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Research papers, University of Canterbury Library

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.

Research Papers, Lincoln University

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.

Research Papers, Lincoln University

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.

Images, UC QuakeStudies

A photograph of All Right? with their Supreme Award, at the 2014 Canterbury Health System Quality Improvement and Innovation Awards evening. From left is (unknown), Neil Brosnahan (CPH Information Team Manager), Rose Henderson (Director of Allied Health with the Specialist Mental Health Service of CDHB), Dr Lucy D'Aeth (Public Health Specialist for CDHB and All Right? Steering Group member), Sue Turner (All Right? Campaign Manager) and Dr Don Mackie (Chief Medical Officer, Ministry of Health).

Images, UC QuakeStudies

A photograph of All Right? with their Supreme Award, at the 2014 Canterbury Health System Quality Improvement and Innovation Awards evening. From left is Gillian Bohm (Principal Advisor Quality Improvement, Health Quality and Safety Commission), David Meates (Chief Executive of the Canterbury and West Coast District Health Boards), Neil Brosnahan (CPH Information Team Manager), Rose Henderson (Director of Allied Health with the Specialist Mental Health Service of CDHB), Dr Lucy D'Aeth (Public Health Specialist for CDHB and All Right? Steering Group member), Sue Turner (All Right? Campaign Manager) and Dr Don Mackie (Chief Medical Officer, Ministry of Health).

Research Papers, Lincoln University

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.

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

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.

Research papers, The University of Auckland Library

Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Research papers, University of Canterbury Library

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.

Videos, UC QuakeStudies

A video of a presentation by Bridget Tehan and Sharon Tortonson during the Community and Social Recovery Stream of the 2016 People in Disasters Conference. The presentation is titled, "Community and Social Service Organisations in Emergencies and Disasters in Australia and New Zealand".The abstract for this presentation reads as follows: What happens when support services for issues such as mental health, foster care or homelessness are impacted by a disaster? What happens to their staff? What happens to their clients? The community sector is a unique, valuable and diverse component of Australasian economy and society. Through its significant numbers of employees and volunteers, its diversity, the range of service and advocacy programs it delivers, and the wide range of people it supports, it delivers value to communities and strengthens society. The community and social services sector builds resilience daily through services to aged care, child welfare and disability, domestic violence, housing and homelessness, and mental health care. The sector's role is particularly vital in assisting disadvantaged people and communities. For many, community sector organisations are their primary connection to the broader community and form the basis of their resilience to everyday adversity, as well as in times of crisis. However, community sector organisations are particularly vulnerable in a major emergency or disaster. Australian research shows that the most community sector organisations are highly vulnerable and unprepared for emergencies. This lack of preparedness can have impacts on service delivery, business continuity, and the wellbeing of clients. The consequences of major disruptions to the provision of social services to vulnerable people are serious and could be life-threatening in a disaster. This presentation will review the Victorian Council of Social Service (Australia) and Social Equity and Wellbeing Network (formerly the Christchurch Council of Social Services) records on the impacts of emergencies on community sector organisations, staff, and clients. From the discussion of records, recommendations will be presented that could improve the resilience of this crucial sector.

Research papers, University of Canterbury Library

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.

Videos, UC QuakeStudies

A video of the keynote presentation by Alexander C. McFarlane during the third plenary of the 2016 People in Disasters Conference. McFarlane is a Professor of Psychiatry at the University of Adelaide and the Heady of the Centre for Traumatic Stress Studies. The presentation is titled, "Holding onto the Lessons Disasters Teach".The abstract for this presentation reads as follows: Disasters are sentinel points in the life of the communities affected. They bring an unusual focus to community mental health. In so doing, they provide unique opportunities for better understanding and caring for communities. However, one of the difficulties in the disaster field is that many of the lessons from previous disasters are frequently lost. If anything, Norris (in 2006) identified that the quality of disaster research had declined over the previous 25 years. What is critical is that a longitudinal perspective is taken of representative cohorts. Equally, the impact of a disaster should always be judged against the background mental health of the communities affected, including emergency service personnel. Understandably, many of those who are particularly distressed in the aftermath of a disaster are people who have previously experienced a psychiatric disorder. It is important that disaster services are framed against knowledge of this background morbidity and have a broad range of expertise to deal with the emerging symptoms. Equally, it is critical that a long-term perspective is considered rather than short-term support that attempts to ameliorate distress. Future improvement of disaster management depends upon sustaining a body of expertise dealing with the consequences of other forms of traumatic stress such as accidents. This expertise can be redirected to co-ordinate and manage the impact of larger scale events when disasters strike communities. This presentation will highlight the relevance of these issues to the disaster planning in a country such as New Zealand that is prone to earthquakes.

Research papers, University of Canterbury Library

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.  

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.

Research papers, The University of Auckland Library

Livelihood holds the key to a rapid recovery following a large-scale devastating disaster, building its resilience is of paramount importance. While much attention has been given to how to help people who are displaced from their jobs to regain employment, little research on livelihood resilience has been undertaken for those relocated communities following a disaster event. By studying five re-located villages post-2004 Indian Ocean Tsunami in Banda Aceh and Aceh Besar, Indonesia, this research has identified the indicators of livelihood resilience and the critical factors driving it for post-disaster relocated communities. A mixed approach, combining questionnaire surveys, semistructured interviews, and field observations, was used for the collection of data. Housing entitlement, the physical and mental health of residents, access to external livelihood support and the provision of infrastructure and basic services were identified as amongst the most critical indicators that represent the level of livelihood resilience. Early recovery income support, physical and mental health, availability and timeliness of livelihood support, together with cultural sensitivity and governance structure, are amongst the most important factors. Given the nature of resettlement, access to infrastructure, location of relocated sites, the safety of the neighbourhood and the ability to transfer to other jobs/skills also play an important role in establishing sustained employment for relocated communities in Indonesia. Those indicators and factors were synthesised into a framework which was further tested in the recovery of Christchurch, and Kaikoura, New Zealand during their recovery from devastating earthquakes. It is suggested that the framework can be used by government agencies and aid organisations to assess the livelihood resilience of post-disaster relocated communities. This will help better them plan support policies and/or prioritise resilience investment strategies to ensure that the recovery needs of those relocated are best met.

Research papers, The University of Auckland Library

The seismic tremor that shook Christchurch on February 22, 2011, not only shattered buildings but also the spirit of the city’s residents. Amidst the ruins, this design-focused thesis unravels two intertwining narratives, each essential to the city’s resurrection. At its core, this thesis probes the preservation of Christchurch’s memory and character, meticulously chronicling the lost heritage architecture and the subsequent urban metamorphosis. Beyond bricks and mortar, it also confronts the silent aftershocks - the pervasive mental health challenges stemming from personal losses and the disfigured cityscape. As a native of Christchurch, intimately connected to its fabric, my lens reflects not just on the architectural reconstruction but also on the emotional reconstruction. My experience as an autistic individual, a recently discovered facet of my identity, infuses this design journey with a distinct prism through which I perceive and interact with the world. The colourful sketches that drive the design process aren’t mere illustrations but manifestations of my interpretation of spaces and concepts, evoking joy and vitality—a testament to embracing diversity in design. Drawing parallels between healing my own traumas with my colourful and joyful neurodivergent worldview, I’ve woven this concept into proposals aimed at healing the city through whimsy, joy, and vibrant colours. Personal experiences during and post-earthquakes profoundly shape my design proposals. Having navigated the labyrinth of my own mental health amid the altered cityscape, I seek avenues for reconciliation, both personal and communal. The vibrant sketches and designs presented in this thesis encapsulate this vision—a fusion of vivid, unconventional interpretations and a dedication to preserving the essence of the original cityscape while still encouraging movement into the future.

Research papers, University of Canterbury Library

There is a growing body of research into the effects of micronutrients on human mental health. There is evidence that multi-ingredient formulas are beneficial especially in relation to serious mental health disorders such as mood and anxiety disorders, attention-deficit hyperactivity disorder and obsessive-compulsive disorders. However there is almost no scientific research which looks at the effects of these formulas in an animal population. Therefore the aim of this study was to investigate the effects of a micronutrient formula, EMPowerplus, on anxiety behaviour in rats, and whether there is a relationship between dose and anxiolytic effect. In order to investigate this 40 male and 40 female rats received a diet consisting of either 0%, 1.25%, 2.5% or 5% EMP+ from when they were weaned (post natal day 30) until the end of testing 141 days later. Animals were tested in a Y maze, a light-dark emergence box and an open field at mid-adulthood (PND 136-138) and late adulthood (PND 186-188). Results found that animals receiving the 5% supplemented diet occupied the centre squares the most, occupied the corner squares the least and ambulated the most in the open field compared to the other experimental groups and control groups. No significant differences were found in the Y maze or Light-dark box. Animals were found to display more anxiety-like behaviour at time 2 than at time 1 regardless of receiving a supplemented diet or not. Overall a higher dose of EMP+ was associated with the greatest reduction in anxiety related behaviour. Due to the impact of the September 4th, 2010 Canterbury Earthquake caution should be taken when interpreting these results.