BT 493.882 227.806 Td /F4 8.7 Tf  [(60)] TJ ET
BT 503.519 227.806 Td /F4 8.7 Tf  [(61)] TJ ET
BT 513.156 227.806 Td /F4 8.7 Tf  [(62)] TJ ET
BT 522.794 227.806 Td /F4 8.7 Tf  [(63)] TJ ET
BT 532.431 227.806 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 542.068 226.299 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 214.394 Td /F1 9.8 Tf  [(intention was to identify documents in the public domain that outline, directly or by implication, models of care for responding to )] TJ ET
BT 26.250 202.489 Td /F1 9.8 Tf  [(the psychosocial and mental health impacts of disasters in general and, if possible, flooding in particular. In this regard, we were )] TJ ET
BT 26.250 190.584 Td /F1 9.8 Tf  [(greatly assisted by advice from experts.)] TJ ET
BT 26.250 171.180 Td /F1 9.8 Tf  [(As a result, the authors analysed the content of guidance documents, research reports, and other papers. They include the )] TJ ET
BT 26.250 159.275 Td /F1 9.8 Tf  [(current policy on psychosocial and mental health care in the set of contemporary emergency preparedness guidance published )] TJ ET
BT 26.250 147.370 Td /F1 9.8 Tf  [(by the Department of Health for England)] TJ ET
0.267 0.267 0.267 rg
BT 200.756 148.877 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 210.393 147.370 Td /F1 9.8 Tf  [( and a report on the research conducted by the University of Lancaster on the )] TJ ET
BT 26.250 135.465 Td /F1 9.8 Tf  [(psychosocial and welfare impacts of the floods that occurred in England in 2007)] TJ ET
0.267 0.267 0.267 rg
BT 370.376 136.973 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 380.014 135.465 Td /F1 9.8 Tf  [(. Each of the documents that the HPA )] TJ ET
BT 26.250 123.561 Td /F1 9.8 Tf  [(reviewed offers practical guidance for policymakers, strategic and operational managers, public health services and clinical )] TJ ET
BT 26.250 111.656 Td /F1 9.8 Tf  [(services. Importantly, their advice fits well with the evidence that emerged from the literature review and which is reviewed in the )] TJ ET
BT 26.250 99.751 Td /F1 9.8 Tf  [(HPA�s report.)] TJ ET
BT 26.250 63.149 Td /F4 12.0 Tf  [(Results)] TJ ET
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0.267 0.267 0.267 rg
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26.625 759.994 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 766.020 Td /F1 9.8 Tf  [(Flood event)] TJ ET
0.267 0.267 0.267 rg
415.396 775.875 165.479 0.750 re f
415.396 759.994 0.750 16.631 re f
580.125 759.994 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 766.020 Td /F1 9.8 Tf  [(Number of papers)] TJ ET
0.267 0.267 0.267 rg
26.625 759.994 389.521 0.750 re f
26.625 712.106 0.750 48.638 re f
0.271 0.267 0.267 rg
BT 31.875 750.139 Td /F1 9.8 Tf  [(American Hurricanes 2004/5 \(7-34\))] TJ ET
0.267 0.267 0.267 rg
415.396 759.994 165.479 0.750 re f
415.396 712.106 0.750 48.638 re f
580.125 712.106 0.750 48.638 re f
0.271 0.267 0.267 rg
BT 420.646 750.139 Td /F1 9.8 Tf  [(28)] TJ ET
0.267 0.267 0.267 rg
26.625 712.106 389.521 0.750 re f
26.625 696.225 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 702.251 Td /F1 9.8 Tf  [(Poland 1997 \(35;36\))] TJ ET
0.267 0.267 0.267 rg
415.396 712.106 165.479 0.750 re f
415.396 696.225 0.750 16.631 re f
580.125 696.225 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 702.251 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 696.225 389.521 0.750 re f
26.625 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 686.370 Td /F1 9.8 Tf  [(Mexico 1999 \(37;38\))] TJ ET
0.267 0.267 0.267 rg
415.396 696.225 165.479 0.750 re f
415.396 680.344 0.750 16.631 re f
580.125 680.344 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 686.370 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 680.344 389.521 0.750 re f
26.625 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 670.489 Td /F1 9.8 Tf  [(China, Hunan province 1998 \(39-41\))] TJ ET
0.267 0.267 0.267 rg
415.396 680.344 165.479 0.750 re f
415.396 664.462 0.750 16.631 re f
580.125 664.462 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 670.489 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
26.625 664.462 389.521 0.750 re f
26.625 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 654.608 Td /F1 9.8 Tf  [(Vietnam, Xangsane Typhoon 2006 \(42\))] TJ ET
0.267 0.267 0.267 rg
415.396 664.462 165.479 0.750 re f
415.396 648.581 0.750 16.631 re f
580.125 648.581 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 654.608 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 648.581 389.521 0.750 re f
26.625 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 638.726 Td /F1 9.8 Tf  [(Sri Lanka, Tsunami 2004 \(43\))] TJ ET
0.267 0.267 0.267 rg
415.396 648.581 165.479 0.750 re f
415.396 632.700 0.750 16.631 re f
580.125 632.700 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 638.726 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 632.700 389.521 0.750 re f
26.625 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 622.845 Td /F1 9.8 Tf  [(Germany 2002 \(44\))] TJ ET
0.267 0.267 0.267 rg
415.396 632.700 165.479 0.750 re f
415.396 616.819 0.750 16.631 re f
580.125 616.819 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 622.845 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 616.819 389.521 0.750 re f
26.625 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 606.964 Td /F1 9.8 Tf  [(Korea 2006 \(45\))] TJ ET
0.267 0.267 0.267 rg
415.396 616.819 165.479 0.750 re f
415.396 600.938 0.750 16.631 re f
580.125 600.938 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 606.964 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 600.938 389.521 0.750 re f
26.625 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 591.083 Td /F1 9.8 Tf  [(Carlisle, UK 2005 \(46\))] TJ ET
0.267 0.267 0.267 rg
415.396 600.938 165.479 0.750 re f
415.396 585.056 0.750 16.631 re f
580.125 585.056 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 591.083 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 585.056 389.521 0.750 re f
26.625 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 575.201 Td /F1 9.8 Tf  [(Iowa, US 1993 \(47;48\))] TJ ET
0.267 0.267 0.267 rg
415.396 585.056 165.479 0.750 re f
415.396 569.175 0.750 16.631 re f
580.125 569.175 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 575.201 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 569.175 389.521 0.750 re f
26.625 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 559.320 Td /F1 9.8 Tf  [(Mississippi River \(Illinois and Missouri\)1993 \(49;50\))] TJ ET
0.267 0.267 0.267 rg
415.396 569.175 165.479 0.750 re f
415.396 553.294 0.750 16.631 re f
580.125 553.294 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 559.320 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 553.294 389.521 0.750 re f
26.625 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 543.439 Td /F1 9.8 Tf  [(Italy 1996 \(51\))] TJ ET
0.267 0.267 0.267 rg
415.396 553.294 165.479 0.750 re f
415.396 537.413 0.750 16.631 re f
580.125 537.413 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 543.439 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 537.413 389.521 0.750 re f
26.625 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.558 Td /F1 9.8 Tf  [(UK 2007 \(52;53\))] TJ ET
0.267 0.267 0.267 rg
415.396 537.413 165.479 0.750 re f
415.396 521.531 0.750 16.631 re f
580.125 521.531 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 527.558 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
26.625 521.531 389.521 0.750 re f
26.625 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 511.676 Td /F1 9.8 Tf  [(UK 1998-2002 \(54\))] TJ ET
0.267 0.267 0.267 rg
415.396 521.531 165.479 0.750 re f
415.396 505.650 0.750 16.631 re f
580.125 505.650 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 511.676 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
26.625 505.650 389.521 0.750 re f
26.625 489.769 389.521 0.750 re f
26.625 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 495.795 Td /F1 9.8 Tf  [(Total)] TJ ET
0.267 0.267 0.267 rg
415.396 505.650 165.479 0.750 re f
415.396 489.769 165.479 0.750 re f
415.396 489.769 0.750 16.631 re f
580.125 489.769 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 420.646 495.795 Td /F1 9.8 Tf  [(48)] TJ ET
BT 26.250 434.870 Td /F1 9.8 Tf  [(Twenty-eight \(28\) of the papers assessed people�s mental health after hurricanes in America and 20 after floods. The authors )] TJ ET
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BT 26.250 411.060 Td /F1 9.8 Tf  [(it was important to include the extensive data on the mental health of people affected by hurricanes because of the health )] TJ ET
BT 26.250 399.156 Td /F1 9.8 Tf  [(impacts of the floods immediately following Hurricane Katrina.)] TJ ET
BT 26.250 379.751 Td /F1 9.8 Tf  [(The majority of papers that the authors reviewed consider population samples of adults who are affected by a particular flood. A )] TJ ET
BT 26.250 367.846 Td /F1 9.8 Tf  [(number of papers report research on samples taken from specific populations: six relate to people aged under 18 )] TJ ET
0.267 0.267 0.267 rg
BT 516.149 369.353 Td /F4 8.7 Tf  [(9)] TJ ET
BT 520.967 369.353 Td /F4 8.7 Tf  [(12)] TJ ET
BT 530.605 369.353 Td /F4 8.7 Tf  [(13)] TJ ET
BT 540.242 369.353 Td /F4 8.7 Tf  [(16)] TJ ET
BT 549.879 369.353 Td /F4 8.7 Tf  [(40)] TJ ET
BT 559.517 369.353 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 569.154 367.846 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 355.941 Td /F1 9.8 Tf  [(two studies were conducted in evacuation shelters after Hurricane Katrina )] TJ ET
0.267 0.267 0.267 rg
BT 347.054 357.449 Td /F4 8.7 Tf  [(17)] TJ ET
BT 356.692 357.449 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 366.329 355.941 Td /F1 9.8 Tf  [(; one specifically sampled ethnic minorities )] TJ ET
0.267 0.267 0.267 rg
BT 553.266 357.449 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 562.903 355.941 Td /F1 9.8 Tf  [(; )] TJ ET
BT 26.250 344.037 Td /F1 9.8 Tf  [(one assessed patients evacuated from a heart centre)] TJ ET
0.267 0.267 0.267 rg
BT 256.038 345.544 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 265.675 344.037 Td /F1 9.8 Tf  [(; and one study was of pregnant women )] TJ ET
0.267 0.267 0.267 rg
BT 441.273 345.544 Td /F4 8.7 Tf  [(14)] TJ ET
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BT 450.910 344.037 Td /F1 9.8 Tf  [(. The majority of the studies )] TJ ET
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BT 26.250 312.727 Td /F1 9.8 Tf  [(The timing of the studies, relative to the flood considered by the research, varied from data collected pre-event, to data collected )] TJ ET
BT 26.250 300.822 Td /F1 9.8 Tf  [(after zero to two weeks, and up to eight years after flooding. However, the vast majority of the studies took place between six )] TJ ET
BT 26.250 288.918 Td /F1 9.8 Tf  [(months and 24 months after the index event. The size of the population samples was also very diverse, ranging from 50 to )] TJ ET
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BT 26.250 257.608 Td /F5 9.8 Tf  [(THE REVIEW OF RECENT GUIDANCE DOCUMENTS)] TJ ET
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BT 474.607 227.806 Td /F4 8.7 Tf  [(58)] TJ ET
BT 484.244 227.806 Td /F4 8.7 Tf  [(59)] TJ ET
BT 493.882 227.806 Td /F4 8.7 Tf  [(60)] TJ ET
BT 503.519 227.806 Td /F4 8.7 Tf  [(61)] TJ ET
BT 513.156 227.806 Td /F4 8.7 Tf  [(62)] TJ ET
BT 522.794 227.806 Td /F4 8.7 Tf  [(63)] TJ ET
BT 532.431 227.806 Td /F4 8.7 Tf  [(64)] TJ ET
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BT 26.250 190.584 Td /F1 9.8 Tf  [(greatly assisted by advice from experts.)] TJ ET
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BT 26.250 767.476 Td /F5 9.8 Tf  [(CORE FINDINGS FROM THE PAPERS REVIEWED IN THE REPORT)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The studies analysed in the report are clear that flooding is very stressful and that the stress continues for a long time after the )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(water has receded. Flooding affects people of all ages and it can herald: bereavement; economic problems for families; )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(behavioural problems in children; increased substance use and/or misuse; increased domestic violence; as well as )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(exacerbating, precipitating or provoking people�s existing problems with their mental health.)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(Often, people�s experiences, which reflect the personal and social meanings of the event for them, and the understandings and )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(meanings they derive from it, have more influence on the psychosocial impact of the event than the event itself. Recovery from )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(distress after disasters, including flooding, is characterised by adaptation to circumstances that have changed and by rebuilding )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(communities.)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Many people experience distress that may be relatively transient after any disaster and being distressed temporarily is not )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(antithetical to people also being resilient. Furthermore, the wider literature shows that the experiences of people who are )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(distressed in the aftermath of all disasters including floods, are not always easy to distinguish from the symptoms of common )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(mental disorders. On the other hand, the research suggests that the incidence and prevalence of common mental disorders )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(after flooding is substantially increased and that these disorders can persist long after the flooding has passed. This stresses )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(the importance of planning for and providing effective and timely public mental health and clinical responses.)] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(The threshold between what might be considered a common or anticipated response to an extreme event and what is indicative )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(of a person developing a disorder are difficult to define. Much turns on the severity, duration, impacts of these experiences on )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(people�s lives, and, particularly, the trajectory of their reactions over time, and the severity and persistence of any dysfunction )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(they accrue, when it comes to differentiating distress and disorder. The authors found that the focus in the literature is on post-)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(traumatic stress disorder \(PTSD\). While that is valuable, it is also accompanied by a relative neglect of the crucial wider )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(background morbidity that is found in all populations, including after disasters. For example, depression is a diagnosis that is )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(under-represented in the published data. However, a consistent finding across many studies is that people�s level of exposure to )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(the event and their earlier exposures to other traumatic experiences are strongly associated with PTSD.)] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(When considering PTSD, findings reveal that the symptoms may not decline over time as quickly as was thought previously. )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(The authors found, though, that social cohesion has a significant effect on susceptibility to symptoms of PTSD and it, therefore, )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(must be considered when developing public health strategies.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(As regards people who develop mental disorders, risk factors and co-variants did not a have a constant association with poorer )] TJ ET
BT 26.250 401.048 Td /F1 9.8 Tf  [(mental health across all the studies, partly due to methodological differences and partly because of the unique characteristics of )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(each flood. However, as in general population studies, levels of exposure to the event\(s\), gender, age, and socio-economic )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(status were generally associated with mental ill health.)] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(There is a lack of studies which have investigated the impact of flooding on the mental health of children, young people and )] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(older people. There are, however, indications that both children and older people suffer PTSD after flooding and that the )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(prevalence figures may well be greater than those that are found for adults of working age. Children, young people and older )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(people may be more vulnerable than are adults of working age because they are dependent on adults� responses to the floods )] TJ ET
BT 26.250 310.215 Td /F1 9.8 Tf  [(that affect families. Parents� wellbeing, for example, affects the quality of their parenting; people�s direct experiences and those )] TJ ET
BT 26.250 298.310 Td /F1 9.8 Tf  [(that affect their carers may, separately and in interaction, either protect them or intensify the negative effects on children and )] TJ ET
BT 26.250 286.405 Td /F1 9.8 Tf  [(older people.)] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(As the review observes, the studies analysed in it illustrate how floods can have great impacts on people�s psychosocial needs )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(and mental health. Evidence-based guidance on the factors that could influence the course of an illness are valuable when )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(developing tools to minimise the psychosocial and mental health impacts of flooding. As an example, the extended timeframe of )] TJ ET
BT 26.250 231.286 Td /F1 9.8 Tf  [(the impacts of flooding on people, their homes and their communities are such that the effects of secondary stressors are highly )] TJ ET
BT 26.250 219.381 Td /F1 9.8 Tf  [(important because they prolong the welfare, physical and psychosocial impacts. Recognition of the longer timeframe in which )] TJ ET
BT 26.250 207.477 Td /F1 9.8 Tf  [(adequate welfare, psychosocial and mental healthcare responses are required is an important lesson that has been learned )] TJ ET
BT 26.250 195.572 Td /F1 9.8 Tf  [(from floods in the past, and that lesson is supported strongly by the findings from the review.)] TJ ET
BT 26.250 176.167 Td /F5 9.8 Tf  [(PLANNING, DESIGNING AND DELIVERING HEALTHCARE RESPONSES)] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(Documents that set out current policy in planning, designing and delivering healthcare responses for people who experience )] TJ ET
BT 26.250 144.858 Td /F1 9.8 Tf  [(flooding and general disasters were reviewed)] TJ ET
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BT 438.572 146.365 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 448.209 144.858 Td /F1 9.8 Tf  [( and research)] TJ ET
0.267 0.267 0.267 rg
BT 507.821 146.365 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 517.458 144.858 Td /F1 9.8 Tf  [( which offers )] TJ ET
BT 26.250 132.953 Td /F1 9.8 Tf  [(theoretical standpoints and outline, directly or by implication, models of care for responding to the psychosocial and mental )] TJ ET
BT 26.250 121.048 Td /F1 9.8 Tf  [(health impacts of disasters were also reviewed. The documents offer access to practical guidance for managers, public health )] TJ ET
BT 26.250 109.143 Td /F1 9.8 Tf  [(services and clinical services. The key themes that emerge from this guidance include:)] TJ ET
0.271 0.267 0.267 RG
40.337 92.706 m 
40.337 93.153 40.154 93.597 39.838 93.913 c
39.522 94.229 39.078 94.412 38.631 94.412 c
38.185 94.412 37.741 94.229 37.425 93.913 c
37.109 93.597 36.925 93.153 36.925 92.706 c
36.925 92.260 37.109 91.816 37.425 91.500 c
37.741 91.184 38.185 91.000 38.631 91.000 c
39.078 91.000 39.522 91.184 39.838 91.500 c
40.154 91.816 40.337 92.260 40.337 92.706 c f
BT 45.750 89.739 Td /F1 9.8 Tf  [(The importance of adopting a multi-sector approach to promoting wellbeing and recovery that involves communities as well )] TJ ET
BT 45.750 77.834 Td /F1 9.8 Tf  [(as agencies;)] TJ ET
40.337 65.147 m 
40.337 65.593 40.154 66.037 39.838 66.353 c
39.522 66.669 39.078 66.853 38.631 66.853 c
38.185 66.853 37.741 66.669 37.425 66.353 c
37.109 66.037 36.925 65.593 36.925 65.147 c
36.925 64.700 37.109 64.256 37.425 63.940 c
37.741 63.624 38.185 63.440 38.631 63.440 c
39.078 63.440 39.522 63.624 39.838 63.940 c
40.154 64.256 40.337 64.700 40.337 65.147 c f
BT 45.750 62.179 Td /F1 9.8 Tf  [(Most people who are affected by flooding are remarkably resilient;)] TJ ET
40.337 49.492 m 
40.337 49.939 40.154 50.383 39.838 50.699 c
39.522 51.014 39.078 51.198 38.631 51.198 c
38.185 51.198 37.741 51.014 37.425 50.699 c
37.109 50.383 36.925 49.939 36.925 49.492 c
36.925 49.045 37.109 48.601 37.425 48.285 c
37.741 47.970 38.185 47.786 38.631 47.786 c
39.078 47.786 39.522 47.970 39.838 48.285 c
40.154 48.601 40.337 49.045 40.337 49.492 c f
BT 45.750 46.524 Td /F1 9.8 Tf  [(Many people who are affected face psychosocial challenges and most have distressing experiences for which they require )] TJ ET
Q
q
15.000 32.239 577.500 744.761 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F5 9.8 Tf  [(CORE FINDINGS FROM THE PAPERS REVIEWED IN THE REPORT)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The studies analysed in the report are clear that flooding is very stressful and that the stress continues for a long time after the )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(water has receded. Flooding affects people of all ages and it can herald: bereavement; economic problems for families; )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(behavioural problems in children; increased substance use and/or misuse; increased domestic violence; as well as )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(exacerbating, precipitating or provoking people�s existing problems with their mental health.)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(Often, people�s experiences, which reflect the personal and social meanings of the event for them, and the understandings and )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(meanings they derive from it, have more influence on the psychosocial impact of the event than the event itself. Recovery from )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(distress after disasters, including flooding, is characterised by adaptation to circumstances that have changed and by rebuilding )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(communities.)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Many people experience distress that may be relatively transient after any disaster and being distressed temporarily is not )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(antithetical to people also being resilient. Furthermore, the wider literature shows that the experiences of people who are )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(distressed in the aftermath of all disasters including floods, are not always easy to distinguish from the symptoms of common )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(mental disorders. On the other hand, the research suggests that the incidence and prevalence of common mental disorders )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(after flooding is substantially increased and that these disorders can persist long after the flooding has passed. This stresses )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(the importance of planning for and providing effective and timely public mental health and clinical responses.)] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(The threshold between what might be considered a common or anticipated response to an extreme event and what is indicative )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(of a person developing a disorder are difficult to define. Much turns on the severity, duration, impacts of these experiences on )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(people�s lives, and, particularly, the trajectory of their reactions over time, and the severity and persistence of any dysfunction )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(they accrue, when it comes to differentiating distress and disorder. The authors found that the focus in the literature is on post-)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(traumatic stress disorder \(PTSD\). While that is valuable, it is also accompanied by a relative neglect of the crucial wider )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(background morbidity that is found in all populations, including after disasters. For example, depression is a diagnosis that is )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(under-represented in the published data. However, a consistent finding across many studies is that people�s level of exposure to )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(the event and their earlier exposures to other traumatic experiences are strongly associated with PTSD.)] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(When considering PTSD, findings reveal that the symptoms may not decline over time as quickly as was thought previously. )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(The authors found, though, that social cohesion has a significant effect on susceptibility to symptoms of PTSD and it, therefore, )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(must be considered when developing public health strategies.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(As regards people who develop mental disorders, risk factors and co-variants did not a have a constant association with poorer )] TJ ET
BT 26.250 401.048 Td /F1 9.8 Tf  [(mental health across all the studies, partly due to methodological differences and partly because of the unique characteristics of )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(each flood. However, as in general population studies, levels of exposure to the event\(s\), gender, age, and socio-economic )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(status were generally associated with mental ill health.)] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(There is a lack of studies which have investigated the impact of flooding on the mental health of children, young people and )] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(older people. There are, however, indications that both children and older people suffer PTSD after flooding and that the )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(prevalence figures may well be greater than those that are found for adults of working age. Children, young people and older )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(people may be more vulnerable than are adults of working age because they are dependent on adults� responses to the floods )] TJ ET
BT 26.250 310.215 Td /F1 9.8 Tf  [(that affect families. Parents� wellbeing, for example, affects the quality of their parenting; people�s direct experiences and those )] TJ ET
BT 26.250 298.310 Td /F1 9.8 Tf  [(that affect their carers may, separately and in interaction, either protect them or intensify the negative effects on children and )] TJ ET
BT 26.250 286.405 Td /F1 9.8 Tf  [(older people.)] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(As the review observes, the studies analysed in it illustrate how floods can have great impacts on people�s psychosocial needs )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(and mental health. Evidence-based guidance on the factors that could influence the course of an illness are valuable when )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(developing tools to minimise the psychosocial and mental health impacts of flooding. As an example, the extended timeframe of )] TJ ET
BT 26.250 231.286 Td /F1 9.8 Tf  [(the impacts of flooding on people, their homes and their communities are such that the effects of secondary stressors are highly )] TJ ET
BT 26.250 219.381 Td /F1 9.8 Tf  [(important because they prolong the welfare, physical and psychosocial impacts. Recognition of the longer timeframe in which )] TJ ET
BT 26.250 207.477 Td /F1 9.8 Tf  [(adequate welfare, psychosocial and mental healthcare responses are required is an important lesson that has been learned )] TJ ET
BT 26.250 195.572 Td /F1 9.8 Tf  [(from floods in the past, and that lesson is supported strongly by the findings from the review.)] TJ ET
BT 26.250 176.167 Td /F5 9.8 Tf  [(PLANNING, DESIGNING AND DELIVERING HEALTHCARE RESPONSES)] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(Documents that set out current policy in planning, designing and delivering healthcare responses for people who experience )] TJ ET
BT 26.250 144.858 Td /F1 9.8 Tf  [(flooding and general disasters were reviewed)] TJ ET
0.267 0.267 0.267 rg
BT 221.874 146.365 Td /F4 8.7 Tf  [(4)] TJ ET
BT 226.693 146.365 Td /F4 8.7 Tf  [(9)] TJ ET
BT 231.511 146.365 Td /F4 8.7 Tf  [(59)] TJ ET
BT 241.149 146.365 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 250.786 144.858 Td /F1 9.8 Tf  [(. In addition, other guidance)] TJ ET
0.267 0.267 0.267 rg
BT 371.111 146.365 Td /F4 8.7 Tf  [(55)] TJ ET
BT 380.748 146.365 Td /F4 8.7 Tf  [(56)] TJ ET
BT 390.385 146.365 Td /F4 8.7 Tf  [(57)] TJ ET
BT 400.023 146.365 Td /F4 8.7 Tf  [(58)] TJ ET
BT 409.660 146.365 Td /F4 8.7 Tf  [(60)] TJ ET
BT 419.297 146.365 Td /F4 8.7 Tf  [(61)] TJ ET
BT 428.935 146.365 Td /F4 8.7 Tf  [(62)] TJ ET
BT 438.572 146.365 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 448.209 144.858 Td /F1 9.8 Tf  [( and research)] TJ ET
0.267 0.267 0.267 rg
BT 507.821 146.365 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 517.458 144.858 Td /F1 9.8 Tf  [( which offers )] TJ ET
BT 26.250 132.953 Td /F1 9.8 Tf  [(theoretical standpoints and outline, directly or by implication, models of care for responding to the psychosocial and mental )] TJ ET
BT 26.250 121.048 Td /F1 9.8 Tf  [(health impacts of disasters were also reviewed. The documents offer access to practical guidance for managers, public health )] TJ ET
BT 26.250 109.143 Td /F1 9.8 Tf  [(services and clinical services. The key themes that emerge from this guidance include:)] TJ ET
0.271 0.267 0.267 RG
40.337 92.706 m 
40.337 93.153 40.154 93.597 39.838 93.913 c
39.522 94.229 39.078 94.412 38.631 94.412 c
38.185 94.412 37.741 94.229 37.425 93.913 c
37.109 93.597 36.925 93.153 36.925 92.706 c
36.925 92.260 37.109 91.816 37.425 91.500 c
37.741 91.184 38.185 91.000 38.631 91.000 c
39.078 91.000 39.522 91.184 39.838 91.500 c
40.154 91.816 40.337 92.260 40.337 92.706 c f
BT 45.750 89.739 Td /F1 9.8 Tf  [(The importance of adopting a multi-sector approach to promoting wellbeing and recovery that involves communities as well )] TJ ET
BT 45.750 77.834 Td /F1 9.8 Tf  [(as agencies;)] TJ ET
40.337 65.147 m 
40.337 65.593 40.154 66.037 39.838 66.353 c
39.522 66.669 39.078 66.853 38.631 66.853 c
38.185 66.853 37.741 66.669 37.425 66.353 c
37.109 66.037 36.925 65.593 36.925 65.147 c
36.925 64.700 37.109 64.256 37.425 63.940 c
37.741 63.624 38.185 63.440 38.631 63.440 c
39.078 63.440 39.522 63.624 39.838 63.940 c
40.154 64.256 40.337 64.700 40.337 65.147 c f
BT 45.750 62.179 Td /F1 9.8 Tf  [(Most people who are affected by flooding are remarkably resilient;)] TJ ET
40.337 49.492 m 
40.337 49.939 40.154 50.383 39.838 50.699 c
39.522 51.014 39.078 51.198 38.631 51.198 c
38.185 51.198 37.741 51.014 37.425 50.699 c
37.109 50.383 36.925 49.939 36.925 49.492 c
36.925 49.045 37.109 48.601 37.425 48.285 c
37.741 47.970 38.185 47.786 38.631 47.786 c
39.078 47.786 39.522 47.970 39.838 48.285 c
40.154 48.601 40.337 49.045 40.337 49.492 c f
BT 45.750 46.524 Td /F1 9.8 Tf  [(Many people who are affected face psychosocial challenges and most have distressing experiences for which they require )] TJ ET
Q
q
15.000 32.239 577.500 744.761 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F5 9.8 Tf  [(CORE FINDINGS FROM THE PAPERS REVIEWED IN THE REPORT)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The studies analysed in the report are clear that flooding is very stressful and that the stress continues for a long time after the )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(water has receded. Flooding affects people of all ages and it can herald: bereavement; economic problems for families; )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(behavioural problems in children; increased substance use and/or misuse; increased domestic violence; as well as )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(exacerbating, precipitating or provoking people�s existing problems with their mental health.)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(Often, people�s experiences, which reflect the personal and social meanings of the event for them, and the understandings and )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(meanings they derive from it, have more influence on the psychosocial impact of the event than the event itself. Recovery from )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(distress after disasters, including flooding, is characterised by adaptation to circumstances that have changed and by rebuilding )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(communities.)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Many people experience distress that may be relatively transient after any disaster and being distressed temporarily is not )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(antithetical to people also being resilient. Furthermore, the wider literature shows that the experiences of people who are )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(distressed in the aftermath of all disasters including floods, are not always easy to distinguish from the symptoms of common )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(mental disorders. On the other hand, the research suggests that the incidence and prevalence of common mental disorders )] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(after flooding is substantially increased and that these disorders can persist long after the flooding has passed. This stresses )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(the importance of planning for and providing effective and timely public mental health and clinical responses.)] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(The threshold between what might be considered a common or anticipated response to an extreme event and what is indicative )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(of a person developing a disorder are difficult to define. Much turns on the severity, duration, impacts of these experiences on )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(people�s lives, and, particularly, the trajectory of their reactions over time, and the severity and persistence of any dysfunction )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(they accrue, when it comes to differentiating distress and disorder. The authors found that the focus in the literature is on post-)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(traumatic stress disorder \(PTSD\). While that is valuable, it is also accompanied by a relative neglect of the crucial wider )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(background morbidity that is found in all populations, including after disasters. For example, depression is a diagnosis that is )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(under-represented in the published data. However, a consistent finding across many studies is that people�s level of exposure to )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(the event and their earlier exposures to other traumatic experiences are strongly associated with PTSD.)] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(When considering PTSD, findings reveal that the symptoms may not decline over time as quickly as was thought previously. )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(The authors found, though, that social cohesion has a significant effect on susceptibility to symptoms of PTSD and it, therefore, )] TJ ET
BT 26.250 432.357 Td /F1 9.8 Tf  [(must be considered when developing public health strategies.)] TJ ET
BT 26.250 412.953 Td /F1 9.8 Tf  [(As regards people who develop mental disorders, risk factors and co-variants did not a have a constant association with poorer )] TJ ET
BT 26.250 401.048 Td /F1 9.8 Tf  [(mental health across all the studies, partly due to methodological differences and partly because of the unique characteristics of )] TJ ET
BT 26.250 389.143 Td /F1 9.8 Tf  [(each flood. However, as in general population studies, levels of exposure to the event\(s\), gender, age, and socio-economic )] TJ ET
BT 26.250 377.238 Td /F1 9.8 Tf  [(status were generally associated with mental ill health.)] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(There is a lack of studies which have investigated the impact of flooding on the mental health of children, young people and )] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(older people. There are, however, indications that both children and older people suffer PTSD after flooding and that the )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(prevalence figures may well be greater than those that are found for adults of working age. Children, young people and older )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(people may be more vulnerable than are adults of working age because they are dependent on adults� responses to the floods )] TJ ET
BT 26.250 310.215 Td /F1 9.8 Tf  [(that affect families. Parents� wellbeing, for example, affects the quality of their parenting; people�s direct experiences and those )] TJ ET
BT 26.250 298.310 Td /F1 9.8 Tf  [(that affect their carers may, separately and in interaction, either protect them or intensify the negative effects on children and )] TJ ET
BT 26.250 286.405 Td /F1 9.8 Tf  [(older people.)] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(As the review observes, the studies analysed in it illustrate how floods can have great impacts on people�s psychosocial needs )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(and mental health. Evidence-based guidance on the factors that could influence the course of an illness are valuable when )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(developing tools to minimise the psychosocial and mental health impacts of flooding. As an example, the extended timeframe of )] TJ ET
BT 26.250 231.286 Td /F1 9.8 Tf  [(the impacts of flooding on people, their homes and their communities are such that the effects of secondary stressors are highly )] TJ ET
BT 26.250 219.381 Td /F1 9.8 Tf  [(important because they prolong the welfare, physical and psychosocial impacts. Recognition of the longer timeframe in which )] TJ ET
BT 26.250 207.477 Td /F1 9.8 Tf  [(adequate welfare, psychosocial and mental healthcare responses are required is an important lesson that has been learned )] TJ ET
BT 26.250 195.572 Td /F1 9.8 Tf  [(from floods in the past, and that lesson is supported strongly by the findings from the review.)] TJ ET
BT 26.250 176.167 Td /F5 9.8 Tf  [(PLANNING, DESIGNING AND DELIVERING HEALTHCARE RESPONSES)] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(Documents that set out current policy in planning, designing and delivering healthcare responses for people who experience )] TJ ET
BT 26.250 144.858 Td /F1 9.8 Tf  [(flooding and general disasters were reviewed)] TJ ET
0.267 0.267 0.267 rg
BT 221.874 146.365 Td /F4 8.7 Tf  [(4)] TJ ET
BT 226.693 146.365 Td /F4 8.7 Tf  [(9)] TJ ET
BT 231.511 146.365 Td /F4 8.7 Tf  [(59)] TJ ET
BT 241.149 146.365 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 250.786 144.858 Td /F1 9.8 Tf  [(. In addition, other guidance)] TJ ET
0.267 0.267 0.267 rg
BT 371.111 146.365 Td /F4 8.7 Tf  [(55)] TJ ET
BT 380.748 146.365 Td /F4 8.7 Tf  [(56)] TJ ET
BT 390.385 146.365 Td /F4 8.7 Tf  [(57)] TJ ET
BT 400.023 146.365 Td /F4 8.7 Tf  [(58)] TJ ET
BT 409.660 146.365 Td /F4 8.7 Tf  [(60)] TJ ET
BT 419.297 146.365 Td /F4 8.7 Tf  [(61)] TJ ET
BT 428.935 146.365 Td /F4 8.7 Tf  [(62)] TJ ET
BT 438.572 146.365 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 448.209 144.858 Td /F1 9.8 Tf  [( and research)] TJ ET
0.267 0.267 0.267 rg
BT 507.821 146.365 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 517.458 144.858 Td /F1 9.8 Tf  [( which offers )] TJ ET
BT 26.250 132.953 Td /F1 9.8 Tf  [(theoretical standpoints and outline, directly or by implication, models of care for responding to the psychosocial and mental )] TJ ET
BT 26.250 121.048 Td /F1 9.8 Tf  [(health impacts of disasters were also reviewed. The documents offer access to practical guidance for managers, public health )] TJ ET
BT 26.250 109.143 Td /F1 9.8 Tf  [(services and clinical services. The key themes that emerge from this guidance include:)] TJ ET
0.271 0.267 0.267 RG
40.337 92.706 m 
40.337 93.153 40.154 93.597 39.838 93.913 c
39.522 94.229 39.078 94.412 38.631 94.412 c
38.185 94.412 37.741 94.229 37.425 93.913 c
37.109 93.597 36.925 93.153 36.925 92.706 c
36.925 92.260 37.109 91.816 37.425 91.500 c
37.741 91.184 38.185 91.000 38.631 91.000 c
39.078 91.000 39.522 91.184 39.838 91.500 c
40.154 91.816 40.337 92.260 40.337 92.706 c f
BT 45.750 89.739 Td /F1 9.8 Tf  [(The importance of adopting a multi-sector approach to promoting wellbeing and recovery that involves communities as well )] TJ ET
BT 45.750 77.834 Td /F1 9.8 Tf  [(as agencies;)] TJ ET
40.337 65.147 m 
40.337 65.593 40.154 66.037 39.838 66.353 c
39.522 66.669 39.078 66.853 38.631 66.853 c
38.185 66.853 37.741 66.669 37.425 66.353 c
37.109 66.037 36.925 65.593 36.925 65.147 c
36.925 64.700 37.109 64.256 37.425 63.940 c
37.741 63.624 38.185 63.440 38.631 63.440 c
39.078 63.440 39.522 63.624 39.838 63.940 c
40.154 64.256 40.337 64.700 40.337 65.147 c f
BT 45.750 62.179 Td /F1 9.8 Tf  [(Most people who are affected by flooding are remarkably resilient;)] TJ ET
40.337 49.492 m 
40.337 49.939 40.154 50.383 39.838 50.699 c
39.522 51.014 39.078 51.198 38.631 51.198 c
38.185 51.198 37.741 51.014 37.425 50.699 c
37.109 50.383 36.925 49.939 36.925 49.492 c
36.925 49.045 37.109 48.601 37.425 48.285 c
37.741 47.970 38.185 47.786 38.631 47.786 c
39.078 47.786 39.522 47.970 39.838 48.285 c
40.154 48.601 40.337 49.045 40.337 49.492 c f
BT 45.750 46.524 Td /F1 9.8 Tf  [(Many people who are affected face psychosocial challenges and most have distressing experiences for which they require )] TJ ET
Q
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BT 45.750 696.702 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care)] TJ ET
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BT 225.978 696.702 Td /F1 9.8 Tf  [( is a very useful tool.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care allows planners to take into account sources of personal and collective social support, and )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(how responses to events are developed. It also allows psychosocial care and mental healthcare to be planned and delivered in )] TJ ET
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BT 26.250 212.536 Td /F1 9.8 Tf  [(stressors and the author�s finding that PTSD symptoms do not necessarily remit rapidly after flooding.)] TJ ET
BT 26.250 175.934 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 155.979 Td /F5 9.8 Tf  [(KEY THEMES)] TJ ET
BT 26.250 136.575 Td /F1 9.8 Tf  [(Core findings and recommendations that emerged from the guidance inform the themes that follow.)] TJ ET
BT 32.206 117.187 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 117.170 Td /F1 9.8 Tf  [(It is important to understand stress, and the stressors that are inflicted upon people by floods and how they cause short-)] TJ ET
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BT 45.750 93.360 Td /F1 9.8 Tf  [(and populations.)] TJ ET
BT 32.206 77.723 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 77.706 Td /F1 9.8 Tf  [(Primary stressors are inherent in all disasters and encompass any experiences that people have that are directly related to, )] TJ ET
BT 45.750 65.801 Td /F1 9.8 Tf  [(or consequent on their exposure to disasters.)] TJ ET
BT 32.206 50.164 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 50.146 Td /F1 9.8 Tf  [(A majority of people experience distress after disasters. But, personal and collective psychosocial resilience are inherent in )] TJ ET
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37.741 698.148 38.185 697.964 38.631 697.964 c
39.078 697.964 39.522 698.148 39.838 698.463 c
40.154 698.779 40.337 699.223 40.337 699.670 c f
BT 45.750 696.702 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care)] TJ ET
0.267 0.267 0.267 rg
BT 206.703 698.210 Td /F4 8.7 Tf  [(59)] TJ ET
BT 216.340 698.210 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 225.978 696.702 Td /F1 9.8 Tf  [( is a very useful tool.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care allows planners to take into account sources of personal and collective social support, and )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(how responses to events are developed. It also allows psychosocial care and mental healthcare to be planned and delivered in )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(integrated ways that follow the trajectories of the needs of people who require them. Thereby, the responsible authorities can )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(create a dynamic, flexible and needs-led approach to mounting effective responses to flooding. Understanding the overlaps )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(between the steps can be facilitated by incorporating knowledge of the:)] TJ ET
40.337 609.491 m 
40.337 609.938 40.154 610.382 39.838 610.698 c
39.522 611.014 39.078 611.198 38.631 611.198 c
38.185 611.198 37.741 611.014 37.425 610.698 c
37.109 610.382 36.925 609.938 36.925 609.491 c
36.925 609.045 37.109 608.601 37.425 608.285 c
37.741 607.969 38.185 607.785 38.631 607.785 c
39.078 607.785 39.522 607.969 39.838 608.285 c
40.154 608.601 40.337 609.045 40.337 609.491 c f
BT 45.750 606.524 Td /F1 9.8 Tf  [(Nature of each flood and its consequences;)] TJ ET
40.337 593.837 m 
40.337 594.283 40.154 594.727 39.838 595.043 c
39.522 595.359 39.078 595.543 38.631 595.543 c
38.185 595.543 37.741 595.359 37.425 595.043 c
37.109 594.727 36.925 594.283 36.925 593.837 c
36.925 593.390 37.109 592.946 37.425 592.630 c
37.741 592.314 38.185 592.130 38.631 592.130 c
39.078 592.130 39.522 592.314 39.838 592.630 c
40.154 592.946 40.337 593.390 40.337 593.837 c f
BT 45.750 590.869 Td /F1 9.8 Tf  [(Primary and secondary stressors; and)] TJ ET
40.337 578.182 m 
40.337 578.629 40.154 579.073 39.838 579.389 c
39.522 579.704 39.078 579.888 38.631 579.888 c
38.185 579.888 37.741 579.704 37.425 579.389 c
37.109 579.073 36.925 578.629 36.925 578.182 c
36.925 577.735 37.109 577.291 37.425 576.975 c
37.741 576.660 38.185 576.476 38.631 576.476 c
39.078 576.476 39.522 576.660 39.838 576.975 c
40.154 577.291 40.337 577.735 40.337 578.182 c f
BT 45.750 575.214 Td /F1 9.8 Tf  [(Means of delivering care.)] TJ ET
BT 26.250 552.060 Td /F1 9.8 Tf  [(People�s psychosocial needs, and the mental disorders that they might develop as a consequence of their being flooded, pose )] TJ ET
BT 26.250 540.155 Td /F1 9.8 Tf  [(core challenges for community, public health, primary care and specialist mental healthcare services.)] TJ ET
BT 26.250 520.750 Td /F1 9.8 Tf  [(Public health measures that are put in place after floods should include considering the social as well as psychological impacts )] TJ ET
BT 26.250 508.845 Td /F1 9.8 Tf  [(of events, and especially because evidence suggests that good social support can act as a protective factor against negative )] TJ ET
BT 26.250 496.941 Td /F1 9.8 Tf  [(psychological and psychiatric impacts of being flooded. Furthermore, recently published results from a randomized trial provide )] TJ ET
BT 26.250 485.036 Td /F1 9.8 Tf  [(provisional evidence that psychosocial interventions, which target the resilience resources \(e.g. emotional engagement and )] TJ ET
BT 26.250 473.131 Td /F1 9.8 Tf  [(social connectedness\) of veterans who have PTSD, may alleviate their anxiety and depressive symptoms and improve their )] TJ ET
BT 26.250 461.226 Td /F1 9.8 Tf  [(positive emotional and cognitive functioning)] TJ ET
0.267 0.267 0.267 rg
BT 214.298 462.734 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 223.936 461.226 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 441.822 Td /F1 9.8 Tf  [(After being affected by floods, people may have substantial psychosocial needs, and/or develop mental health problems and )] TJ ET
BT 26.250 429.917 Td /F1 9.8 Tf  [(mental disorders in the short-, medium- or long-terms. People who are affected need responding organisations to: support their )] TJ ET
BT 26.250 418.012 Td /F1 9.8 Tf  [(psychosocial resilience and maintain their emotional wellbeing; recognise and respond to their distress; and take actions to )] TJ ET
BT 26.250 406.107 Td /F1 9.8 Tf  [(prevent the onset of additional mental health problems or disorders. These responses should be flexible and varied according to )] TJ ET
BT 26.250 394.203 Td /F1 9.8 Tf  [(people�s needs and according to their sources of social support, as well as their economic and social circumstances. )] TJ ET
BT 26.250 382.298 Td /F1 9.8 Tf  [(Understanding flooding in these terms should aid and direct the responses from services as well as from communities. This )] TJ ET
BT 26.250 370.393 Td /F1 9.8 Tf  [(applies not only to initial emergency responses, but also to support and reconstruction during recovery as many people and )] TJ ET
BT 26.250 358.488 Td /F1 9.8 Tf  [(communities can experience continuing social and economic disruption after flooding. A multi-sector approach that involves )] TJ ET
BT 26.250 346.584 Td /F1 9.8 Tf  [(communities and families as well as agencies is the best way to achieve these effects. It is important to recognise that family )] TJ ET
BT 26.250 334.679 Td /F1 9.8 Tf  [(and community assets are vitally important to maintaining and promoting personal and collective psychosocial resilience.)] TJ ET
BT 26.250 315.274 Td /F1 9.8 Tf  [(Everyone is likely to require continuing psychosocial support. Most people�s psychosocial needs are met through their close )] TJ ET
BT 26.250 303.369 Td /F1 9.8 Tf  [(relationships with their families, friends and communities. However, some people require assessment by primary care services if )] TJ ET
BT 26.250 291.465 Td /F1 9.8 Tf  [(their symptoms persist or are associated with dysfunction. A smaller proportion of people is likely to require referral for )] TJ ET
BT 26.250 279.560 Td /F1 9.8 Tf  [(specialised mental healthcare.)] TJ ET
BT 26.250 260.155 Td /F1 9.8 Tf  [(These findings support the requirement for a public mental health approach to flooding that comprises both universal and )] TJ ET
BT 26.250 248.250 Td /F1 9.8 Tf  [(targeted plans and interventions, which are well coordinated with adequate, timely access for people in need as well as long-)] TJ ET
BT 26.250 236.346 Td /F1 9.8 Tf  [(term availability of specialist care for a sizeable minority of affected people. Primary care and specialist mental health services )] TJ ET
BT 26.250 224.441 Td /F1 9.8 Tf  [(should recognise the long duration of the stress that affects people after they are inundated, the high frequency of secondary )] TJ ET
BT 26.250 212.536 Td /F1 9.8 Tf  [(stressors and the author�s finding that PTSD symptoms do not necessarily remit rapidly after flooding.)] TJ ET
BT 26.250 175.934 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 155.979 Td /F5 9.8 Tf  [(KEY THEMES)] TJ ET
BT 26.250 136.575 Td /F1 9.8 Tf  [(Core findings and recommendations that emerged from the guidance inform the themes that follow.)] TJ ET
BT 32.206 117.187 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 117.170 Td /F1 9.8 Tf  [(It is important to understand stress, and the stressors that are inflicted upon people by floods and how they cause short-)] TJ ET
BT 45.750 105.265 Td /F1 9.8 Tf  [(term distress in many people, influence their medium- and longer-term wellbeing, and affect the mental health of persons )] TJ ET
BT 45.750 93.360 Td /F1 9.8 Tf  [(and populations.)] TJ ET
BT 32.206 77.723 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 77.706 Td /F1 9.8 Tf  [(Primary stressors are inherent in all disasters and encompass any experiences that people have that are directly related to, )] TJ ET
BT 45.750 65.801 Td /F1 9.8 Tf  [(or consequent on their exposure to disasters.)] TJ ET
BT 32.206 50.164 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 50.146 Td /F1 9.8 Tf  [(A majority of people experience distress after disasters. But, personal and collective psychosocial resilience are inherent in )] TJ ET
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q
15.000 35.860 577.500 741.140 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(psychosocial support; these responses can be anticipated, as should be their needs for support;)] TJ ET
0.271 0.267 0.267 RG
40.337 754.789 m 
40.337 755.236 40.154 755.680 39.838 755.996 c
39.522 756.311 39.078 756.495 38.631 756.495 c
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39.078 753.083 39.522 753.267 39.838 753.582 c
40.154 753.898 40.337 754.342 40.337 754.789 c f
BT 45.750 751.821 Td /F1 9.8 Tf  [(Most people�s psychosocial needs are met by people who are close to them, but some people may require more substantial )] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(psychosocial care and approaches that are based on the principles of psychological first aid are appropriate;)] TJ ET
40.337 727.230 m 
40.337 727.676 40.154 728.120 39.838 728.436 c
39.522 728.752 39.078 728.936 38.631 728.936 c
38.185 728.936 37.741 728.752 37.425 728.436 c
37.109 728.120 36.925 727.676 36.925 727.230 c
36.925 726.783 37.109 726.339 37.425 726.023 c
37.741 725.707 38.185 725.523 38.631 725.523 c
39.078 725.523 39.522 725.707 39.838 726.023 c
40.154 726.339 40.337 726.783 40.337 727.230 c f
BT 45.750 724.262 Td /F1 9.8 Tf  [(A substantial minority of people who are affected by flooding are at risk of developing a mental disorder and they may )] TJ ET
BT 45.750 712.357 Td /F1 9.8 Tf  [(require healthcare services that include psychosocial care and mental healthcare;)] TJ ET
40.337 699.670 m 
40.337 700.117 40.154 700.561 39.838 700.877 c
39.522 701.192 39.078 701.376 38.631 701.376 c
38.185 701.376 37.741 701.192 37.425 700.877 c
37.109 700.561 36.925 700.117 36.925 699.670 c
36.925 699.223 37.109 698.779 37.425 698.463 c
37.741 698.148 38.185 697.964 38.631 697.964 c
39.078 697.964 39.522 698.148 39.838 698.463 c
40.154 698.779 40.337 699.223 40.337 699.670 c f
BT 45.750 696.702 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care)] TJ ET
0.267 0.267 0.267 rg
BT 206.703 698.210 Td /F4 8.7 Tf  [(59)] TJ ET
BT 216.340 698.210 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 225.978 696.702 Td /F1 9.8 Tf  [( is a very useful tool.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(The Strategic Stepped Model of Care allows planners to take into account sources of personal and collective social support, and )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(how responses to events are developed. It also allows psychosocial care and mental healthcare to be planned and delivered in )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(integrated ways that follow the trajectories of the needs of people who require them. Thereby, the responsible authorities can )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(create a dynamic, flexible and needs-led approach to mounting effective responses to flooding. Understanding the overlaps )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(between the steps can be facilitated by incorporating knowledge of the:)] TJ ET
40.337 609.491 m 
40.337 609.938 40.154 610.382 39.838 610.698 c
39.522 611.014 39.078 611.198 38.631 611.198 c
38.185 611.198 37.741 611.014 37.425 610.698 c
37.109 610.382 36.925 609.938 36.925 609.491 c
36.925 609.045 37.109 608.601 37.425 608.285 c
37.741 607.969 38.185 607.785 38.631 607.785 c
39.078 607.785 39.522 607.969 39.838 608.285 c
40.154 608.601 40.337 609.045 40.337 609.491 c f
BT 45.750 606.524 Td /F1 9.8 Tf  [(Nature of each flood and its consequences;)] TJ ET
40.337 593.837 m 
40.337 594.283 40.154 594.727 39.838 595.043 c
39.522 595.359 39.078 595.543 38.631 595.543 c
38.185 595.543 37.741 595.359 37.425 595.043 c
37.109 594.727 36.925 594.283 36.925 593.837 c
36.925 593.390 37.109 592.946 37.425 592.630 c
37.741 592.314 38.185 592.130 38.631 592.130 c
39.078 592.130 39.522 592.314 39.838 592.630 c
40.154 592.946 40.337 593.390 40.337 593.837 c f
BT 45.750 590.869 Td /F1 9.8 Tf  [(Primary and secondary stressors; and)] TJ ET
40.337 578.182 m 
40.337 578.629 40.154 579.073 39.838 579.389 c
39.522 579.704 39.078 579.888 38.631 579.888 c
38.185 579.888 37.741 579.704 37.425 579.389 c
37.109 579.073 36.925 578.629 36.925 578.182 c
36.925 577.735 37.109 577.291 37.425 576.975 c
37.741 576.660 38.185 576.476 38.631 576.476 c
39.078 576.476 39.522 576.660 39.838 576.975 c
40.154 577.291 40.337 577.735 40.337 578.182 c f
BT 45.750 575.214 Td /F1 9.8 Tf  [(Means of delivering care.)] TJ ET
BT 26.250 552.060 Td /F1 9.8 Tf  [(People�s psychosocial needs, and the mental disorders that they might develop as a consequence of their being flooded, pose )] TJ ET
BT 26.250 540.155 Td /F1 9.8 Tf  [(core challenges for community, public health, primary care and specialist mental healthcare services.)] TJ ET
BT 26.250 520.750 Td /F1 9.8 Tf  [(Public health measures that are put in place after floods should include considering the social as well as psychological impacts )] TJ ET
BT 26.250 508.845 Td /F1 9.8 Tf  [(of events, and especially because evidence suggests that good social support can act as a protective factor against negative )] TJ ET
BT 26.250 496.941 Td /F1 9.8 Tf  [(psychological and psychiatric impacts of being flooded. Furthermore, recently published results from a randomized trial provide )] TJ ET
BT 26.250 485.036 Td /F1 9.8 Tf  [(provisional evidence that psychosocial interventions, which target the resilience resources \(e.g. emotional engagement and )] TJ ET
BT 26.250 473.131 Td /F1 9.8 Tf  [(social connectedness\) of veterans who have PTSD, may alleviate their anxiety and depressive symptoms and improve their )] TJ ET
BT 26.250 461.226 Td /F1 9.8 Tf  [(positive emotional and cognitive functioning)] TJ ET
0.267 0.267 0.267 rg
BT 214.298 462.734 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 223.936 461.226 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 441.822 Td /F1 9.8 Tf  [(After being affected by floods, people may have substantial psychosocial needs, and/or develop mental health problems and )] TJ ET
BT 26.250 429.917 Td /F1 9.8 Tf  [(mental disorders in the short-, medium- or long-terms. People who are affected need responding organisations to: support their )] TJ ET
BT 26.250 418.012 Td /F1 9.8 Tf  [(psychosocial resilience and maintain their emotional wellbeing; recognise and respond to their distress; and take actions to )] TJ ET
BT 26.250 406.107 Td /F1 9.8 Tf  [(prevent the onset of additional mental health problems or disorders. These responses should be flexible and varied according to )] TJ ET
BT 26.250 394.203 Td /F1 9.8 Tf  [(people�s needs and according to their sources of social support, as well as their economic and social circumstances. )] TJ ET
BT 26.250 382.298 Td /F1 9.8 Tf  [(Understanding flooding in these terms should aid and direct the responses from services as well as from communities. This )] TJ ET
BT 26.250 370.393 Td /F1 9.8 Tf  [(applies not only to initial emergency responses, but also to support and reconstruction during recovery as many people and )] TJ ET
BT 26.250 358.488 Td /F1 9.8 Tf  [(communities can experience continuing social and economic disruption after flooding. A multi-sector approach that involves )] TJ ET
BT 26.250 346.584 Td /F1 9.8 Tf  [(communities and families as well as agencies is the best way to achieve these effects. It is important to recognise that family )] TJ ET
BT 26.250 334.679 Td /F1 9.8 Tf  [(and community assets are vitally important to maintaining and promoting personal and collective psychosocial resilience.)] TJ ET
BT 26.250 315.274 Td /F1 9.8 Tf  [(Everyone is likely to require continuing psychosocial support. Most people�s psychosocial needs are met through their close )] TJ ET
BT 26.250 303.369 Td /F1 9.8 Tf  [(relationships with their families, friends and communities. However, some people require assessment by primary care services if )] TJ ET
BT 26.250 291.465 Td /F1 9.8 Tf  [(their symptoms persist or are associated with dysfunction. A smaller proportion of people is likely to require referral for )] TJ ET
BT 26.250 279.560 Td /F1 9.8 Tf  [(specialised mental healthcare.)] TJ ET
BT 26.250 260.155 Td /F1 9.8 Tf  [(These findings support the requirement for a public mental health approach to flooding that comprises both universal and )] TJ ET
BT 26.250 248.250 Td /F1 9.8 Tf  [(targeted plans and interventions, which are well coordinated with adequate, timely access for people in need as well as long-)] TJ ET
BT 26.250 236.346 Td /F1 9.8 Tf  [(term availability of specialist care for a sizeable minority of affected people. Primary care and specialist mental health services )] TJ ET
BT 26.250 224.441 Td /F1 9.8 Tf  [(should recognise the long duration of the stress that affects people after they are inundated, the high frequency of secondary )] TJ ET
BT 26.250 212.536 Td /F1 9.8 Tf  [(stressors and the author�s finding that PTSD symptoms do not necessarily remit rapidly after flooding.)] TJ ET
BT 26.250 175.934 Td /F4 12.0 Tf  [(Discussion)] TJ ET
BT 26.250 155.979 Td /F5 9.8 Tf  [(KEY THEMES)] TJ ET
BT 26.250 136.575 Td /F1 9.8 Tf  [(Core findings and recommendations that emerged from the guidance inform the themes that follow.)] TJ ET
BT 32.206 117.187 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 117.170 Td /F1 9.8 Tf  [(It is important to understand stress, and the stressors that are inflicted upon people by floods and how they cause short-)] TJ ET
BT 45.750 105.265 Td /F1 9.8 Tf  [(term distress in many people, influence their medium- and longer-term wellbeing, and affect the mental health of persons )] TJ ET
BT 45.750 93.360 Td /F1 9.8 Tf  [(and populations.)] TJ ET
BT 32.206 77.723 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 77.706 Td /F1 9.8 Tf  [(Primary stressors are inherent in all disasters and encompass any experiences that people have that are directly related to, )] TJ ET
BT 45.750 65.801 Td /F1 9.8 Tf  [(or consequent on their exposure to disasters.)] TJ ET
BT 32.206 50.164 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 50.146 Td /F1 9.8 Tf  [(A majority of people experience distress after disasters. But, personal and collective psychosocial resilience are inherent in )] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(6)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 45.750 767.476 Td /F1 9.8 Tf  [(each population, and families, communities and non-statutory and statutory services offer protection for people against )] TJ ET
BT 45.750 755.571 Td /F1 9.8 Tf  [(psychosocial adversity during and after extreme events.)] TJ ET
BT 32.206 739.934 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(Secondary stressors follow on from, or are consequential on primary stressors: they include infrastructure failure and )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(challenges to people, families and communities returning to normality and repairing buildings, or failure to adjust to the �new )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(normality,� i.e., the new set of living circumstances, that ensues after disasters.)] TJ ET
BT 32.206 700.470 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 45.750 700.452 Td /F1 9.8 Tf  [(People�s psychosocial experiences can be shaped by the origin and delivery of care and the timeframes of activation of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(stressors: this makes it possible to describe how and where public health responses should be delivered.)] TJ ET
BT 32.206 672.911 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 45.750 672.893 Td /F1 9.8 Tf  [(People�s psychosocial experiences in the aftermath can oscillate between distress and recovery, and the aftermath of their )] TJ ET
BT 45.750 660.988 Td /F1 9.8 Tf  [(recovery from floods tends to be a phase of, at least, medium-term duration, which can endure for weeks, months or years. )] TJ ET
BT 45.750 649.083 Td /F1 9.8 Tf  [(This is because:)] TJ ET
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40.337 628.896 m 
40.337 629.343 40.154 629.787 39.838 630.103 c
39.522 630.419 39.078 630.602 38.631 630.602 c
38.185 630.602 37.741 630.419 37.425 630.103 c
37.109 629.787 36.925 629.343 36.925 628.896 c
36.925 628.450 37.109 628.006 37.425 627.690 c
37.741 627.374 38.185 627.190 38.631 627.190 c
39.078 627.190 39.522 627.374 39.838 627.690 c
40.154 628.006 40.337 628.450 40.337 628.896 c f
BT 45.750 625.929 Td /F1 9.8 Tf  [(Secondary stressors often arise during the responses to the clean up, recovery and rebuilding phases after flooding.)] TJ ET
40.337 613.241 m 
40.337 613.688 40.154 614.132 39.838 614.448 c
39.522 614.764 39.078 614.948 38.631 614.948 c
38.185 614.948 37.741 614.764 37.425 614.448 c
37.109 614.132 36.925 613.688 36.925 613.241 c
36.925 612.795 37.109 612.351 37.425 612.035 c
37.741 611.719 38.185 611.535 38.631 611.535 c
39.078 611.535 39.522 611.719 39.838 612.035 c
40.154 612.351 40.337 612.795 40.337 613.241 c f
BT 45.750 610.274 Td /F1 9.8 Tf  [(Some people�s experiences may be of the quantity, severity and duration or are associated with sustained dysfunction such )] TJ ET
BT 45.750 598.369 Td /F1 9.8 Tf  [(that it is appropriate to call them symptoms of mental disorders.)] TJ ET
40.337 585.682 m 
40.337 586.129 40.154 586.573 39.838 586.889 c
39.522 587.204 39.078 587.388 38.631 587.388 c
38.185 587.388 37.741 587.204 37.425 586.889 c
37.109 586.573 36.925 586.129 36.925 585.682 c
36.925 585.235 37.109 584.791 37.425 584.475 c
37.741 584.160 38.185 583.976 38.631 583.976 c
39.078 583.976 39.522 584.160 39.838 584.475 c
40.154 584.791 40.337 585.235 40.337 585.682 c f
BT 45.750 582.714 Td /F1 9.8 Tf  [(Support networks may not provide enough support for a small proportion of people, or some people may not recover from )] TJ ET
BT 45.750 570.810 Td /F1 9.8 Tf  [(distress even though stressors are removed. In this situation, more persistent problems, or mental disorders, can develop, )] TJ ET
BT 45.750 558.905 Td /F1 9.8 Tf  [(or pre-existing ones are provoked.)] TJ ET
BT 26.250 535.750 Td /F1 9.8 Tf  [(People who are affected in these ways should be assessed by the primary care services and some of them require treatment by )] TJ ET
BT 26.250 523.845 Td /F1 9.8 Tf  [(the specialist mental health services.)] TJ ET
BT 26.250 504.441 Td /F5 9.8 Tf  [(COMPLEXITIES AND LIMITATIONS)] TJ ET
BT 26.250 485.036 Td /F1 9.8 Tf  [(It became apparent to the authors that there are a substantial number of methodological complexities and challenges which )] TJ ET
BT 26.250 473.131 Td /F1 9.8 Tf  [(emerged in their review of the literature. They include:)] TJ ET
40.337 456.694 m 
40.337 457.141 40.154 457.585 39.838 457.901 c
39.522 458.216 39.078 458.400 38.631 458.400 c
38.185 458.400 37.741 458.216 37.425 457.901 c
37.109 457.585 36.925 457.141 36.925 456.694 c
36.925 456.247 37.109 455.803 37.425 455.487 c
37.741 455.172 38.185 454.988 38.631 454.988 c
39.078 454.988 39.522 455.172 39.838 455.487 c
40.154 455.803 40.337 456.247 40.337 456.694 c f
BT 45.750 453.726 Td /F1 9.8 Tf  [(The lack of universally agreed definitions used when researching disasters. The authors found that researchers may use )] TJ ET
BT 45.750 441.822 Td /F1 9.8 Tf  [(the same and different terms to describe people�s experiences and responses, including inconsistencies in their use of the )] TJ ET
BT 45.750 429.917 Td /F1 9.8 Tf  [(different classifications of mental disorders, which have differing thresholds for caseness;)] TJ ET
40.337 417.230 m 
40.337 417.676 40.154 418.120 39.838 418.436 c
39.522 418.752 39.078 418.936 38.631 418.936 c
38.185 418.936 37.741 418.752 37.425 418.436 c
37.109 418.120 36.925 417.676 36.925 417.230 c
36.925 416.783 37.109 416.339 37.425 416.023 c
37.741 415.707 38.185 415.524 38.631 415.524 c
39.078 415.524 39.522 415.707 39.838 416.023 c
40.154 416.339 40.337 416.783 40.337 417.230 c f
BT 45.750 414.262 Td /F1 9.8 Tf  [(The wide variety of methodologies that are used across the studies that were scrutinised;)] TJ ET
40.337 401.575 m 
40.337 402.022 40.154 402.466 39.838 402.782 c
39.522 403.097 39.078 403.281 38.631 403.281 c
38.185 403.281 37.741 403.097 37.425 402.782 c
37.109 402.466 36.925 402.022 36.925 401.575 c
36.925 401.128 37.109 400.684 37.425 400.368 c
37.741 400.053 38.185 399.869 38.631 399.869 c
39.078 399.869 39.522 400.053 39.838 400.368 c
40.154 400.684 40.337 401.128 40.337 401.575 c f
BT 45.750 398.607 Td /F1 9.8 Tf  [(The broad range of mental disorders that are described and assessed in the literature;)] TJ ET
40.337 385.920 m 
40.337 386.367 40.154 386.811 39.838 387.127 c
39.522 387.443 39.078 387.627 38.631 387.627 c
38.185 387.627 37.741 387.443 37.425 387.127 c
37.109 386.811 36.925 386.367 36.925 385.920 c
36.925 385.474 37.109 385.030 37.425 384.714 c
37.741 384.398 38.185 384.214 38.631 384.214 c
39.078 384.214 39.522 384.398 39.838 384.714 c
40.154 385.030 40.337 385.474 40.337 385.920 c f
BT 45.750 382.953 Td /F1 9.8 Tf  [(Diversity in the co-variants that different researchers have assessed;)] TJ ET
40.337 370.266 m 
40.337 370.712 40.154 371.156 39.838 371.472 c
39.522 371.788 39.078 371.972 38.631 371.972 c
38.185 371.972 37.741 371.788 37.425 371.472 c
37.109 371.156 36.925 370.712 36.925 370.266 c
36.925 369.819 37.109 369.375 37.425 369.059 c
37.741 368.743 38.185 368.559 38.631 368.559 c
39.078 368.559 39.522 368.743 39.838 369.059 c
40.154 369.375 40.337 369.819 40.337 370.266 c f
BT 45.750 367.298 Td /F1 9.8 Tf  [(The use of a variety of different diagnostic measurement tools; and)] TJ ET
40.337 354.611 m 
40.337 355.057 40.154 355.501 39.838 355.817 c
39.522 356.133 39.078 356.317 38.631 356.317 c
38.185 356.317 37.741 356.133 37.425 355.817 c
37.109 355.501 36.925 355.057 36.925 354.611 c
36.925 354.164 37.109 353.720 37.425 353.404 c
37.741 353.088 38.185 352.905 38.631 352.905 c
39.078 352.905 39.522 353.088 39.838 353.404 c
40.154 353.720 40.337 354.164 40.337 354.611 c f
BT 45.750 351.643 Td /F1 9.8 Tf  [(Complexity when classifying the nature of each flood and population that was exposed to it.)] TJ ET
BT 26.250 328.488 Td /F1 9.8 Tf  [(In addition to these inconsistencies, the recent literature on disasters, especially that on flooding, has tended to focus on the )] TJ ET
BT 26.250 316.584 Td /F1 9.8 Tf  [(single and narrow concept of PTSD. The result is that, first, less research has been conducted on the psychosocial needs of )] TJ ET
BT 26.250 304.679 Td /F1 9.8 Tf  [(people who are distressed rather than disordered. Second, the canon of research has tended to neglect the crucial wider and, )] TJ ET
BT 26.250 292.774 Td /F1 9.8 Tf  [(sometimes, more prevalent morbidity that is found in all populations, including that which affects people who are involved in )] TJ ET
BT 26.250 280.869 Td /F1 9.8 Tf  [(flooding.)] TJ ET
BT 26.250 261.465 Td /F1 9.8 Tf  [(This is why much of the evidence relates to people who develop a narrow selection of mental disorders. There are two other )] TJ ET
BT 26.250 249.560 Td /F1 9.8 Tf  [(groups of people about which healthcare services need to know more: people who develop disorders other than PTSD, which )] TJ ET
BT 26.250 237.655 Td /F1 9.8 Tf  [(the literature shows is very often co-morbid with other mental disorders; and the wider group of people who are distressed by )] TJ ET
BT 26.250 225.750 Td /F1 9.8 Tf  [(events, temporarily or otherwise \(a highly relevant matter after flooding\) and who have psychosocial needs that relate to )] TJ ET
BT 26.250 213.846 Td /F1 9.8 Tf  [(sustaining their mental health and emotional wellbeing and also preventing their developing mental disorders.)] TJ ET
BT 26.250 194.441 Td /F5 9.8 Tf  [(THE WAY FORWARD FOR RESEARCH)] TJ ET
BT 26.250 175.036 Td /F1 9.8 Tf  [(The authors identify significant research gaps, which, if filled, could support better design and delivery of future psychosocial )] TJ ET
BT 26.250 163.131 Td /F1 9.8 Tf  [(and public mental health responses, and improved primary and secondary mental healthcare responses to people�s needs )] TJ ET
BT 26.250 151.227 Td /F1 9.8 Tf  [(before and after flooding.)] TJ ET
BT 26.250 131.822 Td /F1 9.8 Tf  [(In general terms, more research is required, which studies:)] TJ ET
40.337 115.385 m 
40.337 115.831 40.154 116.275 39.838 116.591 c
39.522 116.907 39.078 117.091 38.631 117.091 c
38.185 117.091 37.741 116.907 37.425 116.591 c
37.109 116.275 36.925 115.831 36.925 115.385 c
36.925 114.938 37.109 114.494 37.425 114.178 c
37.741 113.862 38.185 113.678 38.631 113.678 c
39.078 113.678 39.522 113.862 39.838 114.178 c
40.154 114.494 40.337 114.938 40.337 115.385 c f
BT 45.750 112.417 Td /F1 9.8 Tf  [(The responses of, and impacts on populations before and after untoward and extreme events, major incidents and )] TJ ET
BT 45.750 100.512 Td /F1 9.8 Tf  [(disasters including flooding;)] TJ ET
40.337 87.825 m 
40.337 88.272 40.154 88.716 39.838 89.032 c
39.522 89.348 39.078 89.531 38.631 89.531 c
38.185 89.531 37.741 89.348 37.425 89.032 c
37.109 88.716 36.925 88.272 36.925 87.825 c
36.925 87.379 37.109 86.935 37.425 86.619 c
37.741 86.303 38.185 86.119 38.631 86.119 c
39.078 86.119 39.522 86.303 39.838 86.619 c
40.154 86.935 40.337 87.379 40.337 87.825 c f
BT 45.750 84.858 Td /F1 9.8 Tf  [(The impacts of major incidents and disasters, including flooding, on people�s psychosocial experiences in the short-, )] TJ ET
BT 45.750 72.953 Td /F1 9.8 Tf  [(medium- and longer-terms;)] TJ ET
40.337 60.266 m 
40.337 60.712 40.154 61.156 39.838 61.472 c
39.522 61.788 39.078 61.972 38.631 61.972 c
38.185 61.972 37.741 61.788 37.425 61.472 c
37.109 61.156 36.925 60.712 36.925 60.266 c
36.925 59.819 37.109 59.375 37.425 59.059 c
37.741 58.743 38.185 58.559 38.631 58.559 c
39.078 58.559 39.522 58.743 39.838 59.059 c
40.154 59.375 40.337 59.819 40.337 60.266 c f
BT 45.750 57.298 Td /F1 9.8 Tf  [(The impacts of successive floods on populations;)] TJ ET
40.337 44.611 m 
40.337 45.058 40.154 45.502 39.838 45.818 c
39.522 46.133 39.078 46.317 38.631 46.317 c
38.185 46.317 37.741 46.133 37.425 45.818 c
37.109 45.502 36.925 45.058 36.925 44.611 c
36.925 44.164 37.109 43.720 37.425 43.404 c
37.741 43.089 38.185 42.905 38.631 42.905 c
39.078 42.905 39.522 43.089 39.838 43.404 c
40.154 43.720 40.337 44.164 40.337 44.611 c f
BT 45.750 41.643 Td /F1 9.8 Tf  [(The contextual and subjective, qualitative features of peoples� experiences which distinguish distress after disasters from )] TJ ET
Q
q
15.000 27.358 577.500 749.642 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(each population, and families, communities and non-statutory and statutory services offer protection for people against )] TJ ET
BT 45.750 755.571 Td /F1 9.8 Tf  [(psychosocial adversity during and after extreme events.)] TJ ET
BT 32.206 739.934 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(Secondary stressors follow on from, or are consequential on primary stressors: they include infrastructure failure and )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(challenges to people, families and communities returning to normality and repairing buildings, or failure to adjust to the �new )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(normality,� i.e., the new set of living circumstances, that ensues after disasters.)] TJ ET
BT 32.206 700.470 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 45.750 700.452 Td /F1 9.8 Tf  [(People�s psychosocial experiences can be shaped by the origin and delivery of care and the timeframes of activation of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(stressors: this makes it possible to describe how and where public health responses should be delivered.)] TJ ET
BT 32.206 672.911 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 45.750 672.893 Td /F1 9.8 Tf  [(People�s psychosocial experiences in the aftermath can oscillate between distress and recovery, and the aftermath of their )] TJ ET
BT 45.750 660.988 Td /F1 9.8 Tf  [(recovery from floods tends to be a phase of, at least, medium-term duration, which can endure for weeks, months or years. )] TJ ET
BT 45.750 649.083 Td /F1 9.8 Tf  [(This is because:)] TJ ET
0.271 0.267 0.267 RG
40.337 628.896 m 
40.337 629.343 40.154 629.787 39.838 630.103 c
39.522 630.419 39.078 630.602 38.631 630.602 c
38.185 630.602 37.741 630.419 37.425 630.103 c
37.109 629.787 36.925 629.343 36.925 628.896 c
36.925 628.450 37.109 628.006 37.425 627.690 c
37.741 627.374 38.185 627.190 38.631 627.190 c
39.078 627.190 39.522 627.374 39.838 627.690 c
40.154 628.006 40.337 628.450 40.337 628.896 c f
BT 45.750 625.929 Td /F1 9.8 Tf  [(Secondary stressors often arise during the responses to the clean up, recovery and rebuilding phases after flooding.)] TJ ET
40.337 613.241 m 
40.337 613.688 40.154 614.132 39.838 614.448 c
39.522 614.764 39.078 614.948 38.631 614.948 c
38.185 614.948 37.741 614.764 37.425 614.448 c
37.109 614.132 36.925 613.688 36.925 613.241 c
36.925 612.795 37.109 612.351 37.425 612.035 c
37.741 611.719 38.185 611.535 38.631 611.535 c
39.078 611.535 39.522 611.719 39.838 612.035 c
40.154 612.351 40.337 612.795 40.337 613.241 c f
BT 45.750 610.274 Td /F1 9.8 Tf  [(Some people�s experiences may be of the quantity, severity and duration or are associated with sustained dysfunction such )] TJ ET
BT 45.750 598.369 Td /F1 9.8 Tf  [(that it is appropriate to call them symptoms of mental disorders.)] TJ ET
40.337 585.682 m 
40.337 586.129 40.154 586.573 39.838 586.889 c
39.522 587.204 39.078 587.388 38.631 587.388 c
38.185 587.388 37.741 587.204 37.425 586.889 c
37.109 586.573 36.925 586.129 36.925 585.682 c
36.925 585.235 37.109 584.791 37.425 584.475 c
37.741 584.160 38.185 583.976 38.631 583.976 c
39.078 583.976 39.522 584.160 39.838 584.475 c
40.154 584.791 40.337 585.235 40.337 585.682 c f
BT 45.750 582.714 Td /F1 9.8 Tf  [(Support networks may not provide enough support for a small proportion of people, or some people may not recover from )] TJ ET
BT 45.750 570.810 Td /F1 9.8 Tf  [(distress even though stressors are removed. In this situation, more persistent problems, or mental disorders, can develop, )] TJ ET
BT 45.750 558.905 Td /F1 9.8 Tf  [(or pre-existing ones are provoked.)] TJ ET
BT 26.250 535.750 Td /F1 9.8 Tf  [(People who are affected in these ways should be assessed by the primary care services and some of them require treatment by )] TJ ET
BT 26.250 523.845 Td /F1 9.8 Tf  [(the specialist mental health services.)] TJ ET
BT 26.250 504.441 Td /F5 9.8 Tf  [(COMPLEXITIES AND LIMITATIONS)] TJ ET
BT 26.250 485.036 Td /F1 9.8 Tf  [(It became apparent to the authors that there are a substantial number of methodological complexities and challenges which )] TJ ET
BT 26.250 473.131 Td /F1 9.8 Tf  [(emerged in their review of the literature. They include:)] TJ ET
40.337 456.694 m 
40.337 457.141 40.154 457.585 39.838 457.901 c
39.522 458.216 39.078 458.400 38.631 458.400 c
38.185 458.400 37.741 458.216 37.425 457.901 c
37.109 457.585 36.925 457.141 36.925 456.694 c
36.925 456.247 37.109 455.803 37.425 455.487 c
37.741 455.172 38.185 454.988 38.631 454.988 c
39.078 454.988 39.522 455.172 39.838 455.487 c
40.154 455.803 40.337 456.247 40.337 456.694 c f
BT 45.750 453.726 Td /F1 9.8 Tf  [(The lack of universally agreed definitions used when researching disasters. The authors found that researchers may use )] TJ ET
BT 45.750 441.822 Td /F1 9.8 Tf  [(the same and different terms to describe people�s experiences and responses, including inconsistencies in their use of the )] TJ ET
BT 45.750 429.917 Td /F1 9.8 Tf  [(different classifications of mental disorders, which have differing thresholds for caseness;)] TJ ET
40.337 417.230 m 
40.337 417.676 40.154 418.120 39.838 418.436 c
39.522 418.752 39.078 418.936 38.631 418.936 c
38.185 418.936 37.741 418.752 37.425 418.436 c
37.109 418.120 36.925 417.676 36.925 417.230 c
36.925 416.783 37.109 416.339 37.425 416.023 c
37.741 415.707 38.185 415.524 38.631 415.524 c
39.078 415.524 39.522 415.707 39.838 416.023 c
40.154 416.339 40.337 416.783 40.337 417.230 c f
BT 45.750 414.262 Td /F1 9.8 Tf  [(The wide variety of methodologies that are used across the studies that were scrutinised;)] TJ ET
40.337 401.575 m 
40.337 402.022 40.154 402.466 39.838 402.782 c
39.522 403.097 39.078 403.281 38.631 403.281 c
38.185 403.281 37.741 403.097 37.425 402.782 c
37.109 402.466 36.925 402.022 36.925 401.575 c
36.925 401.128 37.109 400.684 37.425 400.368 c
37.741 400.053 38.185 399.869 38.631 399.869 c
39.078 399.869 39.522 400.053 39.838 400.368 c
40.154 400.684 40.337 401.128 40.337 401.575 c f
BT 45.750 398.607 Td /F1 9.8 Tf  [(The broad range of mental disorders that are described and assessed in the literature;)] TJ ET
40.337 385.920 m 
40.337 386.367 40.154 386.811 39.838 387.127 c
39.522 387.443 39.078 387.627 38.631 387.627 c
38.185 387.627 37.741 387.443 37.425 387.127 c
37.109 386.811 36.925 386.367 36.925 385.920 c
36.925 385.474 37.109 385.030 37.425 384.714 c
37.741 384.398 38.185 384.214 38.631 384.214 c
39.078 384.214 39.522 384.398 39.838 384.714 c
40.154 385.030 40.337 385.474 40.337 385.920 c f
BT 45.750 382.953 Td /F1 9.8 Tf  [(Diversity in the co-variants that different researchers have assessed;)] TJ ET
40.337 370.266 m 
40.337 370.712 40.154 371.156 39.838 371.472 c
39.522 371.788 39.078 371.972 38.631 371.972 c
38.185 371.972 37.741 371.788 37.425 371.472 c
37.109 371.156 36.925 370.712 36.925 370.266 c
36.925 369.819 37.109 369.375 37.425 369.059 c
37.741 368.743 38.185 368.559 38.631 368.559 c
39.078 368.559 39.522 368.743 39.838 369.059 c
40.154 369.375 40.337 369.819 40.337 370.266 c f
BT 45.750 367.298 Td /F1 9.8 Tf  [(The use of a variety of different diagnostic measurement tools; and)] TJ ET
40.337 354.611 m 
40.337 355.057 40.154 355.501 39.838 355.817 c
39.522 356.133 39.078 356.317 38.631 356.317 c
38.185 356.317 37.741 356.133 37.425 355.817 c
37.109 355.501 36.925 355.057 36.925 354.611 c
36.925 354.164 37.109 353.720 37.425 353.404 c
37.741 353.088 38.185 352.905 38.631 352.905 c
39.078 352.905 39.522 353.088 39.838 353.404 c
40.154 353.720 40.337 354.164 40.337 354.611 c f
BT 45.750 351.643 Td /F1 9.8 Tf  [(Complexity when classifying the nature of each flood and population that was exposed to it.)] TJ ET
BT 26.250 328.488 Td /F1 9.8 Tf  [(In addition to these inconsistencies, the recent literature on disasters, especially that on flooding, has tended to focus on the )] TJ ET
BT 26.250 316.584 Td /F1 9.8 Tf  [(single and narrow concept of PTSD. The result is that, first, less research has been conducted on the psychosocial needs of )] TJ ET
BT 26.250 304.679 Td /F1 9.8 Tf  [(people who are distressed rather than disordered. Second, the canon of research has tended to neglect the crucial wider and, )] TJ ET
BT 26.250 292.774 Td /F1 9.8 Tf  [(sometimes, more prevalent morbidity that is found in all populations, including that which affects people who are involved in )] TJ ET
BT 26.250 280.869 Td /F1 9.8 Tf  [(flooding.)] TJ ET
BT 26.250 261.465 Td /F1 9.8 Tf  [(This is why much of the evidence relates to people who develop a narrow selection of mental disorders. There are two other )] TJ ET
BT 26.250 249.560 Td /F1 9.8 Tf  [(groups of people about which healthcare services need to know more: people who develop disorders other than PTSD, which )] TJ ET
BT 26.250 237.655 Td /F1 9.8 Tf  [(the literature shows is very often co-morbid with other mental disorders; and the wider group of people who are distressed by )] TJ ET
BT 26.250 225.750 Td /F1 9.8 Tf  [(events, temporarily or otherwise \(a highly relevant matter after flooding\) and who have psychosocial needs that relate to )] TJ ET
BT 26.250 213.846 Td /F1 9.8 Tf  [(sustaining their mental health and emotional wellbeing and also preventing their developing mental disorders.)] TJ ET
BT 26.250 194.441 Td /F5 9.8 Tf  [(THE WAY FORWARD FOR RESEARCH)] TJ ET
BT 26.250 175.036 Td /F1 9.8 Tf  [(The authors identify significant research gaps, which, if filled, could support better design and delivery of future psychosocial )] TJ ET
BT 26.250 163.131 Td /F1 9.8 Tf  [(and public mental health responses, and improved primary and secondary mental healthcare responses to people�s needs )] TJ ET
BT 26.250 151.227 Td /F1 9.8 Tf  [(before and after flooding.)] TJ ET
BT 26.250 131.822 Td /F1 9.8 Tf  [(In general terms, more research is required, which studies:)] TJ ET
40.337 115.385 m 
40.337 115.831 40.154 116.275 39.838 116.591 c
39.522 116.907 39.078 117.091 38.631 117.091 c
38.185 117.091 37.741 116.907 37.425 116.591 c
37.109 116.275 36.925 115.831 36.925 115.385 c
36.925 114.938 37.109 114.494 37.425 114.178 c
37.741 113.862 38.185 113.678 38.631 113.678 c
39.078 113.678 39.522 113.862 39.838 114.178 c
40.154 114.494 40.337 114.938 40.337 115.385 c f
BT 45.750 112.417 Td /F1 9.8 Tf  [(The responses of, and impacts on populations before and after untoward and extreme events, major incidents and )] TJ ET
BT 45.750 100.512 Td /F1 9.8 Tf  [(disasters including flooding;)] TJ ET
40.337 87.825 m 
40.337 88.272 40.154 88.716 39.838 89.032 c
39.522 89.348 39.078 89.531 38.631 89.531 c
38.185 89.531 37.741 89.348 37.425 89.032 c
37.109 88.716 36.925 88.272 36.925 87.825 c
36.925 87.379 37.109 86.935 37.425 86.619 c
37.741 86.303 38.185 86.119 38.631 86.119 c
39.078 86.119 39.522 86.303 39.838 86.619 c
40.154 86.935 40.337 87.379 40.337 87.825 c f
BT 45.750 84.858 Td /F1 9.8 Tf  [(The impacts of major incidents and disasters, including flooding, on people�s psychosocial experiences in the short-, )] TJ ET
BT 45.750 72.953 Td /F1 9.8 Tf  [(medium- and longer-terms;)] TJ ET
40.337 60.266 m 
40.337 60.712 40.154 61.156 39.838 61.472 c
39.522 61.788 39.078 61.972 38.631 61.972 c
38.185 61.972 37.741 61.788 37.425 61.472 c
37.109 61.156 36.925 60.712 36.925 60.266 c
36.925 59.819 37.109 59.375 37.425 59.059 c
37.741 58.743 38.185 58.559 38.631 58.559 c
39.078 58.559 39.522 58.743 39.838 59.059 c
40.154 59.375 40.337 59.819 40.337 60.266 c f
BT 45.750 57.298 Td /F1 9.8 Tf  [(The impacts of successive floods on populations;)] TJ ET
40.337 44.611 m 
40.337 45.058 40.154 45.502 39.838 45.818 c
39.522 46.133 39.078 46.317 38.631 46.317 c
38.185 46.317 37.741 46.133 37.425 45.818 c
37.109 45.502 36.925 45.058 36.925 44.611 c
36.925 44.164 37.109 43.720 37.425 43.404 c
37.741 43.089 38.185 42.905 38.631 42.905 c
39.078 42.905 39.522 43.089 39.838 43.404 c
40.154 43.720 40.337 44.164 40.337 44.611 c f
BT 45.750 41.643 Td /F1 9.8 Tf  [(The contextual and subjective, qualitative features of peoples� experiences which distinguish distress after disasters from )] TJ ET
Q
q
15.000 27.358 577.500 749.642 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(each population, and families, communities and non-statutory and statutory services offer protection for people against )] TJ ET
BT 45.750 755.571 Td /F1 9.8 Tf  [(psychosocial adversity during and after extreme events.)] TJ ET
BT 32.206 739.934 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(Secondary stressors follow on from, or are consequential on primary stressors: they include infrastructure failure and )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(challenges to people, families and communities returning to normality and repairing buildings, or failure to adjust to the �new )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(normality,� i.e., the new set of living circumstances, that ensues after disasters.)] TJ ET
BT 32.206 700.470 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 45.750 700.452 Td /F1 9.8 Tf  [(People�s psychosocial experiences can be shaped by the origin and delivery of care and the timeframes of activation of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(stressors: this makes it possible to describe how and where public health responses should be delivered.)] TJ ET
BT 32.206 672.911 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 45.750 672.893 Td /F1 9.8 Tf  [(People�s psychosocial experiences in the aftermath can oscillate between distress and recovery, and the aftermath of their )] TJ ET
BT 45.750 660.988 Td /F1 9.8 Tf  [(recovery from floods tends to be a phase of, at least, medium-term duration, which can endure for weeks, months or years. )] TJ ET
BT 45.750 649.083 Td /F1 9.8 Tf  [(This is because:)] TJ ET
0.271 0.267 0.267 RG
40.337 628.896 m 
40.337 629.343 40.154 629.787 39.838 630.103 c
39.522 630.419 39.078 630.602 38.631 630.602 c
38.185 630.602 37.741 630.419 37.425 630.103 c
37.109 629.787 36.925 629.343 36.925 628.896 c
36.925 628.450 37.109 628.006 37.425 627.690 c
37.741 627.374 38.185 627.190 38.631 627.190 c
39.078 627.190 39.522 627.374 39.838 627.690 c
40.154 628.006 40.337 628.450 40.337 628.896 c f
BT 45.750 625.929 Td /F1 9.8 Tf  [(Secondary stressors often arise during the responses to the clean up, recovery and rebuilding phases after flooding.)] TJ ET
40.337 613.241 m 
40.337 613.688 40.154 614.132 39.838 614.448 c
39.522 614.764 39.078 614.948 38.631 614.948 c
38.185 614.948 37.741 614.764 37.425 614.448 c
37.109 614.132 36.925 613.688 36.925 613.241 c
36.925 612.795 37.109 612.351 37.425 612.035 c
37.741 611.719 38.185 611.535 38.631 611.535 c
39.078 611.535 39.522 611.719 39.838 612.035 c
40.154 612.351 40.337 612.795 40.337 613.241 c f
BT 45.750 610.274 Td /F1 9.8 Tf  [(Some people�s experiences may be of the quantity, severity and duration or are associated with sustained dysfunction such )] TJ ET
BT 45.750 598.369 Td /F1 9.8 Tf  [(that it is appropriate to call them symptoms of mental disorders.)] TJ ET
40.337 585.682 m 
40.337 586.129 40.154 586.573 39.838 586.889 c
39.522 587.204 39.078 587.388 38.631 587.388 c
38.185 587.388 37.741 587.204 37.425 586.889 c
37.109 586.573 36.925 586.129 36.925 585.682 c
36.925 585.235 37.109 584.791 37.425 584.475 c
37.741 584.160 38.185 583.976 38.631 583.976 c
39.078 583.976 39.522 584.160 39.838 584.475 c
40.154 584.791 40.337 585.235 40.337 585.682 c f
BT 45.750 582.714 Td /F1 9.8 Tf  [(Support networks may not provide enough support for a small proportion of people, or some people may not recover from )] TJ ET
BT 45.750 570.810 Td /F1 9.8 Tf  [(distress even though stressors are removed. In this situation, more persistent problems, or mental disorders, can develop, )] TJ ET
BT 45.750 558.905 Td /F1 9.8 Tf  [(or pre-existing ones are provoked.)] TJ ET
BT 26.250 535.750 Td /F1 9.8 Tf  [(People who are affected in these ways should be assessed by the primary care services and some of them require treatment by )] TJ ET
BT 26.250 523.845 Td /F1 9.8 Tf  [(the specialist mental health services.)] TJ ET
BT 26.250 504.441 Td /F5 9.8 Tf  [(COMPLEXITIES AND LIMITATIONS)] TJ ET
BT 26.250 485.036 Td /F1 9.8 Tf  [(It became apparent to the authors that there are a substantial number of methodological complexities and challenges which )] TJ ET
BT 26.250 473.131 Td /F1 9.8 Tf  [(emerged in their review of the literature. They include:)] TJ ET
40.337 456.694 m 
40.337 457.141 40.154 457.585 39.838 457.901 c
39.522 458.216 39.078 458.400 38.631 458.400 c
38.185 458.400 37.741 458.216 37.425 457.901 c
37.109 457.585 36.925 457.141 36.925 456.694 c
36.925 456.247 37.109 455.803 37.425 455.487 c
37.741 455.172 38.185 454.988 38.631 454.988 c
39.078 454.988 39.522 455.172 39.838 455.487 c
40.154 455.803 40.337 456.247 40.337 456.694 c f
BT 45.750 453.726 Td /F1 9.8 Tf  [(The lack of universally agreed definitions used when researching disasters. The authors found that researchers may use )] TJ ET
BT 45.750 441.822 Td /F1 9.8 Tf  [(the same and different terms to describe people�s experiences and responses, including inconsistencies in their use of the )] TJ ET
BT 45.750 429.917 Td /F1 9.8 Tf  [(different classifications of mental disorders, which have differing thresholds for caseness;)] TJ ET
40.337 417.230 m 
40.337 417.676 40.154 418.120 39.838 418.436 c
39.522 418.752 39.078 418.936 38.631 418.936 c
38.185 418.936 37.741 418.752 37.425 418.436 c
37.109 418.120 36.925 417.676 36.925 417.230 c
36.925 416.783 37.109 416.339 37.425 416.023 c
37.741 415.707 38.185 415.524 38.631 415.524 c
39.078 415.524 39.522 415.707 39.838 416.023 c
40.154 416.339 40.337 416.783 40.337 417.230 c f
BT 45.750 414.262 Td /F1 9.8 Tf  [(The wide variety of methodologies that are used across the studies that were scrutinised;)] TJ ET
40.337 401.575 m 
40.337 402.022 40.154 402.466 39.838 402.782 c
39.522 403.097 39.078 403.281 38.631 403.281 c
38.185 403.281 37.741 403.097 37.425 402.782 c
37.109 402.466 36.925 402.022 36.925 401.575 c
36.925 401.128 37.109 400.684 37.425 400.368 c
37.741 400.053 38.185 399.869 38.631 399.869 c
39.078 399.869 39.522 400.053 39.838 400.368 c
40.154 400.684 40.337 401.128 40.337 401.575 c f
BT 45.750 398.607 Td /F1 9.8 Tf  [(The broad range of mental disorders that are described and assessed in the literature;)] TJ ET
40.337 385.920 m 
40.337 386.367 40.154 386.811 39.838 387.127 c
39.522 387.443 39.078 387.627 38.631 387.627 c
38.185 387.627 37.741 387.443 37.425 387.127 c
37.109 386.811 36.925 386.367 36.925 385.920 c
36.925 385.474 37.109 385.030 37.425 384.714 c
37.741 384.398 38.185 384.214 38.631 384.214 c
39.078 384.214 39.522 384.398 39.838 384.714 c
40.154 385.030 40.337 385.474 40.337 385.920 c f
BT 45.750 382.953 Td /F1 9.8 Tf  [(Diversity in the co-variants that different researchers have assessed;)] TJ ET
40.337 370.266 m 
40.337 370.712 40.154 371.156 39.838 371.472 c
39.522 371.788 39.078 371.972 38.631 371.972 c
38.185 371.972 37.741 371.788 37.425 371.472 c
37.109 371.156 36.925 370.712 36.925 370.266 c
36.925 369.819 37.109 369.375 37.425 369.059 c
37.741 368.743 38.185 368.559 38.631 368.559 c
39.078 368.559 39.522 368.743 39.838 369.059 c
40.154 369.375 40.337 369.819 40.337 370.266 c f
BT 45.750 367.298 Td /F1 9.8 Tf  [(The use of a variety of different diagnostic measurement tools; and)] TJ ET
40.337 354.611 m 
40.337 355.057 40.154 355.501 39.838 355.817 c
39.522 356.133 39.078 356.317 38.631 356.317 c
38.185 356.317 37.741 356.133 37.425 355.817 c
37.109 355.501 36.925 355.057 36.925 354.611 c
36.925 354.164 37.109 353.720 37.425 353.404 c
37.741 353.088 38.185 352.905 38.631 352.905 c
39.078 352.905 39.522 353.088 39.838 353.404 c
40.154 353.720 40.337 354.164 40.337 354.611 c f
BT 45.750 351.643 Td /F1 9.8 Tf  [(Complexity when classifying the nature of each flood and population that was exposed to it.)] TJ ET
BT 26.250 328.488 Td /F1 9.8 Tf  [(In addition to these inconsistencies, the recent literature on disasters, especially that on flooding, has tended to focus on the )] TJ ET
BT 26.250 316.584 Td /F1 9.8 Tf  [(single and narrow concept of PTSD. The result is that, first, less research has been conducted on the psychosocial needs of )] TJ ET
BT 26.250 304.679 Td /F1 9.8 Tf  [(people who are distressed rather than disordered. Second, the canon of research has tended to neglect the crucial wider and, )] TJ ET
BT 26.250 292.774 Td /F1 9.8 Tf  [(sometimes, more prevalent morbidity that is found in all populations, including that which affects people who are involved in )] TJ ET
BT 26.250 280.869 Td /F1 9.8 Tf  [(flooding.)] TJ ET
BT 26.250 261.465 Td /F1 9.8 Tf  [(This is why much of the evidence relates to people who develop a narrow selection of mental disorders. There are two other )] TJ ET
BT 26.250 249.560 Td /F1 9.8 Tf  [(groups of people about which healthcare services need to know more: people who develop disorders other than PTSD, which )] TJ ET
BT 26.250 237.655 Td /F1 9.8 Tf  [(the literature shows is very often co-morbid with other mental disorders; and the wider group of people who are distressed by )] TJ ET
BT 26.250 225.750 Td /F1 9.8 Tf  [(events, temporarily or otherwise \(a highly relevant matter after flooding\) and who have psychosocial needs that relate to )] TJ ET
BT 26.250 213.846 Td /F1 9.8 Tf  [(sustaining their mental health and emotional wellbeing and also preventing their developing mental disorders.)] TJ ET
BT 26.250 194.441 Td /F5 9.8 Tf  [(THE WAY FORWARD FOR RESEARCH)] TJ ET
BT 26.250 175.036 Td /F1 9.8 Tf  [(The authors identify significant research gaps, which, if filled, could support better design and delivery of future psychosocial )] TJ ET
BT 26.250 163.131 Td /F1 9.8 Tf  [(and public mental health responses, and improved primary and secondary mental healthcare responses to people�s needs )] TJ ET
BT 26.250 151.227 Td /F1 9.8 Tf  [(before and after flooding.)] TJ ET
BT 26.250 131.822 Td /F1 9.8 Tf  [(In general terms, more research is required, which studies:)] TJ ET
40.337 115.385 m 
40.337 115.831 40.154 116.275 39.838 116.591 c
39.522 116.907 39.078 117.091 38.631 117.091 c
38.185 117.091 37.741 116.907 37.425 116.591 c
37.109 116.275 36.925 115.831 36.925 115.385 c
36.925 114.938 37.109 114.494 37.425 114.178 c
37.741 113.862 38.185 113.678 38.631 113.678 c
39.078 113.678 39.522 113.862 39.838 114.178 c
40.154 114.494 40.337 114.938 40.337 115.385 c f
BT 45.750 112.417 Td /F1 9.8 Tf  [(The responses of, and impacts on populations before and after untoward and extreme events, major incidents and )] TJ ET
BT 45.750 100.512 Td /F1 9.8 Tf  [(disasters including flooding;)] TJ ET
40.337 87.825 m 
40.337 88.272 40.154 88.716 39.838 89.032 c
39.522 89.348 39.078 89.531 38.631 89.531 c
38.185 89.531 37.741 89.348 37.425 89.032 c
37.109 88.716 36.925 88.272 36.925 87.825 c
36.925 87.379 37.109 86.935 37.425 86.619 c
37.741 86.303 38.185 86.119 38.631 86.119 c
39.078 86.119 39.522 86.303 39.838 86.619 c
40.154 86.935 40.337 87.379 40.337 87.825 c f
BT 45.750 84.858 Td /F1 9.8 Tf  [(The impacts of major incidents and disasters, including flooding, on people�s psychosocial experiences in the short-, )] TJ ET
BT 45.750 72.953 Td /F1 9.8 Tf  [(medium- and longer-terms;)] TJ ET
40.337 60.266 m 
40.337 60.712 40.154 61.156 39.838 61.472 c
39.522 61.788 39.078 61.972 38.631 61.972 c
38.185 61.972 37.741 61.788 37.425 61.472 c
37.109 61.156 36.925 60.712 36.925 60.266 c
36.925 59.819 37.109 59.375 37.425 59.059 c
37.741 58.743 38.185 58.559 38.631 58.559 c
39.078 58.559 39.522 58.743 39.838 59.059 c
40.154 59.375 40.337 59.819 40.337 60.266 c f
BT 45.750 57.298 Td /F1 9.8 Tf  [(The impacts of successive floods on populations;)] TJ ET
40.337 44.611 m 
40.337 45.058 40.154 45.502 39.838 45.818 c
39.522 46.133 39.078 46.317 38.631 46.317 c
38.185 46.317 37.741 46.133 37.425 45.818 c
37.109 45.502 36.925 45.058 36.925 44.611 c
36.925 44.164 37.109 43.720 37.425 43.404 c
37.741 43.089 38.185 42.905 38.631 42.905 c
39.078 42.905 39.522 43.089 39.838 43.404 c
40.154 43.720 40.337 44.164 40.337 44.611 c f
BT 45.750 41.643 Td /F1 9.8 Tf  [(The contextual and subjective, qualitative features of peoples� experiences which distinguish distress after disasters from )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(7)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
0.271 0.267 0.267 RG
q
15.000 22.953 577.500 754.047 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(the symptoms of mental disorders;)] TJ ET
0.271 0.267 0.267 RG
40.337 754.789 m 
40.337 755.236 40.154 755.680 39.838 755.996 c
39.522 756.311 39.078 756.495 38.631 756.495 c
38.185 756.495 37.741 756.311 37.425 755.996 c
37.109 755.680 36.925 755.236 36.925 754.789 c
36.925 754.342 37.109 753.898 37.425 753.582 c
37.741 753.267 38.185 753.083 38.631 753.083 c
39.078 753.083 39.522 753.267 39.838 753.582 c
40.154 753.898 40.337 754.342 40.337 754.789 c f
BT 45.750 751.821 Td /F1 9.8 Tf  [(The longitudinal effects of major incidents and disasters, including floods, on people�s mental health and ill health. Better )] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(use could be made of national psychiatric morbidity survey programmes, which could provide useful baseline data for )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(populations that are flooded subsequently, as well as comparison/control data from populations which reside in non-flooded )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(areas;)] TJ ET
40.337 703.420 m 
40.337 703.867 40.154 704.311 39.838 704.627 c
39.522 704.942 39.078 705.126 38.631 705.126 c
38.185 705.126 37.741 704.942 37.425 704.627 c
37.109 704.311 36.925 703.867 36.925 703.420 c
36.925 702.973 37.109 702.529 37.425 702.213 c
37.741 701.898 38.185 701.714 38.631 701.714 c
39.078 701.714 39.522 701.898 39.838 702.213 c
40.154 702.529 40.337 702.973 40.337 703.420 c f
BT 45.750 700.452 Td /F1 9.8 Tf  [(Co-morbidity of mental disorders and how this can affect treatment plans: each disorder is assessed discretely in most of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(the papers reviewed and this does not necessarily reflect the reality of the experiences of people who are affected. When )] TJ ET
BT 45.750 676.643 Td /F1 9.8 Tf  [(specific plans or protocols are developed for intervening with people who have particular disorders, they should reflect real )] TJ ET
BT 45.750 664.738 Td /F1 9.8 Tf  [(situations in which co-morbidity is an important matter for treatment algorithms;)] TJ ET
40.337 652.051 m 
40.337 652.498 40.154 652.942 39.838 653.258 c
39.522 653.573 39.078 653.757 38.631 653.757 c
38.185 653.757 37.741 653.573 37.425 653.258 c
37.109 652.942 36.925 652.498 36.925 652.051 c
36.925 651.604 37.109 651.160 37.425 650.844 c
37.741 650.529 38.185 650.345 38.631 650.345 c
39.078 650.345 39.522 650.529 39.838 650.844 c
40.154 651.160 40.337 651.604 40.337 652.051 c f
BT 45.750 649.083 Td /F1 9.8 Tf  [(The consequences and implications of diagnosing PTSD after people are flooded; and)] TJ ET
40.337 636.396 m 
40.337 636.843 40.154 637.287 39.838 637.603 c
39.522 637.919 39.078 638.102 38.631 638.102 c
38.185 638.102 37.741 637.919 37.425 637.603 c
37.109 637.287 36.925 636.843 36.925 636.396 c
36.925 635.950 37.109 635.506 37.425 635.190 c
37.741 634.874 38.185 634.690 38.631 634.690 c
39.078 634.690 39.522 634.874 39.838 635.190 c
40.154 635.506 40.337 635.950 40.337 636.396 c f
BT 45.750 633.429 Td /F1 9.8 Tf  [(The mechanisms for people developing, and the consequences of them having, PTSD, including their rates and trajectories )] TJ ET
BT 45.750 621.524 Td /F1 9.8 Tf  [(of recovery.)] TJ ET
BT 26.250 598.369 Td /F1 9.8 Tf  [(The methodological variables and limitations that the HPA identifies in its report point to the importance of improving the quality )] TJ ET
BT 26.250 586.464 Td /F1 9.8 Tf  [(of research. Further research should focus on:)] TJ ET
40.337 570.027 m 
40.337 570.474 40.154 570.918 39.838 571.234 c
39.522 571.550 39.078 571.733 38.631 571.733 c
38.185 571.733 37.741 571.550 37.425 571.234 c
37.109 570.918 36.925 570.474 36.925 570.027 c
36.925 569.581 37.109 569.137 37.425 568.821 c
37.741 568.505 38.185 568.321 38.631 568.321 c
39.078 568.321 39.522 568.505 39.838 568.821 c
40.154 569.137 40.337 569.581 40.337 570.027 c f
BT 45.750 567.060 Td /F1 9.8 Tf  [(Using overt definitions of psychosocial need, mental health and mental ill health that are agreed, understood and used )] TJ ET
BT 45.750 555.155 Td /F1 9.8 Tf  [(internationally and which include overt thresholds for caseness;)] TJ ET
40.337 542.468 m 
40.337 542.914 40.154 543.358 39.838 543.674 c
39.522 543.990 39.078 544.174 38.631 544.174 c
38.185 544.174 37.741 543.990 37.425 543.674 c
37.109 543.358 36.925 542.914 36.925 542.468 c
36.925 542.021 37.109 541.577 37.425 541.261 c
37.741 540.945 38.185 540.762 38.631 540.762 c
39.078 540.762 39.522 540.945 39.838 541.261 c
40.154 541.577 40.337 542.021 40.337 542.468 c f
BT 45.750 539.500 Td /F1 9.8 Tf  [(Achieve development of systems for cross comparison of research findings; and)] TJ ET
40.337 526.813 m 
40.337 527.260 40.154 527.704 39.838 528.020 c
39.522 528.335 39.078 528.519 38.631 528.519 c
38.185 528.519 37.741 528.335 37.425 528.020 c
37.109 527.704 36.925 527.260 36.925 526.813 c
36.925 526.366 37.109 525.922 37.425 525.606 c
37.741 525.291 38.185 525.107 38.631 525.107 c
39.078 525.107 39.522 525.291 39.838 525.606 c
40.154 525.922 40.337 526.366 40.337 526.813 c f
BT 45.750 523.845 Td /F1 9.8 Tf  [(Take forward findings to formal meta-analysis to identify better welfare and public health guidance and professional practice.)] TJ ET
BT 26.250 500.691 Td /F1 9.8 Tf  [(Better design of research instruments would help researchers to appraise people�s common experiences and symptoms rather )] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(than a narrow subset, and might provide better information about the duration, severity and effects of people�s experiences and )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(symptoms. Subsequently, it will be possible to look at the impacts on public health of people�s psychosocial experiences and )] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(needs as well as the effects on populations of mental disorders.)] TJ ET
BT 26.250 445.572 Td /F1 9.8 Tf  [(We identify the requirement for more research on: children and young people; older people; and people who respond to others )] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(needs in the aftermath of major events or disasters. This would help the research community to address: who or which groups )] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(of people are more at risk; how and why certain groups of people suffer more; and what should be done in addition to current )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(interventions to respond effectively to people�s needs.)] TJ ET
BT 26.250 390.453 Td /F1 9.8 Tf  [(The authors did not explore in their report the secondary health impacts of disasters, the pathways from disasters to mental ill )] TJ ET
BT 26.250 378.548 Td /F1 9.8 Tf  [(health, or the consequential impacts of developing a mental disorder. The authors considered one study that researched the )] TJ ET
BT 26.250 366.643 Td /F1 9.8 Tf  [(somatic effects of mental ill health)] TJ ET
0.267 0.267 0.267 rg
BT 172.559 368.150 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 177.377 366.643 Td /F1 9.8 Tf  [(, another that researched substance misuse)] TJ ET
0.267 0.267 0.267 rg
BT 367.054 368.150 Td /F4 8.7 Tf  [(50)] TJ ET
0.271 0.267 0.267 rg
BT 376.691 366.643 Td /F1 9.8 Tf  [(, and others that have considered gender-)] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(based violence)] TJ ET
0.267 0.267 0.267 rg
BT 91.282 356.246 Td /F4 8.7 Tf  [(27)] TJ ET
BT 100.920 356.246 Td /F4 8.7 Tf  [(28)] TJ ET
BT 110.557 356.246 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 120.195 354.738 Td /F1 9.8 Tf  [(. They conclude that clarification is required about what constitutes best practice in each of these areas.)] TJ ET
BT 26.250 335.334 Td /F1 9.8 Tf  [(Further work on the effects of flooding on mental health could follow the Preferred Reporting Items for Systematic Reviews and )] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(Meta-Analyses \(PRISMA\) statement)] TJ ET
0.267 0.267 0.267 rg
BT 182.835 324.936 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 192.472 323.429 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 304.024 Td /F5 9.8 Tf  [(RECOMMENDATIONS)] TJ ET
BT 26.250 284.619 Td /F1 9.8 Tf  [(It is now clear that psychosocial distress and mental disorders may be provoked or exacerbated by people�s exposure to floods.)] TJ ET
BT 26.250 265.215 Td /F1 9.8 Tf  [(Together, the peer-reviewed research papers and guidance reported by the HPA allow the authors of that report to make )] TJ ET
BT 26.250 253.310 Td /F1 9.8 Tf  [(recommendations for a variety of public agencies. They are presented here in general terms so that they can be interpreted and )] TJ ET
BT 26.250 241.405 Td /F1 9.8 Tf  [(applied in all countries and jurisdictions.)] TJ ET
BT 26.250 222.000 Td /F5 9.8 Tf  [(Policymakers)] TJ ET
BT 26.250 202.596 Td /F1 9.8 Tf  [(It is clear that there is sufficient evidence available to show that the short- and long-term psychosocial and mental health )] TJ ET
BT 26.250 190.691 Td /F1 9.8 Tf  [(consequences of flooding should be a high priority for policymakers. Development of evidence-based policy in this area should )] TJ ET
BT 26.250 178.786 Td /F1 9.8 Tf  [(be a priority for people who are responsible for planning for and responding to emergencies, healthcare, social care, and mental )] TJ ET
BT 26.250 166.881 Td /F1 9.8 Tf  [(healthcare services. Government departments should work together to achieve integrated policies in order to avoid �recovery )] TJ ET
BT 26.250 154.977 Td /F1 9.8 Tf  [(gaps,� i.e. gaps in societal responses that arise in the period after the emergency responses have ended when people must rely )] TJ ET
BT 26.250 143.072 Td /F1 9.8 Tf  [(on the services that are available ordinarily in communities to support their continuing recovery)] TJ ET
0.267 0.267 0.267 rg
BT 433.741 144.579 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 443.379 143.072 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 123.667 Td /F1 9.8 Tf  [(Government organisations are advised to work with research funding agencies to identify priorities and to develop research )] TJ ET
BT 26.250 111.762 Td /F1 9.8 Tf  [(evidence of increasing quality and relevance to policymakers. In particular, they should be aware of the HPA�s commentary on )] TJ ET
BT 26.250 99.858 Td /F1 9.8 Tf  [(the existing research in this topic area and of its recommendations for future research and how it is conducted.)] TJ ET
BT 26.250 80.453 Td /F5 9.8 Tf  [(Emergency Planners)] TJ ET
BT 26.250 61.048 Td /F1 9.8 Tf  [(People who have responsibilities for emergency preparedness within governmental, non-governmental, service planning, and )] TJ ET
BT 26.250 49.143 Td /F1 9.8 Tf  [(delivery organisations, and within the commercial sector, should also consider the short- and long-term psychosocial and mental )] TJ ET
BT 26.250 37.239 Td /F1 9.8 Tf  [(health consequences of flooding. They should work with the agencies that are responsible for managing the environments in )] TJ ET
Q
q
15.000 22.953 577.500 754.047 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(the symptoms of mental disorders;)] TJ ET
0.271 0.267 0.267 RG
40.337 754.789 m 
40.337 755.236 40.154 755.680 39.838 755.996 c
39.522 756.311 39.078 756.495 38.631 756.495 c
38.185 756.495 37.741 756.311 37.425 755.996 c
37.109 755.680 36.925 755.236 36.925 754.789 c
36.925 754.342 37.109 753.898 37.425 753.582 c
37.741 753.267 38.185 753.083 38.631 753.083 c
39.078 753.083 39.522 753.267 39.838 753.582 c
40.154 753.898 40.337 754.342 40.337 754.789 c f
BT 45.750 751.821 Td /F1 9.8 Tf  [(The longitudinal effects of major incidents and disasters, including floods, on people�s mental health and ill health. Better )] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(use could be made of national psychiatric morbidity survey programmes, which could provide useful baseline data for )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(populations that are flooded subsequently, as well as comparison/control data from populations which reside in non-flooded )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(areas;)] TJ ET
40.337 703.420 m 
40.337 703.867 40.154 704.311 39.838 704.627 c
39.522 704.942 39.078 705.126 38.631 705.126 c
38.185 705.126 37.741 704.942 37.425 704.627 c
37.109 704.311 36.925 703.867 36.925 703.420 c
36.925 702.973 37.109 702.529 37.425 702.213 c
37.741 701.898 38.185 701.714 38.631 701.714 c
39.078 701.714 39.522 701.898 39.838 702.213 c
40.154 702.529 40.337 702.973 40.337 703.420 c f
BT 45.750 700.452 Td /F1 9.8 Tf  [(Co-morbidity of mental disorders and how this can affect treatment plans: each disorder is assessed discretely in most of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(the papers reviewed and this does not necessarily reflect the reality of the experiences of people who are affected. When )] TJ ET
BT 45.750 676.643 Td /F1 9.8 Tf  [(specific plans or protocols are developed for intervening with people who have particular disorders, they should reflect real )] TJ ET
BT 45.750 664.738 Td /F1 9.8 Tf  [(situations in which co-morbidity is an important matter for treatment algorithms;)] TJ ET
40.337 652.051 m 
40.337 652.498 40.154 652.942 39.838 653.258 c
39.522 653.573 39.078 653.757 38.631 653.757 c
38.185 653.757 37.741 653.573 37.425 653.258 c
37.109 652.942 36.925 652.498 36.925 652.051 c
36.925 651.604 37.109 651.160 37.425 650.844 c
37.741 650.529 38.185 650.345 38.631 650.345 c
39.078 650.345 39.522 650.529 39.838 650.844 c
40.154 651.160 40.337 651.604 40.337 652.051 c f
BT 45.750 649.083 Td /F1 9.8 Tf  [(The consequences and implications of diagnosing PTSD after people are flooded; and)] TJ ET
40.337 636.396 m 
40.337 636.843 40.154 637.287 39.838 637.603 c
39.522 637.919 39.078 638.102 38.631 638.102 c
38.185 638.102 37.741 637.919 37.425 637.603 c
37.109 637.287 36.925 636.843 36.925 636.396 c
36.925 635.950 37.109 635.506 37.425 635.190 c
37.741 634.874 38.185 634.690 38.631 634.690 c
39.078 634.690 39.522 634.874 39.838 635.190 c
40.154 635.506 40.337 635.950 40.337 636.396 c f
BT 45.750 633.429 Td /F1 9.8 Tf  [(The mechanisms for people developing, and the consequences of them having, PTSD, including their rates and trajectories )] TJ ET
BT 45.750 621.524 Td /F1 9.8 Tf  [(of recovery.)] TJ ET
BT 26.250 598.369 Td /F1 9.8 Tf  [(The methodological variables and limitations that the HPA identifies in its report point to the importance of improving the quality )] TJ ET
BT 26.250 586.464 Td /F1 9.8 Tf  [(of research. Further research should focus on:)] TJ ET
40.337 570.027 m 
40.337 570.474 40.154 570.918 39.838 571.234 c
39.522 571.550 39.078 571.733 38.631 571.733 c
38.185 571.733 37.741 571.550 37.425 571.234 c
37.109 570.918 36.925 570.474 36.925 570.027 c
36.925 569.581 37.109 569.137 37.425 568.821 c
37.741 568.505 38.185 568.321 38.631 568.321 c
39.078 568.321 39.522 568.505 39.838 568.821 c
40.154 569.137 40.337 569.581 40.337 570.027 c f
BT 45.750 567.060 Td /F1 9.8 Tf  [(Using overt definitions of psychosocial need, mental health and mental ill health that are agreed, understood and used )] TJ ET
BT 45.750 555.155 Td /F1 9.8 Tf  [(internationally and which include overt thresholds for caseness;)] TJ ET
40.337 542.468 m 
40.337 542.914 40.154 543.358 39.838 543.674 c
39.522 543.990 39.078 544.174 38.631 544.174 c
38.185 544.174 37.741 543.990 37.425 543.674 c
37.109 543.358 36.925 542.914 36.925 542.468 c
36.925 542.021 37.109 541.577 37.425 541.261 c
37.741 540.945 38.185 540.762 38.631 540.762 c
39.078 540.762 39.522 540.945 39.838 541.261 c
40.154 541.577 40.337 542.021 40.337 542.468 c f
BT 45.750 539.500 Td /F1 9.8 Tf  [(Achieve development of systems for cross comparison of research findings; and)] TJ ET
40.337 526.813 m 
40.337 527.260 40.154 527.704 39.838 528.020 c
39.522 528.335 39.078 528.519 38.631 528.519 c
38.185 528.519 37.741 528.335 37.425 528.020 c
37.109 527.704 36.925 527.260 36.925 526.813 c
36.925 526.366 37.109 525.922 37.425 525.606 c
37.741 525.291 38.185 525.107 38.631 525.107 c
39.078 525.107 39.522 525.291 39.838 525.606 c
40.154 525.922 40.337 526.366 40.337 526.813 c f
BT 45.750 523.845 Td /F1 9.8 Tf  [(Take forward findings to formal meta-analysis to identify better welfare and public health guidance and professional practice.)] TJ ET
BT 26.250 500.691 Td /F1 9.8 Tf  [(Better design of research instruments would help researchers to appraise people�s common experiences and symptoms rather )] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(than a narrow subset, and might provide better information about the duration, severity and effects of people�s experiences and )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(symptoms. Subsequently, it will be possible to look at the impacts on public health of people�s psychosocial experiences and )] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(needs as well as the effects on populations of mental disorders.)] TJ ET
BT 26.250 445.572 Td /F1 9.8 Tf  [(We identify the requirement for more research on: children and young people; older people; and people who respond to others )] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(needs in the aftermath of major events or disasters. This would help the research community to address: who or which groups )] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(of people are more at risk; how and why certain groups of people suffer more; and what should be done in addition to current )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(interventions to respond effectively to people�s needs.)] TJ ET
BT 26.250 390.453 Td /F1 9.8 Tf  [(The authors did not explore in their report the secondary health impacts of disasters, the pathways from disasters to mental ill )] TJ ET
BT 26.250 378.548 Td /F1 9.8 Tf  [(health, or the consequential impacts of developing a mental disorder. The authors considered one study that researched the )] TJ ET
BT 26.250 366.643 Td /F1 9.8 Tf  [(somatic effects of mental ill health)] TJ ET
0.267 0.267 0.267 rg
BT 172.559 368.150 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 177.377 366.643 Td /F1 9.8 Tf  [(, another that researched substance misuse)] TJ ET
0.267 0.267 0.267 rg
BT 367.054 368.150 Td /F4 8.7 Tf  [(50)] TJ ET
0.271 0.267 0.267 rg
BT 376.691 366.643 Td /F1 9.8 Tf  [(, and others that have considered gender-)] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(based violence)] TJ ET
0.267 0.267 0.267 rg
BT 91.282 356.246 Td /F4 8.7 Tf  [(27)] TJ ET
BT 100.920 356.246 Td /F4 8.7 Tf  [(28)] TJ ET
BT 110.557 356.246 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 120.195 354.738 Td /F1 9.8 Tf  [(. They conclude that clarification is required about what constitutes best practice in each of these areas.)] TJ ET
BT 26.250 335.334 Td /F1 9.8 Tf  [(Further work on the effects of flooding on mental health could follow the Preferred Reporting Items for Systematic Reviews and )] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(Meta-Analyses \(PRISMA\) statement)] TJ ET
0.267 0.267 0.267 rg
BT 182.835 324.936 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 192.472 323.429 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 304.024 Td /F5 9.8 Tf  [(RECOMMENDATIONS)] TJ ET
BT 26.250 284.619 Td /F1 9.8 Tf  [(It is now clear that psychosocial distress and mental disorders may be provoked or exacerbated by people�s exposure to floods.)] TJ ET
BT 26.250 265.215 Td /F1 9.8 Tf  [(Together, the peer-reviewed research papers and guidance reported by the HPA allow the authors of that report to make )] TJ ET
BT 26.250 253.310 Td /F1 9.8 Tf  [(recommendations for a variety of public agencies. They are presented here in general terms so that they can be interpreted and )] TJ ET
BT 26.250 241.405 Td /F1 9.8 Tf  [(applied in all countries and jurisdictions.)] TJ ET
BT 26.250 222.000 Td /F5 9.8 Tf  [(Policymakers)] TJ ET
BT 26.250 202.596 Td /F1 9.8 Tf  [(It is clear that there is sufficient evidence available to show that the short- and long-term psychosocial and mental health )] TJ ET
BT 26.250 190.691 Td /F1 9.8 Tf  [(consequences of flooding should be a high priority for policymakers. Development of evidence-based policy in this area should )] TJ ET
BT 26.250 178.786 Td /F1 9.8 Tf  [(be a priority for people who are responsible for planning for and responding to emergencies, healthcare, social care, and mental )] TJ ET
BT 26.250 166.881 Td /F1 9.8 Tf  [(healthcare services. Government departments should work together to achieve integrated policies in order to avoid �recovery )] TJ ET
BT 26.250 154.977 Td /F1 9.8 Tf  [(gaps,� i.e. gaps in societal responses that arise in the period after the emergency responses have ended when people must rely )] TJ ET
BT 26.250 143.072 Td /F1 9.8 Tf  [(on the services that are available ordinarily in communities to support their continuing recovery)] TJ ET
0.267 0.267 0.267 rg
BT 433.741 144.579 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 443.379 143.072 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 123.667 Td /F1 9.8 Tf  [(Government organisations are advised to work with research funding agencies to identify priorities and to develop research )] TJ ET
BT 26.250 111.762 Td /F1 9.8 Tf  [(evidence of increasing quality and relevance to policymakers. In particular, they should be aware of the HPA�s commentary on )] TJ ET
BT 26.250 99.858 Td /F1 9.8 Tf  [(the existing research in this topic area and of its recommendations for future research and how it is conducted.)] TJ ET
BT 26.250 80.453 Td /F5 9.8 Tf  [(Emergency Planners)] TJ ET
BT 26.250 61.048 Td /F1 9.8 Tf  [(People who have responsibilities for emergency preparedness within governmental, non-governmental, service planning, and )] TJ ET
BT 26.250 49.143 Td /F1 9.8 Tf  [(delivery organisations, and within the commercial sector, should also consider the short- and long-term psychosocial and mental )] TJ ET
BT 26.250 37.239 Td /F1 9.8 Tf  [(health consequences of flooding. They should work with the agencies that are responsible for managing the environments in )] TJ ET
Q
q
15.000 22.953 577.500 754.047 re W n
0.271 0.267 0.267 rg
BT 45.750 767.476 Td /F1 9.8 Tf  [(the symptoms of mental disorders;)] TJ ET
0.271 0.267 0.267 RG
40.337 754.789 m 
40.337 755.236 40.154 755.680 39.838 755.996 c
39.522 756.311 39.078 756.495 38.631 756.495 c
38.185 756.495 37.741 756.311 37.425 755.996 c
37.109 755.680 36.925 755.236 36.925 754.789 c
36.925 754.342 37.109 753.898 37.425 753.582 c
37.741 753.267 38.185 753.083 38.631 753.083 c
39.078 753.083 39.522 753.267 39.838 753.582 c
40.154 753.898 40.337 754.342 40.337 754.789 c f
BT 45.750 751.821 Td /F1 9.8 Tf  [(The longitudinal effects of major incidents and disasters, including floods, on people�s mental health and ill health. Better )] TJ ET
BT 45.750 739.917 Td /F1 9.8 Tf  [(use could be made of national psychiatric morbidity survey programmes, which could provide useful baseline data for )] TJ ET
BT 45.750 728.012 Td /F1 9.8 Tf  [(populations that are flooded subsequently, as well as comparison/control data from populations which reside in non-flooded )] TJ ET
BT 45.750 716.107 Td /F1 9.8 Tf  [(areas;)] TJ ET
40.337 703.420 m 
40.337 703.867 40.154 704.311 39.838 704.627 c
39.522 704.942 39.078 705.126 38.631 705.126 c
38.185 705.126 37.741 704.942 37.425 704.627 c
37.109 704.311 36.925 703.867 36.925 703.420 c
36.925 702.973 37.109 702.529 37.425 702.213 c
37.741 701.898 38.185 701.714 38.631 701.714 c
39.078 701.714 39.522 701.898 39.838 702.213 c
40.154 702.529 40.337 702.973 40.337 703.420 c f
BT 45.750 700.452 Td /F1 9.8 Tf  [(Co-morbidity of mental disorders and how this can affect treatment plans: each disorder is assessed discretely in most of )] TJ ET
BT 45.750 688.548 Td /F1 9.8 Tf  [(the papers reviewed and this does not necessarily reflect the reality of the experiences of people who are affected. When )] TJ ET
BT 45.750 676.643 Td /F1 9.8 Tf  [(specific plans or protocols are developed for intervening with people who have particular disorders, they should reflect real )] TJ ET
BT 45.750 664.738 Td /F1 9.8 Tf  [(situations in which co-morbidity is an important matter for treatment algorithms;)] TJ ET
40.337 652.051 m 
40.337 652.498 40.154 652.942 39.838 653.258 c
39.522 653.573 39.078 653.757 38.631 653.757 c
38.185 653.757 37.741 653.573 37.425 653.258 c
37.109 652.942 36.925 652.498 36.925 652.051 c
36.925 651.604 37.109 651.160 37.425 650.844 c
37.741 650.529 38.185 650.345 38.631 650.345 c
39.078 650.345 39.522 650.529 39.838 650.844 c
40.154 651.160 40.337 651.604 40.337 652.051 c f
BT 45.750 649.083 Td /F1 9.8 Tf  [(The consequences and implications of diagnosing PTSD after people are flooded; and)] TJ ET
40.337 636.396 m 
40.337 636.843 40.154 637.287 39.838 637.603 c
39.522 637.919 39.078 638.102 38.631 638.102 c
38.185 638.102 37.741 637.919 37.425 637.603 c
37.109 637.287 36.925 636.843 36.925 636.396 c
36.925 635.950 37.109 635.506 37.425 635.190 c
37.741 634.874 38.185 634.690 38.631 634.690 c
39.078 634.690 39.522 634.874 39.838 635.190 c
40.154 635.506 40.337 635.950 40.337 636.396 c f
BT 45.750 633.429 Td /F1 9.8 Tf  [(The mechanisms for people developing, and the consequences of them having, PTSD, including their rates and trajectories )] TJ ET
BT 45.750 621.524 Td /F1 9.8 Tf  [(of recovery.)] TJ ET
BT 26.250 598.369 Td /F1 9.8 Tf  [(The methodological variables and limitations that the HPA identifies in its report point to the importance of improving the quality )] TJ ET
BT 26.250 586.464 Td /F1 9.8 Tf  [(of research. Further research should focus on:)] TJ ET
40.337 570.027 m 
40.337 570.474 40.154 570.918 39.838 571.234 c
39.522 571.550 39.078 571.733 38.631 571.733 c
38.185 571.733 37.741 571.550 37.425 571.234 c
37.109 570.918 36.925 570.474 36.925 570.027 c
36.925 569.581 37.109 569.137 37.425 568.821 c
37.741 568.505 38.185 568.321 38.631 568.321 c
39.078 568.321 39.522 568.505 39.838 568.821 c
40.154 569.137 40.337 569.581 40.337 570.027 c f
BT 45.750 567.060 Td /F1 9.8 Tf  [(Using overt definitions of psychosocial need, mental health and mental ill health that are agreed, understood and used )] TJ ET
BT 45.750 555.155 Td /F1 9.8 Tf  [(internationally and which include overt thresholds for caseness;)] TJ ET
40.337 542.468 m 
40.337 542.914 40.154 543.358 39.838 543.674 c
39.522 543.990 39.078 544.174 38.631 544.174 c
38.185 544.174 37.741 543.990 37.425 543.674 c
37.109 543.358 36.925 542.914 36.925 542.468 c
36.925 542.021 37.109 541.577 37.425 541.261 c
37.741 540.945 38.185 540.762 38.631 540.762 c
39.078 540.762 39.522 540.945 39.838 541.261 c
40.154 541.577 40.337 542.021 40.337 542.468 c f
BT 45.750 539.500 Td /F1 9.8 Tf  [(Achieve development of systems for cross comparison of research findings; and)] TJ ET
40.337 526.813 m 
40.337 527.260 40.154 527.704 39.838 528.020 c
39.522 528.335 39.078 528.519 38.631 528.519 c
38.185 528.519 37.741 528.335 37.425 528.020 c
37.109 527.704 36.925 527.260 36.925 526.813 c
36.925 526.366 37.109 525.922 37.425 525.606 c
37.741 525.291 38.185 525.107 38.631 525.107 c
39.078 525.107 39.522 525.291 39.838 525.606 c
40.154 525.922 40.337 526.366 40.337 526.813 c f
BT 45.750 523.845 Td /F1 9.8 Tf  [(Take forward findings to formal meta-analysis to identify better welfare and public health guidance and professional practice.)] TJ ET
BT 26.250 500.691 Td /F1 9.8 Tf  [(Better design of research instruments would help researchers to appraise people�s common experiences and symptoms rather )] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(than a narrow subset, and might provide better information about the duration, severity and effects of people�s experiences and )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(symptoms. Subsequently, it will be possible to look at the impacts on public health of people�s psychosocial experiences and )] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(needs as well as the effects on populations of mental disorders.)] TJ ET
BT 26.250 445.572 Td /F1 9.8 Tf  [(We identify the requirement for more research on: children and young people; older people; and people who respond to others )] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(needs in the aftermath of major events or disasters. This would help the research community to address: who or which groups )] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(of people are more at risk; how and why certain groups of people suffer more; and what should be done in addition to current )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(interventions to respond effectively to people�s needs.)] TJ ET
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BT 26.250 253.310 Td /F1 9.8 Tf  [(recommendations for a variety of public agencies. They are presented here in general terms so that they can be interpreted and )] TJ ET
BT 26.250 241.405 Td /F1 9.8 Tf  [(applied in all countries and jurisdictions.)] TJ ET
BT 26.250 222.000 Td /F5 9.8 Tf  [(Policymakers)] TJ ET
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BT 26.250 166.881 Td /F1 9.8 Tf  [(healthcare services. Government departments should work together to achieve integrated policies in order to avoid �recovery )] TJ ET
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BT 26.250 111.762 Td /F1 9.8 Tf  [(evidence of increasing quality and relevance to policymakers. In particular, they should be aware of the HPA�s commentary on )] TJ ET
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BT 26.250 748.071 Td /F5 9.8 Tf  [(Social Care Services)] TJ ET
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BT 26.250 484.381 Td /F1 9.8 Tf  [(disorders that are provoked or exacerbated by their involvement in floods.)] TJ ET
BT 26.250 447.779 Td /F4 12.0 Tf  [(Conclusions)] TJ ET
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BT 26.250 336.991 Td /F1 9.8 Tf  [(need for greater discipline in defining and using terminology is another important message. The authors identify the implications )] TJ ET
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BT 26.250 293.777 Td /F1 9.8 Tf  [(improved services to support people who are affected by flooding with the intention of reducing their suffering, reducing the risks )] TJ ET
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BT 26.250 258.063 Td /F1 9.8 Tf  [(England and recommended by NATO.)] TJ ET
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BT 26.250 142.532 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 115.077 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 115.077 Td /F1 9.8 Tf  [(Jakubicka T, Vos F, Phalkey R, Marx M. \(2010\) Health impacts of floods in Europe: Data gaps and information needs from a )] TJ ET
BT 26.250 103.173 Td /F1 9.8 Tf  [(spatial perspective. A MICRODIS report. Brussels, Centre for Research on the Epidemiology of Disasters \(CRED\).)] TJ ET
BT 26.250 83.768 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 83.768 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2011\). Climate change: Facts and figures. )] TJ ET
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BT 38.132 56.732 Td /F1 9.8 Tf  [( Ahern M, Kovats RS, Wilkinson P, Few R, Matthies F. \(2005\) Global health impacts of floods: Epidemiologic evidence. )] TJ ET
BT 26.250 44.827 Td /F1 9.8 Tf  [(Epidemiologic Reviews; 27:36-46.)] TJ ET
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BT 26.250 587.119 Td /F1 9.8 Tf  [(clear about the impact of floods in provoking more people than might otherwise do so to develop anxiety disorders, depression )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(and PTSD. This is because of limited availability of population comparisons, and before and after evaluation studies. Local )] TJ ET
BT 26.250 563.310 Td /F1 9.8 Tf  [(healthcare services should be aware that a substantial minority of people may develop mental disorders in the medium- and )] TJ ET
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BT 26.250 539.500 Td /F1 9.8 Tf  [(people�s pre-existing disorders to presentation.)] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(This health intelligence should inform the preparedness of healthcare agencies and their practical plans. Specialist mental )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(healthcare agencies should be prepared to provide advice to emergency planners, community healthcare services, and social )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(care organisations. They should also be available to deliver focused specialist services for people who may have mental )] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(disorders that are provoked or exacerbated by their involvement in floods.)] TJ ET
BT 26.250 447.779 Td /F4 12.0 Tf  [(Conclusions)] TJ ET
BT 26.250 427.824 Td /F1 9.8 Tf  [(The frequency of floods is increasing. The mortality relating to flooding is variable and depends on the enormity or otherwise of )] TJ ET
BT 26.250 415.920 Td /F1 9.8 Tf  [(each extreme event and the capability of the rescue and recovery services. But, when compared with other types of disaster, )] TJ ET
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BT 26.250 392.110 Td /F1 9.8 Tf  [(policymakers, service designers and practitioners to the substantial morbidity that is posed by flooding.)] TJ ET
BT 26.250 372.705 Td /F1 9.8 Tf  [(The Health Protection Agency�s report on the outcomes and recommendations from the peer-reviewed literature, and selected )] TJ ET
BT 26.250 360.801 Td /F1 9.8 Tf  [(governmental policy and non-governmental guidance, provides a picture that is based on key messages from research and )] TJ ET
BT 26.250 348.896 Td /F1 9.8 Tf  [(expert consensus. It identifies clearly the requirement for more research that is of improved clarity of purpose and method. The )] TJ ET
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BT 26.250 305.682 Td /F1 9.8 Tf  [(The HPA has identified the responsibilities that should fall on a number of public and other organisations to plan and deliver )] TJ ET
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BT 26.250 281.872 Td /F1 9.8 Tf  [(of them developing long-term mental disorders that are so very costly across the full diversity of meaning of that concept, and )] TJ ET
BT 26.250 269.967 Td /F1 9.8 Tf  [(aiding recovery of imperilled communities and families. They map well onto the stepped strategic model of care that is policy in )] TJ ET
BT 26.250 258.063 Td /F1 9.8 Tf  [(England and recommended by NATO.)] TJ ET
BT 26.250 238.658 Td /F1 9.8 Tf  [(The HPA found that there is a growing body of evidence which suggests that floods can have profound effects on people�s )] TJ ET
BT 26.250 226.753 Td /F1 9.8 Tf  [(wellbeing, psychosocial resilience, relationships and mental health, often over extended periods of time. The lessons learned )] TJ ET
BT 26.250 214.848 Td /F1 9.8 Tf  [(about the relationship between flooding and its impacts on mental health may be applicable to other disasters as well. )] TJ ET
BT 26.250 202.944 Td /F5 9.8 Tf  [(The effects of flooding on mental health: Outcomes and recommendations from a review of the literature)] TJ ET
BT 474.955 202.944 Td /F1 9.8 Tf  [( offers a summary of )] TJ ET
BT 26.250 191.039 Td /F1 9.8 Tf  [(epidemiological research, government and non-government guidance on the effects of flooding on mental health and up-to-date )] TJ ET
BT 26.250 179.134 Td /F1 9.8 Tf  [(strategies for mitigating the impacts of flooding on affected populations.)] TJ ET
BT 26.250 142.532 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 115.077 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 115.077 Td /F1 9.8 Tf  [(Jakubicka T, Vos F, Phalkey R, Marx M. \(2010\) Health impacts of floods in Europe: Data gaps and information needs from a )] TJ ET
BT 26.250 103.173 Td /F1 9.8 Tf  [(spatial perspective. A MICRODIS report. Brussels, Centre for Research on the Epidemiology of Disasters \(CRED\).)] TJ ET
BT 26.250 83.768 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 83.768 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2011\). Climate change: Facts and figures. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 75.282 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 56.732 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 56.732 Td /F1 9.8 Tf  [( Ahern M, Kovats RS, Wilkinson P, Few R, Matthies F. \(2005\) Global health impacts of floods: Epidemiologic evidence. )] TJ ET
BT 26.250 44.827 Td /F1 9.8 Tf  [(Epidemiologic Reviews; 27:36-46.)] TJ ET
Q
q
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BT 26.250 767.476 Td /F1 9.8 Tf  [(which people live to achieve these aims because measures for preventing floods can reduce the health impacts on populations.)] TJ ET
BT 26.250 748.071 Td /F5 9.8 Tf  [(Social Care Services)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(The concept of psychosocial resilience, with its personal and collective components, points to the importance of mitigating the )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(distressing effects as well as the social and health risks posed by flooding. Social cohesion of communities and families before )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(calamities occur and their restoration as soon as possible afterwards, restoring communications between people, and keeping )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(families together are core to reducing people�s suffering and promoting their effective recovery. These actions are important )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(components of Psychological First Aid)] TJ ET
0.267 0.267 0.267 rg
BT 190.976 682.555 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 200.614 681.048 Td /F1 9.8 Tf  [(, which is now agreed internationally to be an important set of principles for )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(psychosocial care.)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Agencies that are responsible for social care and commercial companies, including builders and insurance companies that are )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(involved in rebuilding and restoration, should work together to ensure that there are no �recovery gaps�)] TJ ET
0.267 0.267 0.267 rg
BT 466.833 639.341 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 476.470 637.833 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 618.429 Td /F5 9.8 Tf  [(Healthcare Services)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(All healthcare agencies should be aware of the distress that flooding may cause people who are affected. The literature is not )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(clear about the impact of floods in provoking more people than might otherwise do so to develop anxiety disorders, depression )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(and PTSD. This is because of limited availability of population comparisons, and before and after evaluation studies. Local )] TJ ET
BT 26.250 563.310 Td /F1 9.8 Tf  [(healthcare services should be aware that a substantial minority of people may develop mental disorders in the medium- and )] TJ ET
BT 26.250 551.405 Td /F1 9.8 Tf  [(longer-terms after flooding. Also, whatever the relative contribution of flooding as a causative agent, floods are likely to bring )] TJ ET
BT 26.250 539.500 Td /F1 9.8 Tf  [(people�s pre-existing disorders to presentation.)] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(This health intelligence should inform the preparedness of healthcare agencies and their practical plans. Specialist mental )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(healthcare agencies should be prepared to provide advice to emergency planners, community healthcare services, and social )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(care organisations. They should also be available to deliver focused specialist services for people who may have mental )] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(disorders that are provoked or exacerbated by their involvement in floods.)] TJ ET
BT 26.250 447.779 Td /F4 12.0 Tf  [(Conclusions)] TJ ET
BT 26.250 427.824 Td /F1 9.8 Tf  [(The frequency of floods is increasing. The mortality relating to flooding is variable and depends on the enormity or otherwise of )] TJ ET
BT 26.250 415.920 Td /F1 9.8 Tf  [(each extreme event and the capability of the rescue and recovery services. But, when compared with other types of disaster, )] TJ ET
BT 26.250 404.015 Td /F1 9.8 Tf  [(the mortality may be interpreted as low when floods occur in well-prepared areas of the world. However, this should not blind )] TJ ET
BT 26.250 392.110 Td /F1 9.8 Tf  [(policymakers, service designers and practitioners to the substantial morbidity that is posed by flooding.)] TJ ET
BT 26.250 372.705 Td /F1 9.8 Tf  [(The Health Protection Agency�s report on the outcomes and recommendations from the peer-reviewed literature, and selected )] TJ ET
BT 26.250 360.801 Td /F1 9.8 Tf  [(governmental policy and non-governmental guidance, provides a picture that is based on key messages from research and )] TJ ET
BT 26.250 348.896 Td /F1 9.8 Tf  [(expert consensus. It identifies clearly the requirement for more research that is of improved clarity of purpose and method. The )] TJ ET
BT 26.250 336.991 Td /F1 9.8 Tf  [(need for greater discipline in defining and using terminology is another important message. The authors identify the implications )] TJ ET
BT 26.250 325.086 Td /F1 9.8 Tf  [(of their review for policymakers, the responsible government agencies, and health and social care services.)] TJ ET
BT 26.250 305.682 Td /F1 9.8 Tf  [(The HPA has identified the responsibilities that should fall on a number of public and other organisations to plan and deliver )] TJ ET
BT 26.250 293.777 Td /F1 9.8 Tf  [(improved services to support people who are affected by flooding with the intention of reducing their suffering, reducing the risks )] TJ ET
BT 26.250 281.872 Td /F1 9.8 Tf  [(of them developing long-term mental disorders that are so very costly across the full diversity of meaning of that concept, and )] TJ ET
BT 26.250 269.967 Td /F1 9.8 Tf  [(aiding recovery of imperilled communities and families. They map well onto the stepped strategic model of care that is policy in )] TJ ET
BT 26.250 258.063 Td /F1 9.8 Tf  [(England and recommended by NATO.)] TJ ET
BT 26.250 238.658 Td /F1 9.8 Tf  [(The HPA found that there is a growing body of evidence which suggests that floods can have profound effects on people�s )] TJ ET
BT 26.250 226.753 Td /F1 9.8 Tf  [(wellbeing, psychosocial resilience, relationships and mental health, often over extended periods of time. The lessons learned )] TJ ET
BT 26.250 214.848 Td /F1 9.8 Tf  [(about the relationship between flooding and its impacts on mental health may be applicable to other disasters as well. )] TJ ET
BT 26.250 202.944 Td /F5 9.8 Tf  [(The effects of flooding on mental health: Outcomes and recommendations from a review of the literature)] TJ ET
BT 474.955 202.944 Td /F1 9.8 Tf  [( offers a summary of )] TJ ET
BT 26.250 191.039 Td /F1 9.8 Tf  [(epidemiological research, government and non-government guidance on the effects of flooding on mental health and up-to-date )] TJ ET
BT 26.250 179.134 Td /F1 9.8 Tf  [(strategies for mitigating the impacts of flooding on affected populations.)] TJ ET
BT 26.250 142.532 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 115.077 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 115.077 Td /F1 9.8 Tf  [(Jakubicka T, Vos F, Phalkey R, Marx M. \(2010\) Health impacts of floods in Europe: Data gaps and information needs from a )] TJ ET
BT 26.250 103.173 Td /F1 9.8 Tf  [(spatial perspective. A MICRODIS report. Brussels, Centre for Research on the Epidemiology of Disasters \(CRED\).)] TJ ET
BT 26.250 83.768 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 83.768 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2011\). Climate change: Facts and figures. )] TJ ET
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BT 26.250 75.282 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 56.732 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 56.732 Td /F1 9.8 Tf  [( Ahern M, Kovats RS, Wilkinson P, Few R, Matthies F. \(2005\) Global health impacts of floods: Epidemiologic evidence. )] TJ ET
BT 26.250 44.827 Td /F1 9.8 Tf  [(Epidemiologic Reviews; 27:36-46.)] TJ ET
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BT 26.250 759.976 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 759.976 Td /F1 9.8 Tf  [(Murray V, Caldin H, Amlot R, Stanke C, Lock S, Rowlatt H, Williams R. \(2011\) The effects of flooding on mental health. )] TJ ET
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BT 26.250 721.035 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 721.035 Td /F1 9.8 Tf  [(Mental Health Division, DoH. \(2009\) New Horizons: A Shared Vision for Mental Health.)] TJ ET
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BT 26.250 712.549 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 693.999 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 693.999 Td /F1 9.8 Tf  [(HM Government Department of Health: Mental Health Division. \(2011\) No Health Without Mental Health: A Cross-)] TJ ET
BT 26.250 682.095 Td /F1 9.8 Tf  [(Government Mental Health Outcomes Strategy for People of All Ages. )] TJ ET
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BT 26.250 673.609 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 655.059 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 655.059 Td /F1 9.8 Tf  [(Ruggiero KJ, Amstadter AB, Acierno R, Kilpatrick DG, Resnick HS, Tracy M et al. \(2009\) Social and psychological resources )] TJ ET
BT 26.250 643.154 Td /F1 9.8 Tf  [(associated with health status in a representative sample of adults affected by the 2004 Florida hurricanes. Psychiatry; 72\(2\):195-)] TJ ET
BT 26.250 631.249 Td /F1 9.8 Tf  [(210.)] TJ ET
BT 26.250 611.844 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 611.844 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Galea S, Resnick HS, Koenen K, Roitzsch J et al. \(2007\) Psychological sequelae resulting from the )] TJ ET
BT 26.250 599.940 Td /F1 9.8 Tf  [(2004 Florida hurricanes: implications for postdisaster intervention. American Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 580.535 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 580.535 Td /F1 9.8 Tf  [(Hensley L, Varela RE. \(2008\) PTSD symptoms and somatic complaints following Hurricane Katrina: The roles of trait anxiety )] TJ ET
BT 26.250 568.630 Td /F1 9.8 Tf  [(and anxiety sensitivity. Journal of Clinical Child and Adolescent Psychology; 37\(3\):542-552.)] TJ ET
BT 26.250 549.225 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 549.225 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessely S. \(2008\) Trends in mental illness and suicidality after )] TJ ET
BT 26.250 537.321 Td /F1 9.8 Tf  [(Hurricane Katrina. Molecular Psychiatry; 13\(4\):374-384.)] TJ ET
BT 26.250 517.916 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 517.916 Td /F1 9.8 Tf  [(Kishore V, Theall KP, Robinson W, Pichon J, Scribner R, Roberson E et al. \(2008\) Resource loss, coping, alcohol use, and )] TJ ET
BT 26.250 506.011 Td /F1 9.8 Tf  [(posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study. American journal of disaster )] TJ ET
BT 26.250 494.106 Td /F1 9.8 Tf  [(medicine; 3\(6\):345-357.)] TJ ET
BT 26.250 474.702 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 474.702 Td /F1 9.8 Tf  [( Pina AA, Villalta IK, Ortiz CD, Gottschall AC, Costa NM, Weems CF. \(2008\) Social support, discrimination, and coping as )] TJ ET
BT 26.250 462.797 Td /F1 9.8 Tf  [(predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina. Journal of Clinical Child and Adolescent )] TJ ET
BT 26.250 450.892 Td /F1 9.8 Tf  [(Psychology; 37\(3\):564-574.)] TJ ET
BT 26.250 431.487 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 431.487 Td /F1 9.8 Tf  [(Scheeringa MS, Zeanah CH. \(2008\) Reconsideration of harm's way: Onsets and comorbidity patterns of disorders in )] TJ ET
BT 26.250 419.583 Td /F1 9.8 Tf  [(preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology; )] TJ ET
BT 26.250 407.678 Td /F1 9.8 Tf  [(37\(3\):508-518.)] TJ ET
BT 26.250 388.273 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 388.273 Td /F1 9.8 Tf  [(Harville EW, Xiong X, Pridjian G, Elkind-Hirsch K, Buekens P. \(2009\) Postpartum mental health after Hurricane Katrina: A )] TJ ET
BT 26.250 376.368 Td /F1 9.8 Tf  [(cohort study. BMC Pregnancy and Childbirth; 9.)] TJ ET
BT 26.250 356.964 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 356.964 Td /F1 9.8 Tf  [(Norris FH, VanLandingham MJ, Vu L. \(2009\) PTSD in Vietnamese Americans following Hurricane Katrina: Prevalence, )] TJ ET
BT 26.250 345.059 Td /F1 9.8 Tf  [(patterns, and predictors. Journal of Traumatic Stress; 22\(2\):91-101.)] TJ ET
BT 26.250 325.654 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 325.654 Td /F1 9.8 Tf  [(Weems CF, Taylor LK, Cannon MF, Marino RC, Romano DM, Scott BG et al. \(2009\) Post Traumatic Stress, Context, and )] TJ ET
BT 26.250 313.749 Td /F1 9.8 Tf  [(the Lingering Effects of the Hurricane Katrina Disaster among Ethnic Minority Youth. Journal of Abnormal Child Psychology; )] TJ ET
BT 26.250 301.845 Td /F1 9.8 Tf  [(38\(1\):49-56.)] TJ ET
BT 26.250 282.440 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 282.440 Td /F1 9.8 Tf  [(Sprang G, LaJoie AS. \(2009\) Exposure, avoidance, and PTSD among hurricane katrina evacuees. Traumatology; 15\(2\):10-)] TJ ET
BT 26.250 270.535 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 26.250 251.130 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 251.130 Td /F1 9.8 Tf  [(Coker AL, Hanks JS, Eggleston KS, Risser J, Tee PG, Chronister KJ et al. \(2006\) Social and Mental Health Needs )] TJ ET
BT 26.250 239.226 Td /F1 9.8 Tf  [(Assessment of Katrina Evacuees. Disaster Management and Response; 4\(3\):88-94.)] TJ ET
BT 26.250 219.821 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 219.821 Td /F1 9.8 Tf  [(Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA et al. \(2007\) Exposure to hurricane-related stressors and )] TJ ET
BT 26.250 207.916 Td /F1 9.8 Tf  [(mental illness after Hurricane Katrina. Archives of General Psychiatry; 64\(12\):1427-1434.)] TJ ET
BT 26.250 188.511 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 188.511 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Jones RT, Parker HA. \(2006\) Mental illness and suicidality after Hurricane Katrina. Bulletin of the )] TJ ET
BT 26.250 176.607 Td /F1 9.8 Tf  [(World Health Organization; 84\(12\):930-939.)] TJ ET
BT 26.250 157.202 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 157.202 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2007\) Mental health service use among )] TJ ET
BT 26.250 145.297 Td /F1 9.8 Tf  [(Hurricane Katrina survivors in the eight months after the disaster. Psychiatric Services; 58\(11\):1403-1411.)] TJ ET
BT 26.250 125.892 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 125.892 Td /F1 9.8 Tf  [(Abramson D, Stehling-Ariza T, Garfield R, Redlener I. \(2008\) Prevalence and predictors of mental health distress post-)] TJ ET
BT 26.250 113.988 Td /F1 9.8 Tf  [(katrina: Findings from the gulf coast child and family health study. Disaster Medicine and Public Health Preparedness; 2\(2\):77-)] TJ ET
BT 26.250 102.083 Td /F1 9.8 Tf  [(86.)] TJ ET
BT 26.250 82.678 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 82.678 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2008\) Disruption of existing mental health )] TJ ET
BT 26.250 70.773 Td /F1 9.8 Tf  [(treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry; 165\(1\):34-41.)] TJ ET
BT 26.250 51.369 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 51.369 Td /F1 9.8 Tf  [(Madrid PA, Garfield R, Jaberi P, Daly M, Richard G, Grant R. \(2008\) Mental Health Services in Louisiana School-Based )] TJ ET
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BT 26.250 721.035 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 721.035 Td /F1 9.8 Tf  [(Mental Health Division, DoH. \(2009\) New Horizons: A Shared Vision for Mental Health.)] TJ ET
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BT 26.250 693.999 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 693.999 Td /F1 9.8 Tf  [(HM Government Department of Health: Mental Health Division. \(2011\) No Health Without Mental Health: A Cross-)] TJ ET
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BT 26.250 655.059 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 655.059 Td /F1 9.8 Tf  [(Ruggiero KJ, Amstadter AB, Acierno R, Kilpatrick DG, Resnick HS, Tracy M et al. \(2009\) Social and psychological resources )] TJ ET
BT 26.250 643.154 Td /F1 9.8 Tf  [(associated with health status in a representative sample of adults affected by the 2004 Florida hurricanes. Psychiatry; 72\(2\):195-)] TJ ET
BT 26.250 631.249 Td /F1 9.8 Tf  [(210.)] TJ ET
BT 26.250 611.844 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 611.844 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Galea S, Resnick HS, Koenen K, Roitzsch J et al. \(2007\) Psychological sequelae resulting from the )] TJ ET
BT 26.250 599.940 Td /F1 9.8 Tf  [(2004 Florida hurricanes: implications for postdisaster intervention. American Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 580.535 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 580.535 Td /F1 9.8 Tf  [(Hensley L, Varela RE. \(2008\) PTSD symptoms and somatic complaints following Hurricane Katrina: The roles of trait anxiety )] TJ ET
BT 26.250 568.630 Td /F1 9.8 Tf  [(and anxiety sensitivity. Journal of Clinical Child and Adolescent Psychology; 37\(3\):542-552.)] TJ ET
BT 26.250 549.225 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 549.225 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessely S. \(2008\) Trends in mental illness and suicidality after )] TJ ET
BT 26.250 537.321 Td /F1 9.8 Tf  [(Hurricane Katrina. Molecular Psychiatry; 13\(4\):374-384.)] TJ ET
BT 26.250 517.916 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 517.916 Td /F1 9.8 Tf  [(Kishore V, Theall KP, Robinson W, Pichon J, Scribner R, Roberson E et al. \(2008\) Resource loss, coping, alcohol use, and )] TJ ET
BT 26.250 506.011 Td /F1 9.8 Tf  [(posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study. American journal of disaster )] TJ ET
BT 26.250 494.106 Td /F1 9.8 Tf  [(medicine; 3\(6\):345-357.)] TJ ET
BT 26.250 474.702 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 474.702 Td /F1 9.8 Tf  [( Pina AA, Villalta IK, Ortiz CD, Gottschall AC, Costa NM, Weems CF. \(2008\) Social support, discrimination, and coping as )] TJ ET
BT 26.250 462.797 Td /F1 9.8 Tf  [(predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina. Journal of Clinical Child and Adolescent )] TJ ET
BT 26.250 450.892 Td /F1 9.8 Tf  [(Psychology; 37\(3\):564-574.)] TJ ET
BT 26.250 431.487 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 431.487 Td /F1 9.8 Tf  [(Scheeringa MS, Zeanah CH. \(2008\) Reconsideration of harm's way: Onsets and comorbidity patterns of disorders in )] TJ ET
BT 26.250 419.583 Td /F1 9.8 Tf  [(preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology; )] TJ ET
BT 26.250 407.678 Td /F1 9.8 Tf  [(37\(3\):508-518.)] TJ ET
BT 26.250 388.273 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 388.273 Td /F1 9.8 Tf  [(Harville EW, Xiong X, Pridjian G, Elkind-Hirsch K, Buekens P. \(2009\) Postpartum mental health after Hurricane Katrina: A )] TJ ET
BT 26.250 376.368 Td /F1 9.8 Tf  [(cohort study. BMC Pregnancy and Childbirth; 9.)] TJ ET
BT 26.250 356.964 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 356.964 Td /F1 9.8 Tf  [(Norris FH, VanLandingham MJ, Vu L. \(2009\) PTSD in Vietnamese Americans following Hurricane Katrina: Prevalence, )] TJ ET
BT 26.250 345.059 Td /F1 9.8 Tf  [(patterns, and predictors. Journal of Traumatic Stress; 22\(2\):91-101.)] TJ ET
BT 26.250 325.654 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 325.654 Td /F1 9.8 Tf  [(Weems CF, Taylor LK, Cannon MF, Marino RC, Romano DM, Scott BG et al. \(2009\) Post Traumatic Stress, Context, and )] TJ ET
BT 26.250 313.749 Td /F1 9.8 Tf  [(the Lingering Effects of the Hurricane Katrina Disaster among Ethnic Minority Youth. Journal of Abnormal Child Psychology; )] TJ ET
BT 26.250 301.845 Td /F1 9.8 Tf  [(38\(1\):49-56.)] TJ ET
BT 26.250 282.440 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 282.440 Td /F1 9.8 Tf  [(Sprang G, LaJoie AS. \(2009\) Exposure, avoidance, and PTSD among hurricane katrina evacuees. Traumatology; 15\(2\):10-)] TJ ET
BT 26.250 270.535 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 26.250 251.130 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 251.130 Td /F1 9.8 Tf  [(Coker AL, Hanks JS, Eggleston KS, Risser J, Tee PG, Chronister KJ et al. \(2006\) Social and Mental Health Needs )] TJ ET
BT 26.250 239.226 Td /F1 9.8 Tf  [(Assessment of Katrina Evacuees. Disaster Management and Response; 4\(3\):88-94.)] TJ ET
BT 26.250 219.821 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 219.821 Td /F1 9.8 Tf  [(Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA et al. \(2007\) Exposure to hurricane-related stressors and )] TJ ET
BT 26.250 207.916 Td /F1 9.8 Tf  [(mental illness after Hurricane Katrina. Archives of General Psychiatry; 64\(12\):1427-1434.)] TJ ET
BT 26.250 188.511 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 188.511 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Jones RT, Parker HA. \(2006\) Mental illness and suicidality after Hurricane Katrina. Bulletin of the )] TJ ET
BT 26.250 176.607 Td /F1 9.8 Tf  [(World Health Organization; 84\(12\):930-939.)] TJ ET
BT 26.250 157.202 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 157.202 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2007\) Mental health service use among )] TJ ET
BT 26.250 145.297 Td /F1 9.8 Tf  [(Hurricane Katrina survivors in the eight months after the disaster. Psychiatric Services; 58\(11\):1403-1411.)] TJ ET
BT 26.250 125.892 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 125.892 Td /F1 9.8 Tf  [(Abramson D, Stehling-Ariza T, Garfield R, Redlener I. \(2008\) Prevalence and predictors of mental health distress post-)] TJ ET
BT 26.250 113.988 Td /F1 9.8 Tf  [(katrina: Findings from the gulf coast child and family health study. Disaster Medicine and Public Health Preparedness; 2\(2\):77-)] TJ ET
BT 26.250 102.083 Td /F1 9.8 Tf  [(86.)] TJ ET
BT 26.250 82.678 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 82.678 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2008\) Disruption of existing mental health )] TJ ET
BT 26.250 70.773 Td /F1 9.8 Tf  [(treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry; 165\(1\):34-41.)] TJ ET
BT 26.250 51.369 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 51.369 Td /F1 9.8 Tf  [(Madrid PA, Garfield R, Jaberi P, Daly M, Richard G, Grant R. \(2008\) Mental Health Services in Louisiana School-Based )] TJ ET
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BT 38.132 759.976 Td /F1 9.8 Tf  [(Murray V, Caldin H, Amlot R, Stanke C, Lock S, Rowlatt H, Williams R. \(2011\) The effects of flooding on mental health. )] TJ ET
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BT 26.250 721.035 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 721.035 Td /F1 9.8 Tf  [(Mental Health Division, DoH. \(2009\) New Horizons: A Shared Vision for Mental Health.)] TJ ET
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BT 26.250 673.609 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 655.059 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 655.059 Td /F1 9.8 Tf  [(Ruggiero KJ, Amstadter AB, Acierno R, Kilpatrick DG, Resnick HS, Tracy M et al. \(2009\) Social and psychological resources )] TJ ET
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BT 26.250 631.249 Td /F1 9.8 Tf  [(210.)] TJ ET
BT 26.250 611.844 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 611.844 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Galea S, Resnick HS, Koenen K, Roitzsch J et al. \(2007\) Psychological sequelae resulting from the )] TJ ET
BT 26.250 599.940 Td /F1 9.8 Tf  [(2004 Florida hurricanes: implications for postdisaster intervention. American Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 580.535 Td /F1 9.8 Tf  [(9.)] TJ ET
BT 38.132 580.535 Td /F1 9.8 Tf  [(Hensley L, Varela RE. \(2008\) PTSD symptoms and somatic complaints following Hurricane Katrina: The roles of trait anxiety )] TJ ET
BT 26.250 568.630 Td /F1 9.8 Tf  [(and anxiety sensitivity. Journal of Clinical Child and Adolescent Psychology; 37\(3\):542-552.)] TJ ET
BT 26.250 549.225 Td /F1 9.8 Tf  [(10.)] TJ ET
BT 43.553 549.225 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessely S. \(2008\) Trends in mental illness and suicidality after )] TJ ET
BT 26.250 537.321 Td /F1 9.8 Tf  [(Hurricane Katrina. Molecular Psychiatry; 13\(4\):374-384.)] TJ ET
BT 26.250 517.916 Td /F1 9.8 Tf  [(11.)] TJ ET
BT 43.553 517.916 Td /F1 9.8 Tf  [(Kishore V, Theall KP, Robinson W, Pichon J, Scribner R, Roberson E et al. \(2008\) Resource loss, coping, alcohol use, and )] TJ ET
BT 26.250 506.011 Td /F1 9.8 Tf  [(posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study. American journal of disaster )] TJ ET
BT 26.250 494.106 Td /F1 9.8 Tf  [(medicine; 3\(6\):345-357.)] TJ ET
BT 26.250 474.702 Td /F1 9.8 Tf  [(12.)] TJ ET
BT 43.553 474.702 Td /F1 9.8 Tf  [( Pina AA, Villalta IK, Ortiz CD, Gottschall AC, Costa NM, Weems CF. \(2008\) Social support, discrimination, and coping as )] TJ ET
BT 26.250 462.797 Td /F1 9.8 Tf  [(predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina. Journal of Clinical Child and Adolescent )] TJ ET
BT 26.250 450.892 Td /F1 9.8 Tf  [(Psychology; 37\(3\):564-574.)] TJ ET
BT 26.250 431.487 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 431.487 Td /F1 9.8 Tf  [(Scheeringa MS, Zeanah CH. \(2008\) Reconsideration of harm's way: Onsets and comorbidity patterns of disorders in )] TJ ET
BT 26.250 419.583 Td /F1 9.8 Tf  [(preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology; )] TJ ET
BT 26.250 407.678 Td /F1 9.8 Tf  [(37\(3\):508-518.)] TJ ET
BT 26.250 388.273 Td /F1 9.8 Tf  [(14.)] TJ ET
BT 43.553 388.273 Td /F1 9.8 Tf  [(Harville EW, Xiong X, Pridjian G, Elkind-Hirsch K, Buekens P. \(2009\) Postpartum mental health after Hurricane Katrina: A )] TJ ET
BT 26.250 376.368 Td /F1 9.8 Tf  [(cohort study. BMC Pregnancy and Childbirth; 9.)] TJ ET
BT 26.250 356.964 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 356.964 Td /F1 9.8 Tf  [(Norris FH, VanLandingham MJ, Vu L. \(2009\) PTSD in Vietnamese Americans following Hurricane Katrina: Prevalence, )] TJ ET
BT 26.250 345.059 Td /F1 9.8 Tf  [(patterns, and predictors. Journal of Traumatic Stress; 22\(2\):91-101.)] TJ ET
BT 26.250 325.654 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 325.654 Td /F1 9.8 Tf  [(Weems CF, Taylor LK, Cannon MF, Marino RC, Romano DM, Scott BG et al. \(2009\) Post Traumatic Stress, Context, and )] TJ ET
BT 26.250 313.749 Td /F1 9.8 Tf  [(the Lingering Effects of the Hurricane Katrina Disaster among Ethnic Minority Youth. Journal of Abnormal Child Psychology; )] TJ ET
BT 26.250 301.845 Td /F1 9.8 Tf  [(38\(1\):49-56.)] TJ ET
BT 26.250 282.440 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 282.440 Td /F1 9.8 Tf  [(Sprang G, LaJoie AS. \(2009\) Exposure, avoidance, and PTSD among hurricane katrina evacuees. Traumatology; 15\(2\):10-)] TJ ET
BT 26.250 270.535 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 26.250 251.130 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 251.130 Td /F1 9.8 Tf  [(Coker AL, Hanks JS, Eggleston KS, Risser J, Tee PG, Chronister KJ et al. \(2006\) Social and Mental Health Needs )] TJ ET
BT 26.250 239.226 Td /F1 9.8 Tf  [(Assessment of Katrina Evacuees. Disaster Management and Response; 4\(3\):88-94.)] TJ ET
BT 26.250 219.821 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 219.821 Td /F1 9.8 Tf  [(Galea S, Brewin CR, Gruber M, Jones RT, King DW, King LA et al. \(2007\) Exposure to hurricane-related stressors and )] TJ ET
BT 26.250 207.916 Td /F1 9.8 Tf  [(mental illness after Hurricane Katrina. Archives of General Psychiatry; 64\(12\):1427-1434.)] TJ ET
BT 26.250 188.511 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 188.511 Td /F1 9.8 Tf  [(Kessler RC, Galea S, Jones RT, Parker HA. \(2006\) Mental illness and suicidality after Hurricane Katrina. Bulletin of the )] TJ ET
BT 26.250 176.607 Td /F1 9.8 Tf  [(World Health Organization; 84\(12\):930-939.)] TJ ET
BT 26.250 157.202 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 157.202 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2007\) Mental health service use among )] TJ ET
BT 26.250 145.297 Td /F1 9.8 Tf  [(Hurricane Katrina survivors in the eight months after the disaster. Psychiatric Services; 58\(11\):1403-1411.)] TJ ET
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BT 43.553 125.892 Td /F1 9.8 Tf  [(Abramson D, Stehling-Ariza T, Garfield R, Redlener I. \(2008\) Prevalence and predictors of mental health distress post-)] TJ ET
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BT 26.250 102.083 Td /F1 9.8 Tf  [(86.)] TJ ET
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BT 43.553 82.678 Td /F1 9.8 Tf  [(Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB et al.\(2008\) Disruption of existing mental health )] TJ ET
BT 26.250 70.773 Td /F1 9.8 Tf  [(treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry; 165\(1\):34-41.)] TJ ET
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BT 43.553 51.369 Td /F1 9.8 Tf  [(Madrid PA, Garfield R, Jaberi P, Daly M, Richard G, Grant R. \(2008\) Mental Health Services in Louisiana School-Based )] TJ ET
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BT 43.553 716.762 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS, Gale S. \(2006\) Risk and protective factors for psychopathology among )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(older versus younger adults after the 2004 Florida hurricanes. American Journal of Geriatric Psychiatry; 14\(12\):1051-1059.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Larrance R, Anastario M, Lawry L. \(2007\) Health Status Among Internally Displaced Persons in Louisiana and Mississippi )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Travel Trailer Parks. Annals of Emergency Medicine; 49\(5\):590-601.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(28.)] TJ ET
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BT 43.553 591.524 Td /F1 9.8 Tf  [(Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon MF. \(2007\) Predisaster trait anxiety and negative affect )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(predict posttraumatic stress in youths after Hurricane Katrina. Journal of Consulting and Clinical Psychology; 75\(1\):154-159.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Terranova AM, Boxer P, Morris AS. \(2009\) Factors influencing the course of posttraumatic stress following a natural )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(disaster: Children's reactions to Hurricane Katrina. Journal of Applied Developmental Psychology; 30\(3\):344-355.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Weems CF, Watts SE, Marsee MA, Taylor LK, Costa NM, Cannon MF et al. \(2007\) The psychosocial impact of Hurricane )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(Katrina: Contextual differences in psychological symptoms, social support, and discrimination. Behaviour Research and )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(Therapy; 45\(10\):2295-2306.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Mills MA, Edmondson D, Park CL. \(2007\) Trauma and stress response among Hurricane Katrina evacuees. American )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 454.381 Td /F1 9.8 Tf  [(Weisler RH, Barbee IV JG, Townsend MH. \(2006\) Mental health and recovery in the Gulf Coast after hurricanes Katrina and )] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(Rita. Journal of the American Medical Association; 296\(5\):585-588.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(Stepien A, Hadrys T, Kantorska-Janiec M. \(2005\) Posttraumatic stress disorder \(PTSD\) as a result of the 1997 flood - )] TJ ET
BT 26.250 411.167 Td /F1 9.8 Tf  [(Incidence and clinical picture. Archives of Psychiatry and Psychotherapy; 7\(2\):29-39.)] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 391.762 Td /F1 9.8 Tf  [(Strelau J, Zawadzki B. \(2005\)Trauma and temperament as predictors of intensity of posttraumatic stress disorder symptoms )] TJ ET
BT 26.250 379.857 Td /F1 9.8 Tf  [(after disaster. European Psychologist; 10\(2\):124-135.)] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 360.453 Td /F1 9.8 Tf  [(Norris FH, Murphy AD, Baker CK, Perilla JL. \(2004\) Postdisaster PTSD over four waves of a panel study of Mexico's 1999 )] TJ ET
BT 26.250 348.548 Td /F1 9.8 Tf  [(flood. Journal of Traumatic Stress; 17\(4\):283-292.)] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 329.143 Td /F1 9.8 Tf  [(Norris FH, Baker CK, Murphy AD, Kaniasty K. \(2005\) Social support mobilization and deterioration after Mexico's 1999 )] TJ ET
BT 26.250 317.238 Td /F1 9.8 Tf  [(flood: Effects of context, gender, and time. American Journal of Community Psychology; 36\(1-2\):15-28.)] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 297.834 Td /F1 9.8 Tf  [(Feng S, Tan H, Benjamin A, Wen S, Liu A, Zhou J et al. \(2007\) Social Support and Posttraumatic Stress Disorder among )] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(Flood Victims in Hunan, China. Annals of Epidemiology; 17\(10\):827-833.)] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 266.524 Td /F1 9.8 Tf  [(Huang P, Tan H, Liu A, Feng S, Chen M. \(2010\) Prediction of Post Traumatic Stress Disorder among adults in flood district. )] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(BMC Public Health; 10\(207\).)] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 235.215 Td /F1 9.8 Tf  [(Liu A, Tan H, Zhou J, Li S, Yang T, Wang J et al. \(2006\) An epidemiologic study of posttraumatic stress disorder in flood )] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(victims in Hunan China. Canadian Journal of Psychiatry; 51\(6\):350-354.)] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 203.905 Td /F1 9.8 Tf  [(Amstadter AB, Acierno R, Richardson LK, Kilpatrick DG, Gros DF, Gaboury MT et al. \(2009\) Posttyphoon prevalence of )] TJ ET
BT 26.250 192.000 Td /F1 9.8 Tf  [(posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety disorder in a Vietnamese )] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(sample. Journal of Traumatic Stress; 22\(3\):180-188.)] TJ ET
BT 26.250 160.691 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 160.691 Td /F1 9.8 Tf  [(Dewaraja R, Kawamura N. \(2006\)Trauma intensity and posttraumatic stress: Implications of the tsunami experience in Sri )] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(Lanka for the management of future disasters. 1287, 69-73.)] TJ ET
BT 26.250 129.381 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 129.381 Td /F1 9.8 Tf  [(Nitschke M, Einsle F, Lippmann C, Simonis G, Kollner V, Strasser R. \(2006\) Emergency evacuation of the Dresden Heart )] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(Centre in the flood disaster in Germany 2002: Perceptions of patients and psychosocial burdens. International Journal of )] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(Disaster Medicine; 4\(3\):118-124.)] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 86.167 Td /F1 9.8 Tf  [(Heo JH, Kim MH, Koh SB, Noh S, Park JH, Ahn JS et al. \(2008\) A prospective study on changes in health status following )] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(flood disaster. Psychiatry Investigation; 5\(3\):186-192.)] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 54.858 Td /F1 9.8 Tf  [(Carroll B, Morbey H, Balogh R, Araoz G. \(2009\) Flooded homes, broken bonds, the meaning of home, psychological )] TJ ET
Q
q
15.000 40.572 577.500 736.428 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Health Centers Post-Hurricanes Katrina and Rita. Professional Psychology: Research and Practice; 39\(1\):45-51.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Vigil JM, Geary DC. \(2008\) A Preliminary Investigation of Family Coping Styles and Psychological Well-Being Among )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Adolescent Survivors of Hurricane Katrina. Journal of Family Psychology; 22\(1\):176-180.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS, Gale S. \(2006\) Risk and protective factors for psychopathology among )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(older versus younger adults after the 2004 Florida hurricanes. American Journal of Geriatric Psychiatry; 14\(12\):1051-1059.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Larrance R, Anastario M, Lawry L. \(2007\) Health Status Among Internally Displaced Persons in Louisiana and Mississippi )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Travel Trailer Parks. Annals of Emergency Medicine; 49\(5\):590-601.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Anastario MP, Larrance R, Lawry L. \(2008\) Using mental health indicators to identify postdisaster gender-based violence )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(among women displaced by Hurricane Katrina. Journal of Women's Health; 17\(9\):1437-1444.)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 622.833 Td /F1 9.8 Tf  [(Anastario M, Lawry L, Shehab N. \(2009\) Increased gender-based violence among women internally displaced in mississippi )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(2 years post-Hurricane Katrina. Disaster Medicine and Public Health Preparedness; 3\(1\):18-26.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 591.524 Td /F1 9.8 Tf  [(Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon MF. \(2007\) Predisaster trait anxiety and negative affect )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(predict posttraumatic stress in youths after Hurricane Katrina. Journal of Consulting and Clinical Psychology; 75\(1\):154-159.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Terranova AM, Boxer P, Morris AS. \(2009\) Factors influencing the course of posttraumatic stress following a natural )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(disaster: Children's reactions to Hurricane Katrina. Journal of Applied Developmental Psychology; 30\(3\):344-355.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Weems CF, Watts SE, Marsee MA, Taylor LK, Costa NM, Cannon MF et al. \(2007\) The psychosocial impact of Hurricane )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(Katrina: Contextual differences in psychological symptoms, social support, and discrimination. Behaviour Research and )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(Therapy; 45\(10\):2295-2306.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Mills MA, Edmondson D, Park CL. \(2007\) Trauma and stress response among Hurricane Katrina evacuees. American )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 454.381 Td /F1 9.8 Tf  [(Weisler RH, Barbee IV JG, Townsend MH. \(2006\) Mental health and recovery in the Gulf Coast after hurricanes Katrina and )] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(Rita. Journal of the American Medical Association; 296\(5\):585-588.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(Stepien A, Hadrys T, Kantorska-Janiec M. \(2005\) Posttraumatic stress disorder \(PTSD\) as a result of the 1997 flood - )] TJ ET
BT 26.250 411.167 Td /F1 9.8 Tf  [(Incidence and clinical picture. Archives of Psychiatry and Psychotherapy; 7\(2\):29-39.)] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 391.762 Td /F1 9.8 Tf  [(Strelau J, Zawadzki B. \(2005\)Trauma and temperament as predictors of intensity of posttraumatic stress disorder symptoms )] TJ ET
BT 26.250 379.857 Td /F1 9.8 Tf  [(after disaster. European Psychologist; 10\(2\):124-135.)] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 360.453 Td /F1 9.8 Tf  [(Norris FH, Murphy AD, Baker CK, Perilla JL. \(2004\) Postdisaster PTSD over four waves of a panel study of Mexico's 1999 )] TJ ET
BT 26.250 348.548 Td /F1 9.8 Tf  [(flood. Journal of Traumatic Stress; 17\(4\):283-292.)] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 329.143 Td /F1 9.8 Tf  [(Norris FH, Baker CK, Murphy AD, Kaniasty K. \(2005\) Social support mobilization and deterioration after Mexico's 1999 )] TJ ET
BT 26.250 317.238 Td /F1 9.8 Tf  [(flood: Effects of context, gender, and time. American Journal of Community Psychology; 36\(1-2\):15-28.)] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 297.834 Td /F1 9.8 Tf  [(Feng S, Tan H, Benjamin A, Wen S, Liu A, Zhou J et al. \(2007\) Social Support and Posttraumatic Stress Disorder among )] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(Flood Victims in Hunan, China. Annals of Epidemiology; 17\(10\):827-833.)] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 266.524 Td /F1 9.8 Tf  [(Huang P, Tan H, Liu A, Feng S, Chen M. \(2010\) Prediction of Post Traumatic Stress Disorder among adults in flood district. )] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(BMC Public Health; 10\(207\).)] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 235.215 Td /F1 9.8 Tf  [(Liu A, Tan H, Zhou J, Li S, Yang T, Wang J et al. \(2006\) An epidemiologic study of posttraumatic stress disorder in flood )] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(victims in Hunan China. Canadian Journal of Psychiatry; 51\(6\):350-354.)] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 203.905 Td /F1 9.8 Tf  [(Amstadter AB, Acierno R, Richardson LK, Kilpatrick DG, Gros DF, Gaboury MT et al. \(2009\) Posttyphoon prevalence of )] TJ ET
BT 26.250 192.000 Td /F1 9.8 Tf  [(posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety disorder in a Vietnamese )] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(sample. Journal of Traumatic Stress; 22\(3\):180-188.)] TJ ET
BT 26.250 160.691 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 160.691 Td /F1 9.8 Tf  [(Dewaraja R, Kawamura N. \(2006\)Trauma intensity and posttraumatic stress: Implications of the tsunami experience in Sri )] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(Lanka for the management of future disasters. 1287, 69-73.)] TJ ET
BT 26.250 129.381 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 129.381 Td /F1 9.8 Tf  [(Nitschke M, Einsle F, Lippmann C, Simonis G, Kollner V, Strasser R. \(2006\) Emergency evacuation of the Dresden Heart )] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(Centre in the flood disaster in Germany 2002: Perceptions of patients and psychosocial burdens. International Journal of )] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(Disaster Medicine; 4\(3\):118-124.)] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 86.167 Td /F1 9.8 Tf  [(Heo JH, Kim MH, Koh SB, Noh S, Park JH, Ahn JS et al. \(2008\) A prospective study on changes in health status following )] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(flood disaster. Psychiatry Investigation; 5\(3\):186-192.)] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 54.858 Td /F1 9.8 Tf  [(Carroll B, Morbey H, Balogh R, Araoz G. \(2009\) Flooded homes, broken bonds, the meaning of home, psychological )] TJ ET
Q
q
15.000 40.572 577.500 736.428 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Health Centers Post-Hurricanes Katrina and Rita. Professional Psychology: Research and Practice; 39\(1\):45-51.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Vigil JM, Geary DC. \(2008\) A Preliminary Investigation of Family Coping Styles and Psychological Well-Being Among )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Adolescent Survivors of Hurricane Katrina. Journal of Family Psychology; 22\(1\):176-180.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS, Gale S. \(2006\) Risk and protective factors for psychopathology among )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(older versus younger adults after the 2004 Florida hurricanes. American Journal of Geriatric Psychiatry; 14\(12\):1051-1059.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Larrance R, Anastario M, Lawry L. \(2007\) Health Status Among Internally Displaced Persons in Louisiana and Mississippi )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Travel Trailer Parks. Annals of Emergency Medicine; 49\(5\):590-601.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Anastario MP, Larrance R, Lawry L. \(2008\) Using mental health indicators to identify postdisaster gender-based violence )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(among women displaced by Hurricane Katrina. Journal of Women's Health; 17\(9\):1437-1444.)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 622.833 Td /F1 9.8 Tf  [(Anastario M, Lawry L, Shehab N. \(2009\) Increased gender-based violence among women internally displaced in mississippi )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(2 years post-Hurricane Katrina. Disaster Medicine and Public Health Preparedness; 3\(1\):18-26.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 591.524 Td /F1 9.8 Tf  [(Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon MF. \(2007\) Predisaster trait anxiety and negative affect )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(predict posttraumatic stress in youths after Hurricane Katrina. Journal of Consulting and Clinical Psychology; 75\(1\):154-159.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Terranova AM, Boxer P, Morris AS. \(2009\) Factors influencing the course of posttraumatic stress following a natural )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(disaster: Children's reactions to Hurricane Katrina. Journal of Applied Developmental Psychology; 30\(3\):344-355.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Weems CF, Watts SE, Marsee MA, Taylor LK, Costa NM, Cannon MF et al. \(2007\) The psychosocial impact of Hurricane )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(Katrina: Contextual differences in psychological symptoms, social support, and discrimination. Behaviour Research and )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(Therapy; 45\(10\):2295-2306.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Mills MA, Edmondson D, Park CL. \(2007\) Trauma and stress response among Hurricane Katrina evacuees. American )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(Journal of Public Health; 97 Suppl 1.)] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 454.381 Td /F1 9.8 Tf  [(Weisler RH, Barbee IV JG, Townsend MH. \(2006\) Mental health and recovery in the Gulf Coast after hurricanes Katrina and )] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(Rita. Journal of the American Medical Association; 296\(5\):585-588.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(Stepien A, Hadrys T, Kantorska-Janiec M. \(2005\) Posttraumatic stress disorder \(PTSD\) as a result of the 1997 flood - )] TJ ET
BT 26.250 411.167 Td /F1 9.8 Tf  [(Incidence and clinical picture. Archives of Psychiatry and Psychotherapy; 7\(2\):29-39.)] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 391.762 Td /F1 9.8 Tf  [(Strelau J, Zawadzki B. \(2005\)Trauma and temperament as predictors of intensity of posttraumatic stress disorder symptoms )] TJ ET
BT 26.250 379.857 Td /F1 9.8 Tf  [(after disaster. European Psychologist; 10\(2\):124-135.)] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 360.453 Td /F1 9.8 Tf  [(Norris FH, Murphy AD, Baker CK, Perilla JL. \(2004\) Postdisaster PTSD over four waves of a panel study of Mexico's 1999 )] TJ ET
BT 26.250 348.548 Td /F1 9.8 Tf  [(flood. Journal of Traumatic Stress; 17\(4\):283-292.)] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 329.143 Td /F1 9.8 Tf  [(Norris FH, Baker CK, Murphy AD, Kaniasty K. \(2005\) Social support mobilization and deterioration after Mexico's 1999 )] TJ ET
BT 26.250 317.238 Td /F1 9.8 Tf  [(flood: Effects of context, gender, and time. American Journal of Community Psychology; 36\(1-2\):15-28.)] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 297.834 Td /F1 9.8 Tf  [(Feng S, Tan H, Benjamin A, Wen S, Liu A, Zhou J et al. \(2007\) Social Support and Posttraumatic Stress Disorder among )] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(Flood Victims in Hunan, China. Annals of Epidemiology; 17\(10\):827-833.)] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 266.524 Td /F1 9.8 Tf  [(Huang P, Tan H, Liu A, Feng S, Chen M. \(2010\) Prediction of Post Traumatic Stress Disorder among adults in flood district. )] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(BMC Public Health; 10\(207\).)] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 235.215 Td /F1 9.8 Tf  [(Liu A, Tan H, Zhou J, Li S, Yang T, Wang J et al. \(2006\) An epidemiologic study of posttraumatic stress disorder in flood )] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(victims in Hunan China. Canadian Journal of Psychiatry; 51\(6\):350-354.)] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 203.905 Td /F1 9.8 Tf  [(Amstadter AB, Acierno R, Richardson LK, Kilpatrick DG, Gros DF, Gaboury MT et al. \(2009\) Posttyphoon prevalence of )] TJ ET
BT 26.250 192.000 Td /F1 9.8 Tf  [(posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety disorder in a Vietnamese )] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(sample. Journal of Traumatic Stress; 22\(3\):180-188.)] TJ ET
BT 26.250 160.691 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 160.691 Td /F1 9.8 Tf  [(Dewaraja R, Kawamura N. \(2006\)Trauma intensity and posttraumatic stress: Implications of the tsunami experience in Sri )] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(Lanka for the management of future disasters. 1287, 69-73.)] TJ ET
BT 26.250 129.381 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 129.381 Td /F1 9.8 Tf  [(Nitschke M, Einsle F, Lippmann C, Simonis G, Kollner V, Strasser R. \(2006\) Emergency evacuation of the Dresden Heart )] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(Centre in the flood disaster in Germany 2002: Perceptions of patients and psychosocial burdens. International Journal of )] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(Disaster Medicine; 4\(3\):118-124.)] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 86.167 Td /F1 9.8 Tf  [(Heo JH, Kim MH, Koh SB, Noh S, Park JH, Ahn JS et al. \(2008\) A prospective study on changes in health status following )] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(flood disaster. Psychiatry Investigation; 5\(3\):186-192.)] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 54.858 Td /F1 9.8 Tf  [(Carroll B, Morbey H, Balogh R, Araoz G. \(2009\) Flooded homes, broken bonds, the meaning of home, psychological )] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(11)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 31.677 577.500 745.323 re W n
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BT 26.250 767.476 Td /F1 9.8 Tf  [(processes and their impact on psychological health in a disaster. Health and Place; 15\(2\):540-547.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Stimpson JP, Wilson FA, Jeffries SK. \(2008\) Seeking help for disaster services after a flood. Disaster Medicine and Public )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Health Preparedness; 2\(3\):139-141.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Stimpson JP. \(2006\) Short communication: Prospective evidence for a reciprocal relationship between sense of control and )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(depressive symptoms following a flood. Stress and Health; 22\(3\):161-166.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Taft CT, Monson CM, Schumm JA, Watkins LE, Panuzio J, Resick PA. \(2009\) Posttraumatic stress disorder symptoms, )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(relationship adjustment, and relationship aggression in a sample of female flood victims. Journal of Family Violence; 24\(6\):389-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(396.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 642.238 Td /F1 9.8 Tf  [(North CS, Kawasaki A, Spitznagel EL, Hong BA. \(2004\)The course of PTSD, major depression, substance abuse, and )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(somatization after a natural disaster. Journal of Nervous and Mental Disease; 192\(12\):823-829.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 610.929 Td /F1 9.8 Tf  [(Di Fiorino M, Massimetti G, Corretti G, Paoli RA. \(2005\) Post traumatic stress psychopathology 8 years after a flooding in )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(Italy. Bridging Eastern and Western Psychiatry; 3\(1\):49-57.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 579.619 Td /F1 9.8 Tf  [(Hayes J, Mason J, Brown F, Mather R. \(2009\) Floods in 2007 and older adult services: Lessons learnt. Psychiatric Bulletin; )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(33\(9\):332-336.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 548.310 Td /F1 9.8 Tf  [(Paranjothy S, Gallacher J, Amlot R, Rubin G J, Page L, Baxter T et al. \(2011\) Psychosocial impact of the summer 2007 )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(flood in England. BMC Public Health; 11\(145\).)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 517.000 Td /F1 9.8 Tf  [(Tunstall S, Tapsell S, Green C, Floyd P, George C. \(2006\) The health effects of flooding: Social research results from )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(England and Wales. Journal of Water and Health; 4\(3\):365-380.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee \(IASC\).\(2010\) Mental Health and Psychosocial Support in Humanitarian Emergencies: )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(What Should Humanitarian Health Actors Know? Geneva. IASC Reference Group for Mental Health and Psychosocial Support )] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(in Emergency Settings.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 442.476 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Social Impact Conceptual Model and Framework. D1.2.3.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Health Impact Conceptual Model. D1.1.4.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(MICRODIS Health Working Group. \(2008\)The health and health care system impacts of earthquakes, windstorms and )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(floods � A systematic review.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Department of Health Emergency Preparedness Division. \(2009\) NHS Emergency Planning Guidance: Planning for the )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(psychosocial and mental health care of people affected by major incidents and disasters: Interim national strategic guidance.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 351.967 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 333.417 Td /F1 9.8 Tf  [(60.)] TJ ET
BT 43.553 333.417 Td /F1 9.8 Tf  [(Williams R, Bisson J, Ajdukovic D, Kemp V, Olff M, Alexander D et al. \(2009\) Guidance for Responding to the Psychosocial )] TJ ET
BT 26.250 321.512 Td /F1 9.8 Tf  [(and Mental Health Needs of People Affected by Disasters or Major Incidents. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 313.026 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 294.476 Td /F1 9.8 Tf  [(61.)] TJ ET
BT 43.553 294.476 Td /F1 9.8 Tf  [(CDC Centers for Disease Control and Prevention. Coping with a disaster or traumatic event. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 285.990 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 267.440 Td /F1 9.8 Tf  [(62.)] TJ ET
BT 43.553 267.440 Td /F1 9.8 Tf  [(UCLA Center for Public Health and Disasters. PsySTART rapid mental health triage and incident management system. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 258.954 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 240.404 Td /F1 9.8 Tf  [(63.)] TJ ET
BT 43.553 240.404 Td /F1 9.8 Tf  [(Whittle R, Medd W, Deeming H, Kashefi E, Mort M, Twigger Ross C et al. \(2010\) After the Rain - learning the lessons from )] TJ ET
BT 26.250 228.499 Td /F1 9.8 Tf  [(flood recovery in Hull. Final project report for 'Flood, Vulnerability and Urban Resilience: a real-time study of local recovery )] TJ ET
BT 26.250 216.594 Td /F1 9.8 Tf  [(following the floods of June 2007 in Hull'. Lancaster UK, Lancaster University.)] TJ ET
BT 26.250 197.190 Td /F1 9.8 Tf  [(64.)] TJ ET
BT 43.553 197.190 Td /F1 9.8 Tf  [(NATO Joint Medical Committee. \(2008\) Psychosocial Care for People Affected by Disasters and Major Incidents: A Model )] TJ ET
BT 26.250 185.285 Td /F1 9.8 Tf  [(for Designing, Delivering and Managing Psychosocial Services for People Involved in Major Incidents, Conflicts, Disasters and )] TJ ET
BT 26.250 173.380 Td /F1 9.8 Tf  [(Terrorism. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 164.894 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 146.344 Td /F1 9.8 Tf  [(65.)] TJ ET
BT 43.553 146.344 Td /F1 9.8 Tf  [(HM Government Department of Health. \(2010\) Healthy Lives, Healthy People: Our strategy for public health in England.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 137.858 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 119.308 Td /F1 9.8 Tf  [(66.)] TJ ET
BT 43.553 119.308 Td /F1 9.8 Tf  [(Kent M, Davis M, Stark S, Stewart L. \(2011\) A resilience-orientated treatment for posttraumatic stress disorder: results of a )] TJ ET
BT 26.250 107.403 Td /F1 9.8 Tf  [(preliminary randomized clinical trial. Journal of Traumatic Stress; 24\(5\):591-595.)] TJ ET
BT 26.250 87.999 Td /F1 9.8 Tf  [(67.)] TJ ET
BT 43.553 87.999 Td /F1 9.8 Tf  [(PRISMA: Transparent Reporting of Systematic Reviews and Meta-Analyses.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 79.513 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
Q
q
15.000 31.677 577.500 745.323 re W n
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BT 26.250 767.476 Td /F1 9.8 Tf  [(processes and their impact on psychological health in a disaster. Health and Place; 15\(2\):540-547.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Stimpson JP, Wilson FA, Jeffries SK. \(2008\) Seeking help for disaster services after a flood. Disaster Medicine and Public )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Health Preparedness; 2\(3\):139-141.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Stimpson JP. \(2006\) Short communication: Prospective evidence for a reciprocal relationship between sense of control and )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(depressive symptoms following a flood. Stress and Health; 22\(3\):161-166.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Taft CT, Monson CM, Schumm JA, Watkins LE, Panuzio J, Resick PA. \(2009\) Posttraumatic stress disorder symptoms, )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(relationship adjustment, and relationship aggression in a sample of female flood victims. Journal of Family Violence; 24\(6\):389-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(396.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 642.238 Td /F1 9.8 Tf  [(North CS, Kawasaki A, Spitznagel EL, Hong BA. \(2004\)The course of PTSD, major depression, substance abuse, and )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(somatization after a natural disaster. Journal of Nervous and Mental Disease; 192\(12\):823-829.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 610.929 Td /F1 9.8 Tf  [(Di Fiorino M, Massimetti G, Corretti G, Paoli RA. \(2005\) Post traumatic stress psychopathology 8 years after a flooding in )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(Italy. Bridging Eastern and Western Psychiatry; 3\(1\):49-57.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 579.619 Td /F1 9.8 Tf  [(Hayes J, Mason J, Brown F, Mather R. \(2009\) Floods in 2007 and older adult services: Lessons learnt. Psychiatric Bulletin; )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(33\(9\):332-336.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 548.310 Td /F1 9.8 Tf  [(Paranjothy S, Gallacher J, Amlot R, Rubin G J, Page L, Baxter T et al. \(2011\) Psychosocial impact of the summer 2007 )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(flood in England. BMC Public Health; 11\(145\).)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 517.000 Td /F1 9.8 Tf  [(Tunstall S, Tapsell S, Green C, Floyd P, George C. \(2006\) The health effects of flooding: Social research results from )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(England and Wales. Journal of Water and Health; 4\(3\):365-380.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee \(IASC\).\(2010\) Mental Health and Psychosocial Support in Humanitarian Emergencies: )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(What Should Humanitarian Health Actors Know? Geneva. IASC Reference Group for Mental Health and Psychosocial Support )] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(in Emergency Settings.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 442.476 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Social Impact Conceptual Model and Framework. D1.2.3.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Health Impact Conceptual Model. D1.1.4.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(MICRODIS Health Working Group. \(2008\)The health and health care system impacts of earthquakes, windstorms and )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(floods � A systematic review.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Department of Health Emergency Preparedness Division. \(2009\) NHS Emergency Planning Guidance: Planning for the )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(psychosocial and mental health care of people affected by major incidents and disasters: Interim national strategic guidance.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 351.967 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 333.417 Td /F1 9.8 Tf  [(60.)] TJ ET
BT 43.553 333.417 Td /F1 9.8 Tf  [(Williams R, Bisson J, Ajdukovic D, Kemp V, Olff M, Alexander D et al. \(2009\) Guidance for Responding to the Psychosocial )] TJ ET
BT 26.250 321.512 Td /F1 9.8 Tf  [(and Mental Health Needs of People Affected by Disasters or Major Incidents. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 313.026 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 294.476 Td /F1 9.8 Tf  [(61.)] TJ ET
BT 43.553 294.476 Td /F1 9.8 Tf  [(CDC Centers for Disease Control and Prevention. Coping with a disaster or traumatic event. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 285.990 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 267.440 Td /F1 9.8 Tf  [(62.)] TJ ET
BT 43.553 267.440 Td /F1 9.8 Tf  [(UCLA Center for Public Health and Disasters. PsySTART rapid mental health triage and incident management system. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 258.954 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 240.404 Td /F1 9.8 Tf  [(63.)] TJ ET
BT 43.553 240.404 Td /F1 9.8 Tf  [(Whittle R, Medd W, Deeming H, Kashefi E, Mort M, Twigger Ross C et al. \(2010\) After the Rain - learning the lessons from )] TJ ET
BT 26.250 228.499 Td /F1 9.8 Tf  [(flood recovery in Hull. Final project report for 'Flood, Vulnerability and Urban Resilience: a real-time study of local recovery )] TJ ET
BT 26.250 216.594 Td /F1 9.8 Tf  [(following the floods of June 2007 in Hull'. Lancaster UK, Lancaster University.)] TJ ET
BT 26.250 197.190 Td /F1 9.8 Tf  [(64.)] TJ ET
BT 43.553 197.190 Td /F1 9.8 Tf  [(NATO Joint Medical Committee. \(2008\) Psychosocial Care for People Affected by Disasters and Major Incidents: A Model )] TJ ET
BT 26.250 185.285 Td /F1 9.8 Tf  [(for Designing, Delivering and Managing Psychosocial Services for People Involved in Major Incidents, Conflicts, Disasters and )] TJ ET
BT 26.250 173.380 Td /F1 9.8 Tf  [(Terrorism. )] TJ ET
0.267 0.267 0.267 rg
BT 26.250 164.894 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 146.344 Td /F1 9.8 Tf  [(65.)] TJ ET
BT 43.553 146.344 Td /F1 9.8 Tf  [(HM Government Department of Health. \(2010\) Healthy Lives, Healthy People: Our strategy for public health in England.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 137.858 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 119.308 Td /F1 9.8 Tf  [(66.)] TJ ET
BT 43.553 119.308 Td /F1 9.8 Tf  [(Kent M, Davis M, Stark S, Stewart L. \(2011\) A resilience-orientated treatment for posttraumatic stress disorder: results of a )] TJ ET
BT 26.250 107.403 Td /F1 9.8 Tf  [(preliminary randomized clinical trial. Journal of Traumatic Stress; 24\(5\):591-595.)] TJ ET
BT 26.250 87.999 Td /F1 9.8 Tf  [(67.)] TJ ET
BT 43.553 87.999 Td /F1 9.8 Tf  [(PRISMA: Transparent Reporting of Systematic Reviews and Meta-Analyses.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 79.513 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
Q
q
15.000 31.677 577.500 745.323 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(processes and their impact on psychological health in a disaster. Health and Place; 15\(2\):540-547.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 748.071 Td /F1 9.8 Tf  [(Stimpson JP, Wilson FA, Jeffries SK. \(2008\) Seeking help for disaster services after a flood. Disaster Medicine and Public )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Health Preparedness; 2\(3\):139-141.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 716.762 Td /F1 9.8 Tf  [(Stimpson JP. \(2006\) Short communication: Prospective evidence for a reciprocal relationship between sense of control and )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(depressive symptoms following a flood. Stress and Health; 22\(3\):161-166.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Taft CT, Monson CM, Schumm JA, Watkins LE, Panuzio J, Resick PA. \(2009\) Posttraumatic stress disorder symptoms, )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(relationship adjustment, and relationship aggression in a sample of female flood victims. Journal of Family Violence; 24\(6\):389-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(396.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 642.238 Td /F1 9.8 Tf  [(North CS, Kawasaki A, Spitznagel EL, Hong BA. \(2004\)The course of PTSD, major depression, substance abuse, and )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(somatization after a natural disaster. Journal of Nervous and Mental Disease; 192\(12\):823-829.)] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 610.929 Td /F1 9.8 Tf  [(Di Fiorino M, Massimetti G, Corretti G, Paoli RA. \(2005\) Post traumatic stress psychopathology 8 years after a flooding in )] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(Italy. Bridging Eastern and Western Psychiatry; 3\(1\):49-57.)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 579.619 Td /F1 9.8 Tf  [(Hayes J, Mason J, Brown F, Mather R. \(2009\) Floods in 2007 and older adult services: Lessons learnt. Psychiatric Bulletin; )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(33\(9\):332-336.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 548.310 Td /F1 9.8 Tf  [(Paranjothy S, Gallacher J, Amlot R, Rubin G J, Page L, Baxter T et al. \(2011\) Psychosocial impact of the summer 2007 )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(flood in England. BMC Public Health; 11\(145\).)] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 517.000 Td /F1 9.8 Tf  [(Tunstall S, Tapsell S, Green C, Floyd P, George C. \(2006\) The health effects of flooding: Social research results from )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(England and Wales. Journal of Water and Health; 4\(3\):365-380.)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 485.691 Td /F1 9.8 Tf  [(Inter-Agency Standing Committee \(IASC\).\(2010\) Mental Health and Psychosocial Support in Humanitarian Emergencies: )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(What Should Humanitarian Health Actors Know? Geneva. IASC Reference Group for Mental Health and Psychosocial Support )] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(in Emergency Settings.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 442.476 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Social Impact Conceptual Model and Framework. D1.2.3.)] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 423.072 Td /F1 9.8 Tf  [(MICRODIS. \(2008\) Health Impact Conceptual Model. D1.1.4.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(MICRODIS Health Working Group. \(2008\)The health and health care system impacts of earthquakes, windstorms and )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(floods � A systematic review.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Department of Health Emergency Preparedness Division. \(2009\) NHS Emergency Planning Guidance: Planning for the )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(psychosocial and mental health care of people affected by major incidents and disasters: Interim national strategic guidance.)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 351.967 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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