title: Gender differences in depression and anxiety symptoms eight years after mild traumatic brain injury

authors: Leidig, Rebecca Dawn

abstract: The majority of all treated cases of traumatic brain injury are classified as being in the mild severity range (MTBI) but many symptoms are far from mild and can result in difficulties that persist for years after the initial injury, severely affecting quality of life.  Chronic depression and anxiety symptoms can be masked by acute post-concussion symptoms and can affect males and females differently in the long-term but little research has been undertaken in this area.  The aims of this study were to investigate the gender differences in depression and anxiety over 1-month, 12-months and 8-years following a mild traumatic brain injury and to investigate gender differences in depression and anxiety between a group of MTBI subjects (8-years post-injury), and a group of participants who were TBI-free, by comparing Hospital Anxiety and Depression Scale (HADS) scores and self-reported symptoms.  A MTBI cohort consisting of a population-based sample of 151 adults who sustained a mild TBI between 2010 and 2011 was identified from an earlier longitudinal study: Brain Injury Incidence and Outcomes New Zealand In the Community Study (BIONIC).  Additionally, 213 participants with no history of head injury were recruited for comparison.  Both groups answered questions about current anxiety and depression symptoms using the HADS.
Overall, results suggest that males and females with MTBI have the same overall course of recovery in relation to depression and anxiety symptoms over the 8-years following injury but that females consistently report significantly increased symptoms than males over time, as reflected in the general population.  Depression and anxiety scores fluctuate over the 8-years post-MTBI but, overall, depression increases, anxiety decreases and symptom levels are below clinical severity.  Females with MTBI are significantly more likely than males to experience anxiety in the clinical range at 12-months post-injury.  
There were no significant gender differences in depression or anxiety levels between the MTBI and comparison groups, and average HADS scores were not significantly different between groups.  However,  individual symptom analysis showed that females who were 8-years post-MTBI experienced increased panic symptoms than females with no TBI and that both males and females with MTBI reported increased anhedonia and “restlessness’ symptoms than those without MTBI.   Overall, females reported significantly higher severity symptoms related to nervousness and feeling slowed down than males.
The clinical implications of this study suggest a focus on the longer-term impacts of MTBI  as patients may experience later onset depression or anxiety that may not be present in the acute phase.  Evaluating individual symptoms as well as overall scores on measures can identify important clinical effects at symptom level that are masked by total score analysis.    
Practitioners should consider gender differences in how patients respond to self-report symptom measures to ensure accurate clinical assessment of both males and females, particularly in relation to MTBI which has a higher male prevalence.  Future research into MTBI outcomes that includes a broader range of measures, in addition to self-report, will ensure comprehensive clinical data is obtained about individual symptoms and risk factors. 
This study uniquely contributes to current research into gender outcomes post-MTBI and may guide clinical practice to develop effective, timely and targeted assessment and treatment interventions for depression and anxiety symptoms experienced by both males and females after mild traumatic brain injury.

text: Gender differences in depression and anxiety symptoms eight years after mild traumatic brain injury The majority of all treated cases of traumatic brain injury are classified as being in the mild severity range (MTBI) but many symptoms are far from mild and can result in difficulties that persist for years after the initial injury, severely affecting quality of life.  Chronic depression and anxiety symptoms can be masked by acute post-concussion symptoms and can affect males and females differently in the long-term but little research has been undertaken in this area.  The aims of this study were to investigate the gender differences in depression and anxiety over 1-month, 12-months and 8-years following a mild traumatic brain injury and to investigate gender differences in depression and anxiety between a group of MTBI subjects (8-years post-injury), and a group of participants who were TBI-free, by comparing Hospital Anxiety and Depression Scale (HADS) scores and self-reported symptoms.  A MTBI cohort consisting of a population-based sample of 151 adults who sustained a mild TBI between 2010 and 2011 was identified from an earlier longitudinal study: Brain Injury Incidence and Outcomes New Zealand In the Community Study (BIONIC).  Additionally, 213 participants with no history of head injury were recruited for comparison.  Both groups answered questions about current anxiety and depression symptoms using the HADS.
Overall, results suggest that males and females with MTBI have the same overall course of recovery in relation to depression and anxiety symptoms over the 8-years following injury but that females consistently report significantly increased symptoms than males over time, as reflected in the general population.  Depression and anxiety scores fluctuate over the 8-years post-MTBI but, overall, depression increases, anxiety decreases and symptom levels are below clinical severity.  Females with MTBI are significantly more likely than males to experience anxiety in the clinical range at 12-months post-injury.  
There were no significant gender differences in depression or anxiety levels between the MTBI and comparison groups, and average HADS scores were not significantly different between groups.  However,  individual symptom analysis showed that females who were 8-years post-MTBI experienced increased panic symptoms than females with no TBI and that both males and females with MTBI reported increased anhedonia and “restlessness’ symptoms than those without MTBI.   Overall, females reported significantly higher severity symptoms related to nervousness and feeling slowed down than males.
The clinical implications of this study suggest a focus on the longer-term impacts of MTBI  as patients may experience later onset depression or anxiety that may not be present in the acute phase.  Evaluating individual symptoms as well as overall scores on measures can identify important clinical effects at symptom level that are masked by total score analysis.    
Practitioners should consider gender differences in how patients respond to self-report symptom measures to ensure accurate clinical assessment of both males and females, particularly in relation to MTBI which has a higher male prevalence.  Future research into MTBI outcomes that includes a broader range of measures, in addition to self-report, will ensure comprehensive clinical data is obtained about individual symptoms and risk factors. 
This study uniquely contributes to current research into gender outcomes post-MTBI and may guide clinical practice to develop effective, timely and targeted assessment and treatment interventions for depression and anxiety symptoms experienced by both males and females after mild traumatic brain injury.

year: 2020

title: Recent and historical sedimentation and sediment characteristics of Ōhiwa Harbour, New Zealand

authors: La Croix, Andrew D.

abstract: The Bay of Plenty Regional Council is seeking to understand historical and recent sedimentation in Ōhiwa Harbour, a barrier-enclosed lagoon, to help establish sediment accumulation rates and water quality limits in accordance with the Resource Management Act (1991) and the NZ Freshwater Policy Statement. To provide sedimentation data that is independent of sediment plate data already being collected by the Council, and to supplement other historical data, a series of nine vibracores, nine box cores, and 73 surface sediment samples were collected from across Ōhiwa Harbour.
Three key vibracores were analyzed for their radionuclide activity (²¹⁰Pb and ²²⁶Ra) in an attempt to determine their sediment accumulation rates. However, no rate could be established due to very low and irregular radionuclide activity through the cores. It is probable that the method did not work due to the combined effects of hydrodynamic mixing and bioturbation.
Sedimentological analysis was undertaken on all nine vibracores and box cores, which indicated that the intertidal sediments consist of five distinctive depositional units: clast supported calci-gravel, ripple to cross bedded sand, bioturbated sand, laminated to rippled silt, and bioturbated silt. Recognition and interpretation of these units will be useful for future workers interested in reconstructing the evolution of sedimentation within the harbour.
Grain size of core sediment and surficial sediment around the harbour was compared to historical surface sediment maps. They show clearly that Ōhiwa Harbour is becoming muddier through time, although in a non-linear and complex way with some parts of the harbour getting sandier. The perimeter of the harbour and the upper harbour are the main areas affected by a fining grain size trend.
Loss-on-ignition (LOI) of sediment indicates that organic carbon is more concentrated in fine-grained sediment than coarser sediment across the harbour. No clear stratigraphic pattern of LOI could be established. However, surface sediments display larger LOI along the perimeter of the harbour where the proportion of mud is greater.
Three recommendations are put forth based on the results of this study, as well as gaps in knowledge discovered during data collection and analysis. The first is that determining longer-term (decadesâ€“millennia) sediment accumulation rates may be achievable by carbondating the abundant shell material contained within cores. The second is that calculation of sediment compaction under its own weight ('autocompaction') may help determine the causes of sedimentation and erosion in the harbour. The third and final recommendation is for repeat surface sediment surveys to be undertaken regularly, at intervals no greater than every five years. These insights will together yield a more complete picture of past, present, and future sedimentation and its effects in Ōhiwa Harbour.

text: Recent and historical sedimentation and sediment characteristics of Ōhiwa Harbour, New Zealand The Bay of Plenty Regional Council is seeking to understand historical and recent sedimentation in Ōhiwa Harbour, a barrier-enclosed lagoon, to help establish sediment accumulation rates and water quality limits in accordance with the Resource Management Act (1991) and the NZ Freshwater Policy Statement. To provide sedimentation data that is independent of sediment plate data already being collected by the Council, and to supplement other historical data, a series of nine vibracores, nine box cores, and 73 surface sediment samples were collected from across Ōhiwa Harbour.
Three key vibracores were analyzed for their radionuclide activity (²¹⁰Pb and ²²⁶Ra) in an attempt to determine their sediment accumulation rates. However, no rate could be established due to very low and irregular radionuclide activity through the cores. It is probable that the method did not work due to the combined effects of hydrodynamic mixing and bioturbation.
Sedimentological analysis was undertaken on all nine vibracores and box cores, which indicated that the intertidal sediments consist of five distinctive depositional units: clast supported calci-gravel, ripple to cross bedded sand, bioturbated sand, laminated to rippled silt, and bioturbated silt. Recognition and interpretation of these units will be useful for future workers interested in reconstructing the evolution of sedimentation within the harbour.
Grain size of core sediment and surficial sediment around the harbour was compared to historical surface sediment maps. They show clearly that Ōhiwa Harbour is becoming muddier through time, although in a non-linear and complex way with some parts of the harbour getting sandier. The perimeter of the harbour and the upper harbour are the main areas affected by a fining grain size trend.
Loss-on-ignition (LOI) of sediment indicates that organic carbon is more concentrated in fine-grained sediment than coarser sediment across the harbour. No clear stratigraphic pattern of LOI could be established. However, surface sediments display larger LOI along the perimeter of the harbour where the proportion of mud is greater.
Three recommendations are put forth based on the results of this study, as well as gaps in knowledge discovered during data collection and analysis. The first is that determining longer-term (decadesâ€“millennia) sediment accumulation rates may be achievable by carbondating the abundant shell material contained within cores. The second is that calculation of sediment compaction under its own weight ('autocompaction') may help determine the causes of sedimentation and erosion in the harbour. The third and final recommendation is for repeat surface sediment surveys to be undertaken regularly, at intervals no greater than every five years. These insights will together yield a more complete picture of past, present, and future sedimentation and its effects in Ōhiwa Harbour.

year: 2022

title: Evaluation of the Whānau Ora Wellbeing Service of Te Whakaruruhau: Final report

authors: Robertson, Neville

subjects: whānau ora

abstract: Domestic violence and child abuse represent significant threats to whānau ora. Conversely, the weakening or loss of whānau ties can increase the vulnerability of whānau members to domestic violence and child abuse. Thus enhancing whānau ora in the context of domestic violence and child abuse is both a high priority and a significant challenge.

Te Whakaruruhau Māori Women’s Refuge has been providing safe housing, support and advocacy to women and children for over two decades and has become a key agency in family violence networks in Kirikiriroa. The development of the Whānau Ora Wellbeing Service, the focus of this evaluation, was a logical extension of Refuge services.

The Māori and Psychology Research Unit was commissioned in mid‐2011 to conduct this evaluation. It is based on ten case studies of clients in the programme, interviews with Te Whakaruruhau staff and key informants in allied agencies, and participant‐observation of Refuge activities. The case studies provide insights into the lived experience of women dealing with violence, their attempts to protect themselves and their children, and their experiences of – and reflections upon – the Whānau Ora Wellbeing programme.

text: Evaluation of the Whānau Ora Wellbeing Service of Te Whakaruruhau: Final report Domestic violence and child abuse represent significant threats to whānau ora. Conversely, the weakening or loss of whānau ties can increase the vulnerability of whānau members to domestic violence and child abuse. Thus enhancing whānau ora in the context of domestic violence and child abuse is both a high priority and a significant challenge.

Te Whakaruruhau Māori Women’s Refuge has been providing safe housing, support and advocacy to women and children for over two decades and has become a key agency in family violence networks in Kirikiriroa. The development of the Whānau Ora Wellbeing Service, the focus of this evaluation, was a logical extension of Refuge services.

The Māori and Psychology Research Unit was commissioned in mid‐2011 to conduct this evaluation. It is based on ten case studies of clients in the programme, interviews with Te Whakaruruhau staff and key informants in allied agencies, and participant‐observation of Refuge activities. The case studies provide insights into the lived experience of women dealing with violence, their attempts to protect themselves and their children, and their experiences of – and reflections upon – the Whānau Ora Wellbeing programme.

year: 2013-07-20