Affect Risk Assessment Research Articles

Mental Health Risk Assessment and Safety Planning During UK Covid-19 Pandemic Lockdown: Mixed Methods Survey and Interview Study

Risk assessment and safety planning are central to mental health nursing practice but were seriously affected by the Covid-19 pandemic and associated lockdowns. In this study, we aimed to explore how the UK pandemic lockdowns affected risk assessment and safety planning from the perspective of mental health practitioners. A sequential, mixed methods study design was used. A link to an online survey questionnaire was distributed and semi-structured interviews with a subset of respondents were conducted. Survey data were analysed to describe perceived changes in the frequency and nature of risk assessment and safety planning during the pandemic lockdowns. This was supplemented by thematic analysis of qualitative interview data. In total, 106 practitioners were surveyed and 10 participated in semi-structured interviews. More respondents increased than decreased risk assessment frequency but there was no significant overall change. Remote contact was more common in community settings and largely involved telephone appointments. Participants did not wish to continue with remote working following the pandemic. Risk assessment practice changed in UK mental health services as a result of COVID-19 lockdowns.

Reappraisal of the Concept and Implications of Pulmonary Hypertension in Degenerative Mitral Regurgitation

BackgroundEuropean and U.S. clinical guidelines diverge regarding pulmonary hypertension (PHTN) in degenerative mitral regurgitation (DMR). Gaps in knowledge underpinning these divergences affect risk assessment and management recommendations attached to systolic pulmonary pressure (SPAP) in DMR. ObjectivesThis study sought to define PHTN links to DMR severity, prognostic thresholds, and independent outcome impact in a large quantitative DMR registry. MethodsThis study gathered a large multicentric registry of consecutive patients with isolated moderate-to-severe DMR, with DMR and SPAP quantified prospectively at diagnosis. ResultsIn 3,712 patients (age 67 ± 15 years, 36% women) with ≥ moderate-to-severe DMR, effective regurgitant orifice (ERO) was 0.42 ± 0.19 cm2, regurgitant volume 66 ± 327 mL/beat and SPAP 41 ± 16 mm Hg. Spline-curve analysis showed excess mortality under medical management emerging around SPAP 35 mm Hg and doubling around SPAP 50 mm Hg. Accordingly, severe pulmonary hypertension (sPHTN) (SPAP ≥50 mm Hg) was detected in 916 patients, moderate pulmonary hypertension (mPHTN) (SPAP 35-49 mm Hg) in 1,128, and no-PHTN (SPAP <35 mm Hg) in 1,668. Whereas SPAP was strongly associated with DMR-ERO, nevertheless excess mortality with sPHTN (adjusted HR: 1.65; 95% CI: 1.24-2.20) and mPHTN (adjusted HR: 1.44; 95% CI: 1.11-1.85; both P ≤ 0.005) was observed independently of ERO and all baseline characteristics and in all patient subsets. Nested models demonstrated incremental prognostic value of mPHTN and sPHTN (all P < 0.0001). Despite higher operative risk with mPHTN and sPHTN, DMR surgical correction was followed by higher survival in all PHTN ranges with strong survival benefit of early surgery (<3 months). Postoperatively, excess mortality was abolished (P ≥ 0.30) in mPHTN, but only abated in sPHTN. ConclusionsThis large international registry, with prospectively quantified DMR and SPAP, demonstrates a Doppler-defined PHTN impact on mortality, independent of DMR severity. Crucially, it defines objectively the new and frequent mPHTN range, independently linked to excess mortality under medical management, which is abolished by DMR correction. Thus, at DMR diagnosis, Doppler-SPAP measurement defining these new PHTN ranges, is crucial to guiding DMR management.

Performing risk assessment for critical infrastructure protection: A study of human decision-making and practitioners' transnationalism considerations

This paper investigates the views of practitioners on the decision-making influences and the transnational considerations affecting risk assessment (RA) for critical infrastructure (CI) and its protection (CIP).The investigation is based on a thematic analysis of the interviews of twelve RA practitioners. The analysis identified an overarching theme supporting the view that the team approach is the one true remedy to RA process shortcomings as well as five other themes: (1) the value of the human influence in RA; (2) transnationalism - an unfathomable notion; (3) consistency is no panacea to performance; (4) CI organizational RA-influencing forces; and (5) CI RA-enablers and impediments.The investigation suggests that the team approach to effective RA for CIP is considered as the absolute panacea in the eyes of practitioners although both insights from the current industry RA practice through the interviews themselves, and an investigation of relevant literature suggests that although this is warmheartedly recommended (a) there are no set rules and guidelines in its application, (b) it is not coordinated nor applied consistently, and (c) it is not an integral part of RA processes. Notwithstanding the reality that a team approach to RA for CIP is being contemplated by practitioners, albeit with lagging consistency and coordination, it is evident that additional research is necessary to broaden the understanding of its value.

Objectivity Threats: Would it Jeopardise Malaysian Internal Auditors’ Risk Judgment Quality?

In the realm of internal auditing, the rise of Risk-Based Internal Auditing has heightened the demand for auditors to excel in risk assessment. Failing in this role not only endangers audits but also exposes companies to significant losses and reputational harm. Internal auditors entrusted with critical decisions grapple with objectivity challenges that impede their ability to assess a company's risks accurately. This study investigates objectivity challenges in Malaysian internal auditing and their impact on risk assessment. Employing experimental tasks of varying complexity, it reveals that all nine objectivity threats outlined in the "International Standards for Professional Practices of Internal Auditing (IPPF): Practice Guide on Independence and Objectivity" are prevalent in Malaysia. These threats negatively affect risk assessment, regardless of task complexity. Prominent objectivity threats include social pressure, familiarity, and intimidation. Crucially, these threats have a more significant impact on risk assessment during simpler tasks, especially when auditors assess familiar, less intricate areas. These highlight the urgent need for internal auditors to manage objectivity effectively, strengthening their role as impartial, dependable risk assessors.

Current practice of cancer predisposition testing in pediatric patients with CNS tumors in the United States.

An estimated 8.6% of all pediatric patients with central nervous system tumors (CNSTs) have underlying hereditary cancer predisposition (HCP). Identifying HCP affects risk assessment and medical management options for the patients and their family members. However, there is a lack of consensus on the optimal germline genetic testing (GT) approach for pediatric patients with CNSTs. As a first step in addressing the need for consensus, we surveyed oncology and genetics providers from 47 institutions in professional organizations across the United States. We investigated their current practice (e.g., GT decisions and ordering practices) when assessing pediatric patients with CNSTs for HCP. We received 60 responses from 21 pediatric oncologists, 10 neuro-oncologists, 28 genetics providers, and one neuro-oncologist/geneticist. Results demonstrate genetic counselors, followed by oncologists, most often facilitated consent, ordered testing, and selected which test to order. The most ordered test was a multi-gene panel (60%). Of 18 CNST diagnoses, choroid plexus carcinoma (CPC) was the diagnosis for which most providers (78%) reported they would offer GT. For medulloblastoma, 56% overall reported they would offer GT (64% of genetics providers, 62% of neuro-oncologists, 20% of pediatric oncologists; p=.050). Findings suggest that even for the CNSTs most commonly known to be associated with HCP regardless of family history, there was variability in providers' decisions to offer GT. The lack of consensus in GT decisions in our study indicates inconsistencies in the genetics care of pediatric patients with CNSTs, demonstrating a need for consensus guidelines to promote consistent genetics care.

Cognitive concerns are a risk factor for mortality in people with human immunodeficiency virus and COVID-19.

Data supporting dementia as a risk factor for COVID-19 mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well-established for people with HIV (PWH), and its reliance may affect risk assessment. This retrospective cohort analysis of PWH with SARS-CoV-2 polymerase chain reaction positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by ICD-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death (OR [95% confidence interval]); models adjusted for VACS Index 2.0. Sixty-four PWH were identified out of 14,129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared to PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, p = 0.01) and cognitive concerns (21.9% vs. 15.8%, p = 0.04). Death was more frequent in PWH (p < 0.01). Adjusted for VACS Index 2.0, dementia (2.4 [1.0-5.8], p = 0.05) and cognitive concerns (2.4 [1.1-5.3], p = 0.03) were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance (3.92 [0.81-20.19], p = 0.09); there was no association with dementia. Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with pre-existing cognitive deficits.

Managing business continuity in the Arctic: Experiences from mining.

This article presents a model for business continuity capacity, which shows how organizations can analyze possible gaps in their business continuity capability and thereby increase their capacity to recover value-adding critical activities. Using an example of a flooded mine on Svalbard, the study investigated how the mining company Store Norske Spitsbergen Coal Company (SNSK), with considerable experience with similar events and an excellent safety record, could fail to manage a well-known event and reduce recovery times of its critical activities. The analysis explored how experience in safety and incident management does not necessarily mean that these abilities are transferable to a new but similar event. The study sought to answer the research question: To what extent does SNSK's systematic work with safety, and experience with flooding events, improve business continuity capacity? In the Arctic, emergency response can take hours or days to arrive after the event. A structured recovery system can support pre-existing platforms aimed at safety, to include the critical activities needed to ensure an organization's overall survival. Systematic work can improve performance and make the organization engage in a virtuous cycle by implementing management structures, risk identification systems, competency development, and processes for the in situ evaluation of hazards. However, as seen here, the organization needs to pay attention to changes that could affect risk assessments and threat levels well-known events. These insights can be utilized by other organizations seeking synergy when strengthening their safety and business continuity performance.

Evolving the IT audit

Nowadays, modern technologies are becoming an essential part of any organization's activities, therefore the main priority for internal audit is to perform IT risk assessment and management control in consulting. Therefore, IT environment programs and computer operations as a part of the IT infrastructure have to be appreciated by auditors. Monitoring of IT infrastructure will afford auditors to uncover infrastructure vulnerability. The basis for assessing infrastructure vulnerability that affects internal organization structure is formed by the monitoring system of IT hardware, software, network and data components. For example, systems and networks connected to the Internet are exposed to threats that do not exist for self-contained systems and networks. When thorough understanding of the IT environment has been achieved, the executive auditor and the internal audit group can perform the risk assessment and develop the audit plan. Evolving an audit plan, many administrative factors are have to be taken into account, such as a kind of industry, revenue, a type of revenue, process complexity, and geographic location. Two factors that openly affect risk assessment and the very essence to audit IT environment are process and its role. Key words: audit, IT audit, IT infrastructure, risk, audit plan evolving.

Framework for Operational Resilience Management of Critical Infrastructures and Organizations

Progressing digitalization and networking of systems and organizations representing Critical Infrastructures opens promising new potentials and opportunities, which on the downside, are accompanied by rising complexity and increasingly opaque interdependencies. The consequently increasing lack of knowledge leads to uncertainties affecting risk assessment and decision-making in case of adverse events. This trend motivated recent discussions and developments in risk science, emphasizing the need to handle such uncertainties. Complementarily, research in the resilience domain focuses on system capabilities to handle surprising hazardous situations. Several frameworks presented in the literature aim at combining both perspectives but either lack the focus on operational management, have a rather theoretical approach, or are designed for specific applications. Based on this observation, we propose an approach that integrates resilience management into the actual operation of Critical Infrastructure Systems and Organizations by providing an operational process that coordinates the fundamental resilience capabilities of responding, monitoring, anticipation, and learning. Furthermore, we tackle the challenge of uncertainties resulting from a lack of knowledge by aligning the concepts of digital twin and resilience management. The proposed framework is extensively discussed, and required processes are presented in detail. Eventually, its applicability and potential are reviewed by means of a complex hazardous situation at a Bavarian district heating power plant.

Sub-custodian network management in a post-pandemic world

This paper describes a vision for sub-custodian network management in a post-pandemic world. It examines how the COVID-19 crisis affected risk assessment functions and the approach to due diligence. It also considers the wider roles network managers play in market advocacy, intelligence gathering, relationship management and infrastructure development, and looks at whether the global pandemic has accelerated a bifurcation of these roles. It makes the case for continued on-site meetings when the pandemic ends and examines new considerations for such visits. It goes on to explore some of the components that will shape the future evolution of the network manager, including the impact of digitalisation and technological innovation and trends and themes transforming the custody business itself. Successful network managers should embrace the digital paradigm, and support and enable their sub-custodians to do the same. As sub-custodian business models change and markets evolve, network managers should continue to leverage their high level of market expertise to support their own organisations in their decision making. Network managers should increasingly become agents of change, as they navigate new complexities and identify opportunities for key stakeholders across the sub-custodian network.

Influence of practitioners' characteristics on risk assessment in Green Building projects in emerging economies: a case of Vietnam

PurposeRisks are considered a significant obstacle to Green Building (GB) development and have recently received significant attention from both construction practitioners and academics. This study aimed to identify critical GB risks and explore the relationship between participants' characteristics and risk assessment.Design/methodology/approachFirstly, a list of GB risks was developed based on a comprehensive literature review and interviewing GB experts. After that, a survey of 207 construction professionals was then conducted to validate these GB risk factors. Finally, this research adopted the ANOVA test and hierarchical regression analysis to examine the relationship between participants' characteristics and risk assessment.FindingsThe results provided a list of GB risks classified and evaluated according to the GB project life cycle and, thus, may serve as a helpful reference for GB practitioners. Notably, the ANOVA analysis revealed that risk assessment negatively correlates with participants' GB experience, while their industry experience does not affect risk assessment. Furthermore, the hierarchical regression analysis proved that participant roles do not moderate the association between risk assessment and GB experience.Originality/valueThis study contributed to GB literature by implementing empirical research on GB risks in a developing country. The results implied the essential role of professionals with rich GB experience in risk management in GB projects. Furthermore, this research could help construction practitioners understand GB risks adequately and thereby have better risk-management strategies for future GB projects.

Key Factors for Improving the Carcinogenic Risk Assessment of PAH Inhalation Exposure by Monte Carlo Simulation.

Monte Carlo simulation (MCS) is a computational technique widely used in exposure and risk assessment. However, the result of traditional health risk assessment based on the MCS method has always been questioned due to the uncertainty introduced in parameter estimation and the difficulty in result validation. Herein, data from a large-scale investigation of individual polycyclic aromatic hydrocarbon (PAH) exposure was used to explore the key factors for improving the MCS method. Research participants were selected using a statistical sampling method in a typical PAH polluted city. Atmospheric PAH concentrations from 25 sampling sites in the area were detected by GC-MS and exposure parameters of participants were collected by field measurement. The incremental lifetime cancer risk (ILCR) of participants was calculated based on the measured data and considered to be the actual carcinogenic risk of the population. Predicted risks were evaluated by traditional assessment method based on MCS and three improved models including concentration-adjusted, age-stratified, and correlated-parameter-adjusted Monte Carlo methods. The goodness of fit of the models was evaluated quantitatively by comparing with the actual risk. The results showed that the average risk derived by traditional and age-stratified Monte Carlo simulation was 2.6 times higher, and the standard deviation was 3.7 times higher than the actual values. In contrast, the predicted risks of concentration- and correlated-parameter-adjusted models were in good agreement with the actual ILCR. The results of the comparison suggested that accurate simulation of exposure concentration and adjustment of correlated parameters could greatly improve the MCS. The research also reveals that the social factors related to exposure and potential relationship between variables are important issues affecting risk assessment, which require full consideration in assessment and further study in future research.

Powder Fever and Its Impact on Decision-Making in Avalanche Terrain.

We examined the effect of emotions, associated with “powder fever”, on decision-making in avalanche terrain. Background: Skiing in avalanche terrain is a voluntary activity that exposes the participant to potentially fatal risk. Impaired decision-making in this context can therefore have devastating results, often with limited prior corrective feedback and learning opportunities. Previous research has suggested that arousal caused by emotions affects risk assessment and intentions to engage in risky behavior. We propose that powder fever may induce similar responses. Methods: We used the following two experimental methods: laboratory studies with visual visceral stimuli (ski movies) and a field study with real stimuli (skiing exciting terrain). We evaluated the effect of emotions on attention, risk assessment, and willingness to expose oneself and others to risk. Results: Both the laboratory studies and the field study showed that skiing-related stimuli had a relatively strong effect on reported emotions. However, we found very few significant effects on decision-making or assessment of risk. Conclusions: Skiing activities make people happier. However, despite the clear parallels to sexual arousal, powder fever does not appear to significantly impair decision-making in our study. More research on the effects of powder fewer on milder forms of risk-taking behavior is needed.

Decynium-22 affects behavior in the zebrafish light/dark test

Decynium-22 (D-22) is an inhibitor of the uptake2 system of monoamine clearance, resulting in increased levels of dopamine and norepinephrine (and in some cases serotonin) in the nervous system and elsewhere. Uptake2 is mediated by low-affinity, high-capacity transporters that are inhibited by glucocorticoids, suggesting a mechanism of fast glucocorticoid-monoamine interaction in the brain and a possible target for antidepressants. D-22 dose-dependently increased anxiety-like behavior in adult zebrafish exposed to the light/dark test, monotonically increasing scototaxis (dark preference), but affecting risk assessment with an inverted-U-shaped response. These results suggest that the uptake2 system has a role in defensive behavior in zebrafish, presenting a novel mechanism by which stress and glucocorticoids could produce fast neurobehavioral adjustments in vertebrates.

Love thy prickly neighbor? Sea urchin density affects risk assessment in damselfish

In coral reef communities, sea urchins and reef fish have a variety of commensal relationships. However, if fish view urchins as a potential form of predator protection, then urchin presence should influence reef fish risk assessment. We investigated whether dusky damselfish (Stegastes nigricans) perceive burrowing urchins (Echinometra mathaei) as a form of predator protection by asking whether and how urchin presence explains variation in flight initiation distance, the distance a fish fled an approaching threat. We found that when individuals were subjected to a high-risk approach (i.e., one that started relatively close to the fish), and urchin density was high, dusky damselfish tolerated a closer approach than when subjected to high risk with low urchin density. However, when there was low risk and high urchin density, the damselfish fled sooner. We conclude that under high risk, damselfish perceive burrowing urchins as providing added security from approaching threats.

Characteristics and clinical course of the first 500 patients (pts) from SPHERE (SelexiPag: tHe usErs dRug rEgistry) receiving selexipag in real-world clinical practice

Abstract Background SPHERE is a US, multicentre, prospective registry collecting real-world data from pts with pulmonary arterial hypertension (PAH) treated with selexipag, a selective oral IP prostacyclin receptor agonist. Methods SPHERE (planned N=800) included newly initiated (NI, receiving selexipag ≤60 days) and previously initiated (PI) pts. We describe disease characteristics, selexipag dose and clinical course of the first 500 pts and risk assessment based on REVEAL 2.0 risk calculator and COMPERA risk assessment strategy. Results Disease characteristics at initiation were: 75.0% female, median age 61.0 years, idiopathic etiology (49.2%) or associated with connective tissue disease (26.4%). Pts were mostly WHO functional class (FC) II (31.0%) or III (49.6%) (unknown for 9.2%). Median time from PAH diagnosis to selexipag initiation was 3.4 years. Of the first 500 pts enrolled, 138 (28%) were NI and 362 (72%) were PI; characteristics were consistent between NI and PI. Risk classification at initiation differed depending on method used: with REVEAL 2.0, low/intermediate/high risk were 41.8%/29.6%/28.6% (38.4%/26.1%/35.5% for NI and 43.1%/30.9%/26.0% for PI, respectively) and with COMPERA were 22.0%/67.2%/9.6% (13.8%/73.2%/10.9% for NI and 25.1%/64.9%/9.1% for PI), respectively. Note, missing variables in real-world registry data may affect risk assessment. In both cohorts, median individualised maintenance dose was 1200 μg twice daily (NI 1000 μg, PI 1200 μg); median time to individualised maintenance dose was 8.1 weeks. Median treatment duration was 21.7 months (17.7 months NI, 25.8 months PI). Overall, 32.4% of pts discontinued selexipag (46.4% NI, 27.1% PI), most commonly (22.8%) for adverse events (AEs) (34.8% NI, 18.2% PI). Of note, disease progression is classified as an AE. No selexipag-related deaths were reported. At 18 months, WHO FC improved/remained stable in the majority of pts (205/235, 87%; improved, 24%; stable, 63%), but worsened in 12.8% of pts. At 18 months, the majority of pts had improved/stable risk by REVEAL 2.0 (265/334, 79% [improved, 22%; stable, 57%]) and by COMPERA (255/316, 81% [improved, 23%; stable, 58%]). This was consistent for NI and PI. For both risk assessment tools higher risk was associated with increased risk of death. With REVEAL 2.0, risk of death was 2.9 and 9.3 times higher for intermediate and high risk, respectively vs low risk. Similarly with COMPERA, risk of death was 3.2 and 11.4 times higher in intermediate and high risk, respectively vs low risk. Conclusions Of the first 500 pts in SPHERE, the vast majority were prevalent PAH cases in FC II or III. Around one-quarter of pts had improved FC and/or risk; the majority of pts remained stable risk. Higher risk was associated with increased mortality risk. Over 50% of pts completed 18 months of selexipag. Discontinuations were most commonly for AEs and/or PAH progression. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.

Spatial heterogeneity can lead to substantial local variations in COVID-19 timing and severity

Standard epidemiological models for COVID-19 employ variants of compartment (SIR or susceptible-infectious-recovered) models at local scales, implicitly assuming spatially uniform local mixing. Here, we examine the effect of employing more geographically detailed diffusion models based on known spatial features of interpersonal networks, most particularly the presence of a long-tailed but monotone decline in the probability of interaction with distance, on disease diffusion. Based on simulations of unrestricted COVID-19 diffusion in 19 US cities, we conclude that heterogeneity in population distribution can have large impacts on local pandemic timing and severity, even when aggregate behavior at larger scales mirrors a classic SIR-like pattern. Impacts observed include severe local outbreaks with long lag time relative to the aggregate infection curve, and the presence of numerous areas whose disease trajectories correlate poorly with those of neighboring areas. A simple catchment model for hospital demand illustrates potential implications for health care utilization, with substantial disparities in the timing and extremity of impacts even without distancing interventions. Likewise, analysis of social exposure to others who are morbid or deceased shows considerable variation in how the epidemic can appear to individuals on the ground, potentially affecting risk assessment and compliance with mitigation measures. These results demonstrate the potential for spatial network structure to generate highly nonuniform diffusion behavior even at the scale of cities, and suggest the importance of incorporating such structure when designing models to inform health care planning, predict community outcomes, or identify potential disparities.

Different Sources, Different Responses? How Local Sociopolitical Pressures Affect Risk Assessment

Prior research in the field of organizational theory has overlooked how changes in sociopolitical environment affect intermediate organizational outcomes, such as risk assessments. The current chap...

Material- and Site-Specific Partition Coefficients for Beneficial Use Assessments.

Partition coefficient (Kd) values available in the literature are often used in fate and transport modeling conducted as part of beneficial use risk assessments for industrial byproducts. Because element partitioning depends on soil properties as well as characteristics of the byproduct leachate, site-specific Kd values may lead to more accurate risk assessment. In this study, contamination risk to groundwater of beneficially reused byproducts was assessed using batch leaching tests on waste to energy bottom ash and coal combustion fly ash. Leachates were equilibrated with eight different soils to obtain the waste-soil-specific Kd,exp values for the metals of interest. The Kd,exp values were used as inputs in the Industrial Waste Management Evaluation Model to demonstrate the degree to which Kd estimates affect risk assessment outcomes. Measured Kd,exp values for the most part fell within the large range of Kd values reported in the literature, but IWEM results using default Kd values for some types of soils resulted in overestimated risk compared to those derived from Kd,exp values. Modeled concentration at the receptor location was much lower for some elements for those soils with high concentrations of iron and aluminum.

Residential insurance market responses after earthquake: A survey of Christchurch dwellers

Lack of effective information on the impact of catastrophe on insurance market affects risk assessment and the quantity of insurance coverage. This leads to suboptimal decision making with respect to level of insurance coverage to purchase. This study investigates the New Zealand residential insurance after the 2010–11 earthquakes. A set of hypotheses are used to investigate the impact of catastrophe from an economic analysis perspective with appropriate statistical tests. The results show that change from full replacement value policy to nominated replacement value policy is the key determinant of the direction of change in the level of insurance coverage in the aftermath of the earthquakes. Policyholders increased the level of insurance coverage to comply with the new policy modification; other varying reasons for the insurance coverage change are observed. The earthquakes highlighted the plight of those who were underinsured prompting policyholders to update their insurance coverage to reflect the estimated cost of re-building their property. It is also observed that insurance policyholders update their risk perception immediately after major catastrophe losses. The level of risk aversion has an impact on decisions made post-disaster and both risk aversion and perception are positively correlated with change in the level of insurance coverage at all levels of income. Thus, if insurance demanders perceive a higher possibility of further natural disasters then they will always adjust their insurance coverage appropriately. A more comprehensive data set and robust econometric analysis is required to rigorously investigate this proposition.