Māori, Pacific and Asian New Zealanders are more at risk of depression and anxiety disorders and yet are likely to be under-diagnosed, say the authors of a new study.
Around one in six New Zealand adults are diagnosed with an anxiety or mood disorder in their lifetime. However some minorities are less likely to be diagnosed, despite appearing to have higher rates of psychological distress. New research, published today in the New Zealand Medical Journal, highlights these inequalities and shows that depression and anxiety are very likely under-diagnosed in Māori, Pacific and Asian communities.
The findings are based on data from the long-running New Zealand Values and Attitudes Study (NZVAS) at Auckland University, which in 2015/14 surveyed almost 16,000 New Zealanders.
Included in the survey was a version of the Kessler Scale, which measures psychological distress and is widely used to identify individuals at risk of anxiety of depression. Respondents were also asked if they had been diagnosed with depression or anxiety disorder by a doctor in the last five years.
The study’s findings:
Maori, Pacific and Asian New Zealanders were more likely to score in the ‘at risk’ range of the Kessler-6 scale, indicating an increased likelihood of depression or anxiety, relative to European New Zealanders. However, European New Zealanders reported the highest rate of actual diagnosis with depression or anxiety in the previous five-year period.
The researchers found that Māori are 1.32 times more likely, Pacific peoples 1.54 times more likely and Asian peoples 1.67 times more likely to be undiagnosed compared to Europeans. They conclude:
Mental health problems of ethnic minorities, especially Pacific and Asian peoples, are more likely to be ‘missed’, while those of Europeans are more likely to be ‘hit’. These findings are likely to reflect ethnic inequalities in access to, expectations from and style of communication with, medical professionals.
Barriers to care
For Asian peoples, under-diagnosis could be linked with language or cultural barriers, say the authors. This includes the greater stigma surrounding mental illness in Asian cultures. Language barriers may also be a problem for Pacific peoples, but cost and transport could also be contributing to a lower use of healthcare services.
The authors also note that some cultures place greater emphasis on managing illness as a family and these differences need to be recognised by doctors:
Unlike Western perspectives, Pacific peoples place greater emphasis on familial well-being as an aspect of their own subjective well-being. Similarly, Asian peoples tend to work through health problems as a family and often endorse non-Western models of health treatment.
These cultural beliefs may be influencing how Pacific and Asian peoples express their mental illness in differential ways and hence, medical professionals need to develop cultural competence to understand and accurately diagnose these individuals.