The Associations Between Cultural Identity and Mental Health Outcomes for Indigenous Māori Youth in New Zealand

Objectives: To explore the relationships between Māori cultural identity, ethnic discrimination and mental health outcomes for Māori youth in New Zealand.Study Design: Nationally representative, anonymous cross-sectional study of New Zealand secondary school students in 2012.Methods: Secondary analysis of Māori students (n = 1699) from the national Youth'12 secondary school students survey was undertaken. Theoretical development and exploratory factor analysis were undertaken to develop a 14-item Māori Cultural Identity Scale (MCIS). Māori students reporting > 8 items were classified as having a strong MCIS. Prevalence of indicators were reported and logistic regression models were used to explore how wellbeing (WHO-5), depressive symptoms (Reynolds Adolescent Depression Scale-SF), and suicide attempts were associated with the MCIS.Results: After adjusting for age, sex, ethnic discrimination and NZ Deprivation Index (NZDep), a strong Māori cultural identity (MCIS) was associated with improved wellbeing scores (OR 1.53, 95% CI 1.18–2.01) and fewer depressive symptoms (OR 0.53, 95% CI 0.38–0.73). Experiencing discrimination was associated with poorer wellbeing scores (OR 0.50, 95% CI 0.39–0.65), greater depressive symptoms (OR 2.2, 95% CI 1.55–3.18), and a previous suicide attempt (OR 2.47, 95% CI 1.71–3.58). Females less frequently reported good (WHO-5) wellbeing (OR 0.33, 95% CI 0.26–0.42), increased (RADS-SF) depressive symptoms (2.61, 95% CI 1.86–3.64) and increased suicide attempts [OR 3.35 (2.07–5.41)] compared to males. Wellbeing, depressive symptoms and suicide attempts did not differ by age or neighborhood level socio-economic deprivation, except those living in neighborhoods characterized as having medium level incomes, were less likely to have made a suicide attempt (OR 0.49, 95% CI 0.27–0.91).Conclusions: Māori youth who have a strong cultural identity were more likely to experience good mental health outcomes. Discrimination has a serious negative impact on Māori youth mental health. Our findings suggest that programmes, policies and practice that promote strong cultural identities and eliminate ethnic discrimination are required to improve mental health equity for Māori youth

Urban green space and mental well-being of Aotearoa New Zealand adolescents : A path analysis

Background Growing evidence shows the positive influence of neighbourhood green space on mental well-being among adults through multiple health behaviours, but similar studies are lacking for adolescents. Methods Data were drawn from the 2019 wave of the Youth2000 survey series in Aotearoa, New Zealand with secondary school students (aged 10-19 years) from the city of Tamaki Makaurau, Auckland. Emotional well-being was measured with the World Health Organization-5 Well-being Index, and depressive symptoms were assessed using the Reynolds Adolescent Depression Scale-short form. Neighbourhood green space was assessed using three different measures: percentage of green space, Normalised Difference Vegetation Index (NDVI) and the distance to nearest green space from place of residence. Exposure areas of these measures were calculated using Euclidean buffers of 100m, 300m, 800m and 1600m around participants’ meshblock residential addresses. Three mediating (physical activity, social cohesion, sleep) and ten control variables (in adjusted models) were included in path analysis to test the direct and indirect relationships between green space and adolescent mental well-being. Results In unadjusted models, percentage of green space had a negative relationship with emotional well-being, and inconsistent effects of NDVI were detected in different buffers. Minor indirect effects of physical activity and sleep were also found. Depressive symptoms and emotional well-being were more strongly related to other individual and neighbourhood factors (e.g., neighbourhood deprivation). After adjusting for control variables, no significant associations of green space with adolescent depressive symptoms and emotional well-being were identified. Conclusions Urban neighbourhood green space does not appear to be a dominant factor contributing to adolescent mental well-being through physical activity, social cohesion and sleep. Appropriate individual and environmental control variables are needed to take into consideration in future studies that explore the green space-mental well-being relationships in adolescents

The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12).

Purpose To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. Methods Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. Results Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their nontransgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval[CI], .2 -.4), depressive symptoms (OR, 5.7; 95% CI, 3.6-9.2), suicide attempts (OR, 5.0; 95% CI, 2.9-8.8), and school bullying (OR, 4.5; 95% CI, 2.4-8.2). Conclusions This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth

Unhealthy Gambling Amongst New Zealand Secondary School Students: An Exploration of Risk and Protective Factors

This study sought to determine the prevalence of gambling and unhealthy gambling behaviour and describe risk and protective factors associated with these behaviours amongst a nationally representative sample of New Zealand secondary school students (n = 8,500). Factor analysis and item response theory were used to develop a model to provide a measure of ‘unhealthy gambling’. Logistic regressions and multiple logistic regression models were used to investigate associations between unhealthy gambling behaviour and selected outcomes. Approximately one-quarter (24.2 %) of students had gambled in the last year, and 4.8 % had two or more indicators of unhealthy gambling. Multivariate analyses found that unhealthy gambling was associated with four main factors: more accepting attitudes towards gambling (pp = 0.0061); being worried about and/or trying to cut down on gambling (p p = 0.0009). Unhealthy gambling is a significant health issue for young people in New Zealand. Ethnic and social inequalities were apparent and these disparities need to be addressed

Ethnic discrimination prevalence and associations with health outcomes: data from a nationally representative cross-sectional survey of secondary school students in New Zealand

<p>Abstract</p> <p>Background</p> <p>Reported ethnic discrimination is higher among indigenous and minority adult populations. There is a paucity of nationally representative prevalence studies of ethnic discrimination among adolescents. Experiencing ethnic discrimination has been associated with a range of adverse health outcomes. NZ has a diverse ethnic population. There are health inequalities among young people from Māori and Pacific ethnic groups.</p> <p>Methods</p> <p>9107 randomly selected secondary school students participated in a nationally representative cross-sectional health and wellbeing survey conducted in 2007. The prevalence of ethnic discrimination by health professionals, by police, and ethnicity-related bullying were analysed. Logistic regression was used to examine the associations between ethnic discrimination and six health/wellbeing outcomes: self-rated health status, depressive symptoms in the last 12 months, cigarette smoking, binge alcohol use, feeling safe in ones neighbourhood, and self-rated school achievement.</p> <p>Results</p> <p>There were significant ethnic differences in the prevalences of ethnic discrimination. Students who experienced ethnic discrimination were less likely to report excellent/very good/good self-rated general health (OR 0.51; 95% CI 0.39, 0.65), feel safe in their neighbourhood (OR 0.48; 95% CI 0.40, 0.58), and more likely to report an episode of binge drinking in the previous 4 weeks (OR 1.77; 95% CI 1.45, 2.17). For all these outcomes the odds ratios for the group who were 'unsure' if they had experienced ethnic discrimination were similar to those of the 'yes' group.</p> <p>Ethnicity stratified associations between ethnic discrimination and the depression, cigarette smoking, and self-rated school achievement are reported. Within each ethnic group participants reporting ethnic discrimination were more likely to have adverse outcomes for these three variables. For all three outcomes the direction and size of the association between experience of ethnic discrimination and the outcome were similar across all ethnic groups.</p> <p>Conclusions</p> <p>Ethnic discrimination is more commonly reported by Indigenous and minority group students. Both experiencing and being 'unsure' about experiencing ethnic discrimination are associated with a range of adverse health/wellbeing outcomes. Our findings highlight the progress yet to be made to ensure that rights to be free from ethnic discrimination are met for young people living in New Zealand.</p

Distinct profiles of mental health need and high need overall among New Zealand adolescents – Cluster analysis of population survey data

Objective: The objective was to identify clinically meaningful groups of adolescents based on self-reported mental health and wellbeing data in a population sample of New Zealand secondary school students. Methods: We conducted a cluster analysis of six variables from the Youth19 Rangatahi Smart Survey ( n = 7721, ages 13–18 years, 2019): wellbeing (World Health Organization Well-Being Index), possible anxiety symptoms (Generalized Anxiety Disorder 2-item, adapted), depression symptoms (short form of the Reynolds Adolescent Depression Scale) and past-year self-harm, suicide ideation and suicide attempt. Demographic, contextual and behavioural predictors of cluster membership were determined through multiple discriminant function analysis. We performed cross-validation analyses using holdout samples. Results: We identified five clusters ( n = 7083). The healthy cluster ( n = 2855, 40.31%) reported positive mental health across indicators; the anxious cluster ( n = 1994, 28.15%) reported high possible anxiety symptoms and otherwise generally positive results; the stressed and hurting cluster ( n = 667, 9.42%) reported sub-clinical depression and possible anxiety symptoms and some self-harm; the distressed and ideating cluster ( n = 1116, 15.76%) reported above-cutoff depression and possible anxiety symptoms and high suicide ideation; and the severe cluster ( n = 451; 6.37%) reported the least positive mental health across indicators. Female, rainbow, Māori and Pacific students and those in higher deprivation areas were overrepresented in higher severity clusters. Factors including exposure to sexual harm and discrimination were associated with increasing cluster severity. Conclusion: We identified high prevalence of mental health challenges among adolescents, with distinct clusters of need. Youth mental health is not ‘one size fits all’. Future research should explore youth behaviour and preferences in accessing support and consider how to best support the mental health of each cluster

Health and wellbeing of Māori secondary school students in New Zealand: Trends between 2001, 2007 and 2012

Abstract Objective: To describe the health status over time of Māori secondary school students in New Zealand compared to European students. Methods: Anonymous representative health surveys of New Zealand secondary school students were conducted in 2001, 2007 and 2012 (total n=27,306 including 5,747 Māori). Results: Compared to 2001, Māori students in 2012 experienced improved health, family and school connections. However, considerable inequity persists with Māori students reporting poorer health, greater exposure to violence and socioeconomic adversity compared to European students. When controlling for socioeconomic deprivation, inequity was substantially reduced, although worse Māori health outcomes remained for general health, mental health, contraceptive use, healthy weight, substance use, access to healthcare and exposure to violence. There was some evidence of convergence between Māori and European students on some indicators. Conclusions: There have been significant improvements for Māori youth in areas of health where there has been investment. Priority areas identified require adequate resourcing alongside addressing systematic discrimination and poverty. Implications for public health: Socioeconomic contexts, discrimination, healthcare access and identified priority health areas must be addressed to improve equity for Māori youth. Building on these gains and hastening action on indicators that have not improved, or have worsened, is required

Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data

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Te Tapatoru: a model of whanaungatanga to support rangatahi wellbeing

ABSTRACTWhanaungatanga (nurturing of relationships) is at the heart of wellbeing for rangatahi (Māori youth), yet little research has considered how rangatahi understand and experience whanaungatanga. Furthermore, policy makers, organisations and practitioners have had limited guidance to reflect on whanaungatanga with young Māori in ways that support rangatahi wellbeing and aspirations. As part of a broader photo-elicitation project on whanaungatanga with young Māori, we describe Te Tapatoru, a model of whanaungatanga based on the experiences and insights of 51 rangatahi. Using a Māori critical realist approach, we demarcated rangatahi descriptions of whanaungatanga into three interconnected areas. The first component, ko wai, a reciprocal connection, emphasised the importance of a reciprocal connection with people (or more than people). The second component, he wā pai, a genuine time/place, spoke to how contexts, time and places provided the space for meaningful connections to take root and flourish. The final component, he kaupapa pai, a genuine kaupapa (activity, process) considered how rangatahi desired connection which responded to their desires and aspirations. This approach harnesses rangatahi potential by creating reciprocal and invigorating supportive environments based on rangatahi aspirations and insights. Policy and practice recommendations are made which centre this rangatahi informed approach to whanaungatanga