Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001-2019

Developing a Transition Tool for Young Adults With Neurodevelopmental Conditions

BACKGROUND

Transition from paediatric to adult healthcare is a challenging time for young adults with neurodevelopmental conditions (NDC). The fragmentation and deficits in health, social and disability systems, and the increasing numbers of people with NDC, mean a more guided transition focusing on health independence is needed. This study aimed to develop a holistic transition tool and identify areas for improvement in transition services based on the consensus of experts involved with the care of children with NDC in Aotearoa, New Zealand.

METHODS

Utilising the Delphi method, two rounds (Round One: open-ended, Round Two: Likert scale) of online questionnaires involving 61 panellists (healthcare professionals, educators and caregivers) reviewed areas for improvement in transition services and ideas for a transition tool.

RESULTS

In Round One, Delphi participants identified seven themes related to transition services, including processes, resources, professionals, governance and culture; and 10 themes related to components of the tool, including communication, healthcare management, rights, activities, supports and community connectedness, whānau/family, culture, mental and spiritual health and sexual health. In Round Two, 94% of the ideas for transition services items reached consensus (26% with strong consensus [> 95%]). All the components of the transition tool reached consensus, and 62% of items reached strong consensus (> 95%).

CONCLUSION

This study provides direction on key domains related to transition services and a framework for a transition tool for young adults with NDC in Aotearoa, New Zealand. Its inclusion of domains related to culture, mental and spiritual health, rights for young adults, family involvement and community connectedness is a first step in developing a holistic approach to support a successful transition.

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.

The impact of area-level socioeconomic status in childhood on mental health in adolescence and adulthood: A prospective birth cohort study in Aotearoa New Zealand

Mental health conditions pose a significant public health challenge, and low area-level socioeconomic status (SES) is a potentially important upstream determinant. Childhood exposure might have influences on later-life mental health. This study, utilises data from the Christchurch Health and Development Study birth cohort, examining the impact of area-level SES trajectories in childhood (from birth to age 16) on mental health at age 16 and from age 18-40 years. Findings revealed some associations between distinct SES trajectories and mental health. The study underscores the importance of using a spatial lifecourse epidemiology framework to understand long-term environmental impacts on later-life health.

Well-being and cultural identity for Māori: Knowledge of iwi (tribal) affiliations does not strongly relate to health and social service outcomes

Research indicates that experiences in health and social services vary depending on identity. For Indigenous groups, identity and affiliation is complex. This paper explores ethnicity and knowledge of tribal (iwi) affiliations for Māori (the Indigenous peoples of Aotearoa New Zealand), and links this to health and social service outcomes in administrative data, the national Census, and Māori social survey data. While many initiatives have sought to connect Māori to iwi - where such knowledge has been severed by colonization - we find surprisingly few differences in data between those who named tribal affiliations and those who did not, across sole- and mixed-Māori ethnicity groups. Those who did not name an iwi were less likely to live in overcrowded homes, but were less likely to own that home, and more likely to be a smoker. Unsurprisingly, those who did not name tribal affiliations were less likely to find Māori culture as important, although many still did. These groups also had slightly less contact with social networks and support, plus felt lonelier. The results also point to sole-ethnic identification as Māori as a key marker of experiences of inequity and suggest that connections to tribal affiliations are more complicated than a binary of "connected" or "disconnected". However, in some indicator areas, affiliation differences should be followed up with future work. We argue these results give further weight to the need for good quality data and indicators designed with Māori populations in mind to measure and monitor inequity.

Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys

OBJECTIVE

To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students.

METHODS

Representative cross-sectional youth health surveys with 2-4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548).

RESULTS

In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale-Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Māori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students.

CONCLUSION

Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Māori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened.