A video of a presentation by Toni Gutschlag, General Manager of Mental Health Services at the CDHB, at the 2016 Seismics in the City Conference. The presentation is titled, "Shaping Young Minds: Mental health issues and solutions".
Worries about the mental health impacts of the Canterbury earthquakes dominated a fiery meeting at Parliament today.
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.
Karen Brown reports from Chch, where there seems to be no end in sight for the mental health problems caused by the earthquakes
A PDF copy of pages 362-363 of the book Christchurch: The Transitional City Pt IV. The pages document the transitional project 'All Right?'. Photos: All Right?
An infographic giving the status of Canterbury District Health Board mental health service buildings.
An earthquake memories story from Susan Kovacs, Mental Health GP Liaison, Rural Canterbury Primary Health Organisation, titled, "We watched it all unfolding".
This report presents the experiences of Tangata Whaiora (Mental health clients) through the disastrous earthquakes that struck Otautahi/Christchurch in 2010-11. It further analysis these experience to how show the social networks these individuals, their whānau, supporting staff respond and recover to a significant urban disaster. The disaster challenged the mental health of those individuals who are impacted and the operations of organisations and networks that support and care for the mentally ill. How individuals and their families navigate a post-disaster landscape provides an unfortunate but unique opportunity to analyse how these support networks respond to severe disruption. Tangata Whaiora possess experiences of micro-scale personal and family disasters and were not necessarily shocked by the loss of normality in Ōtautahi as a result of the earthquakes. The organic provision of clear leadership, outstanding commitment by staff, and ongoing personal and institutional dedication in the very trying circumstances of working in a post-disaster landscape all contributed to Te Awa o te Ora’s notable response to the disaster.
This paper identifies and analyses the networks of support for tangata whaiora (mental health clients) utilising a kaupapa Mäori health service following the Ötautahi/Christchurch earthquakes in Aotearoa New Zealand from 2010 to 2012. Semi- structured interviews were undertaken with 39 participants, comprising clients (Mäori and Päkehä), staff, managers and board members of a kaupapa Mäori provider in the city. Selected quotes are presented alongside a social network analysis of the support accessed by all participants. Results show the signifi cant isolation of both Mäori and Päkehä mental health clients post- disaster and the complexity of individuals and collectives dealing with temporally and spatially overlapping hazards and disasters at personal, whänau and community level.
Dr Sue Bagshaw, the head of a youth health clinic Christchurch, fears the high rates of Post Traumatic Stress Disorder among children will skyrocket due to the earthquake.
The number of emergency psychiatric assessments in Christchurch has more than doubled since the earthquakes struck.
An infographic giving the status of Canterbury District Health Board mental regional hospitals.
The increase began after Christchurch's 2011 earthquakes, but the District Health Board is expecting to face even more challenges following effects of the Port Hills fires and last year's earthquake in Kaikoura.
The Canterbury earthquake is taking a toll on the mental health of people in the region. 30% more people in Christchurch are requesting treatment for anxiety, depression and addiction, compared with usual numbers.
There's growing frustration over the government's work to match it's promise to tackle the country's suicide rates. A Mental Health Commission report describes frustration over the pace of change - and points to an urgent need for an overarching action plan. Mental health advocates are also criticising the lack of progress in helping people in Canterbury, with many still severely affected by ongoing trauma from earthquakes and the 2019 Mosque shootings. Eleisha Foon reports.
The chief medical officer for Te Aka Whaiora said lessons had been learnt from the Christchurch earthquakes.
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.
This report presents research on the affects of the Ōtautahi/Christchurch earthquakes of 2010 to 2012 on the city’s Tangata Whaiora community, ‘people seeking health’ as Māori frame mental health clients. Drawing on the voices of 39 participants of a Kaupapa Māori provider (Te Awa o te Ora), this report presents extended quotes from Tangata Whaiora, their support staff (many of whom are Tangata Whaiora), and managers as they speak of the events, their experiences, and support that sustained them in recoveries of well-being through the worse disaster in Aotearoa/New Zealand in three generations. Ōtautahi contains a significant urban Māori population, many living in suburbs that were seriously impacted by the earthquakes that began before dawn on September 4th, 2010, and continued throughout 2011 and 2012. The most damaging event occurred on February 22nd, 2011, and killed 185 people and severely damaged the CBD as well as many thousands of homes. The thousands of aftershocks delayed the rebuilding of homes and infrastructure and exacerbated the stress and dislocation felt by residents. The tensions and disorder continue for numerous residents into 2014 and it will be many years before full social and physical recovery can be expected. This report presents extended excerpts from the interviews of Tangata Whaiora and their support staff. Their stories of survival through the disaster reinforce themes of community and whānau while emphasising the reality that a significant number of Tangata Whaiora do not or cannot draw on this supports. The ongoing need for focused responses in the area of housing and accommodation, sufficiently resourced psycho-social support, and the value of Kaupapa Māori provision for Māori and non-Māori mental health clients cannot be overstated. The report also collates advice from participants to other Tangata Whaiora, their whānau, providers and indeed all residents of places subject to irregular but potentially devastating disaster. Much of this advice is relevant for more daily challenges and should not be underestimated despite its simplicity.
Education advisors are warning that children could suffer mental health problems for years to come if schools botch their return to the classroom. They say the Christchurch earthquakes and Australian bushfires show teachers should resist the temptation to launch straight back into normal lessons after a major event. Principals are hoping to learn today when they will move into alert level two and how many of their students will be able to return to school. RNZ's education correspondent John Gerritsen reports.
A mental wellbeing programme for primary and intermediate school students will be expanded to five more district health board areas. Mana Ake started in 2018 in Canterbury and Kaikōura, and was a response to the ongoing trauma some tamariki were experiencing following the earthquakes. Now more year 1 to 8 pupils will receive extra help if they're struggling. Our reporter Kirsty Frame was at the announcement in Auckland.
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.
Mental health experts in Christchurch are warning the worst could be still to come for people suffering from anxiety, depression and stress related to the earthquakes.
The immediate aftermath of the devastating 2011 Christchurch earthquake and its ongoing impact on residents' mental health is being described as a recovery of two halves. The latest wellbeing survey from the Canterbury District Health Board shows that one in five people, predominantly those living in the eastern suburbs, say they experience stress most or all of the time.
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.
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 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.
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.