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Amane M, Hachoumi N, Laabidi R, Mazzi L, Yakini S, Loulidi S, Jbari S, Mourid EH, Boussaa S. Mental health of nursing students regarding the Moroccan earthquake: A cross-sectional study. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:377-385. [PMID: 39313070 DOI: 10.1016/j.enfcle.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/09/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE In addition to the economic and social impact, mental health issues are one of health needs during natural disaster such as earthquake. Thus, surveillance for mental health variables is crucial for public health planning. Nursing students as professional students may be particularly vulnerable to adverse mental health effects after an earthquake because of their potential role in emergency response and the challenges associated with providing medical care in crisis conditions. The aim of this research was to assess the mental health of students after six months of the Moroccan earthquake and associated factors. METHOD A cross-sectional survey of student nurses was conducted on March 2024; six months after the Moroccan earthquake in front to 261 students using class sampling method. Three validated psychometric measures, Post-Traumatic Stress Disorder (PCL-C), Depression, Anxiety and Stress Scale (DASS-21), and The Connor-Davidson Resilience Scale (CD-RISC) were used to assess the nursing student mental health after Moroccan earthquake. RESULTS Anxiety, Depression, Stress and abnormal post-traumatic stress rank was present respectively in 44.8%, 37.1%, 7.7%, 61.3% of participants. However, a minority of students obtained the high resilience score (13.8%). The results showed that the DAS scale correlated negatively with age (p = 0.034). Furthermore, the female gender, 3rd grade students (as final year for the nursing diploma) and those who had lost a family member in the natural disaster obtained higher medians with a significant difference in the DAS scale score (p < 0.05). The post-traumatic stress scale was only affected by material damage (p = 0.044). However, the high level of scores resilience obtained significantly for students living with their families. In contrast, no association between the mental health of nursing students and attending the phenomenon or living near earthquake foci. CONCLUSION This study has demonstrated the crucial need to train healthcare providers in emotion management in the event of a natural disaster, and to launch a priori initiatives, particularly with regard to the mental health of students in health universities, in order to prepare them psychologically for any intervention in the case of an alert.
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Affiliation(s)
- Mounia Amane
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco.
| | - Nadia Hachoumi
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Rquia Laabidi
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Loubna Mazzi
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Souad Yakini
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Sokaina Loulidi
- Laboratory of Pharmacology, Neurobiology, Anthropobiology and Environment, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech 40000, Morocco
| | - Siham Jbari
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - El Hassane Mourid
- Interdisciplinary Laboratory for Research in Bio-Resources, Environment and Materials, Higher Normal School, Cadi Ayyad University, Marrakesh, Morocco
| | - Samia Boussaa
- ISPITS-Higher Institute of Nursing and Technical Health Occupations, Ministry of Health and Social Protection, Rabat, Morocco
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Kabir S, Newnham EA, Dewan A, Kok KQX, Hamamura T. Climate hazards and psychological health among coastal communities in the Asia-Pacific region: a systematic review of quantitative and qualitative evidence. Health Psychol Rev 2024:1-19. [PMID: 39083637 DOI: 10.1080/17437199.2024.2383224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
This systematic review assesses the relationship between climate induced coastal hazards and psychological well-being of communities in the Asia-Pacific region. The review synthesises findings from 13 peer-reviewed articles published between 2007 and 2020, encompassing data from seven countries: Bangladesh, India, Indonesia, Philippines, Solomon Islands, Tuvalu, and Vietnam. Results reveals a robust negative association between exposure to coastal hazards and psychological outcomes, notably stress, depression, anxiety, and distress. Most of the studies (77%) corroborate negative impacts of coastal hazards on psychological health. Additionally, 69% of the reviewed articles suggest a correlation between coastal hazards and negative outcomes for community livelihoods and essential resources. The review highlights increased psychological vulnerability among marginalised subpopulations, such as economically disadvantaged communities, a trend supported by 92% of the examined articles. The findings indicates that factors such as environmental vulnerability, resource availability, community traits, and coping methods are important in determining whether a community can effectively handle coastal hazards or face increased psychological health risks. This research aligns with international health frameworks, including the World Health Organization's Health Emergency and Disaster Risk Management guidelines. However, a notable research gap emerges - the absence of studies that specifically explore psychological responses of communities to ongoing climate-related coastal hazards, such as sea-level rise. These findings emphasise an urgent need for targeted research to guide comprehensive, multidisciplinary policy interventions aimed at mitigating the psychological and socio-economic repercussions of climate-related coastal hazards.
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Affiliation(s)
- Sajjad Kabir
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Psychology, Faculty of Earth and Life Sciences, Jagannath University, Dhaka, Bangladesh
| | - Elizabeth A Newnham
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Curtin enAble Institute, Perth, Australia
| | - Ashraf Dewan
- Earth and Planetary Sciences (EPS), Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Keegan Qi Xian Kok
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Takeshi Hamamura
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Ozturk GY, Arat NB, Ozdemir AA, Bashan I, Kocyigit BF. The effect of earthquake on fibromyalgia: a comparison of patients on medication and without medication. Rheumatol Int 2024; 44:1345-1351. [PMID: 38722331 PMCID: PMC11178565 DOI: 10.1007/s00296-024-05605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION / OBJECTIVES Stressful events like earthquakes might worsen the symptoms of fibromyalgia, although the influence of medications on these consequences is yet uncertain. The objective of this study was to examine the influence of an earthquake on the symptoms of fibromyalgia and evaluate the impacts of medications used to treat fibromyalgia on the clinical picture. METHOD Ninety-five fibromyalgia patients were enrolled in a comparative study and divided into two groups: medication and non-medication. Three subcategories of medication groups were established: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentinoid drugs (GDs). Before and after the earthquake, clinical evaluations were conducted using the Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), and Jenkins Sleep Rating Scale (JSS). Statistical analyses were conducted to compare the scores before and after the earthquake and evaluate the differences between the groups. RESULTS Statistically significant increases were observed in FIQ, HADS-anxiety, HADS-depression, and JSS scores in the medication and non-medication groups before and after the earthquake comparisons (p < 0.05). Non-medication group reported significantly higher post-earthquake changes in FIQ, HADS-anxiety, HADS-depression, and JSS compared to the medication group (p < 0.05). While HADS-anxiety, HADS-depression, and JSS changes after the earthquake differed according to the drug subgroups (p < 0.05), no statistically significant difference was observed in FIQ values (p > 0.05). The highest scores were detected in the GD subgroup. CONCLUSIONS This study highlights the substantial impact of earthquakes on fibromyalgia patients. Medication use may assist in reducing the detrimental effects of stresses like earthquakes on fibromyalgia symptomatology. Future research with larger sample sizes and more extended follow-up periods is needed to explain these findings and optimize treatment regimens for fibromyalgia patients experiencing significant stressors.
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Affiliation(s)
- Gulsah Yasa Ozturk
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye
| | - Neval Bozok Arat
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye
| | - Asena Ayca Ozdemir
- Department of Medical Education, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ibrahim Bashan
- Department of Medical Education, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Burhan Fatih Kocyigit
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye.
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Cerna-Turoff I, Casey JA, Keyes K, Rudolph KE, Malinsky D. Longitudinal patterns of natural hazard exposures and anxiety and depression symptoms among young adults in four low- and middle-income countries. Sci Rep 2024; 14:10538. [PMID: 38719874 PMCID: PMC11078992 DOI: 10.1038/s41598-024-60106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
We estimated the effect of community-level natural hazard exposure during prior developmental stages on later anxiety and depression symptoms among young adults and potential differences stratified by gender. We analyzed longitudinal data (2002-2020) on 5585 young adults between 19 and 26 years in Ethiopia, India, Peru, and Vietnam. A binary question identified community-level exposure, and psychometrically validated scales measured recent anxiety and depression symptoms. Young adults with three exposure histories ("time point 1," "time point 2," and "both time points") were contrasted with their unexposed peers. We applied a longitudinal targeted minimum loss-based estimator with an ensemble of machine learning algorithms for estimation. Young adults living in exposed communities did not exhibit substantially different anxiety or depression symptoms from their unexposed peers, except for young women in Ethiopia who exhibited less anxiety symptoms (average causal effect [ACE] estimate = - 8.86 [95% CI: - 17.04, - 0.68] anxiety score). In this study, singular and repeated natural hazard exposures generally were not associated with later anxiety and depression symptoms. Further examination is needed to understand how distal natural hazard exposures affect lifelong mental health, which aspects of natural hazards are most salient, how disaster relief may modify symptoms, and gendered, age-specific, and contextual differences.
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Affiliation(s)
- Ilan Cerna-Turoff
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York City, NY, USA.
| | - Joan A Casey
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York City, NY, USA
- School of Public Health, Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Katherine Keyes
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Kara E Rudolph
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Daniel Malinsky
- Mailman School of Public Health, Department of Biostatistics, Columbia University, New York City, NY, USA
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Poma M, Al Amri F, Tawse‐Smith A, Ma S. How are you coping with the COVID-19 pandemic? Survey of undergraduate dental students' well-being during an unexpected global event. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:459-467. [PMID: 34543521 PMCID: PMC8652817 DOI: 10.1111/eje.12721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/21/2021] [Accepted: 07/10/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND COVID-19 pandemic has led to major life changes including suspension of dental education programmes worldwide. The impact of this unexpected disruption in clinical teaching needs to be assessed. AIM The aim of this study was to evaluate the impact of the COVID-19 restriction measures on the undergraduate dental students' perception regarding their physical, mental and social well-being as well as financial stress and anxiety for their future careers. MATERIALS AND METHODS An electronic questionnaire (Qualtrics, Provo, Utah, USA) with main themes (general well-being, academic stressors, financial implications and dental career concerns) related to the COVID-19 lockdown was sent to the undergraduate dental students at the University Of Otago, New Zealand. Participants were asked to rank their answers according to a 5-level Likert scale (strongly disagreed-strongly agreed). Other questions included demographic, fee-paying status and living situation. RESULTS There were 301 out of 376 students who responded to the survey. Generally, the students perceived that the COVID-19 restrictions affected their behavioural and social well-being (3.20 ± 0.75) and less impact on their physical (2.75 ± 0.82) and psychological (2.79 ± 0.62) well-being. Students were significantly worried about their academic work and future careers (3.41 ± 1.20), but less concerned with their financial situation (2.74 ± 1.14). CONCLUSIONS The study provides valuable information on the impact of COVID-19 pandemic on undergraduate dental students, and areas that the University should consider when providing support to the affected students. It is important that the University is proactive and prepared to deal with future pandemics effectively and efficiently.
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Affiliation(s)
- Malosi Poma
- Faculty of DentistryUniversity of OtagoDunedinNew Zealand
| | - Firas Al Amri
- Faculty of DentistryUniversity of OtagoDunedinNew Zealand
| | | | - Sunyoung Ma
- Faculty of DentistryUniversity of OtagoDunedinNew Zealand
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Jarden RJ, Joshanloo M, Weijers D, Sandham MH, Jarden AJ. Predictors of Life Satisfaction in New Zealand: Analysis of a National Dataset. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5612. [PMID: 35565016 PMCID: PMC9103190 DOI: 10.3390/ijerph19095612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
The study aim was to determine prevalence and predictors of life satisfaction in New Zealand. In this observational cross-sectional study, a sample of 10,799 participants from NZ were drawn from the Gallup World Poll from 2006 to 2017. Data were analysed using regression analysis and ANOVA. Prevalence of life satisfaction across time varied little from a high of 7.61 (SD = 1.6) in 2007 to a low of 7.23 (SD = 1.73) in 2011 (range 0-10). Satisfaction with standards of living predicted life satisfaction regardless of age or gender. For males across all age groups and females up to age 40 years, positive experiences and satisfaction with household income were important predictors. Being married was an important predictor for males over 40 years and feeling satisfied with their current city was important for females across all ages and for men under 40. The levels of life satisfaction changed over time, possibly due to major national events. Satisfaction with standards of living was found to predict life satisfaction regardless of age or gender. These results provide a path for policy focus towards increased life satisfaction.
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Affiliation(s)
- Rebecca J. Jarden
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, 161 Barry St., Carlton, VIC 3053, Australia
| | - Mohsen Joshanloo
- Department of Psychology, Keimyung University, 1095 Dalgubeol Boulevard, Dalseo-Gu, Daegu 42601, Korea;
| | - Dan Weijers
- School of Social Sciences, University of Waikato, Gate 1 Knighton Road, Private Bag 3105, Hamilton 3240, New Zealand;
| | - Margaret H. Sandham
- School of Clinical Sciences, Auckland University of Technology (AUT), North Shore Campus, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand;
| | - Aaron J. Jarden
- Centre for Wellbeing Science, Melbourne Graduate School of Education, The University of Melbourne, Kwong Lee Dow Building, 234 Queensberry Street, Parkville, Melbourne, VIC 3053, Australia;
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Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168340. [PMID: 34444094 PMCID: PMC8392681 DOI: 10.3390/ijerph18168340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.
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Kimuli Balikuddembe J, Zeng X, Chen C. Health-Related Rehabilitation after the 2008 Great Wenchuan Earthquake in China: A Ten Year Retrospective Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2297. [PMID: 32235359 PMCID: PMC7177972 DOI: 10.3390/ijerph17072297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/18/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
Being one of the world's seismically hazard-prone countries, the People's Republic of China (PRC) witnessed an 8.0-magnitude earthquake on May 12th 2008-which was reported as one of the most destructive disasters since its founding. Following this earthquake, rehabilitation was greatly required for survivors to enable them to achieve and maintain optimal independence; functioning; full physical, mental and social ability; inclusion; and participation in all aspects of life and environments. We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to retrospectively identify, in five English databases/sources, the existing evidence about the Health-Related Rehabilitation (HRR) that was rendered to the survivors of the 2008 Wenchuan earthquake between 2008 and 2018. Only 11 studies out of 828 initial studies retrieved were included in our study and reported the survivors of the 2008 Wenchuan earthquake to have been aged between 10.5 and 55.7, and predominantly diagnosed with posttraumatic stress disorders. Their HRR was mainly premised on physical and physiological therapies, as well as traditional Chinese medicine and digital technologies. Although all HRR interventions used were reported to be effective, none was identified as much more effective than the others in the post-earthquake era -which calls for more robust research to build upon our systematic review.
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Affiliation(s)
- Joseph Kimuli Balikuddembe
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong-Kong Polytechnic University, Chengdu 610000, China;
| | - Xinglin Zeng
- Rehabilitation Department, West China School of Medicine, Sichuan University, Chengdu 610000, China;
| | - Chuandong Chen
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong-Kong Polytechnic University, Chengdu 610000, China;
- West China School of Public Health, Sichuan University, Chengdu 610000, China
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Beaglehole B, Bloomer C, Zhang T, Hamilton G, Boden JM, Mulder RT, Bell C, Frampton C. The impact of the Canterbury earthquakes on dispensing for older person's mental health. Int J Geriatr Psychiatry 2019; 34:1599-1604. [PMID: 31291027 DOI: 10.1002/gps.5171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the impact of the Canterbury earthquakes on the mental health of older people by examining dispensing patterns of psychotropic medication. METHOD Dispensing data from community pharmacies for antidepressants, antipsychotics, anxiolytics, and sedative/hypnotics are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) (n = 67 760 at study onset) and the rest of New Zealand (n = 469 055 at study onset). We compared older age dispensing data between 2008 and 2018 for Canterbury DHB with older age dispensing data nationally in order to assess the impact of the Canterbury earthquakes on the mental health of older persons. RESULTS Older age residents of Canterbury are dispensed antidepressants, antipsychotics, and anxiolytics at higher rates than national comparators, but this finding predated the onset of the earthquakes. Short-term increases in anxiolytic and sedative/hypnotic dispensing occurred for the month following the February 2011 earthquake. No other short- or longer-term increases in dispensing of psychiatric medication were present. CONCLUSION The February 2011 Canterbury earthquake caused a short-term increase in dispensing of anxiolytics and sedative/hypnotics. No longer-term effects on dispensing were observed. This suggests that older persons sought assistance for insomnia and anxiety in the aftermath of the most devastating earthquake, but longer-term rates of clinically significant anxiety and depression for older persons did not increase as a consequence of the earthquakes sequence.
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Affiliation(s)
- Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Christopher Bloomer
- Division of Mental Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Tao Zhang
- Division of Planning and Funding, Canterbury District Health Board, Christchurch, New Zealand
| | - Greg Hamilton
- Division of Planning and Funding, Canterbury District Health Board, Christchurch, New Zealand
| | - Joseph M Boden
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Caroline Bell
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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