Understanding depression in Tokelauan people in New Zealand
Iain Loan 1 , Wayne Cunningham 2 , Chrystal Jaye 3 41 General Practitioner, Taupo and MGP student, Department of General Practice and Rural Health, University of Otago, New Zealand
2 Professor, Department of Family Medicine, Royal College of Surgeons in Ireland – Medical University of Bahrain, Al Muharraq, Bahrain
3 Associate Professor, Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
4 Correspondence to: Chrystal Jaye, Department of General Practice and Rural Health, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: chrystal.jaye@otago.ac.nz
Journal of Primary Health Care 8(1) 67-74 https://doi.org/10.1071/HC15046
Published: 31 March 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
BACKGROUND: The Tokelauan language lacks a word for ‘depression’ and this can make diagnosing and treating depression in Tokelauan patients difficult for general practitioners.
AIMS: To describe the experience of depression in Tokelauans and thereby assist diagnosis and treatment of the illness.
METHOD: Ten semi-structured in-depth interviews were conducted. The transcripts were thematically analysed using an immersion crystallisation technique.
RESULTS: An illness involving profound sadness exists in the Tokelauan culture. Tokelauans recognise isolation and withdrawal from family and community activities as indicators of extreme sadness. Privacy and pride are important cultural characteristics, which may be barriers to recognising sadness. Often the smiling Tokelauan face becomes the mask hiding sadness.
CONCLUSION: This research demonstrates the complexity of relationships between patients, their illness and their culture, that impacts on how depression manifests. This research indicates that therapy must have a whole person approach involving family, church, community and patients’ spiritual beliefs.
KEYWORDS: Depression; Pacific health
References
[1] Statistics New Zealand. 2013 Census ethnic group profiles: Tokelauan. Secondary 2013 Census ethnic group profiles: Tokelauan 2013. http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/ ethnic-profiles.aspx?request_value=24713&parent_id=24706&tabname= #24713.[2] Oakley Browne MA, Wells JE, Scott KM. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry Of Health, 2003.
[3] Wittchen HU, Robins LN, Cottler LB, et al. Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry 1991; 159 645–53.
| Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK38%2Fps1OrtA%3D%3D&md5=a71ac19257f5010138ea51c615099fe2CAS | 1756340PubMed |
[4] Medical Council of New Zealand. The New Zealand Medical Workforce in 2012: Medical Council of New Zealand, 2012.
[5] Ministry Of Health. Te Orau Ora - Pacific Mental Health Profile. Wellington: Ministry Of Health, 2005.
[6] Health Research Council of New Zealand. Guidelines on Pacific Health Research. Available on www.hrc.govt.nz, 2014.
[7] Ellis PM, Collings SCD. Mental health in New Zealand from a public health perspective. Wellington: Public Health Group, Ministry Of Health, 1997.
[8] Borkan J. Immersion/Crystallization. In: Crabtree B, Miller W, eds. Doing Qualitative Research. London: Sage, 1999.
[9] Crabtree B. Miller W. Using Codes and Code Manuals: A Template Organising Style of Interpretation. In: W CBM, ed. Doing Qualitative Research. London: Sage Publications Ltd, 1999.
[10] Thomas D. A General Inductive Approach for Analyzing Qualitative Evaluation Data. Am J Eval 2006; 27 237–46.
| A General Inductive Approach for Analyzing Qualitative Evaluation Data.Crossref | GoogleScholarGoogle Scholar |
[11] Wilson H, Cunningham W. Models of the consultation. In: Being a Doctor. Dunedin New Zealand: Otago University Press, 2013.
[12] Ministry Of Health. Pacific Peoples and Mental Health. Wellington: Ministry of Health, 2008.
[13] Kupa K. Te Vaka Atafaga: a Tokelau assessment model for suppporting holistic mental health practice with Tokelau people in Aotearoa, New Zealand. Pac Health Dialog 2009; 15 156–63.
| 19585746PubMed |
[14] Suaalii-Sauni T, Wheeler A, Saafi E, et al. Exploration of Pacific perspective of Pacific models of mental health service delivery in New Zealand. Pac Health Dialog 2009; 15 18–27.
| 19585731PubMed |
