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Research papers, University of Canterbury Library

Most people exposed to disasters cope well. Others, however, develop posttraumatic stress disorder (PTSD)–a mental disorder characterised by symptoms of intrusion, avoidance, and hyperarousal–requiring input from specialist mental health services. To date, relatively little research has evaluated these services, and less is known about characteristics of people seeking treatment and their treatment outcomes. In 2010 and 2011, a series of major earthquakes occurred in the Canterbury region of Aotearoa New Zealand, resulting in initiation of the Adult Specialist Services for Earthquake Trauma Treatment (ASSETT) service to provide cognitive behavioural therapy (CBT) for people with earthquake-related PTSD or subthreshold PTSD symptoms. The current research used systematic literature review methods, in conjunction with data collected from people seeking treatment with the ASSETT service, to address issues relevant to the development of disaster mental health responses, particularly specialist mental health services. A systematic review was conducted synthesising research examining mental health service use among adults exposed to natural disasters. A second systematic review and meta-analysis evaluated psychological interventions for earthquake-related PTSD. A series of studies then utilised diagnostic interview and self-report data collected from people seeking treatment with the ASSETT service (n = 184). Data were collected on factors relating to sociodemographics, pre-earthquake mental disorders, current psychological functioning, degree of objective and subjective earthquake exposure, and life events. These studies examined factors distinguishing treatment-seeking participants from earthquake-exposed Canterbury residents who coped well; differences associated with different prior mental disorders and timing of treatment presentation; and outcomes of CBT provided by the service. Four overarching themes emerged across study findings. The first related to the role of objective and subjective disaster exposure in the development of post-disaster mental health outcomes. Subjective peritraumatic responses were found to be an important factor distinguishing treatment-seeking participants from those who coped well following the earthquakes, independent of objective exposure severity. Heightened peritraumatic responses were also associated with poorer treatment outcome, although not beyond their association with pre-treatment PTSD severity and degree of comorbidity. The second theme related to the role of pre-trauma mental health in the development of post-disaster mental health outcomes. Participants with a history of pre-earthquake mental disorder presented with more comorbid disorders than participants with no prior disorder, but reported comparable degrees of PTSD severity and similar treatment outcomes. The third theme related to temporal considerations for disaster mental health responses. Participants who presented at later time points tended to be older and were more likely to have subthreshold PTSD symptoms, but had similar treatment outcomes as those who presented at earlier time points. The fourth theme related to treatment of severe and ongoing earthquake-related distress. CBT without a formal exposure component was associated with clinically significant improvements on a range of outcome measures, with group and individual-based treatment associated with comparable outcomes. Findings of the current research suggest people seeking treatment for severe and ongoing disaster-related distress are not homogenous, and are likely to present for treatment at different time points, have varied mental health histories, and report diverse disaster experiences. CBT is an effective treatment for severe and ongoing post-disaster distress when delivered in real-world mental health service settings. Group CBT represents an efficient, scalable, and effective treatment format for post-disaster distress, and may be an attractive option for treating widespread need using limited resources.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Images, UC QuakeStudies

A photograph of a room in the Diabetes Centre which has been used to store office material while the building is being prepared. Boxes of files and other material have been stacked against the far wall.