Epidemiology Maori Mental Health

Chris Gale

For Otago Psychiatry Trainees.

March 2011

Maori.

● Polynesian. Migrated NZ around 1200 – 1300.– Neolithic (no metals)

– Tribal: simplified hierarchy compared with other polynesian cultures.

● Imported to NZ– Kumara (other crops such as Taro and Banana

required higher temperatures).

– Dogs (kiore)

● Combination of hunting, fishing, gathering & agriculture.

Atua (Gods)

Ethics.

● Tapu– Holy, sacred.

– Only preists (tohunga) or chiefs can approach.

● Noa– Cursed.

– Leads to shame (whakama)

● Utu.– Reciprocation or revenge.

● Northern iwi

– Ngāi Takoto • Ngāpuhi • Ngāti Whātua • Ngāpuhi ki Whaingaroa • Ngāti Kahu • Ngāti Kurī • Ngāti Wai • Te Aupōuri • Te Kawerau • Te Rarawa • Te Roroa

● Waikato-Tainui iwi

– Ngāi Tai (Ngāti Tai) • Ngāti Hako • Ngāti Haua • Ngāti Hei • Ngāti Huia • Ngāti Mahuta • Ngāti Maniapoto• Ngāti Maru •Ngāti Paoa • Ngāti Whānaunga • Ngāti Pūkenga ki Waiau • Patukirikiri • Ngāti Rāhiri Tumutumu • Ngāti Tamaterā • Ngāti Tara Tokanui • Ngāti Te Ata • Waikato

– Tauranga Moana tribes: Ngāi Te Rangi • Ngāti Pūkenga • Ngāti Ranginui

● West coast NI iwi

– Ngā Rauru (Ngāti Rauru) • Ngā Ruahine • Tangahoe • Taranaki • Ngā Ruanui • Ngāti Hau • Ngāti Hauiti • Ngāti Mutunga • Ngāti Ruanui • Ngāti Tama‡ • Pakakohi • Ngāti Maru •Poutini • Te Āti Awa

●

● Te Arawa iwi – Ngāti Pikiao • Ngāti Rangiteaorere • Tuhourangi • Uenuku-Kopako • Ngāti

Rangitihi • Ngāti Tūwharetoa• Tapuika • Tarawhai • Ngāti Rangiwewehi • Ngāti Tahu • Ngāti Whakaue

● Mataatua iwi – Ngāi Tūhoe • Ngāti Awa • Ngāti Manawa • Ngāti Whare • Te Whakatōhea

● East coast iwi – Ngāriki Kaiputahi (Ngā Ariki) • Ngāi Tāmanuhiri (Ngāti Tāmanuhiri) • Ngāti Porou •

Ngāti Ruapani • Ngāti Tutekohe • Rongowhakaata • Te Āti Haunui-a-Paparangi • Ngāti Rongomaiwahine • Te Aitanga-a-Hauiti • Te Whānau-ā-Apanui • Te Aitanga-a-Mahaki

● Ngati Kahungunu – Ngāti Kahungunu

● Southern iwi – Muaūpoko • Ngāti Raukawa • Ngāti Toa (Ngāti Toarangatira) • Ngāti Apa •

Rangitāne (Ngati Rangitane)● South Island iwi

– Ngāi Tahu (Kāi Tahu) • Kāti Mamoe • Waitaha • Ngāti Koata • Ngāti Kuia • Ngāti Rarua • Ngāti Tama‡ • Te Āti Awa

● Urban "pan-tribal" iwi – Ngāti Ākarana • Ngāti Poneke • Ngati Ranana

Treaty of Waitangi.

● 1840. Negotiated at Waitangi with Northern Tribes. Multiple other tribes then signed. Written in Maori and English. Translation was poor and the two versions contradict.

● Tuhoe have never signed.● Three clauses.

– Ceding sovereignty to British Crown.

– Tribes have possession of all their lands and assets.

– Maori have rights of British Citizens.

Short timeline contact.

● 1770s – European explorers (British, French)● 1800s – Small settlements for whaling.● 1810 – 1835.

– Iwi (tribes) start trading flax and kauri for muskets.

– Tribal wars

● 1835– Confederation of tribes of Aoteoroa.

– Declaration of Independence.

Post treaty.● 1854: First Parliament disavows treaty.● 1860s – 1880s. Land Wars.

– Waikato confiscated

– Eastern Bay of Plenty confiscated.

– Taranaki confiscated.

● 1890s – King movement– Tribal unity North Island, led Waikato.

● 1910 – 1930– Young Maori Movement.

● Aparina Ngata● Sir Peter Buck.

Renaissance.

● 1930s.– Ratana Movement aligns with Labour Party.

● 1970s.– Revival Maori Language and culture.

● 1980s– Treaty settlement process.

– Principles of treaty enshrined in law.

– Development of Iwi based businesses esp. by Ngai Tahu.

Kind of data needed for Polynesian groups: US black vs US white and olanzapine.

Estimated change in PANSS total score in olanzapine-treated black and white patients over 24 weeks. Graph based on MMRM Model including fixed terms baseline PANSS total score, treatment week, protocol, investigator, race, and ethnic origin × treatment week. Race P-value = 0.93.

BMC Psychiatry. 2010; 10: 89.

Demographics NZ population ethnicity, NZMHS

Metabolic Status Maori, Non Maori

doi: 10.3945/ajcn.2010.29317

Receiver operating characteristic curves for BMI, waist circumference, and waist-to-height ratio in relation to insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)] and insulin sensitivity (McAuley score). Black solid lines, Māori men; black dashed lines, Māori women; gray solid lines, European men; and gray dashed lines, European women.

Aust N Z J Psychiatry. 2009 Jul;43(7):659-65.

Maori.

Drug Alcohol Rev. 2009 Mar;28(2):166-74.

Perceptions of SCZ: sample

Broadbent. ANZJP in press doi: 10.3109/00048674.2010.561479

Maori perceive that they will unwell for a shorter time than Pakeha.

Broadbent. ANZJP in press doi: 10.3109/00048674.2010.561479

12 month prevalence of disorders by prioritised ethnicity.

Development ● Limited number Maori and Pacific MH workers.

● Limited training available workers.

● Balance effectiveness and clinician and effectiveness within culture ongoing challenge.

● Synergism between mainline services and Maori services necessary.

● Question as to if special status of any ethnic group helping development: In Malaysia it has reduced health status.