The contributions of culture and ethnicity to New Zealand mental health research findings

Background & material: In the last five years a number of studies have been conducted in specialist psychiatric and primary care populations in New Zealand which have allowed comparisons in terms of clinical phenomena and therapeutic experiences between Maori (the indigenous people of New Zealand) and nonMaori. These studies were reviewed in terms of the methodology used, their major findings and their implications. Discussion: In specialist psychiatric services Maori were more likely to present with hallucinations and/or aggression and less likely to present with depression and/or episodes of self-harm. They were overly represented in those with schizophrenia. Maori were more likely to be involved in acts of aggression and to be secluded, and an equivalent episode of care for Maori appeared to be significantly more costly than for non Maori. Other studies, conducted in prison and community-based samples, suggested that Maori were less likely to access care and, when given a diagnosis of depression, less likely to be prescribed anti-depressant medication. The rates of depression were significantly higher in Maori (women) and Maori were also overly represented in those with anxiety and substance misuse disorders. These differences remained even after the sample was standardised for socio-economic status. Further exploration of the genesis and implications of these findings, derived from a strong and relatively well-defined indigenous people, may usefully inform the more general issues of culture and its significance for diagnosis, classification and service use. Conclusions: While the methodologies used and the actual results gained differed across studies, there do seem to be differences in phenomenological profiles at presentation, in the diagnostic patterns, the cost of care, and the therapeutic experiences between Maori and non-Maori New Zealanders. These differences may reflect actual differences between certain ethnic groups, which then explain the differences in the experiences of those users, or they may reflect inadequacies on the parts of non-Maori clinicians, their diagnostic tools and the services in which they operate, in catering for Maori patients.