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"Bell, Caroline"
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Psychological distress and psychiatric disorder after natural disasters: systematic review and meta-analysis
2018
Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.AimsOur aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.
This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.
Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27-0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43-2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.
Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.Declaration of interestNone.
Journal Article
Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study
2020
New Zealand's early response to the novel coronavirus pandemic included a strict lockdown which eliminated community transmission of COVID-19. However, this success was not without cost, both economic and social. In our study, we examined the psychological wellbeing of New Zealanders during the COVID-19 lockdown when restrictions reduced social contact, limited recreation opportunities, and resulted in job losses and financial insecurity. We conducted an online panel survey of a demographically representative sample of 2010 adult New Zealanders in April 2020. The survey contained three standardised measures-the Kessler Psychological Distress Scale (K10), the GAD-7, and the Well-Being Index (WHO-5)-as well as questions designed specifically to measure family violence, suicidal ideation, and alcohol consumption. It also included items assessing positive aspects of the lockdown. Thirty percent of respondents reported moderate to severe psychological distress (K10), 16% moderate to high levels of anxiety, and 39% low wellbeing; well above baseline measures. Poorer outcomes were seen among young people and those who had lost jobs or had less work, those with poor health status, and who had past diagnoses of mental illness. Suicidal ideation was reported by 6%, with 2% reporting making plans for suicide and 2% reporting suicide attempts. Suicidality was highest in those aged 18-34. Just under 10% of participants had directly experienced some form of family harm over the lockdown period. However, not all consequences of the lockdown were negative, with 62% reporting 'silver linings', which included enjoying working from home, spending more time with family, and a quieter, less polluted environment. New Zealand's lockdown successfully eliminated COVID-19 from the community, but our results show this achievement brought a significant psychological toll. Although much of the debate about lockdown measures has focused on their economic effects, our findings emphasise the need to pay equal attention to their effects on psychological wellbeing.
Journal Article
Silver linings of the COVID-19 lockdown in New Zealand
by
Hoek, Janet
,
Rapsey, Charlene
,
Every-Palmer, Susanna
in
Adaptation, Psychological
,
Biology and Life Sciences
,
Bouncing
2021
The COVID-19 pandemic has caused significant disruption, distress, and loss of life around the world. While negative health, economic, and social consequences are being extensively studied, there has been less research on the resilience and post-traumatic growth that people show in the face of adversity. We investigated New Zealanders’ experiences of benefit-finding during the COVID-19 pandemic and analysed qualitative responses to a survey examining mental well-being during the New Zealand lockdown. A total of 1175 of 2010 eligible participants responded to an open-ended question probing ‘silver linings’ (i.e., positive aspects) they may have experienced during this period. We analysed these qualitative responses using a thematic analysis approach. Two thirds of participants identified silver linings from the lockdown and we developed two overarching themes: Surviving (coping well, meeting basic needs, and maintaining health) and thriving (self-development, reflection, and growth). Assessing positive as well as negative consequences of the pandemic provides more nuanced insights into the impact that New Zealand’s response had on mental well-being.
Journal Article
Childhood abuse and psychotic experiences in adulthood: findings from a 35-year longitudinal study
2019
The extent to which exposure to childhood sexual and physical abuse increases the risk of psychotic experiences in adulthood is currently unclear.AimsTo examine the relationship between childhood sexual and physical abuse and psychotic experiences in adulthood taking into account potential confounding and time-dynamic covariate factors.
Data were from a cohort of 1265 participants studied from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood sexual and physical abuse. At ages 30 and 35, they were questioned about psychotic experiences (symptoms of abnormal thought and perception). Generalised estimating equation models investigated covariation of the association between abuse exposure and psychotic experiences including potential confounding factors in childhood (socioeconomic disadvantage, adverse family functioning) and time-dynamic covariate factors (mental health, substance use and life stress).
Data were available for 962 participants; 6.3% had been exposed to severe sexual abuse and 6.4% to severe physical abuse in childhood. After adjustment for confounding and time-dynamic covariate factors, those exposed to severe sexual abuse had rates of abnormal thought and abnormal perception symptoms that were 2.25 and 4.08 times higher, respectively than the 'no exposure' group. There were no significant associations between exposure to severe physical abuse and psychotic experiences.
Findings indicate that exposure to severe childhood sexual (but not physical) abuse is independently associated with an increased risk of psychotic experiences in adulthood (particularly symptoms of abnormal perception) and this association could not be fully accounted for by confounding or time-dynamic covariate factors.Declaration of interestNone.
Journal Article
A systematic review of the psychological impacts of the Canterbury earthquakes on mental health
by
Mulder, Roger T
,
Bell, Caroline J
,
Beaglehole, Ben
in
Anxiety disorders
,
Bias
,
Cohort analysis
2019
This systematic review aims to identify and evaluate all studies that measured psychological distress or mental disorder following the Canterbury earthquakes to establish the psychological consequences of the earthquakes on those exposed. A secondary aim is to outline and emphasise key methodological factors in disaster research.
Eligible studies were identified following a comprehensive literature search. A quality assessment was undertaken for all included studies. This was followed by methodological and descriptive review.
Thirty‐one papers measuring psychological distress or mental disorder following the Canterbury earthquakes were identified. These papers reported outcomes from 20 separate studies of which seven were rated high‐quality, eight were rated medium and five were rated low‐quality. Key methodological findings and outcomes are discussed for each study.
The Canterbury earthquakes were associated with widespread but not universal adverse effects on mental health. Disaster research quality is assisted by representative samples, repeated measures, and the use of appropriate controls to allow accurate assessments of psychological consequences to be made.
The presence of widespread adverse effects as a result of the earthquakes suggests broad‐ranging community initiatives are essential to mitigate the negative consequences of disasters.
Journal Article
Feasibility study of brief group Transdiagnostic Cognitive Behavioural Treatment delivered via Zoom for anxiety and depression in primary care
2023
Reports the feasibility and effectiveness of delivering brief group transdiagnostic cognitive behavioural therapy (TCBT) via Zoom for anxiety and/or depression in primary care. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Journal Article
Thriving in a pandemic: Determinants of excellent wellbeing among New Zealanders during the 2020 COVID-19 lockdown; a cross-sectional survey
2022
Contributes the results of the NZ Lockdown Psychological Distress Survey, an on-line cross-sectional survey of New Zealanders undertaken during the strict lockdown for COVID-19 from 25 March 2020 to 28 April 2020. Reports the proportion of participants with excellent wellbeing, examining the relative importance of individual factors associated with excellent wellbeing. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Journal Article
The thematic series on the psychosocial and mental health impacts of terrorism and collective violence: narrative review of common themes from diverse events, places and research methods
by
Williams, Richard
,
Kaufman, Kenneth R.
,
Bell, Caroline
in
Anxiety
,
collective violence
,
Community
2025
Thematic series were introduced to BJPsych Open by the current Editor-in-Chief to address key topics in psychiatry and mental health, specifically considering the impact on the global burden of diseases with associated treatments, outcomes, policy and research priorities. The increasing submission to BJPsych Open of articles about the psychosocial and mental health impacts of terrorism and collective violence naturally led to this thematic series. This paper introduces the journal’s series of published papers about terrorism and collective violence. While we identify the topics covered by the series and hope to generate conversation, this paper does not report a systematic review of the series. The thematic series consists of 13 articles; 9 were open submissions and 4 were commissioned. They include this review, an editorial concerning research methods and 11 papers reporting how people have responded to terrorist and violent incidents in 4 countries. Including this review, one paper was published in 2020, three in 2022, two in 2023, five in 2024 and two in 2025. The commissioned papers were added to broaden coverage of the Utøya attack on young people in Norway, and the shootings in Christchurch, New Zealand in 2019. Our intention was to enable the papers on these two incidents to sit alongside papers already submitted about them and the Manchester Arena bombing as well as articles about attacks in Germany. We begin by introducing the papers and comment in the discussion on a series of topics that we have selected as prominent in the series.
Journal Article
UNITE Project: understanding neurocognitive impairment after trauma exposure–study protocol of an observational study in Christchurch, New Zealand
2023
IntroductionOur previous research has demonstrated significant cognitive effects of earthquake exposure 2–3 years following the Canterbury earthquake sequence of 2011. Such impairment has major implications for a population trying to recover, and to rebuild, a devastated city. This study aims to examine psychological, cognitive and biological factors that may contribute to subjective cognitive difficulties in a large group of individuals exposed to the Canterbury earthquake sequence.Methods and analysisTwo-hundred earthquake-exposed participants from an existing large cohort study (Christchurch Health and Development Study, CHDS) will be recruited. Inclusion is based on results of online screening of the CHDS cohort, using the Cognitive Failures Questionnaire. Individuals scoring the highest (n=100) and lowest (n=100), representing the highest and lowest levels of subjective cognitive impairment, are selected. Exclusions are: psychotic/bipolar disorders, serious substance/alcohol dependence, chronic medical conditions, pregnancy and previous serious head injury. Participants will undergo a half-day assessment including clinician-rated interviews, self-report measures, objective and subjective cognitive assessments, blood sample collection and physical measurements. The primary analysis will compare cognitive, psychological and biological measures in ‘high’ and ‘low’ subjective cognitive impairment groups. The study will have power (p<0.05, α=0.8) to show a difference between groups of 0.4 SD on any variable.Ethics and disseminationEthical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. The online screening component of the study received ethical approval on 1 April 2021 (16/STH/188, PAF 7), and the main study (subsequent to screening) received approval on 16 August 2021 (Northern A 21/NTA/68). All participants provide written informed consent. Findings will be disseminated initially to the CHDS cohort members, the wider Canterbury community, and then by publication in scientific journals and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT05090046).
Journal Article
Impact of the Canterbury earthquakes on dispensing of psychiatric medication for children and adolescents: longitudinal quantitative study
by
Boden, Joseph M.
,
Frampton, Christopher M. A.
,
Bell, Caroline J.
in
Adolescent
,
Adolescents
,
Adversity
2020
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010-2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
Journal Article