Identification of mental health and substance use-related conditions among Pasifika young people in Aotearoa New Zealand - a national cross-sectional study using the Integrated Data Infrastructure (IDI)

Introduction: Pasifika young people of Aotearoa New Zealand are known to experience higher rates of mental health and addiction conditions (especially anxiety and depression), compared with young non-Māori/non-Pasifika (NMNP). However, there is little information about how well these issues are identified by mental health services. Aim: We compared rates of diagnosis of common mental health and substance use-related conditions between Pasifika and NMNP young people (aged 10-24 years) and examined how these diagnoses varied with deprivation. Method: This national, cross-sectional study was undertaken using 2017/18 fiscal year data from a national database known as the Integrated Data Infrastructure. Specialist mental health service use, hospitalisations and pharmaceutical dispensing for any mental health condition, emotional condition (depression and/or anxiety), substance use-related conditions, and self-harm were examined. Results: A total of 982,305 young people (12.4%, Pasifika and 63.9%, NMNP) were identified. Compared with NMNP, Pasifika young people were significantly less likely to be diagnosed by specialist mental health services with any mental health condition (adjusted Risk Ratio (aRR) = 0.77, 95% CI = 0.75 to 0.78); any emotional condition (aRR= 0.44, 95% Confidence Interval (CI) = 0.43 to 0.45); or to be hospitalised for self-harm (aRR = 0.88, 95% CI = 0.82 to 0.94). However, they were significantly more likely than NMNP to be diagnosed with substance use-related conditions (aRR = 1.68, 95% CI = 1.63 to 1.74). Although the overall rate of mental health issues remained relatively stable across deprivation levels, emotional conditions were much less frequently diagnosed in those with greater deprivation. Discussion: Discrepancies between expected and identified rates of diagnoses of common mental health and substance use-related conditions might indicate different patterns of service access by Pasifika young people, or they may reflect the bias of an inequitable and less than culturally appropriate health system.