Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents’ barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.<br /><br />Key messages<br /><ul><li>Recruitment and retention of longitudinal study participants is challenging following a natural disaster.</li><br /><li>The long-lasting, global effects of the Covid 19 pandemic will increase this problem.</li><br /><li>Longitudinal study researchers should develop protocols to support retention before a disaster occurs.</li><br /><li>Researchers need to be pragmatic and flexible in the design and implementation of their studies.</li></ul>
Understanding posttraumatic stress disorder (PTSD) symptoms in police first-responders is an underdeveloped field. Using a cross-sectional survey, this study investigated demographic and occupational characteristics, coping resources and processes, along with first-responder roles and consequences 18 months following a disaster. Hierarchical linear regression (N = 576) showed that greater symptom levels were significantly positively associated with negative emotional coping (β = .31), a communications role (β = .08) and distress following exposure to resource losses (β = .14), grotesque scenes (β = .21), personal harm (β = .14), and concern for significant others (β = .17). Optimism alone was negatively associated (β=−15), with the overall model being a modest fit (adjusted R2 = .39). The findings highlight variables for further study in police.
There has not been substantial research conducted in the area of fraud and natural disasters. Therefore, this study sought to examine the perceptions of Canterbury residents toward the recovery process following the September 2010 and February 2011 earthquakes and whether residents felt as though contractor fraud occurs in Canterbury. A questionnaire was developed to gauge information about Canterbury residents’ self-reports involving the earthquakes, specific contractors involved, parties involved with the recovery process in general, and demographic information. Participants included a total of 213 residents from the Canterbury region who had been involved with contractors and/or insurance companies due to the recovery process. Results indicated that a high percentage of the participants were not satisfied with the recovery process and that almost half of the participants reported feeling scammed by contractors in Canterbury after the 2010 and 2011 earthquakes. Moreover, the results indicate that participants neither agreed with the assessments made about their property losses nor the plans made to recover their properties. In many cases, participants felt pressured and even reluctant to accept these assessments and/or plans. The present study does not seek to explain why contractor fraud exists or what motivates scammers. Conversely, it attempts to demonstrate the perceptions of contractor fraud and satisfaction that have taken place in the aftermath of the Canterbury earthquakes.
The question of whether forced relocation is beneficial or detrimental to the displaced households is a controversial and important policy question. After the 2011 earthquake in Christchurch, the government designated some of the worst affected areas as Residential Red Zones. Around 20,000 people were forced to move out of these Residential Red Zone areas, and were compensated for that. The objective of this paper is twofold. First, we aim to estimate the impact of relocation on the displaced households in terms of their income, employment, and their mental and physical health. Second, we evaluate whether the impact of relocation varies by the timing of to move, the destination (remaining within the Canterbury region or moving out of it) and demographic factors (gender, age, ethnicity). StatisticsNZ’s Integrated Data Infrastructure (IDI) from 2008 to 2017, which includes data on all households in Canterbury, and a difference-in-difference (DID) technique is used to answer these questions. We find that relocation has a negative impact on the income of the displaced household group. This adverse impact is more severe for later movers. Compared to the control group (that was not relocated), the income of relocated households was reduced by 3% for people who moved immediately after the earthquake in 2011, and 14% for people who moved much later in 2015.
Earthquake events can be sudden, stressful, unpredictable, and uncontrollable events in which an individual’s internal and external assumptions of their environment may be disrupted. A number of studies have found depression, and other psychological symptoms may be common after natural disasters. They have also found an association between depression, losses and disruptions for survivors. The present study compared depression symptoms in two demographically matched communities differentially affected by the Canterbury (New Zealand) earthquakes. Hypotheses were informed by the theory of learned helplessness (Abramson, Seligman & Teasdale, 1978). A door-to-door survey was conducted in a more physically affected community sample (N=67) and a relatively unaffected community sample (N=67), 4 months after the February 2011 earthquake. Participants were again assessed approximately 10 months after the quake. Measures of depression, acute stress, anxiety, aftershock anxiety, losses, physical disruptions and psychological disruptions were taken. In addition, prior psychological symptoms, medication, alcohol and cigarette use were assessed. Participants in the more affected community reported higher depression scores than the less affected community. Overall, elevated depressive score at time 2 were predicted by depression at time 1, acute stress and anxiety symptoms at time 2, physical disruptions following the quake and psychosocial functioning disruptions at time 2. These results suggest the influence of acute stress, anxiety and disruptions in predicting depression sometime after an earthquake. Supportive interventions directed towards depression, and other psychological symptoms, may prove helpful in psychological adjustment following ongoing disruptive stressors and uncontrollable seismic activity.
The 2010-2011 Canterbury Earthquakes brought devastation to the city of Christchurch and has irrevocably affected the lives of the city’s residents. Years after the conclusion of these earthquakes, Christchurch and its residents are well on the path to recovery. Crime has proven an ongoing topic of discussion throughout this period, with news reports of increased burglary and arson in areas left largely abandoned by earthquake damage, and a rise in violent crime in suburban areas of Christchurch. Following the body of research that has considered the reaction of crime to natural disasters, this research has sought to comprehensively examine and understand the effects that the Canterbury Earthquakes had on crime. Examining Christchurch-wide offending, crime rates fell over the study period (July 2008 to June 2013), with the exception of domestic violence. Aside from a momentary increase in burglary in the days immediately following the Christchurch Earthquake, crime rates (as of 2013) have remained largely below pre-earthquake levels. Using Dual Kernel Density Estimation Analysis, a distinct spatial change in pre-earthquake crime hotspots was observed. These changes included an enormous decrease in central city offences, a rise in burglary in the eastern suburbs, and an increase in assault in areas outside of the central city. Logistic regression analysis, using a time-compensated dependent variable, identified a number of statistically-significant relationships between per CAU crime rate change and factors measuring socio-demographic characteristics, community cohesion, and the severity of disaster effects. The significance of these findings was discussed using elements of Social Disorganisation Theory, Routine Activity Theory, and Strain Theory. Consistent with past findings, social order was largely maintained following the Canterbury Earthquakes, with suggestion that increased collective efficacy and therapeutic communities had a negative influence on crime in the post-earthquake period. Areas of increased burglary and assault were associated with large population decreases, suggesting a link with the dissolution of communities and the removal of their inherent informal guardianship. Though observed, the increase in domestic violence was not associated with most neighbourhood-level variables. Trends in crime after the Canterbury Earthquakes were largely consistent with past research, and the media’s portrayal.
Christchurch has experienced a series of over 13,500 earthquakes between September 2010 and January 2012. Some children who have been exposed to earthquakes may experience post-traumatic stress disorder symptoms (PTSD) including difficulty concentrating, feeling anxious, restlessness and confusion. Other children may be resilient to the effects of disaster. Western models of resilience relate to a child’s social support and their capacity to cope. The Māori model of wellbeing relates to whanau (family), wairua (spiritual connections), tinana (the physical body) and hinengaro (the mind and emotions). Children’s concepts of helping, caring and learning may provide insight into resilience without introducing the topic of earthquakes into the conversation, which in itself may provoke an episode of stress. Many researchers have studied the effects of earthquakes on children. However, few studies have examined positive outcomes and resilience or listened to the children’s voices. The objective of this study was to listen to the voices of children who experienced the Canterbury earthquake period in order to gain a deeper understanding of the ideas associated resilience. Individual interviews were conducted with 17 five-year-old participants during their first term of primary school. After the interviews, the teacher shared demographic information and reports on the children’s stress and coping. Six children were identified as New Zealand European and eleven children identified as New Zealand Māori. Children had different views of helping, caring and learning. Themes of resilience from Western and Kaupapa Māori models were identified in transcripts of the children's voices and drawings. Māori children voiced more themes of resilience associated with the Western model, and in the Tapa Whā model, Māori children's transcripts were more likely to be inclusive of all four components of well-being. How five-year-old children, having experienced an earthquake disaster during their preschool years, talk or draw pictures about helping, caring and learning can provide insight into resilience, especially in situations where it is not advisable to re-traumatise children by discussing the disaster event. Future research should interview parents/caregivers and whānau to gain further insights. Considering information from both a Western and a Tapa Whā perspective can also provide new insights into resilience in young children. A limitation of this study is that qualitative studies are not always free from a researcher’s interpretation and are, therefore, subjective.
In September 2010 and February 2011, the Canterbury region experienced devastating earthquakes with an estimated economic cost of over NZ$40 billion (Parker and Steenkamp, 2012; Timar et al., 2014; Potter et al., 2015). The insurance market played an important role in rebuilding the Canterbury region after the earthquakes. Homeowners, insurance and reinsurance markets and New Zealand government agencies faced a difficult task to manage the rebuild process. From an empirical and theoretic research viewpoint, the Christchurch disaster calls for an assessment of how the insurance market deals with such disasters in the future. Previous studies have investigated market responses to losses in global catastrophes by focusing on the insurance supply-side. This study investigates both demand-side and supply-side insurance market responses to the Christchurch earthquakes. Despite the fact that New Zealand is prone to seismic activities, there are scant previous studies in the area of earthquake insurance. This study does offer a unique opportunity to examine and document the New Zealand insurance market response to catastrophe risk, providing results critical for understanding market responses after major loss events in general. A review of previous studies shows higher premiums suppress demand, but how higher premiums and a higher probability of risk affect demand is still largely unknown. According to previous studies, the supply of disaster coverage is curtailed unless the market is subsidised, however, there is still unsettled discussion on why demand decreases with time from the previous disaster even when the supply of coverage is subsidised by the government. Natural disaster risks pose a set of challenges for insurance market players because of substantial ambiguity associated with the probability of such events occurring and high spatial correlation of catastrophe losses. Private insurance market inefficiencies due to high premiums and spatially concentrated risks calls for government intervention in the provision of natural disaster insurance to avert situations of noninsurance and underinsurance. Political economy considerations make it more likely for government support to be called for if many people are uninsured than if few people are uninsured. However, emergency assistance for property owners after catastrophe events can encourage most property owners to not buy insurance against natural disaster and develop adverse selection behaviour, generating larger future risks for homeowners and governments. On the demand-side, this study has developed an intertemporal model to examine how demand for insurance changes post-catastrophe, and how to model it theoretically. In this intertemporal model, insurance can be sought in two sequential periods of time, and at the second period, it is known whether or not a loss event happened in period one. The results show that period one demand for insurance increases relative to the standard single period model when the second period is taken into consideration, period two insurance demand is higher post-loss, higher than both the period one demand and the period two demand without a period one loss. To investigate policyholders experience from the demand-side perspective, a total of 1600 survey questionnaires were administered, and responses from 254 participants received representing a 16 percent response rate. Survey data was gathered from four institutions in Canterbury and is probably not representative of the entire population. The results of the survey show that the change from full replacement value policy to nominated replacement value policy is a key determinant of the direction of change in the level of insurance coverage after the earthquakes. The earthquakes also highlighted the plight of those who were underinsured, prompting policyholders to update their insurance coverage to reflect the estimated cost of re-building their property. The survey has added further evidence to the existing literature, such as those who have had a recent experience with disaster loss report increased risk perception if a similar event happens in future with females reporting a higher risk perception than males. Of the demographic variables, only gender has a relationship with changes in household cover. On the supply-side, this study has built a risk-based pricing model suitable to generate a competitive premium rate for natural disaster insurance cover. Using illustrative data from the Christchurch Red-zone suburbs, the model generates competitive premium rates for catastrophe risk. When the proposed model incorporates the new RMS high-definition New Zealand Earthquake Model, for example, insurers can find the model useful to identify losses at a granular level so as to calculate the competitive premium. This study observes that the key to the success of the New Zealand dual insurance system despite the high prevalence of catastrophe losses are; firstly the EQC’s flat-rate pricing structure keeps private insurance premiums affordable and very high nationwide homeowner take-up rates of natural disaster insurance. Secondly, private insurers and the EQC have an elaborate reinsurance arrangement in place. By efficiently transferring risk to the reinsurer, the cost of writing primary insurance is considerably reduced ultimately expanding primary insurance capacity and supply of insurance coverage.
One of the great challenges facing human systems today is how to prepare for, manage, and adapt successfully to the profound and rapid changes wreaked by disasters. Wellington, New Zealand, is a capital city at significant risk of devastating earthquake and tsunami, potentially requiring mass evacuations with little or short notice. Subsequent hardship and suffering due to widespread property damage and infrastructure failure could cause large areas of the Wellington Region to become uninhabitable for weeks to months. Previous research has shown that positive health and well-being are associated with disaster-resilient outcomes. Preventing adverse outcomes before disaster strikes, through developing strengths-based skill sets in health-protective attitudes and behaviours, is increasingly advocated in disaster research, practise, and management. This study hypothesised that well-being constructs involving an affective heuristic play vital roles in pathways to resilience as proximal determinants of health-protective behaviours. Specifically, this study examined the importance of health-related quality of life and subjective well-being in motivating evacuation preparedness, measured in a community sample (n=695) drawn from the general adult population of Wellington’s isolated eastern suburbs. Using a quantitative epidemiological approach, the study measured the prevalence of key quality of life indicators (physical and mental health, emotional well-being or “Sense of Coherence”, spiritual well-being, social well-being, and life satisfaction) using validated psychometric scales; analysed the strengths of association between these indicators and the level of evacuation preparedness at categorical and continuous levels of measurement; and tested the predictive power of the model to explain the variance in evacuation preparedness activity. This is the first study known to examine multi-dimensional positive health and global well-being as resilient processes for engaging in evacuation preparedness behaviour. A cross-sectional study design and quantitative survey were used to collect self-report data on the study variables; a postal questionnaire was fielded between November 2008 and March 2009 to a sampling frame developed through multi-stage cluster randomisation. The survey response rate was 28.5%, yielding a margin of error of +/- 3.8% with 95% confidence and 80% statistical power to detect a true correlation coefficient of 0.11 or greater. In addition to the primary study variables, data were collected on demographic and ancillary variables relating to contextual factors in the physical environment (risk perception of physical and personal vulnerability to disaster) and the social environment (through the construct of self-determination), and other measures of disaster preparedness. These data are reserved for future analyses. Results of correlational and regression analyses for the primary study variables show that Wellingtonians are highly individualistic in how their well-being influences their preparedness, and a majority are taking inadequate action to build their resilience to future disaster from earthquake- or tsunami-triggered evacuation. At a population level, the conceptual multi-dimensional model of health-related quality of life and global well-being tested in this study shows a positive association with evacuation preparedness at statistically significant levels. However, it must be emphasised that the strength of this relationship is weak, accounting for only 5-7% of the variability in evacuation preparedness. No single dimension of health-related quality of life or well-being stands out as a strong predictor of preparedness. The strongest associations for preparedness are in a positive direction for spiritual well-being, emotional well-being, and life satisfaction; all involve a sense of existential meaningfulness. Spiritual well-being is the only quality of life variable making a statistically significant unique contribution to explaining the variance observed in the regression models. Physical health status is weakly associated with preparedness in a negative direction at a continuous level of measurement. No association was found at statistically significant levels for mental health status and social well-being. These findings indicate that engaging in evacuation preparedness is a very complex, holistic, yet individualised decision-making process, and likely involves highly subjective considerations for what is personally relevant. Gender is not a factor. Those 18-24 years of age are least likely to prepare and evacuation preparedness increases with age. Multidimensional health and global well-being are important constructs to consider in disaster resilience for both pre-event and post-event timeframes. This work indicates a need for promoting self-management of risk and building resilience by incorporating a sense of personal meaning and importance into preparedness actions, and for future research into further understanding preparedness motivations.
As a global phenomenon, many cities are undergoing urban renewal to accommodate rapid growth in urban population. However, urban renewal can struggle to balance social, economic, and environmental outcomes, whereby economic outcomes are often primarily considered by developers. This has important implications for urban forests, which have previously been shown to be negatively affected by development activities. Urban forests serve the purpose of providing ecosystem services and thus are beneficial to human wellbeing. Better understanding the effect of urban renewal on city trees may help improve urban forest outcomes via effective management and policy strategies, thereby maximising ecosystem service provision and human wellbeing. Though the relationship between certain aspects of development and urban forests has received consideration in previous literature, little research has focused on how the complete property redevelopment cycle affects urban forest dynamics over time. This research provides an opportunity to gain a comprehensive understanding of the effect of residential property redevelopment on urban forest dynamics, at a range of spatial scales, in Christchurch, New Zealand following a series of major earthquakes which occurred in 2010 – 2011. One consequence of the earthquakes is the redevelopment of thousands of properties over a relatively short time-frame. The research quantifies changes in canopy cover city-wide, as well as, tree removal, retention, and planting on individual residential properties. Moreover, the research identifies the underlying reasons for these dynamics, by exploring the roles of socio-economic and demographic factors, the spatial relationships between trees and other infrastructure, and finally, the attitudes of residential property owners. To quantify the effect of property redevelopment on canopy cover change in Christchurch, this research delineated tree canopy cover city-wide in 2011 and again in 2015. An object-based image analysis (OBIA) technique was applied to aerial imagery and LiDAR data acquired at both time steps, in order to estimate city-wide canopy cover for 2011 and 2015. Changes in tree canopy cover between 2011 and 2015 were then spatially quantified. Tree canopy cover change was also calculated for all meshblocks (a relatively fine-scale geographic boundary) in Christchurch. The results show a relatively small magnitude of tree canopy cover loss, city-wide, from 10.8% to 10.3% between 2011 and 2015, but a statistically significant change in mean tree canopy cover across all the meshblocks. Tree canopy cover losses were more likely to occur in meshblocks containing properties that underwent a complete redevelopment cycle, but the loss was insensitive to the density of redevelopment within meshblocks. To explore property-scale individual tree dynamics, a mixed-methods approach was used, combining questionnaire data and remote sensing analysis. A mail-based questionnaire was delivered to residential properties to collect resident and household data; 450 residential properties (321 redeveloped, 129 non- redeveloped) returned valid questionnaires and were identified as analysis subjects. Subsequently, 2,422 tree removals and 4,544 tree retentions were identified within the 450 properties; this was done by manually delineating individual tree crowns, based on aerial imagery and LiDAR data, and visually comparing the presence or absence of these trees between 2011 and 2015. The tree removal rate on redeveloped properties (44.0%) was over three times greater than on non-redeveloped properties (13.5%) and the average canopy cover loss on redeveloped properties (52.2%) was significantly greater than on non-redeveloped properties (18.8%). A classification tree (CT) analysis was used to model individual tree dynamics (i.e. tree removal, tree retention) and candidate explanatory variables (i.e. resident and household, economic, land cover, and spatial variables). The results indicate that the model including land cover, spatial, and economic variables had the best predicting ability for individual tree dynamics (accuracy = 73.4%). Relatively small trees were more likely to be removed, while trees with large crowns were more likely to be retained. Trees were most likely to be removed from redeveloped properties with capital values lower than NZ$1,060,000 if they were within 1.4 m of the boundary of a redeveloped building. Conversely, trees were most likely to be retained if they were on a property that was not redeveloped. The analysis suggested that the resident and household factors included as potential explanatory variables did not influence tree removal or retention. To conduct a further exploration of the relationship between resident attitudes and actions towards trees on redeveloped versus non-redeveloped properties, this research also asked the landowners from the 450 properties that returned mail questionnaires to indicate their attitudes towards tree management (i.e. tree removal, tree retention, and tree planting) on their properties. The results show that residents from redeveloped properties were more likely to remove and/or plant trees, while residents from non- redeveloped properties were more likely to retain existing trees. A principal component analysis (PCA) was used to explore resident attitudes towards tree management. The results of the PCA show that residents identified ecosystem disservices (e.g. leaf litter, root damage to infrastructure) as common reasons for tree removal; however, they also noted ecosystem services as important reasons for both tree planting and tree retention on their properties. Moreover, the reasons for tree removal and tree planting varied based on whether residents’ property had been redeveloped. Most tree removal occurred on redeveloped properties because trees were in conflict with redevelopment, but occurred on non- redeveloped properties because of perceived poor tree health. Residents from redeveloped properties were more likely to plant trees due to being aesthetically pleasing or to replace trees removed during redevelopment. Overall, this research adds to, and complements, the existing literature on the effects of residential property redevelopment on urban forest dynamics. The findings of this research provide empirical support for developing specific legislation or policies about urban forest management during residential property redevelopment. The results also imply that urban foresters should enhance public education on the ecosystem services provided by urban forests and thus minimise the potential for tree removal when undertaking property redevelopment.
Natural hazard disasters often have large area-wide impacts, which can cause adverse stress-related mental health outcomes in exposed populations. As a result, increased treatment-seeking may be observed, which puts a strain on the limited public health care resources particularly in the aftermath of a disaster. It is therefore important for public health care planners to know whom to target, but also where and when to initiate intervention programs that promote emotional wellbeing and prevent the development of mental disorders after catastrophic events. A large body of literature assesses factors that predict and mitigate disaster-related mental disorders at various time periods, but the spatial component has rarely been investigated in disaster mental health research. This thesis uses spatial and spatio-temporal analysis techniques to examine when and where higher and lower than expected mood and anxiety symptom treatments occurred in the severely affected Christchurch urban area (New Zealand) after the 2010/11 Canterbury earthquakes. High-risk groups are identified and a possible relationship between exposure to the earthquakes and their physical impacts and mood and anxiety symptom treatments is assessed. The main research aim is to test the hypothesis that more severely affected Christchurch residents were more likely to show mood and anxiety symptoms when seeking treatment than less affected ones, in essence, testing for a dose-response relationship. The data consisted of mood and anxiety symptom treatment information from the New Zealand Ministry of Health’s administrative databases and demographic information from the National Health Index (NHI) register, when combined built a unique and rich source for identifying publically funded stress-related treatments for mood and anxiety symptoms in almost the whole population of the study area. The Christchurch urban area within the Christchurch City Council (CCC) boundary was the area of interest in which spatial variations in these treatments were assessed. Spatial and spatio-temporal analyses were done by applying retrospective space-time and spatial variation in temporal trends analysis using SaTScan™ software, and Bayesian hierarchical modelling techniques for disease mapping using WinBUGS software. The thesis identified an overall earthquake-exposure effect on mood and anxiety symptom treatments among Christchurch residents in the context of the earthquakes as they experienced stronger increases in the risk of being treated especially shortly after the catastrophic 2011 Christchurch earthquake compared to the rest of New Zealand. High-risk groups included females, elderly, children and those with a pre-existing mental illness with elderly and children especially at-risk in the context of the earthquakes. Looking at the spatio-temporal distribution of mood and anxiety symptom treatments in the Christchurch urban area, a high rates cluster ranging from the severely affected central city to the southeast was found post-disaster. Analysing residential exposure to various earthquake impacts found that living in closer proximity to more affected areas was identified as a risk factor for mood and anxiety symptom treatments, which largely confirms a dose-response relationship between level of affectedness and mood and anxiety symptom treatments. However, little changes in the spatial distribution of mood and anxiety symptom treatments occurred in the Christchurch urban area over time indicating that these results may have been biased by pre-existing spatial disparities. Additionally, the post-disaster mobility activity from severely affected eastern to the generally less affected western and northern parts of the city seemed to have played an important role as the strongest increases in treatment rates occurred in less affected northern areas of the city, whereas the severely affected eastern areas tended to show the lowest increases. An investigation into the different effects of mobility confirmed that within-city movers and temporary relocatees were generally more likely to receive care or treatment for mood or anxiety symptoms, but moving within the city was identified as a protective factor over time. In contrast, moving out of the city from minor, moderately or severely damaged plain areas of the city, which are generally less affluent than Port Hills areas, was identified as a risk factor in the second year post-disaster. Moreover, residents from less damaged plain areas of the city showed a decrease in the likelihood of receiving care or treatment for mood or anxiety symptoms compared to those from undamaged plain areas over time, which also contradicts a possible dose-response relationship. Finally, the effects of the social and physical environment, as well as community resilience on mood and anxiety symptom treatments among long-term stayers from Christchurch communities indicate an exacerbation of pre-existing mood and anxiety symptom treatment disparities in the city, whereas exposure to ‘felt’ earthquake intensities did not show a statistically significant effect. The findings of this thesis highlight the complex relationship between different levels of exposure to a severe natural disaster and adverse mental health outcomes in a severely affected region. It is one of the few studies that have access to area-wide health and impact information, are able to do a pre-disaster / post-disaster comparison and track their sample population to apply spatial and spatio-temporal analysis techniques for exposure assessment. Thus, this thesis enhances knowledge about the spatio-temporal distribution of adverse mental health outcomes in the context of a severe natural disaster and informs public health care planners, not only about high-risk groups, but also where and when to target health interventions. The results indicate that such programs should broadly target residents living in more affected areas as they are likely to face daily hardship by living in a disrupted environment and may have already been the most vulnerable ones before the disaster. Special attention should be focussed on women, elderly, children and people with pre-existing mental illnesses as they are most likely to receive care or treatment for stress-related mental health symptoms. Moreover, permanent relocatees from affected areas and temporarily relocatees shortly after the disaster may need special attention as they face additional stressors due to the relocation that may lead to the development of adverse mental health outcomes needing treatment.
