INTRODUCTION: Connections between environmental factors and mental health issues have been postulated in many different countries around the world. Previously undertaken research has shown many possible connections between these fields, especially in relation to air quality and extreme weather events. However, research on this subject is lacking in New Zealand, which is difficult to analyse as an overall nation due to its many micro-climates and regional differences.OBJECTIVES: The aim of this study and subsequent analysis is to explore the associations between environmental factors and poor mental health outcomes in New Zealand by region and predict the number of people with mental health-related illnesses corresponding to the environmental influence.METHODS: Data are collected from various public-available sources, e.g., Stats NZ and Coronial services of New Zealand, which comprised four environmental factors of our interest and two mental health indicators data ranging from 2016 up until 2020. The four environmental factors are air pollution, earthquakes, rainfall and temperature. Two mental health indicators include the number of people seen by District Health Boards (DHBs) for mental health reasons and the statistics on suicide deaths. The initial analysis is carried out on which regions were most affected by the chosen environmental factors. Further analysis using Auto-Regressive Integrated Moving Average(ARIMA) creates a model based on time series of environmental data to generate estimation for the next two years and mental health projected from the ridge regression.RESULTS: In our initial analysis, the environmental data was graphed along with mental health outcomes in regional charts to identify possible associations. Different regions of New Zealand demonstrate quite different relationships between the environmental data and mental health outcomes. The result of later analysis predicts that the suicide rate and DHB mental health visits may increase in Wellington, drop-in Hawke's Bay and slightly increase in Canterbury for the year 2021 and 2022 with different environmental factors considered.CONCLUSION: It is evident that the relationship between environmental and mental health factors is regional and not national due to the many micro-climates that exist around the nation. However, it was observed that not all factors displayed a good relationship between the regions. We conclude that our hypotheses were partially correct, in that increased air pollution was found to correlate to increased mental health-related DHB visits. Rainfall was also highly correlated to some mental health outcomes. Higher levels of rainfall reduced DHB visits and suicide rates in some areas of the country.
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This document reviews research-based understandings of the concept of resilience. A conceptual model is developed which identifies a number of the factors that influence individual and household resilience. Guided by the model, a series of recommendations are developed for practices that will support individual and household resilience in Canterbury in the aftermath of the 2010-2011 earthquakes.
The 22nd February 2011, Mw 6.3 Christchurch earthquake in New Zealand caused major damage to critical infrastructure, including the healthcare system. The Natural Hazard Platform of NZ funded a short-term project called “Hospital Functions and Services” to support the Canterbury District Health Board’s (CDHB) efforts in capturing standardized data that describe the effects of the earthquake on the Canterbury region’s main hospital system. The project utilised a survey tool originally developed by researchers at Johns Hopkins University (JHU) to assess the loss of function of hospitals in the Maule and Bío-Bío regions following the 27th February 2010, Mw 8.8 Maule earthquake in Chile. This paper describes the application of the JHU tool for surveying the impact of Christchurch earthquake on the CDHB Hospital System, including the system’s residual capacity to deliver emergency response and health care. A short summary of the impact of the Christchurch earthquake on other CDHB public and private hospitals is also provided. This study demonstrates that, as was observed in other earthquakes around the world, the effects of damage to non-structural building components, equipment, utility lifelines, and transportation were far more disruptive than the minor structural damage observed in buildings (FEMA 2007). Earthquake related complications with re-supply and other organizational aspects also impacted the emergency response and the healthcare facilities’ residual capacity to deliver services in the short and long terms.
Social and natural capital are fundamental to people’s wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Ōtautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.
Abstract. Natural (e.g., earthquake, flood, wildfires) and human-made (e.g., terrorism, civil strife) disasters are inevitable, can cause extensive disruption, and produce chronic and disabling psychological injuries leading to formal diagnoses (e.g., post-traumatic stress disorder [PTSD]). Following natural disasters of earthquake (Christchurch, Aotearoa/New Zealand, 2010–11) and flood (Calgary, Canada, 2013), controlled research showed statistically and clinically significant reductions in psychological distress for survivors who consumed minerals and vitamins (micronutrients) in the following months. Following a mass shooting in Christchurch (March 15, 2019), where a gunman entered mosques during Friday prayers and killed and injured many people, micronutrients were offered to survivors as a clinical service based on translational science principles and adapted to be culturally appropriate. In this first translational science study in the area of nutrition and disasters, clinical results were reported for 24 clients who completed the Impact of Event Scale – Revised (IES-R), the Depression Anxiety Stress Scales (DASS), and the Modified-Clinical Global Impression (M-CGI-I). The findings clearly replicated prior controlled research. The IES-R Cohen’s d ESs were 1.1 (earthquake), 1.2 (flood), and 1.13 (massacre). Effect sizes (ESs) for the DASS subscales were also consistently positive across all three events. The M-CGI-I identified 58% of the survivors as “responders” (i.e., self-reported as “much” to “very much” improved), in line with those reported in the earthquake (42%) and flood (57%) randomized controlled trials, and PTSD risk reduced from 75% to 17%. Given ease of use and large ESs, this evidence supports the routine use of micronutrients by disaster survivors as part of governmental response.
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.
Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.
Worldwide, the numbers of people living with chronic conditions are rapidly on the rise. Chronic illnesses are enduring and often cannot be cured, requiring a strategy for long term management and intervention to prevent further exacerbation. Globally, there has been an increase in interventions using telecommunications technologies to aid patients in their home setting to manage chronic illnesses. Such interventions have often been delivered by nurses. The purpose of this research was to assess whether a particular intervention that had been successfully implemented in the United Kingdom could also be implemented in Canterbury. In particular, this research assessed the perspectives of Canterbury based practice nurses and district nurses. The findings suggest that a majority of both district and practice nurses did not view the service as compatible with their current work situation. Existing workload and concerns over funding of the proposed service were identified as potential barriers. However, the service was perceived as potentially beneficial for some, with the elderly based in rural areas, or patients with chronic mental health needs identified as more likely to benefit than others. Practice nurses expressed strong views on who should deliver such services. Given that it was identified that practice nurses already have in-depth knowledge of their patients’ health, while valuing the strong relationships established with their communities, it was suggested that patients would most benefit from locally based nurses to deliver any community based health services in the future. It was also found that teletriaging is currently widely used by practice nurses across Canterbury to meet a range of health needs, including chronic mental health needs. This suggests that the scope of teletriaging in community health and its potential and full implications are currently not well understood in New Zealand. Significant events, such as the Christchurch earthquakes indicate the potential role of teletriaging in addressing mental health issues, thereby reducing the chronic health burden in the community.
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>
Rapid, accurate structural health monitoring (SHM) assesses damage to optimise decision-making. Many SHM methods are designed to track nonlinear stiffness changes as damage. However, highly nonlinear pinched hysteretic systems are problematic in SHM. Model-based SHM often fails as any mismatch between model and measured response dynamics leads to significant error. Thus, modelfree methods of hysteresis loop tracking methods have emerged. This study compares the robustness and accuracy in the presence of significant measurement noise of the proven hysteresis loop analysis (HLA) SHM method with 3 emerging model-free methods and 2 further novel adaptations of these methods using a highly nonlinear, 6-story numerical structure to provide a known ground-truth. Mean absolute errors in identifying a known nonlinear stiffness trajectory assessed at four points over two successive ground motion inputs from September 2010 and February 2011 in Christchurch range from 1.71-10.52%. However, the variability is far wider with maximum errors ranging from 3.90-49.72%, where the second largest maximum absolute error was still 19.74%. The lowest mean and maximum absolute errors were for the HLA method. The next best method had mean absolute error of 2.92% and a maximum of 10.51%. These results show the clear superiority of the HLA method over all current emerging model-free methods designed to manage the highly nonlinear pinching responses common in reinforced concrete structures. These results, combined with high robustness and accuracy in scaled and fullscale experimental studies, provide further validation for using HLA for practical implementation.
Interagency Emergency Response Teams (IERTs) play acrucial role in times of disasters. Therefore it is crucial to understand more thoroughly the communication roles and responsibilities of interagency team members and to examine how individual members communicate within a complex, evolving, and unstable environment. It is also important to understand how different organisational identities and their spatial geographies contribute to the interactional dynamics. Earthquakes hit the Canterbury region on September, 2010 and then on February 2011 a more devastating shallow earthquake struck resulting in severe damage to the Aged Residential Care (ARC) sector. Over 600 ARC beds were lost and 500 elderly and disabled people were displaced. Canterbury District Health Board (CDHB) set up an interagency emergency response team to address the issues of vulnerable people with significant health and disability needs who were unable to access their normal supports due to the effects of the earthquake. The purpose of this qualitative interpretive study is to focus on the case study of the response and evacuation of vulnerable people by interagencies responding to the event. Staff within these agencies were interviewed with a focus on the critical incidents that either stabilised or negatively influenced the outcome of the response. The findings included the complexity of navigating multiple agencies communication channels; understanding the different hierarchies and communication methods within each agency; data communication challenges when infrastructures were severely damaged; the importance of having the right skills, personal attributes and understanding of the organisations in the response; and the significance of having a liaison in situ representing and communicating through to agencies geographically dispersed from Canterbury. It is hoped that this research will assist in determining a future framework for interagency communication best practice and policy.
People aged 65 years and older are the fastest growing age group in New Zealand. By the mid-2070s, there are predictions that this age group is likely to comprise approximately one third of the population. Older people are encouraged to stay in their own homes within their community for as long as possible with support to encourage the extension of ageing in place. Currently around 14% of those aged 75 years or older, make the move into retirement villages. This is expected to increase. Little is known by retirement villages about the wellbeing and health of those who decide to live independently in these facilities. Predicting the need for a continuum of care is challenging. This research measured the wellbeing and health of older adults. It was situated in a critical realist paradigm, overlaid with an empathetic axiology. A focused literature review considered the impact on wellbeing from the aspects of living place, age, gender, health status and the 2010/2011 Canterbury earthquakes. Longitudinal studies used the Enlightenment Scale and the interRAI Community Health Assessment (CHA) to measure the wellbeing and health of one group of residents (n=120) living independently in one retirement village in Canterbury, New Zealand. The research was extended to incorporate two cross-section studies when initial results for wellbeing were found to be higher than anticipated. These additional studies included participants living independently from other retirement villages (n=115) and those living independently within the community (n=354). A total of 589 participants, aged 65 – 97 years old, completed the Enlightenment Scale across the four studies. Across the living places, wellbeing continued to significantly improve with age. The Enlightenment Scale was a useful measure of wellbeing with older adults. Participants in the longitudinal studies largely maintained a relatively good health status, showing little change over the study period of 15 months. Predictions for the need for a move to supportive care were not able to be made using the CHA. The health status of participants did not influence their level of wellbeing. The key finding of note is that the wellbeing score of older adults increases by 1.27 points per year, using the Enlightenment Scale, irrespective of where they live.
Background: There has been a psychopathology focus in disaster research examining adolescent mental health and wellbeing, but recently studies have begun to also examine wellbeing-related constructs. Although an increased risk of posttraumatic stress disorder has been established in disaster-exposed adolescents, comparatively little is known about how disasters impact adolescent wellbeing, nor how factors within the post-disaster environment interact to influence holistic adolescent mental health and wellbeing. Objective: The objective of this study was to describe the holistic mental health and wellbeing of adolescents living in an earthquake-struck city by considering a range of mental health and wellbeing indicators, as well as risk and protective factors hypothesised to influence mental health and wellbeing. The dual-factor model of mental health was used as a framework to guide this study. Method: A survey of Christchurch secondary school students was used to gather data about their subjective wellbeing, risk of low wellbeing, psychological distress, quality of life, exposure to Adverse Childhood Experiences, social support from friends and family, school connectedness, and expectations about future quality of life. Results: A slim majority of students reported good subjective wellbeing (52.3%) and high current quality of life (56.4%), whereas a larger majority reported low risk of psychological distress (79%). An equal proportion of students reported high and low risk of low wellbeing. There were no statistically significant differences in any of the variables measured between adolescents who did and did not live through the Christchurch earthquakes. Regression analyses identified that school connectedness, social support from friends and family, and future expectations of quality of life significantly predicted subjective wellbeing, risk of low wellbeing, risk of psychological distress, and current quality of life. The number of Adverse Childhood Experiences significantly predicted only risk of psychological distress when the effects of other variables were controlled for. Conclusion: The findings of this study indicate that there is a low mean level of wellbeing and quality of life in this sample of adolescents living in a severely earthquake- affected community. School connectedness, social support from family and friends, and expectations about future quality of life were shown to significantly predict variance in subjective wellbeing, quality of life, and psychological distress. This suggests that there are social and environmental factors that can be targeted to improve holistic mental health and wellbeing in disaster-affected adolescents who have experienced high levels of trauma. Conclusions in this study are limited by the representativeness of the sample, the cross- sectional nature of the study, and potential sampling bias.
Background: There has been a psychopathology focus in disaster research examining adolescent mental health and wellbeing, but recently studies have begun to also examine wellbeing-related constructs. Although an increased risk of posttraumatic stress disorder has been established in disaster-exposed adolescents, comparatively little is known about how disasters impact adolescent wellbeing, nor how factors within the post-disaster environment interact to influence holistic adolescent mental health and wellbeing. Objective: The objective of this study was to describe the holistic mental health and wellbeing of adolescents living in an earthquake-struck city by considering a range of mental health and wellbeing indicators, as well as risk and protective factors hypothesised to influence mental health and wellbeing. The dual-factor model of mental health was used as a framework to guide this study. Method: A survey of Christchurch secondary school students was used to gather data about their subjective wellbeing, risk of low wellbeing, psychological distress, quality of life, exposure to Adverse Childhood Experiences, social support from friends and family, school connectedness, and expectations about future quality of life. Results: A slim majority of students reported good subjective wellbeing (52.3%) and high current quality of life (56.4%), whereas a larger majority reported low risk of psychological distress (79%). An equal proportion of students reported high and low risk of low wellbeing. There were no statistically significant differences in any of the variables measured between adolescents who did and did not live through the Christchurch earthquakes. Regression analyses identified that school connectedness, social support from friends and family, and future expectations of quality of life significantly predicted subjective wellbeing, risk of low wellbeing, risk of psychological distress, and current quality of life. The number of Adverse Childhood Experiences significantly predicted only risk of psychological distress when the effects of other variables were controlled for. Conclusion: The findings of this study indicate that there is a low mean level of wellbeing and quality of life in this sample of adolescents living in a severely earthquake-affected community. School connectedness, social support from family and friends, and expectations about future quality of life were shown to significantly predict variance in subjective wellbeing, quality of life, and psychological distress. This suggests that there are social and environmental factors that can be targeted to improve holistic mental health and wellbeing in disaster-affected adolescents who have experienced high levels of trauma. Conclusions in this study are limited by the representativeness of the sample, the cross-sectional nature of the study, and potential sampling bias.
Background: There has been a psychopathology focus in disaster research examining adolescent mental health and wellbeing, but recently studies have begun to also examine wellbeing-related constructs. Although an increased risk of posttraumatic stress disorder has been established in disaster-exposed adolescents, comparatively little is known about how disasters impact adolescent wellbeing, nor how factors within the post-disaster environment interact to influence holistic adolescent mental health and wellbeing. Objective: The objective of this study was to describe the holistic mental health and wellbeing of adolescents living in an earthquake-struck city by considering a range of mental health and wellbeing indicators, as well as risk and protective factors hypothesised to influence mental health and wellbeing. The dual-factor model of mental health was used as a framework to guide this study. Method: A survey of Christchurch secondary school students was used to gather data about their subjective wellbeing, risk of low wellbeing, psychological distress, quality of life, exposure to Adverse Childhood Experiences, social support from friends and family, school connectedness, and expectations about future quality of life. Results: A slim majority of students reported good subjective wellbeing (52.3%) and high current quality of life (56.4%), whereas a larger majority reported low risk of psychological distress (79%). An equal proportion of students reported high and low risk of low wellbeing. There were no statistically significant differences in any of the variables measured between adolescents who did and did not live through the Christchurch earthquakes. Regression analyses identified that school connectedness, social support from friends and family, and future expectations of quality of life significantly predicted subjective wellbeing, risk of low wellbeing, risk of psychological distress, and current quality of life. The number of Adverse Childhood Experiences significantly predicted only risk of psychological distress when the effects of other variables were controlled for. Conclusion: The findings of this study indicate that there is a low mean level of wellbeing and quality of life in this sample of adolescents living in a severely earthquake- affected community. School connectedness, social support from family and friends, and expectations about future quality of life were shown to significantly predict variance in subjective wellbeing, quality of life, and psychological distress. This suggests that there are social and environmental factors that can be targeted to improve holistic mental health and wellbeing in disaster-affected adolescents who have experienced high levels of trauma. Conclusions in this study are limited by the representativeness of the sample, the cross- sectional nature of the study, and potential sampling bias.
For the people of Christchurch and its wider environs of Canterbury in New Zealand, the 4th of September 2010 earthquake and the subsequent aftershocks were daunting. To then experience a more deadly earthquake five months later on the 22nd of February 2011 was, for the majority, overwhelming. A total of 185 people were killed and the earthquake and continuing aftershocks caused widespread damage to properties, especially in the central city and eastern suburbs. A growing body of literature consistently documents the negative impact of experiencing natural disasters on existing psychological disorders. As well, several studies have identified positive coping strategies which can be used in response to adversities, including reliance on spiritual and cultural beliefs as well as developing resilience and social support. The lifetime prevalence of severe mental health disorders such as posttraumatic stress disorder (PTSD) occurring as a result of experiencing natural disasters in the general population is low. However, members of refugee communities who were among those affected by these earthquakes, as well as having a past history of experiencing traumatic events, were likely to have an increased vulnerability. The current study was undertaken to investigate the relevance to Canterbury refugee communities of the recent Canterbury Earthquake Recovery Authority (CERA) draft recovery strategy for Christchurch post-earthquakes. This was accomplished by interviewing key informants who worked closely with refugee communities. These participants were drawn from different agencies in Christchurch including Refugee Resettlement Services, the Canterbury Refugee Council, CERA, and health promotion and primary healthcare organisations, in order to obtain the views of people who have comprehensive knowledge of refugee communities as well as expertise in local mainstream services. The findings from the semi-structured interviews were analysed using qualitative thematic analysis to identify common themes raised by the participants. The key informants described CERA’s draft recovery strategy as a significant document which highlighted the key aspects of recovery post disaster. Many key informants identified concerns regarding the practicality of the draft recovery strategy. For the refugee communities, some of those concerns included the short consultation period for the implementation phase of the draft recovery strategy, and issues surrounding communication and collaboration between refugee agencies involved in the recovery. This study draws attention to the importance of communication and collaboration during recovery, especially in the social reconstruction phase following a disaster, for all citizens but most especially for refugee communities.
The aim of this thesis was to examine the spatial and the temporal patterns of anxiety and chest pain resulting from the Canterbury, New Zealand earthquaeks. Three research objectives were identified: examine any spatial or termporal clusters of anxiety and chest pain; examine the associations between anxiety, chest pain and damage to neighbourhood; and determine any statistically significant difference in counts of anxiety and chest pain after each earthquake or aftershock which resulted in severe damage. Measures of the extent of liquefaction the location of CERA red-zones were used as proxy measures for earthquake damage. Cases of those who presented to Christchurch Public Hospital Emergency Department with either anxiety or chest pain between May 2010 and April 2012 were aggregated to census area unit (CAU) level for analysis. This thesis has taken a unique approach to examining the spatial and spatio-temporal variations of anxiety and chest pain after an earthquake and offers unique results. This is the first study of its kind to use a GIS approach when examining Canterbury specific earthquake damage and health variables at a CAU level after the earthquakes. Through the use of spatio-termporal scan modelling, negative and linear regression modelling and temporal linear modelling with dummy variables this research was able to conclude there are significant spatial and temporal variations in anxiety and chest pain resulting from the earthquakes. The spatio-termporal scan modelling identified a hot cluster of both anxiety and chest pain within Christchurch at the same time the earthquakes occurred. The negative binomial model found liquefaction to be a stronger predictor of anxiety than the Canterbury Earthquake Recovery Authority's (CERA) land zones. The linear regression model foun chest pain to be positively associated with all measures of earthquake damage with the exception of being in the red-zone. The temporal modelling identified a significant increase in anxiety cases one month after a major earthquake, and chest pain cases spiked two weeks after an earthquake and gradually decreased over the following five weeks. This research was limited by lack of control period data, limited measures of earthquake damage, ethical restrictions, and the need for population tracking data. The findings of this research will be useful in the planning and allocation of mental wellbeing resources should another similar event like the Canterbury Earthquakes occur in New Zealand.
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.
This study explored the effects of the Canterbury earthquakes of 2010 and 2011 on different areas of quality of life (QOL) for children and adolescents with disabilities. Using a survey developed from the Quality of Life Instrument for People with Developmental Disabilities – Short Version (QOL-PDD-SV) (Brown, Raphael & Renwick, 1997) and The World Health Organisation Quality of Life - (WHOQOL)-BREF, parents or caregivers were asked to identify what level of importance and satisfaction their child or adolescent placed on areas of QOL including physical health, psychological health - stress levels and coping ability, attachment to their neighbourhood, friends, family, leisure activities, community access and schooling. They were also asked to determine what level of impact the earthquakes had had on each area of their child or adolescent’s life and overall quality of life in the aftermath of the earthquakes. A total of 31 parents of 22 males and 9 females between the ages of 2.5 years to 19 years of age (mean age: 12.6 years) responded. The results were collated and analysis was run to measure for the effect of age, gender and geographical location. The results found that the earthquakes affected nearly every area of QOL for the children and adolescents. The biggest impact on the children’s psychological health and their ability to cope It was observed that younger children (<13) were more likely to record improved or lessened effects from the earthquakes in psychological health areas. However, the areas of social belonging and friendships were the least affected by the earthquakes. Female children were more likely to indicate higher scores for social belonging after the earthquakes. Many parents observed that their children developed improved coping skills over the earthquake period. The findings in this study offer a better understanding of how earthquakes can affect the quality of life children and adolescents with disabilities.
This analysis employs both qualitative and quantitative approaches to identify how young adults in New Zealand aged 18-25 years old have engaged with All Right? campaign material. A survey targeting young adults returned 51 viable out of 117 responses due to participation prerequisites. From the survey, five participants elaborated on their thoughts in an in-depth interview voluntarily. Interviews were conducted with key personnel from All Right? to craft broader understanding of the initiative whilst enhancing knowledge of mental health frameworks and their application. Ciaran Fox, Lucy Daeth and Sara Epperson, who have been imperative to the success of the campaign, shared their working experience in the community and public health sector and how this intertwines to their current roles at All Right?. Discussions of key frameworks, community conversations, the development of communication strategies and how All Right? approached Canterbury publics in a post-earthquake setting provided insight to the importance of understanding community circumstance in initial crisis and the correlated secondary stressors.
The greater Wellington region, New Zealand, is highly vulnerable to large earthquakes. While attention has been paid to the consequences of earthquake damage to road, electricity and water supply networks, the consequences of wastewater network damage for public health, environmental health and habitability of homes remain largely unknown for Wellington City. The Canterbury and Kaikōura earthquakes have highlighted the vulnerability of sewerage systems to disruption during a disaster. Management of human waste is one of the critical components of disaster planning to reduce faecal-oral transmission of disease and exposure to disease-bearing vectors. In Canterbury and Kaikōura, emergency sanitation involved a combination of Port-a-loos, chemical toilets and backyard long-drops. While many lessons may be learned from experiences in Canterbury earthquakes, it is important to note that isolation is likely to be a much greater factor for Wellington households, compared to Christchurch, due to the potential for widespread landslides in hill suburbs affecting road access. This in turn implies that human waste may have to be managed onsite, as options such as chemical toilets and Port-a-loos rely completely on road access for delivering chemicals and collecting waste. While some progress has been made on options such as emergency composting toilets, significant knowledge gaps remain on how to safely manage waste onsite. In order to bridge these gaps, laboratory tests will be conducted through the second half of 2019 to assess the pathogen die-off rates in the composting toilet system with variables being the type of carbon bulking material and the addition of a Bokashi composting activator.
For 150,000 Christchurch school students, the 12.51 pm earthquake of 22 February 2011 shattered their normal lunch time activities and thrust their teachers into the role of emergency first responders. Whether helping students (children) escape immediate danger, or identifying and managing the best strategies for keeping children safe, including provision of extended caregiving when parents were unable to return to school to retrieve their children, teachers had to manage their own fears and trauma reactions in order to appear calm and prevent further distress for the children in their care. Only then did teachers return to their families. Eighteen months later, twenty teachers from across Christchurch, were interviewed. At 12.51pm, the teachers were essentially first responders. Using their usual methods for presenting a calm and professional image, the teachers’ emotion regulation (ER) strategies for managing their immediate fears were similar to those of professional first responders, with similar potential for subsequent burnout and negative emotional effects. Teachers’ higher emotional exhaustion and burnout 18 months later, were associated with school relocation. Lower burnout was associated with more emotional awareness, ER and perceived support. Consistent with international research, teachers’ use of cognitive reappraisal (re-thinking a situation) was an effective ER strategy, but this may not prevent teachers’ emotional resources from eventually becoming depleted. Teachers fulfill an important role in supporting children’s psychosocial adjustment following a natural disaster. However, as also acknowledged in international research, we need to also focus on supporting the teachers themselves.
The September 2010 Canterbury and February 2011 Christchurch earthquakes and associated aftershocks have shown that the isolator displacement in Christchurch Women's Hospital (Christchurch City's only base-isolated structure) was significantly less than expected. Occupant accounts of the events have also indicated that the accelerations within the hospital superstructure were larger than would usually be expected within a base-isolated structure and that residual low-level shaking lasts for a longer period of time following the strong-motion of an event than for non-isolated structures.
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.
Children are often overlooked in the aftermath of a natural disaster, and children’s use of coping strategies plays an important part in their post-disaster adaptation (Vernberg, La Greca, Silverman, & Prinstein, 1996). The aim of this qualitative study was to explore the coping strategies of children with adequate self-regulation skills and minimal behaviour problems, living in Christchurch following the major 2010 and 2011 earthquakes. This aim was achieved through the use of semi-structured interviews with five seven-year-old children, their parents, and their teachers. These interviews were analysed using Directed Content Analysis and results showed that children most often reported using active and adaptive coping strategies, followed by avoidant strategies. Results in the current literature regarding children’s coping suggest that children exposed to natural disasters are able to utilise strategies that involve some personal control over their environment and emotions, through the use of active and adaptive coping strategies. Findings from this study contribute to the current understanding of children’s use of coping strategies when faced with commonly occurring childhood upsets. Further research is required regarding the outcomes associated with the use of effective coping strategies following traumatic events.
Triple P parenting programmes have provided promising results for children and families in recent years. The aim of the current project was to explore the experiences of families leading up to participating in a Teen Triple P programme three years following the Christchurch earthquakes and their need for assistance in the management of their teenagers. Parents were interviewed prior to the commencement of the Teen Triple P programme and after its completion. Parents were also asked to complete a journal entry or engage in two brief telephone conversations with the researcher outlining their experiences with the Teen Triple P programme. These outlined the perceived fit of the programme to the needs of the family. Parents provided insight into their family’s experiences of the Christchurch 2010 and 2011 series of earthquakes and the perceived impact this had on their lives and the management of their teenagers. The results indicated that parents felt more positively about their parenting behaviours post-programme and were able to identify changes in their teen and/or family that they felt were as a response to participation in Teen Triple P. Parents provided rich descriptions of their earthquake experiences and the immediate and long-term impacts they endured both individually and as a family. Parents did not feel that the earthquakes fed into their decision to do a Teen Triple P Programme. The results helped improve our understanding of the effectiveness of Teen Triple P as a parenting programme as well increased our understanding of the challenges and needs of families in post-earthquake Christchurch.
In this paper we outline the process and outcomes of a multi-agency, multi-sector research collaboration, led by the Canterbury Earthquake Research Authority (CERA). The CERA Wellbeing Survey (CWS) is a serial, cross-sectional survey that is to be repeated six-monthly (in April and September) until the end of the CERA Act, in April 2016. The survey gathers self-reported wellbeing data to supplement the monitoring of the social recovery undertaken through CERA's Canterbury Wellbeing Index. Thereby informing a range of relevant agency decision-making, the CWS was also intended to provide the community and other sectors with a broad indication of how the population is tracking in the recovery. The primary objective was to ensure that decision-making was appropriately informed, with the concurrent aim of compiling a robust dataset that is of value to future researchers, and to the wider, global hazard and disaster research endeavor. The paper begins with an outline of both the Canterbury earthquake sequence, and the research context informing this collaborative project, before reporting on the methodology and significant results to date. It concludes with a discussion of both the survey results, and the collaborative process through which it was developed.
The magnitude 6.2 Christchurch earthquake struck the city of Christchurch at 12:51pm on February 22, 2011. The earthquake caused 186 fatalities, a large number of injuries, and resulted in widespread damage to the built environment, including significant disruption to lifeline networks and health care facilities. Critical facilities, such as public and private hospitals, government, non-government and private emergency services, physicians’ offices, clinics and others were severely impacted by this seismic event. Despite these challenges many systems were able to adapt and cope. This thesis presents the physical and functional impact of the Christchurch earthquake on the regional public healthcare system by analysing how it adapted to respond to the emergency and continued to provide health services. Firstly, it assesses the seismic performance of the facilities, mechanical and medical equipment, building contents, internal services and back-up resources. Secondly, it investigates the reduction of functionality for clinical and non-clinical services, induced by the structural and non-structural damage. Thirdly it assesses the impact on single facilities and the redundancy of the health system as a whole following damage to the road, power, water, and wastewater networks. Finally, it assesses the healthcare network's ability to operate under reduced and surged conditions. The effectiveness of a variety of seismic vulnerability preparedness and reduction methods are critically reviewed by comparing the observed performances with the predicted outcomes of the seismic vulnerability and disaster preparedness models. Original methodology is proposed in the thesis which was generated by adapting and building on existing methods. The methodology can be used to predict the geographical distribution of functional loss, the residual capacity and the patient transfer travel time for hospital networks following earthquakes. The methodology is used to define the factors which contributed to the overall resilence of the Canterbury hospital network and the areas which decreased the resilence. The results show that the factors which contributed to the resilence, as well as the factors which caused damage and functionality loss were difficult to foresee and plan for. The non-structural damage to utilities and suspended ceilings was far more disruptive to the provision of healthcare than the minor structural damage to buildings. The physical damage to the healthcare network reduced the capacity, which has further strained a health care system already under pressure. Providing the already high rate of occupancy prior to the Christchurch earthquake the Canterbury healthcare network has still provided adequate healthcare to the community.
Previous research has found that the capacity to self-regulate is associated with a number of positive life outcomes and deficits in self-regulation have been linked with poorer life outcomes. Therefore, parent and child self-regulation is an important focus of the Positive Parenting Program for Teenagers (Teen Triple P). The aim of this study was to investigate if Group Teen Triple P was effective in promoting parental self-regulation and adolescent behaviour change in families affected by the earthquakes in Canterbury NZ between 2010 and 2012. METHOD: Five families with teenagers aged 12-16 years were recruited from among families participating in a Group Teen Triple P program specifically implemented by the education authorities for parents self-reporting long-term negative effects of the earthquakes on their family. A single-case multiple-baseline across participants design was used to examine change in target teenager behaviour. Measures of self-regulation skill acquisition were taken using a coding scheme devised for the study from transcripts of three telephone consultations and from three family discussions at pre-intervention, mid-intervention, and post-intervention. Parents and their child also completed questionnaires addressing adolescent functioning, the parent-adolescent relationship and parenting at pre- and post-intervention. RESULTS: The multiple-baseline data showed that parents were successful at changing targeted behaviour for their child. Analysis of the telephone consultations and family discussions showed that parents increased their self-regulation skills over the therapy period and there was positive change in adolescent behavior reported on the Strengths and Difficulties Questionnaire. Additionally, the results suggested that higher rates and levels of self-regulation in the parents were associated with greater improvements in adolescent behaviour. CONCLUSION: This study demonstrated that the Group Teen Triple P -Program was effective in promoting self-regulation in parents and behaviour change in adolescents, specifically in a post-disaster context.
