From Valencia to Understanding the Mental Health Impacts of Floods on Children and Young People

In October 2024, Eastern Spain, particularly the region of Valencia, experienced one of the most devastating floods of this century in Europe. The heavy rains caused more than 200 deaths, left people trapped in their homes and vehicles, and many were reported missing. Material damage, some persisting months later, included the destruction of private property and public infrastructure such as bridges, along with road and rail closures, and interruptions to essential services like water, electricity, and telecommunications (AEBOE, 2024).

Floods are the most common type of natural disaster, with 1.81 billion people facing significant flood risk worldwide, particularly in low- and middle-income countries (Rentschler J. et al, 2022). Among those affected, children and young people are especially vulnerable due to limited coping strategies compared to adults and high dependence on caregivers (EEA, 2024). Despite this, research on the impacts of floods on their mental health remains scarce (Fernandez A. et al, 2015).

Impact of Floods on the Mental Health of Children and Young People

In the immediate aftermath of a flood, children and young people often experience acute emotional reactions, including extreme fear, helplessness, tension, feelings of loss, and sadness. Over the longer term, children and young people affected by floods are at a higher risk of developing mental health issues, including increased levels of post-traumatic stress disorder (PTSD), anxiety, depression, inattention, sleep disturbances and behavioural difficulties. Severe stress and fears about future floods have also been reported (Ali A. et al, 2024; Fernandez A. et al, 2015; Hieronimi A. et al, 2022; Philip N.A. & Vithya V., 2023; Spencer G. & Thompson J., 2024; Stanke C. et al, 2012).

These mental health effects can persist for years, sometimes extending into adulthood. For instance, recurring anxiety during heavy rains years after the flood, and increased suicidal ideation and attempts in young adults exposed to floods during childhood have been reported (Fernandez A. et al, 2015; Hieronimi A. et al, 2022; Schurr A. et al, 2023).

Not only is the mental health of growing children affected, but prenatal exposure to floods and the associated maternal psychological distress have been associated with worse socio-emotional, behavioural, and sleep outcomes, and an increased risk of autistic-like traits in children (Lafortune S. et al, 2021; Lapierre M. et al, 2024).

“In the immediate aftermath of a flood, children and young people often experience acute emotional reactions, including extreme fear, helplessness, tension, feelings of loss, and sadness.”

Stressors, Risk and Protective Factors

Flood-Related factors

Higher exposure to trauma during a flood is associated with worse mental health outcomes (Bokszczanin A., 2007). Significant stressors include physical separation from family members, power outages disrupting communication, and having to reach safety on their own or being rescued. The flooding itself and the subsequent days are particularly stressful, and repeated exposure to floods further exacerbates mental health challenges (Ali A. et al, 2024; Hieronimi A. et al, 2022; Schurr A. et al, 2023; Spencer G. & Thompson J., 2024).

Loss and Damage

Psychological distress following a flood is closely tied to the degree of loss experienced. The loss of family members or friends is a significant factor contributing to emotional distress in children and young people (Cheema H.A. et al, 2023; Hieronimi A. et al, 2022). Housing-related consequences, such as damage to homes, displacement, or relocation, also represent major sources of distress, as they signify the loss of a familiar place. Missing school days, changing schools or losing access to educational facilities disrupt daily routines and reduce opportunities for socialisation, which carry psychological consequences (Ali A. et al, 2024; EEA, 2024; Hieronimi A. et al, 2022; Schurr A. et al, 2023; Spencer G. & Thompson J., 2024). Finally, the loss of pets and small personal possessions, such as study materials, also represents a challenge (Ali A. et al, 2024; Philip N.A. & Vithya V., 2023; Spencer G. & Thompson J., 2024).

Social Environment

The direct social environment of children and adolescents acts as both a risk factor and a protective factor, shaping how they handle the impacts of a flood. Parents’ mental health and coping ability significantly influence their children’s wellbeing and the support they can provide to them. Children’s reactions often revolve around concern for their relatives, and they may internalise parental worries, such as financial difficulties resulting from the flood (Hieronimi A. et al, 2022; Lee M.H. et al, 2021; Philip N.A. & Vithya V., 2023; Spencer G. & Thompson J., 2024). Family conflict and overprotectiveness have been associated with an increased risk of PTSD symptoms (Bokszczanin A., 2008). Conversely, family support and open communication serve as protective factors (Fernandez A. et al, 2015; Schurr A. et al, 2023). Teachers and educators play a vital role in identifying children’s mental health concerns and act as intermediaries for support. Additionally, solidarity and encouragement from the broader community can foster resilience and a sense of shared hardship (Hieronimi A. et al, 2022; Rother H.-A. et al, 2022).

Pre-existing Vulnerabilities and Preparedness

Girls tend to experience higher levels of psychological distress following a flood, although evidence on age-related trends is mixed (Ali A. et al, 2024; Bokszczanin A., 2007; Rother H.-A. et al, 2022). Economic disadvantage and pre-existing mental health issues also heighten vulnerability (Clemens V. et al, 2022; Fernandez A. et al, 2015). Children and young people often lack disaster preparedness, such as understanding evacuation procedures, increasing their sense of fear and vulnerability (Spencer G. & Thompson J., 2024).

“The direct social environment of children and adolescents acts as both a risk factor and a protective factor, shaping how they handle the impacts of a flood.”

Implications for Policy and Practice

Given the increasing global flood risks accentuated by climate change and risky urbanisation patterns, mental health policies for children and young people are urgently needed in flood response efforts (Cheema H.A. et al, 2023; Rentschler J. et al, 2022). Providing psychosocial support can help prevent long-lasting impacts. In addition to general flood response measures that indirectly benefit children and young people, specific recommendations for this group include:

• Enhanced mental health services: Provide immediate and long-term support, including psychological first aid, crisis intervention and ongoing, accessible support (e.g., school-based interventions, tele-counselling).
• Family-centred support: Provide developmentally appropriate resources for caregivers to support children, train first responders to address children’s needs while assisting parents, issue warnings to ensure children remain with caregivers during floods and develop family interventions addressing the interconnected experiences of children and their families.
• Promote a sense of ‘normalcy’: Restore daily routines and reopen schools and sports clubs as soon as possible.
• Educational initiatives: Introduce disaster preparedness programmes in schools and communities to educate families about extreme weather events and effective responses.
• Support for vulnerable populations: Provide specialised support for vulnerable groups, recognising the intersectionality of disadvantages.
• Include children in recovery planning: Involve children in clean-up efforts, relief work or flood preparation to foster their sense of agency, while being mindful of their wellbeing and avoiding placing ‘adult’ responsibilities on them.
• Further research: Invest in research exploring the impacts of floods on children and young people’s mental health, including specific subgroups (e.g., ethnic minorities, rural areas), and the effectiveness of interventions.

These strategies address the immediate and long-term psychosocial needs of children and young people affected by floods (EEA, 2024; Hieronimi A. et al, 2022; Philip N.A. & Vithya V., 2023; Schurr A. et al, 2023; Spencer G. & Thompson J., 2024). Since preparedness, response and recovery depend on the resources available and the unique impacts of floods on different contexts, governmental institutions must ensure sufficient and context-specific resources are allocated.

NB this blog has been peer-reviewed

References

• AEBOE. (2024). Real Decreto-ley 6/2024, de 5 de noviembre, por el que se adoptan medidas urgentes de respuesta ante los daños causados por la Depresión Aislada en Niveles Altos (DANA) en diferentes municipios entre el 28 de octubre y el 4 de noviembre de 2024. Agencia Estatal Boletín Oficial del Estado
• Ali, A., Rahman, F., Sarwar, Z., and Abbas, S. (2024). Behavior Problem and Mental Health of Children Affected by Floods-2022 in Pakistan. Journal of Loss and Trauma, 1-26. https://doi.org/10.1080/15325024.2024.2390445
• Bokszczanin, A. (2007). PTSD symptoms in children and adolescents 28 months after a flood: age and gender differences. J Trauma Stress, 20(3), 347-351. https://doi.org/10.1002/jts.20220
• Bokszczanin, A. (2008). Parental support, family conflict, and overprotectiveness: predicting PTSD symptom levels of adolescents 28 months after a natural disaster. Anxiety Stress Coping, 21(4), 325-335. https://doi.org/10.1080/10615800801950584
• Cheema, H. A., Rehan, S. T., Shahid, A., Head, M. G., Jawad, M. Y., and Shah, J. (2023). The mental health of children in flood-affected areas in Pakistan needs urgent attention. Lancet Psychiatry, 10(1), 7. https://doi.org/10.1016/S2215-0366(22)00381-9
• Clemens, V., von Hirschhausen, E., and Fegert, J. M. (2022). Report of the intergovernmental panel on climate change: implications for the mental health policy of children and adolescents in Europe-a scoping review. Eur Child Adolesc Psychiatry, 31(5), 701-713. https://doi.org/10.1007/s00787-020-01615-3
• EEA. (2024). Responding to climate change impacts on human health in Europe: focus on floods, droughts and water quality. EEA Report 3/2024. European Environment Agency.
• Fernandez, A., Black, J., Jones, M., Wilson, L., Salvador-Carulla, L., Astell-Burt, T., and Black, D. (2015). Flooding and mental health: a systematic mapping review. PLoS One, 10(4), e0119929. https://doi.org/10.1371/journal.pone.0119929
• Hieronimi, A., Elbel, J., Schneider, M., Wermuth, I., Schulte-Korne, G., Nowak, D., and Bose-O’Reilly, S. (2022). A Qualitative Study to Explain the Factors Influencing Mental Health after a Flooding. Int J Environ Res Public Health, 20(1). https://doi.org/10.3390/ijerph20010134
• Lafortune, S., Laplante, D. P., Elgbeili, G., Li, X., Lebel, S., Dagenais, C., and King, S. (2021). Effect of Natural Disaster-Related Prenatal Maternal Stress on Child Development and Health: A Meta-Analytic Review. Int J Environ Res Public Health, 18(16). https://doi.org/10.3390/ijerph18168332
• Lapierre, M., Elgbeili, G., Laplante, D. P., O’Hara, M. W., D’Antono, B., and King, S. (2024). Prenatal maternal subjective distress predicts higher autistic-like traits in offspring: The Iowa Flood Study. Dev Psychopathol, 1-13. https://doi.org/10.1017/S0954579424001494
• Lee, M. H., Pfefferbaum, B., Portley, R., Kotamarti, V., Canan, F., and North, C. S. (2021). The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin. Behav Sci (Basel), 11(4). https://doi.org/10.3390/bs11040046
• Philip, N. A., and Vithya, V. (2023). Impact of flooding on mental health and resilience of adolescents in Kerala, India. International Journal of Disaster Risk Reduction, 96. https://doi.org/10.1016/j.ijdrr.2023.103926
• Rentschler, J., Salhab, M., and Jafino, B. A. (2022). Flood exposure and poverty in 188 countries. Nat Commun, 13(1), 3527. https://doi.org/10.1038/s41467-022-30727-4
• Rother, H.-A., Hayward, R. A., Paulson, J. A., Etzel, R. A., Shelton, M., and Theron, L. C. (2022). Impact of extreme weather events on Sub-Saharan African child and adolescent mental health: The implications of a systematic review of sparse research findings✰. The Journal of Climate Change and Health, 5. https://doi.org/10.1016/j.joclim.2021.100087
• Schurr, A., Elbel, J., Hieronimi, A., Auer, I., Coenen, M., and Bose-O’Reilly, S. (2023). Mental health in adolescents after experiencing a flood event in Bavaria, Germany-A qualitative interview study. Front Public Health, 11, 1210072. https://doi.org/10.3389/fpubh.2023.1210072
• Spencer, G., and Thompson, J. (2024). Children and young people’s perspectives on disasters – Mental health, agency and vulnerability: A scoping review. International Journal of Disaster Risk Reduction, 108. https://doi.org/10.1016/j.ijdrr.2024.104495
• Stanke, C., Murray, V., Amlot, R., Nurse, J., and Williams, R. (2012). The effects of flooding on mental health: Outcomes and recommendations from a review of the literature. PLoS Curr, 4, e4f9f1fa9c3cae. https://doi.org/10.1371/4f9f1fa9c3cae

About the author

Dr. Ariadna Albajara Sáenz is a Research Associate at the Department of Psychiatry at the University of Cambridge, working in Professor Tamsin Ford’s group, the Child and Adolescent Resilience and Mental Health Team. Her research focuses on school-based interventions, schoolteachers’ mental health, SEND (special educational needs and disability) provision, and children’s mental health across countries.