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Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa.
(Elsevier B.V., 2023-11-01) Telfar S; McLeod GFH; Dhakal B; Henderson J; Tanveer S; Broad HET; Woolhouse W; Macfarlane S; Boden JM
BACKGROUND: Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Māori); therefore, we cannot assume the effects of maltreatment are the same across the population. OBJECTIVE: Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Māori/non-Māori). PARTICIPANTS AND SETTING: Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Māori ethnic identity; 82.2 % (n = 883) were non-Māori. METHODS: CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Māori ethnicity. RESULTS: After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Māori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results. CONCLUSIONS: Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Māori childhood maltreatment outcomes.
Home drinking practices among middle-class adults in midlife during the COVID-19 pandemic: Material ubiquity, automatic routines and embodied states.
(John Wiley and Sons, Inc., 2023-07-01) Lyons AC; Young J; Blake D; Evans P; Stephens C
INTRODUCTION: Harmful drinking is increasing among mid-life adults. Using social practice theory, this research investigated the knowledge, actions, materials, places and temporalities that comprise home drinking practices among middle-class adults (40-65 years) in Aotearoa New Zealand during 2021-2022 and post the COVID-19 pandemic lockdowns. METHODS: Nine friendship groups (N = 45; 26 females, 19 males from various life stages and ethnicities) discussed their drinking practices. A subset of 10 participants (8 female, 2 male) shared digital content (photos, screenshots) about alcohol and drinking over 2 weeks, which they subsequently discussed in an individual interview. Group and interview transcripts were thematically analysed using the digital content to inform the analysis. RESULTS: Three themes were identified around home drinking practices, namely: (i) alcohol objects as everywhere, embedded throughout spaces and places in the home; (ii) drinking practices as habitual, automatic and conditioned to mundane everyday domestic chores, routines and times; and (iii) drinking practices intentionally used by participants to achieve desired embodied states to manage feelings linked to domestic and everyday routines. DISCUSSION AND CONCLUSIONS: Alcohol was normalised and everywhere within the homes of these midlife adults. Alcohol-related objects and products had their own agency, being entangled with domestic routines and activities, affecting drinking in both automatic and intentional ways. Developing alcohol policy that would change its ubiquitous and ordinary status, and the 'automatic' nature of many drinking practices, is needed. This includes restricting marketing and availability to disrupt the acceptability and normalisation of alcohol in the everyday domestic lives of adults at midlife.
Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018
(MDPI (Basel, Switzerland), 2022-05-26) Wham C; Curnow J; Towers A
This study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49-87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.
Acceptance and commitment therapy : application in a real-world alcohol and other drug community setting : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology, Massey University, Wellington, New Zealand
(Massey University, 2018) Cotter, Rachel
Treating addictive behaviours in alcohol and drug populations in real-world settings carries a range of issues: standardised treatment approaches have been criticised for their complexity and inaccessibility, their failure to retain clients over the course of therapy, and their inability to address the range of coexisting difficulties present. The development of transdiagnostic third wave therapies has recently emerged as an alternative to traditional approaches. One such therapeutic approach is Acceptance and Commitment Therapy (ACT). ACT has proven to be effective in the treatment of several mental illnesses such as anxiety disorders, mood disorders, psychotic symptoms, and personality disorders; it has been found to be effective with medical issues such as chronic pain, cancer, epilepsy, and weight loss; and, importantly, it has been applied across a variety of challenging conditions and evidence of its effectiveness in treatment of addictive behaviours is promising and growing. The current study aims to examine the effectiveness of a manualised ACT-based group treatment programme applied in a real-world Alcohol and Other Drug (AOD) community setting. It was hypothesised that ACT would lead to reductions in alcohol use, substance use and cravings, and common co-occurring symptomology such as anxiety and stress. It was also hypothesised that there would be an increase in mood management skills and mindfulness tendencies. Findings suggest ACT is a promising approach to treating AOD communities as it is well-regarded by clients and it elicits a reduction in several substance use behaviours; however, several outcomes were not statistically significant for many of the comparisons which is likely due to the study being underpowered. In addition, most coexisting problems reduced by post-group and improvements to mood management were evident. However, a rebound effect was found at the three-month follow-up in which the mood management skills reduced, and coexisting stress and anxiety increased. Mindfulness tendencies demonstrated an accumulative effect and showed significant increases by follow-up. These results, although not statistically significant, still provide support for future development and implementation of transdiagnostic approaches such as ACT, particularly in AOD services that commonly deal with dual diagnosis.
Alcohol problems and socio-economic status : a regional study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology at Massey University
(Massey University, 1981) Pitcher, Douglas
The problem was to explore the apparent relations between occupational status and drinking behaviour and to resolve, if possible, the confusions about which status positions were most likely to consume alcohol and experience problems. The thesis investigates the hypothesis that people occupying high status positions are more vulnerable to high levels of alcohol consumption and alcohol related problems. It was presumed that ranking occupations in terms of the Elley-Irving SES scale, and educational attainment would permit the test of this assumed relationship. The study focused on a sample of 869 males selected from a larger survey of health related issues in the five counties which comprise the Wanganui Hospital Board's area. All males over 15 years of age, employed in a full time occupation who were, or ever had been regular drinkers were interviewed about their levels of consumption, and any alcohol related problems they may have experienced. The general trend of the findings suggested an association between alcohol misuse and low SES. A higher percentage of low status drinkers worried about their drinking; regarded themselves as heavy drinkers; were regarded by others as heavy drinkers; and indicated heavy patterns of consumption (400 + grams of alcohol per week). No relationship between SES and regular drinking was found, although a positive association between regular drinking and educational attainment was suggested. The lack of statistical significance restricts the extent to which we can draw any clear inferences as to the nature of the relationships involved. In conclusion it could be stated that although the findings are not significant they suggest occupational vulnerability is more characteristic of low status occupations. Certain methodological inadequacies make it impossible to draw any firm conclusions concerning alternate hypotheses, for example that low SES positions are more vulnerable. Overreporting by the low SES group, and underreporting by those of high status may have biased the findings. An alternative theory is proposed to the effect that both ends of the status occupational hierarchy are characterised by high vulnerability.
An evaluation of two alcohol education courses in a military setting : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
(Massey University, 1984) Raven, John Michael
An evaluation of two alcohol education courses conducted in a military setting for a supposedly "high risk" group in terms of alcohol related problems, formed the basis of the present study. The two courses differed in length (3 x 2 hour lessons, 2 x 2 hour lessons), and comprized a combination of lecture, film, question-answer and discussion group instructional methods. Pre and post questionnaire responses of the two groups of course participants (n = 28,26) and of a control group (n = 28) were analysed. In addition a follow-up measure was taken of one group of participants four months after programme completion. Results indicated a significant gain in the course participants' knowledge as a result of the programme, but no change in attitudes, or skills-related responses. Despite a small positive post course reaction to the programme, the subjects self-reported alcohol consumption remained unaffected by the course, and on average placed the sample in the top 35% of the New Zealand population in terms of self-reported alcohol consumption. These results were considered to be reflective of the theoretical and practical distances between the concepts and processes of education, prevention and evaluation, by the present author.
Aspects of prohibition and drunkenness in Wanganui, 1880 to 1920 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in History
(Massey University, 1973) Burtt, Andrew Keith
By the 1880's and early 1890's a number of social problems were demanding increased public attention throughout New Zealand. Problems such as larrikinism, disease, labour disputes, drunkenness and the whole question of Chinese immigration and immigrants, were but a few among many being raised both through newspapers and Parliament. A gap between aspiration and reality seemed to be making itself apparent. Also the feeling that New Zealand would be immune from such concerns, that had plagued England, was rapidly being exposed as false. Moreover the passage of time was making it apparent that they were not merely transitory problems, associated with the initial settlement of the country, but were in fact growing with the society. Increasing urbanisation also heightened this public awareness by making these problems more apparent. Yet despite this realization and appraisal there seemed to be little accurate investigation of the problems at the national level. This was in spite of the fact that some degree of knowledge of the areas of concern was possessed at the local level, for example, the prevalence of drunkenness and Chinese immigration and immigrants on the west coast of the South Island. As a result, broad generalizations concerning the problems at the national level were made and readily accepted by many New Zealanders. A recent thesis, by P.F. McKimmey, which examines in part the general problem and patterns of drunkenness in nineteenth century New Zealand, bears out the above general concern raised by contemporaries. He states: New Zealand in the nineteenth century was a society plagued by drunkenness and problems associated either in fact or in the firm opinion of a number of New Zealanders with drink. From the 1830's to the 1890's in every settlement, one of the salient features of life was the widespread drunkenness. P.F. McKimmey, "The Temperance Movement in New Zealand 1835 - 94," Unpublished M.A. Thesis, Auckland, 1968. pp. 29 & 10.
Negotiating recovery from alcoholism in the context of the Canterbury earthquakes : a thesis submitted to Massey University in fulfilment of the requirements for a Master of Philosophy, Massey University, February 2014
(Massey University, 2014) Williamson, Kerry J
This study employs narrative inquiry to document participants’ experiences in relation to maintaining sobriety while living through the Christchurch earthquakes. Eight women and one man were recruited via purposive sampling. Of the 9 participants, 4 were in stable recovery (greater than 5 years), 2 were in sustained recovery (between 1 and 5 years) and 3 were in early recovery (less than 1 year). Qualitative data was gathered using semi-structured, in-depth interviews utilising thematic analysis and incorporating an abductive logic. In the process of recovery from alcohol dependence previous life trauma, environmental conditions, uncertainty about the future and limited resources can be both barriers to recovery from alcoholism and growth opportunities after natural disaster. For some of the participants who contributed to this research, memories of early childhood abuse were recalled and symbolised by the seismic activity during the greater earthquake period. Participants in early recovery or relapsing continued to experience traumatic stress through re-victimisation or trauma re-enactment. Some participants in active addiction identified the earthquakes as both a hindrance and a help with their drinking and self-harming behaviour. For others, a sense of deep personal loss was felt when viewing the devastation of the ruined city which mirrored and reminded them of their life in active addiction. The research findings extend and complement existing theories of ambiguous loss and Post Traumatic Growth (PTG) within the context of addiction and recovery capital. This research also adds to the addiction, domestic violence and disaster literature that is currently available. Narratives of participants in short or long term recovery, suggested that ambiguous loss, and associated grief stemming from both situational and cumulative trauma, surfaced when viewing the earthquake damage. Living through the earthquakes was a time of adaptation and resourcefulness for all but for alcoholics in recovery extra resilience was needed to attend to addiction recovery within the larger picture of daily disaster coping. For all participants post traumatic growth was both an outcome and a process creating a more robust identity at individual levels, post disaster. Findings indicate that trauma can be instrumental in creating alcohol abuse and dependency and that recovery from alcoholism after natural disaster is a complex process requiring personal, community and political interventions.
Personality correlates of problem drinking in New Zealand : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University
(Massey University, 1977) Worthington, Carol Lindsay
In an attempt to isolate differential personality characteristics of problem drinkers in New Zealand, 100 problem drinkers, 60 non-problem drinking psychiatric patients, 30 non-problem drinking prison inmates, and 30 abstainers were compared on a number of characteristics extracted from an extensive literature review, preference being given to those which longitudinal studies had indicated might be predisposing to adoption of an addictive rather than a non-addictive pathology. Predictions were confirmed in that problem drinkers manifested diminished investment in the heterosexual role by being covertly orientated to males rather than females (on a measure of seconds spent eye-fixating on pictures of naked males versus females) while verbalizing overtly a preference for the female picture of each opposite-sex pair, from which it was inferred that "defensive masculinity" functioned to obscure covert masculine inadequacy; problem drinkers were socially isolated, with marked difficulties in establishing close relationships and preferring short-term, superficial, casual encounters coupled with withdrawal from stable emotional commitments (biographical data questionnaire); they were also extremely field dependent (embedded figures), intensely aggressive (inventory and stereoscope), manifested a very short future time perspective (personal events methods), and had considerable difficulties in the area of socialization (inventory). They had also experienced home backgrounds in which they were often deprived of sustained contact with a father, either through lengthy separations or the father's emotional withdrawal or antagonistic, rejecting behaviour. The one prediction not confirmed dealt with an attempt to mobilize anxieties over putative dependency and masculine inadequacy, with the expectation that threat to these would result in greater (spurious) self-sufficiency and masculinity scores on inventories, relative to subjects not threatened. While there was some tentative evidence of threat effect on drinkers and abstainers, results were equivocal and the null hypothesis could not be rejected. However, patients differed from the other groups in readily admitting to much less self-sufficiency and masculinity. On all measures drinkers were distinguished from patients (other than in the sharing of social anxieties, though patients were not socially isolated or superficial), and from abstainers (except that drinkers, abstainers, and criminals did not differ in declaring themselves extremely self-sufficient and masculine), but on socialization, and on aggressiveness as measured by the stereoscope, drinkers did not differ from criminals whereas abstainers were hyper-conventional. By comparing young early with old early starters it proved possible to demonstrate that years of chronic inebriety did not influence the characteristics isolated, especially field dependence, aggressiveness, and under-socialization. Younger drinkers were more disturbed than older ones in the areas of aggressiveness and socialization, on inventory measures and on such indices as wanderlust, occupational instability (from preference), impulsiveness, promiscuity, antisocial behaviour during school years (habitual truanting, stealing, disciplinary problems), and having extensive criminal records. 26% whose pathological drinking began after age 40 were much more neurotic-like. Conclusions were that problem drinkers suffered from a personality disorder more severe than a neurosis, and that early socialization difficulties were those most likely to predict later problem drinking.
Perceptions of adult trauma patients on the acceptability of text messaging as an aid to reduce harmful drinking behaviours.
(4/01/2014) Kool B; Smith E; Raerino K; Ameratunga S
BACKGROUND: Brief interventions (BIs) have been shown to be effective in modifying hazardous drinking behaviours in a range of settings. However, they are underutilised in hospitals due to resource constraints. We explored the perspectives of admitted trauma patients about the appeal, acceptability and content of a Brief Intervention (BI) delivered via text messages. METHODS: Thirty mobile phone users (≥16 years old) admitted to Auckland City Hospital as a result of injury were recruited (December 2010 - January 2011). Participants were interviewed face-to-face during their hospital stay using a semi-structured interview guide that explored topics including perceptions of the proposed intervention to reduce hazardous drinking and related harm, and perceived acceptability of an m-health program. Where issues relating to content of messages were raised by participants these were also captured. In addition, a brief survey captured information on demographic information, mobile phone usage and type of phone, along with the frequency of alcohol use. RESULTS: 22 of the 30 participants were male, and almost half were aged 20 to 39 years. The majority of participants identified as New Zealand Europeans, six as Māori (New Zealand's indigenous population) and of the remainder two each identified as Pacific and of Asian ethnicity. Most (28/30) participants used a mobile phone daily. 18 participants were deemed to be drinking in a non-hazardous manner, seven were hazardous drinkers, and three were non-drinkers. Most participants (21/30) indicated that text messages could be effective in reducing hazardous drinking and related harms, with more than half (17/30) signalling they would sign-up. Factors identified that would increase receptiveness included: awareness that the intervention was evidence-based; participants readiness-to-change; informative messages that include the consequences of drinking and practical advice; non-judgemental messages; and ease-of-use. Areas of potential concern included: confidentiality and frequency of messages. The cultural relevance of the messages for Māori was highlighted as important. CONCLUSIONS: This study indicates that trauma patients recognize potential benefits of mobile-health interventions designed to reduce hazardous drinking. The feedback provided will inform the development of an intervention to be evaluated in a randomised controlled trial.

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