MHS134 Assignment Information

Assignment Tittle : Exploring Depression Symptoms among Children and Primary Caregivers Following Extreme Weather Events in Aotearoa New Zealand.

Introduction

Extreme weather events (EWEs), such as floods, cyclones, heatwaves, and wildfires, are increasingly recognised as major environmental hazards that can negatively impact people’s physical and mental health [18]. These events affect populations worldwide and disrupt housing, livelihoods, education, access to essential services, and often generate prolonged social and economic instability for affected communities [18,19]. EWEs also influence mental health outcomes [20,21,22]. Children and their primary caregivers may be especially vulnerable to these disruptions [21,22]. Among the range of mental health outcomes associated with the environment experiencing depression has been shown to be relatively common following extreme weather events.

In the general population, depressive disorders affect around 4% of the population, approximately 332 million people worldwide [1,2]. Depression accounts for a large proportion of the burden of disease and ranks second for disability worldwide [3,4]. contributed over 56 million disability-adjusted life years (DALYs) globally [1,4]. However, following extreme weather events rates of depression may be higher, with a meta-analysis estimating prevalence of 21.35% [95% CI 9.04 to 33.65]. These elevated estimates highlight the importance of addressing mental health outcomes in the context of extreme weather events. As the frequency and intensity of extreme weather events are increasing, mental health should be a key public health priority.

Depression varies across age groups and life stages and may follow developmental pathways from early vulnerability to recurrent disorder (REFENCES)  In childhood (ages 7–11), major depressive disorder is relatively rare (around 0.6–1.1%), yet early emotional and behavioural difficulties can disrupt learning, relationships, and self-esteem and increase later depressive risk [5,6]. Prenatal exposure to maternal depression contributes to this vulnerability through effects on temperament, emotion regulation, and early brain development [7]. In Aotearoa New Zealand (NZ), primary-aged children (5–11 years) experienc ed higher levels of emotional distress and depressive symptoms than previously reporte d, with 24.9–34.6% of children falling within clinical ranges compared with earlier national estimates of around 8–13.7% [8]. This is concerning given that childhood symptoms often persist or intensify during adolescence [6]. The World Health Organisation recognises adolescence (10–19 years) as a formative period in which depression becomes a leading cause of illness and disability, accounting for approximately 15% of the global disease burden in this age group [10]. As symptoms extend into early adulthood, depression is increasingly associated with educational disruption, interpersonal difficulties, substance use, self-harm, and suicide, now the third leading cause of death among young people aged 15–29 years [5,6,9]. These trajectories often extend into adulthood, where recurrent depression is linked to long-term mental, physical, social, and economic disadvantages,  particularly among caregivers and may be further exacerbated by environmental stressors such as extreme weather events, with impacts often disproportionately affecting those in lower socioeconomic circumstances [5,10]. Therefore, the impacts do not occur evenly across populations and are shaped by broader social and structural conditions that influence exposure.

The social determinants of health are the conditions in which people are born, grow, live, work, and age, which shape the unequal distributions of money, power, and resources [11,12]. These determinants shape how depression is distributed across populations. This pattern is evident in Aotearoa, where Youth2000 data shows a significant decrease in adolescent mental health between 2012 and 2019, with clinically significant depressive symptoms becoming increasingly common [16]. These declines were not uniform but were concentrated among rangatahi Māori, Pacific, and Asian students, as well as those living in high-deprivation areas. Inequity is also produced through how distress is recognised and treated, with rangatahi Māori less likely than non-Māori/non-Pasifika youth to be identified in services for anxiety and depression but more likely to be identified for self-harm and substance-related problems, consistent with barriers to early and culturally safe health care [17]. Understanding how these social and structural conditions shape vulnerability is therefore important when considering environmental stressors that may further influence mental health outcomes. Within this context, exposure to extreme weather events is increasingly recognised as an environmental stressor with the potential to influence mental health outcomes. Exposure to extreme weather events is increasingly recognised as an environmental stressor with the potential to influence mental health outcomes.

Extreme weather events are escalating in severity, frequency, and impact, with climate change increasing both their frequency and intensity [18]. Extreme weather events are unusually severe weather conditions that disrupt everyday life. While the physical and economic consequences of extreme weather events are well documented, their mental health impacts are often under-recognised [18,19]. Growing international research has identified extreme weather events as a significant environmental stressor for mental health [18,19,20,21,22]. Floods, cyclones, and other extreme weather events can disrupt housing, schooling, income, and access to essential services, generating prolonged stress during recovery periods [18–20]. Research indicates that such disruptions, rather than the hazard itself, are associated with elevated depressive symptoms among both caregivers and children [19,20].  Furthermore, a systematic review from Sub-Saharan African highlights that extreme weather can affect children’s mental health both directly and indirectly through displacement, disruption to schooling, loss of livelihoods, and prolonged instability during recovery [25].  An Australian study, demonstrates that adolescents exposed to extreme weather events experience higher psychological distress alongside increased financial and housing challenges, with impacts disproportionately concentrated among those facing social disadvantage [27 ].

Children and primary caregivers appear particularly vulnerable to the mental health impacts of extreme weather events, as instability in home and school environments heightens emotional distress among children [21,22]. Caregiving roles are associated with elevated depression symptoms, particularly among those who feel less prepared for extreme weather, suggest that ongoing worry and perceived lack of control add to psychological strain beyond direct exposure [20]. Those who are women, renters and are from minoritised ethnic communities tend to experience greater psychological distress, reflecting underlying social and economic inequalities that influence recovery and access to support during extreme weather events [20, 22 ]. Extreme weather events can intensify household and psychological stress by disrupting housing, income, schooling, and access to essential services, generating prolonged stress during recovery periods [19,20]. Higher levels of caregiver stress and depression symptoms following extreme weather are closely linked to poorer child mental health outcomes [20,22]. Furthermore, caregiver depression can influence a child’s mental health through emotional availability, caregiving capacity, and household stability. Caregivers play a critical role in supporting children’s emotional wellbeing through providing stability, routines, and responsive care. However, when caregivers experience heightened stress or depressive symptoms following stressful events, children may become more vulnerable to emotional distress and depressionsymptoms [21,22]. This can be due to priorities being focused on physical safety, infrastructure damage, and economic loss, overlooking children’s mental health needs [20,22,26 ].

However, while many studies report increased psychological distress following exposure to extreme weather events, findings are not entirely consistent. Some research suggests that the relationship between climate-related hazards and mental health outcomes may vary depending on contextual factors such as exposure to severity, socioeconomic conditions, and recovery environments [28,29]. For example, one study examining hurricane impacts in Puerto Rico found no statistically significant association between property loss and mental health deterioration [28]. Similarly, another study suggests that increases in average temperatures may not necessarily lead to worsening mental health outcomes if populations adapt over time [29]. These mixed findings highlight the complexity of the relationship between extreme weather exposure and mental health and suggest that broader social and environmental factors may shape vulnerability and recovery.

Taken together, existing evidence highlights the importance of examining depression symptoms following extreme weather events among children and caregivers within broader social and structural contexts. However, despite growing literature linking extreme weather exposure to adverse mental health outcomes, important gaps remain. Much of the exsisiting research focuses on adult populations and gives limited literature on children. More importantly, existing studies often focus on a single extreme weather event in isolation rather than situating mental health outcomes within broader social and structural contexts. There is also limited empirical evidence from Aotearoa New Zealand, particularly research that considers children and primary caregivers together or adopts an equity-focused framework.

The current study focuses on depression symptoms among children and their primary caregivers at two points in time, before and after experiencing extreme weather events in Aotearoa, situating these impacts within the social and structural determinants of health in Aotearoa New Zealand.  We aim to study whether exposure to extreme weather events is associated with changes in depression symptoms among children and their primary caregivers.

We hypothesis that depression symptoms among both children and primary caregivers will be higher following exposure to extreme weather events compared with pre-event. In addition, we hypothesise that higher levels of primary caregiver depression symptoms will be associated with higher levels of depression symptoms among children.

References

1. World Health Organization. Depressive disorder (depression) [Internet]. World Health Organization. 2025. Available from:https://www.who.int/news-room/fact-sheets/detail/depression   
2. https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12844
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12590574/
4. https://www.sciencedirect.com/science/article/abs/pii/S0165032725017410?via%3Dihub
5. https://www.sciencedirect.com/science/article/pii/S1751722216301470
6. https://www.thelancet.com/article/S0140-6736(22)01012-1/abstract
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5502770/
8. https://www.sciencedirect.com/science/article/pii/S1326020023052974
9. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC4687763/
11. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
12. https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-031210-101218
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC11176401/
14. https://www.mdpi.com/1660-4601/22/7/1013
15. https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000015
16. https://pubmed.ncbi.nlm.nih.gov/36521087/
17. https://pubmed.ncbi.nlm.nih.gov/36453262/
18. https://pmc.ncbi.nlm.nih.gov/articles/PMC9013542/
19. https://www.sciencedirect.com/science/article/pii/S2667278225000860
20. https://www.mdpi.com/1660-4601/17/22/8581
21. https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14856
22. https://journals.sagepub.com/doi/10.1177%2F0020731415625254
23. https://www.tandfonline.com/doi/full/10.1080/1177083X.2025.2523344#d1e411
24. https://auckland.figshare.com/articles/report/Te_Matau-a-M_ui_Hawke_s_Bay_and_Te_Tai_R_ whiti_Gisborne_regional_report_of_the_impact_of_extreme_weather_events_on_young_peopl e_and_their_families_Evidence_from_i_Growing_Up_in_New_Zealand_i_/25833685?file=47912 977
25. https://www.sciencedirect.com/science/article/pii/S2667278221000845
26. ttps://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/child-and-ado lescent-mental-health-amidst-emergencies-and-disasters/C112839620C6AF501E8927F994EA228 C
27. https://www.sciencedirect.com/science/article/pii/S001393512500636X?ssrnid=4932935&dgcid =SSRN_redirect_SD
28. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1389051/full 29. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481

Feedback – Supervisor Meeting (13/03/26)

Overall writing

• Some ideas are repeated – combine and integrate them to improve flow.
• The key content is already there; the main task is refinement and fine-tuning.
• Remove unnecessary words and be more concise and direct.
• Reduce long sentences with too many clauses.
• Ensure every sentence carries weight and contributes to the argument.
• Avoid overly simple or vague wording. Be careful using “this”, as it can be ambiguous.

Structure and integration

• Reframe sections so they link clearly back to the central argument.
• Paragraphs should clearly explain how each study is relevant to the research topic.
• Integrate studies together rather than discussing them separately.

Introduction structure

• Use a funnel approach:○ Start broad (global context)

○ Then move to New Zealand context

○ Finally narrow to your specific research focus.

• Introduce extreme weather events (EWE) earlier in the introduction.
• Frame the issue as:
  ○ Depression is increasing

○ Extreme weather events are increasing

○ Therefore this is an important public health issue.

• Then transition to New Zealand-specific issues, including inequities and social determinants of health, particularly how extreme weather affects marginalised groups.

Concepts and terminology

• Be careful when describing environmental stressors; as that wording reflects the role of social determinants of health.
• Use precise and consistent terminology.

Evidence and referencing

• Ensure broad statements are supported by references.
• Use the exact terminology used in the studies (e.g., if studies say primary caregivers, use that wording).
• Complete the full reference list.

Scope and clarity

• Be precise about the population being studied (e.g., if the paper focuses on adults, clearly state adults).