The initial trauma may be over but experts say earthquake-weary Christchurch residents will endure at least six years of "man-made" stressors as the region battles bureaucracy.
A Canterbury Earthquake Recovery Authority draft document on their psychosocial plan for the city says anxiety and stress will continue to dog the population due to ongoing battles with insurance, land issues, changes to schooling and problems rebuilding homes and businesses.
Experts call these secondary stressors or "man-made stressors" which go on far longer than the initial disaster and the report says they will be a major feature in the next six years of recovery.
The report points to international research which timeframe for psychosocial recovery is at least five to 10 years - but mental health and relationship issues emerge during the third year.
Relationships Aotearoa clinical manager Julie Grenfell said it is unfamiliar bureaucratic systems which are causing the majority of the stress.
"It's the school systems, the mergers, EQC, insurance companies - these enormous systems which people have not dealt with before. They are difficult to deal with because they are not part of normal life like birth, divorce, marriage and funerals," she said.
The draft Community in Mind Greater Christchurch Strategic Psychosocial Plan predicts secondary stressors will make it difficult for the region to re-establish normality and affect mental health.
If not dealt with, said the report, the economic cost to New Zealand would cover "many generations".
"Secondary stressors typically persist for longer periods of time and inhibit people's ability to re-establish routines and return to a sense of normality," said the report.
This would be problematic for children who lived through the aftermath of the earthquakes.
"It is widely accepted in academic and medical literature that the effects of trauma are carried by children throughout life and continue to impact on their general health and wellbeing ..." said the report.
Massey University's joint centre for disaster research associate professor Sarb Johal said secondary stressors can be more harmful than the initial disaster because they erode well-being over time.
"It's like a tap dripping. For a day or two it doesn't make too much difference. But over time the ground below will erode and water will seep through causing damage which can't be seen. But not only that it uses up the resource, the water, and so your have less to deal with things," he said.
He said it was difficult to predict how long secondary stressors will plague the city.
"What we do know is that in Kobe earthquake [Japan] is five years later people are still having housing and insurances issues and businesses are struggling with not only population movements but insurance also," he said.
He said even the quality of roads could be deemed a secondary stressor.
Tolerance would be required, he said.
"Recovery goes at multi speeds - everyone has their own. For some people they have moved on and don't want to be reminded of that period. But others are very affected - for example people in the eastern suburbs are confronted with it daily when they travel on the roads," he said.
He said more stressor will emerge as people settle into new area and the city attracts new people.
"There will be a whole new category of people coming into the city attracted by the rebuild or as rebuild workers and it will take some time for them to integrate," he said.
Canterbury District Health Board public health specialist Dr Lucy D'Aeth said families needed to make sure secondary stressors did spread too much into home life.
"We need to nurture our relationships - don't think that it can wait until after the house is built. If you haven't had a good laugh with your children, don't wait until your house is built," she said.
The draft plan encourages "positive spontaneous actions" and "self-organising responses" in the community like that of Gap Filler and neighbourhood events to combat stressors.
A CERA spokeswoman said cabinet are yet to endorse the document and it is currently out for consultation. Funding was also being sought to respond to psychosocial issues at the same time, she said.