Sex-specific analysis of acute alcohol use in suicides and reporting of alcohol as a contributor to suicide deaths in New Zealand 2007-2020: a cross-sectional study of coronial data.

AIM: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor? METHOD: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified. RESULTS: Suicide was more likely to involve AAU among Maori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning. CONCLUSION: Targeted public health interventions designed by and for specific demographic groups (particularly Maori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand.

Prenatal cannabis exposure is associated with alterations in offspring DNA methylation at genes involved in neurodevelopment, across the life course.

Prenatal cannabis exposure (PCE) is of increasing concern globally, due to the potential impact on offspring neurodevelopment, and its association with childhood and adolescent brain development and cognitive function. However, there is currently a lack of research addressing the molecular impact of PCE, that may help to clarify the association between PCE and neurodevelopment. To address this knowledge gap, here we present epigenome-wide association study data across multiple time points, examining the effect of PCE and co-exposure with tobacco using two longitudinal studies, the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Christchurch Health and Development Study (CHDS) at birth (0 y), 7 y and 15-17 y (ALSPAC), and ~27 y (CHDS). Our findings reveal genome-wide significant DNA methylation differences in offspring at 0 y, 7 y, 15-17 y, and 27 y associated with PCE alone, and co-exposure with tobacco. Importantly, we identified significantly differentially methylated CpG sites within the genes LZTS2, NPSR1, NT5E, CRIP2, DOCK8, COQ5, and LRP5 that are shared between different time points throughout development in offspring. Notably, functional pathway analysis showed enrichment for differential DNA methylation in neurodevelopment, neurotransmission, and neuronal structure pathways, and this was consistent across all timepoints in both cohorts. Given the increasing volume of epidemiological evidence that suggests a link between PCE and adverse neurodevelopmental outcomes in exposed offspring, this work highlights the need for further investigation into PCE, particularly in larger cohorts.

The psychosocial impacts of the 15 March terrorist attack on the Christchurch Muslim community: A descriptive, cross-sectional assessment.

OBJECTIVE: On 15 March 2019, a white supremacist terrorist carried out sequential attacks on two mosques in Christchurch, New Zealand during Friday prayers. This resulted in the loss of 51 lives, 40 others sustained gunshot injuries, and there were approximately 250 survivors. This study aimed to evaluate the impacts on community members, assess clinical needs, facilitate access to appropriate interventions and provide insights into working with a traumatised and diverse population. METHODS: This cross-sectional study used semi-structured clinical interviews and self-report measures to assess social and demographic factors, mental health disorders and well-being for adult Muslims 11-32 months post-attack. RESULTS: A total of 189 participants completed assessments. The sample was diverse, representing 34 different ethnicities and participant proximity to the attack was complex, with personal and familial exposures. Elevated levels of psychological distress and psychopathology were found with 38% of participants reporting moderate/severe psychological distress on the Kessler-10, 39% reporting post-traumatic stress disorder on the post-traumatic stress disorder checklist-5, and 40% reporting poor well-being or possible depression on the World Health Organization-5 Well Being Index. Secondary stressors were also documented, as well as high scores for post-traumatic growth and the importance of faith. CONCLUSION: This study provides valuable insights into the repercussions of the Christchurch mosque attack on the affected community, describing the complexity of exposure and the substantial burden of morbidity experienced. It also highlights the high levels of social connectedness and the role of faith in promoting positive outcomes in the recovery process for this population.

The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand.

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health.

The role of social support in reducing the long-term burden of cumulative childhood adversity on adulthood internalising disorder.

PURPOSE: Previous research indicates that social support is protective for the mental health outcomes of exposure to childhood adversity. However, the impact of social support as a protective factor following exposure to cumulative childhood adversity is understudied with prospective longitudinal data. The aim of this present study was to examine how social support mediates the impact of cumulative exposure to childhood adversity on internalising disorder in adulthood. METHODS: The Christchurch Health and Development Study (CHDS) is a general population birth cohort, born in 1977 and representative of Christchurch, New Zealand at the time of the cohort members' birth. The present study used a generalised estimating equations (GEE) framework to analyse direct associations between a cumulative measure of childhood adversity (CA) and internalising disorders (major depression, and any anxiety disorder), and indirect associations through social support. RESULTS: Results indicated a dose-dependent relationship between increased exposure to CA and worsened odds of a diagnosis for major depression and any anxiety disorder, respectively. There was also a significant mediating effect of social support on the direct associations between CA and both major depression (OR (95%CI) =0 .98 (0.97, 0.99), p < 001) and any anxiety disorder (OR (95%CI) = .98 (0.97, 0.99), p < 001). CONCLUSION: The findings indicate that social support reduces the impact of childhood adversity on adult mental health, and is therefore a target for future work examining potential interventions following CA.

The roles of extraversion and neuroticism in the relationship between childhood adversity and adolescent substance misuse.

Although the influences of extraversion and neuroticism on the relationship between childhood adversity and substance misuse have been considered in adults, they are not yet clear and have not been examined among adolescent samples. This study sought to investigate the relationship between childhood adversity and adolescent substance misuse, alongside the influences of extraversion and neuroticism, using data from a longitudinal birth cohort study. Statistical analyses were performed on a longitudinal dataset provided by the Christchurch Health and Development Study (CHDS). After controlling for confounds, childhood adversity was a significant predictor of substance use disorder symptoms in adolescence. Moderation analyses showed that experiences of childhood adversity were most strongly associated with adolescent substance use disorder symptoms at higher levels of extraversion and at higher levels of neuroticism. Among adolescents who have experienced childhood adversity, extraversion and neuroticism may be risk factors for substance use disorder. By encouraging professionals to target adolescent substance misuse intervention and prevention approaches towards those who have experienced childhood adversity and are high in extraversion and/or neuroticism, these findings may help to diminish the prevalence of adolescent substance misuse and improve the health of adolescents.

Modified inverse propensity weighting method to alleviate estimation errors in the model with multiple endogenous variables.

Multiple mental health disorders affect on decisions of people. The disorders are also outcomes of other factors. Health studies commonly follow an inverse propensity weight (IPW) method to address estimation errors associated with the presence of one confounder or covariate number exceeding the recommended sample size. However, approaches of IPW appropriate to alleviate the estimation error associated with multiple confounders distributed unequally in the study samples were not explained in our search literature. This study used longitudinal cohort data from Christchurch Health and Development Study and demonstrated IPW approach to address two confounders with similar natures in terms of etiological process. In our sample, some individuals had no mental health disorder at all, while others had either one of depression or anxiety or both. The methodological step to evaluate a new IPW approach include * Estimated IPWs from all possible combinations of the major depression and anxiety disorder: (a) IPW based on anxiety factor only assuming both mental health problems resulted from the same etiological processes; (b) IPW based on major depression factor only assuming both mental health problems resulted from the same etiological processes; (c) IPW assuming three (independent) categories of etiological processes: neither; either; both of major depression or anxiety disorder, (d) IPW assuming four (independent) categories of etiological processes: neither; major depression only; any anxiety disorder only; both. (e) No IPW or control model (no confounding problem.•Estimated outcome model with one each IPW at a time and one without IPw (control model).•Compared fit statistics of all estimated models.•The IPW derived assuming four categories of etiological processes produced the robust based fit statistics criteria. The study showed significant effects of both mental health problems on investment but the anxiety revealed a stronger effect than that of major depression.

Research following trauma in minority ethnic and faith communities: lessons from a study of the psychosocial sequelae of the Christchurch mosque terror attacks.

Recruiting participants for research from highly traumatised ethnic and faith communities requires a participatory and trauma-informed approach that considers logistic barriers, as well as trauma-related and culture-specific issues. Active community engagement through every stage of the project and employing community members in research roles can help build trust, identify and mitigate concerns early, prevent re-traumatization, and ensure that findings will be of value to the community. Some of these research challenges are discussed in the context of the Christchurch mosque terror attacks. These insights may be helpful for researchers and clinicians working in similarly challenging environments.

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure.

OBJECTIVES: There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. METHODS: This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. RESULTS: Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. CONCLUSIONS: The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

Toku Oranga: the subjective wellbeing and psychological functioning of postgraduate and medical students in Otautahi Christchurch.

AIMS: Postgraduate and medical students are at risk of psychological distress and burnout, which can cause significant functional and occupational impairment. We aimed to report subjective wellbeing, psychological distress and burnout in postgraduate and medical students in Otautahi Christchurch, Aotearoa (New Zealand), and identify any associations between participant and course information and outcome measures including exposure to major earthquakes in 2010/2011 and the 2019 terrorist attack. METHODS: A self-report online survey was completed by 140 students between November 2019 and March 2020. Life satisfaction, psychological distress and burnout were primary outcomes. Data were analysed using univariate and multivariable analysis. RESULTS: High levels of psychological distress were present in both student groups. Burnout was reported by 78% of respondents. There were no significant associations found between exposure to the Christchurch earthquakes or terrorist attack with primary outcomes. Personality factors, resilience and perceived support and success were weakly associated with wellbeing, distress and burnout. CONCLUSIONS: Postgraduates and medical students reported high levels of psychological distress and burnout. The earthquakes and terrorist attack do not appear to be associated with negative effects in these cohorts. Personality and resilience characteristics may assist in predicting students at risk of morbidity and evaluating potentially relevant interventions.

Life course development following childhood adversity: methods and findings from the Christchurch Health and Development Study.

Aim: To review research developments on childhood adversity in the Christchurch Health and Development Study (CHDS) since 2001. Method: Narrative overview of the published work of the CHDS since 2001 in the context of research methods. Results: The CHDS research has continued to evolve as the cohort has aged. A clear focus has remained on the measurement of outcomes associated with psychosocial risk factors over the life course. This focus has allowed the CHDS to examine the linkages between exposure to adversity in childhood and later mental health, psychosocial and occupational outcomes across the life span to middle adulthood. The CHDS has many strengths, including prospective measurement of a broad and deep set of constructs, the use of multiple informants for data, and a range of statistical approaches suited to repeated measures longitudinal data. The CHDS has pioneered new approaches to the study of human development over the lifespan, which has been instrumental in investigating childhood adversity. Conclusion: The CHDS continues to provide unique information from a population cohort that has been studied for more than four decades. Future research will include examination of factors that mitigate the effects of childhood adversity and enhance resilience.

Protective factors for psychosocial outcomes following cumulative childhood adversity: systematic review.

BACKGROUND: The long-term cumulative impact of exposure to childhood adversity is well documented. There is an increasing body of literature examining protective factors following childhood adversity. However, no known reviews have summarised studies examining protective factors for broad psychosocial outcomes following childhood adversity. AIMS: To summarise the current evidence from longitudinal studies of protective factors for adult psychosocial outcomes following cumulative exposure to childhood adversity. METHOD: We conducted a formal systematic review of studies that were longitudinal; were published in a peer-reviewed journal; examined social, environmental or psychological factors that were measured following a cumulative measure of childhood adversity; and resulted in more positive adult psychosocial outcomes. RESULTS: A total of 28 studies from 23 cohorts were included. Because of significant heterogeneity and conceptual differences in the final sample of articles, a meta-analysis was not conducted. The narrative review identified that social support is a protective factor specifically for mental health outcomes following childhood adversity. Findings also suggest that aspects of education are protective factors to adult socioeconomic, mental health and social outcomes following childhood adversity. Personality factors were protective for a variety of outcomes, particularly mental health. The personality factors were too various to summarise into meaningful combined effects. Overall GRADE quality assessments were low and very low, although these scores mostly reflect that all observational studies are low quality by default. CONCLUSIONS: These findings support strategies that improve connection and access to education following childhood adversity exposure. Further research is needed for the roles of personality and dispositional factors, romantic relationship factors and the combined influences of multiple protective factors.

Intervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review.

INTRODUCTION: A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps. METHODS AND ANALYSIS: In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews. ETHICS AND DISSEMINATION: This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42022355861.

UNITE Project: understanding neurocognitive impairment after trauma exposure-study protocol of an observational study in Christchurch, New Zealand.

INTRODUCTION: Our 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 ANALYSIS: Two-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 DISSEMINATION: Ethical 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 NUMBER: ClinicalTrials.gov Registry (NCT05090046).

Validation of a Bayesian learning model to predict the risk for cannabis use disorder.

BACKGROUND: Cannabis use disorder (CUD) is a growing public health problem. Early identification of adolescents and young adults at risk of developing CUD in the future may help stem this trend. A logistic regression model fitted using a Bayesian learning approach was developed recently to predict the risk of future CUD based on seven risk factors in adolescence and youth. A nationally representative longitudinal dataset, Add Health was used to train the model (henceforth referred as Add Health model). METHODS: We validated the Add Health model on two cohorts, namely, Michigan Longitudinal Study (MLS) and Christchurch Health and Development Study (CHDS) using longitudinal data from participants until they were approximately 30 years old (to be consistent with the training data from Add Health). If a participant was diagnosed with CUD at any age during this period, they were considered a case. We calculated the area under the curve (AUC) and the ratio of expected and observed number of cases (E/O). We also explored recalibrating the model to account for differences in population prevalence. RESULTS: The cohort sizes used for validation were 424 (53 cases) for MLS and 637 (105 cases) for CHDS. AUCs for the two cohorts were 0.66 (MLS) and 0.73 (CHDS) and the corresponding E/O ratios (after recalibration) were 0.995 and 0.999. CONCLUSION: The external validation of the Add Health model on two different cohorts lends confidence to the model's ability to identify adolescent or young adult cannabis users at high risk of developing CUD in later life.

Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study.

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.

The New Zealand drug harms ranking study: A multi-criteria decision analysis.

AIMS: The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth. METHODS: Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software. RESULTS: When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others. CONCLUSIONS: The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

The COVID Psychosocial Impacts Scale: A Reliable and Valid Tool to Examine the Psychosocial Impacts of the COVID-19 Pandemic.

This paper reports on the development and validation of the COVID Psychosocial Impacts Scale (CPIS), a self-report measure that comprehensively examines both positive and negative psychosocial impacts from the COVID-19 pandemic. This is the first part of the program of work in which the CPIS was administered and compared with a measure of psychological distress (Kessler Psychological Distress Scale, K-10) and wellbeing (World Health Organization Well-Being Index, WHO-5). The data were obtained online in 2020 and 2022 at two distinct time points to capture different exposures to the pandemic in the New Zealand population to a non-representative sample of 663 and 687 adults, respectively. Two hundred seventy-one participants took part in both surveys. Findings indicate a unidimensional structure within CPIS subscales and inter-relatedness among CPIS stress-related subscales. The scatter plots and correlation matrix indicate CPIS having a positive moderate correlation with K10 and a negative moderate correlation with WHO-5, indicative of construct validity. The paper outlines contextual factors surrounding CPIS development and makes suggestions for future iterations of CPIS. Further work will examine its psychometric properties across cultures.

Predictors of methamphetamine use in a longitudinal birth cohort.

BACKGROUND: Identifying predictors of methamphetamine use can inform population prevention strategies. METHODS: Participants (n = 1265) born in Christchurch, New Zealand were followed from birth to age 40. Methamphetamine outcomes (any use since the last interview, and regular use, defined as any period of at least weekly use) were ascertained by self-report at six interviews from age 18 to 40. Predictors with plausible associations with methamphetamine use were extracted from the study database. These were grouped into early predictors (age 0-16), comprising childhood, familial and individual characteristics; and later time-dynamic correlates of methamphetamine use in adulthood (ages 16-40). Generalised estimating equation models were fitted to identify predictors of methamphetamine use outcomes. RESULTS: In adjusted models, paternal overprotectiveness and childhood anxious / withdrawn behavior were associated with any use of methamphetamine, but not regular use. Conversely, childhood conduct problems and parental illicit drug were associated with regular use but not any use. Male sex, high novelty seeking and deviant peer affiliations were associated with both any use and regular use in adjusted models. The strongest correlates of methamphetamine use in adulthood were unemployment, life stress and other substance use disorders (cannabis, nicotine, and alcohol). CONCLUSION: Markers of externalizing problems in childhood and adolescence (conduct problems, high novelty seeking, parental illicit substance use, and deviant peer affiliations) are the strongest predictors of regular methamphetamine use in adulthood.