Mental health and wellbeing of Pacific students : Protocol of a prospective cohort study

Main Article Content

Faafetai Sopoaga
Shyamala Nada-Raja
Tracie Leckie
Ari Samaranayaka


Pacific health, Mental health, Wellbeing, Protocol, Cohort



Mental disorders are a significant health concern and an increasing burden for Pacific youth in New Zealand. Approximately 30,000 (30%) of Pacific youth aged 18-24 years are enrolled in tertiary studies with sparse information about their mental health and wellbeing. There is increasing recognition of the impact of stresses and emotional problems faced by students in tertiary institutions internationally. This study seeks to describe Pacific tertiary students’ mental health and wellbeing, their expectations and experiences. It seeks also to determine risk and protective factors, access and barriers to using health services and their impact on students’ academic progress.


All Pacific students enrolling for the first time and in their first year of study at the University of Otago in 2019 will be invited to participate and followed over 3 years. A mixed-method research approach will be used with a survey obtaining information from all eligible students. Of these, 30 students will be randomly selected to participate in four interviews over the study period. Research objectives will be addressed by using quantitative statistical methods to analyse cross-sectional and longitudinal self-reported data linked to administrative data.  The Talanoa methodology  and a thematic approach will inform qualitative data collection and analysis.   

Findings/Outcomes measure

The primary mental health measures are the Kessler 10 (distress), PHQ-9 (depression) and the GAD-7 (anxiety). The primary wellbeing measure utilises a validated Pacific Identity and Wellbeing (PIWBS-R) scale and the WHO-5 (subjective wellbeing). Secondary measures include alcohol use, students’ experience and academic progress.  Interviews will provide in-depth perspectives of the students’ journeys, and the relationship to their mental health and wellbeing including the impact on students’ academic progress.


This research seeks to better understand the factors that influence the mental health, wellbeing and academic success of Pacific students in tertiary institutions. The findings will be used to inform advocacy approaches and guide targeted support efforts.

Abstract 587 | PDF Downloads 73


Teevale T, Lee A, Tiatia-Seath J, et al. Risk and protective factors for suicidal behaviours among Pacific youth in New Zealand. Crisis 2016.
2. Tiatia J, Coggan C. Young Pacifican suicide attempts : a review of emergency department medical records, Auckland, New Zealand Pacific Health Dialogue,. 2001;8(1):124-128.
3. Ministry of Health. A strategy to prevent suicide in New Zealand, Draft for public consultation 2017.
4. Kokaua J, Schaaf D, Wells JE, Foliaki S. Twelve-month prevalence, severity, and treatment contact of mental disorders in New Zealand born and migrant Pacific participants in Te Rau Hinengaro : The New Zealand Mental Health Survery. Pacific Health Dialogue. 2009;15(1):9-17.
5. Tualamali'i J. Pacific Youth Calls for Mental Health in Schools.
6. Fukofuka H. Pacific youth views on health and wellbeing : a photovoice study: Otago 2017.
7. Health Promotion Agency. Te Kaveinga - Mental health and wellbeing of Pacific peoples 2018.
8. Foliaki S, Kokaua J, Schaaf D, Tukuitonga C. Twelve months and lifetime prevalences of mental disorders and treatment contact among Pacific people in Te Rau Hinengaro : The New Zealand Mental Health Survey Autralian and New Zealand Journal of Psychiatry 2006;40(10):924-934
9. Craig E, Dell R, Reddintog A, et al. The determinants of Health for Pacific Children and Young People in New Zealand (2012): New Zealand Child and Youth Epidemiology Service, University of Otago; 2013.
10 Fuimaono K Pulotu-Endeman. The Fonofale Health Model. 1984;
11. 11. Crawley L, Pulotu-Endemann FK, Stanley- Findlay RTU. Strategic Directions for the Mental Health Services for Pacific Islands People. Wellington, New Zealand: Ministry of Health; 1995.
12. Sopoaga F, van der Meer J. Building a Pacific health workforce in New Zealand : Initial findings from a transition project in first year health sciences at University The International Journal in the First Year at Higher Education. Vol 22011.
13. Sopoaga F, Zaharic T, Kokaua J, Ekeroma A, Murray G, van der Meer J. Pacific students undertaking the first year of health sciences at the University of Otago, and factors associated with academic performance. NZMJ. 2013;126(1384):96-108.
14. Kokaua J, Sopoaga F, Zaharic T, Van der Meer J. The development of a pre-enrolment screening tool to inform targeted support services in the first year in health sciences The International Journal in the First Year in Higher Education. 2014;5(1):55-66.
15. McKenzie K. Improving mental healthcare for ethnic minorities. Advances in Psychiatric Treatment. 2008;14:285-291.
16. Dowell AC, Garrett S, Collings S, McBain L, McKinlay E, Stanley J. Evaluation of the Primary Mental Health Initiatives. Summary Report 2008.: University of Otago and Ministry of Health, Wellington; 2009.
17. Statistics New Zealand. Pacific peoples ethnic group 2013.
18. Ministry of Education. Profile & Trends. New Zealand's Annual Tertiary Education Enrolments 2016.
19. Brown P. The invisible problem ? Improving students' mental health: Higer Education Policy Institute; 2016.
20. Field R, Duffy J, Huggins A. Supporting transition to law scholl and student well-being : The role of professional legal identity. The International Journal of First Year in Higher Education. 2013;4(2):15-25.
21. Field R, Kift S. Addressing the levels of psychological distress in law students through international assessment and feedback design in the first year law curriculum. The International Journal of First Year in Higher Education. 2010;1(1):65-76.
22. Hussain R, Guppy M, Robertson S, Temple E. Physical and mental health perspectives of first year undergraduate rural university students. BMC Public Health. 2013;13(849).
23. Flatt AK. A suffering generation : Six factors contributing to the mental health crisis in North American higher education. College Quarterly. 2013;16(1).
24. Hunt J, Eisenberg D. Mental health problems and help-seeking behaviour among College students. Journal of Adolescent Health. 2010;46:3-10.
25. Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders. 2009;117:180-185.
26. Cranford JA, Eisenberg D, Serras AM. Substance use of behaviors, mental health problems, and use of mental health sevices in a probability sample of college students. Addictive Behaviors. 2009;34:134-145.
27. Kitzrow MA. The mental health needs of today's college students : Challenges and recommendations. NASPA Journal. 2003;41(1):167-181.
28. Givens JL, Tija J. Depressed medical students' use of mental health services and barriers to use. Academic Medicine. 2002;77(9):918-921.
29. Mori SC. Addressing the mental health concerns of international students. Journal of Counselling. 2000;78(Spring 2000):137-144.
30. Wong SS, Sugimoto-Matsuda JJ, Chang JY, Hishinuma ES. Ethnic differences in risk factors for suicide among American high school students, 2009 : The vulnerability of multiracial and Pacific Islander adolescents. Archives of suicide research. 2012;16:159-173.
31. Else IRN, Andrade NN, Nahulu LB. Suicide and suicide-related behaviors among indigenous Pacific Islanders in the United States. Death Studies. 2007;31(5):479-501.
32. Ran M. Suicide in Micronesia : A Systematic Review. Primary Psychiatry. 2007;14(11):80-87.
33. Ran M, Mendezc AJ, Bansil B, et al. Predictors of mental health among college students in Guam : implications for counselling. Journal of Counselling & Development. 2016;94:344-355.
34. Samaranayake CB, Arroll B, Fernando AT. Sleep disorders, depression, anxiety and satisfaction with life among yoing adults : a survey of university students in Auckland, New Zealand. NZMJ. 2014;127(1399):13-22.
35. Doran G. Psychological distress in New Zealand university students and its association with alcohol consumption: University of Otago; 2015.
36. Jameson M, Smith J. Voices of students in competition. NZMJ. 2011;124(1338):55-66.
37. Willis S. Student Mental Health Services Review : Internal report University of Otago; 2017.
38. Faleafa M, Pulotu-Endemann K. Developing a culturally competent workforce that meets the needs of Pacific people living in New Zealand. In: (Ed.'s) MSaAJ. Workforce Development Theory and Practice in the Mental Health Sector. IGI Global : USA2016.
39. Kingi-Uluvae D, Faleafa M, Brown T, Wong E. Conecting culture and Care : Clinical practice with Pasifika People. In: Evans IM, Rucklidge J, O'Driscoll M. Professional Practice of Psychology in Aotearoa New Zealand2016.
40. Dudley M, Faleafa M, Anderson E. Professional Practice of Psychology in Aotearoa New Zealand2016.
41. Sopoaga F, van der Meer J. Investigating factors that influence success of Pacific students in first-year health sciences at university in New Zealand. NZMJ. 2012;125(1352):28-38.
42. Kessler RC, Andrews G, Colpe LJ, Hiripi E. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959-976.
43. Kroenke K, Spitzer RL, Williams JBW, Lowe B. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med 2001;16(9):606-613.
44. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalised anxiety disorder. Arch Intern Med. 2006;166(10):1092-1097.
45. Eisenberg D, Gollust SE, Golberstein E, Hefner JL. Prevalence and correlates of depression, anxiety, and suicidality among University students. American Journal of Orthopsychiatry. 2007;77(4):534-542.
46. Manuela S, Sibley C. The Pacific Identity and Wellbeing Scale (PIWBS) : A culturally-appropriate self-report measure for Pacific Peoples in New Zealand. Social Indicators Research. 2013;112(1):83-103.
47. Manuela S, Sibley C. The Pacific Identity and Wellbeing Scale-Revised (PIWBS-R). Cultural Diversity and Ethnic Minority Psychology. 2017;21(1):146.
48. Topp CW, Ostergaard SD, Sondergaard S. The WHO-5 Well-Being Index. Psychotherapy and Psychosomatics. 2015;84:167-176.
49. Bush K, Kivlahan DR, McDonell MB, Fihn SD. The AUDIT Alcohol consumption questions (AUDIT-C). Arch Intern Med. 1998;158:1789-1795.
50. Clark T, Fleming T, Bullen P, et al. Health and wellbeing of secondary school students in New Zealand. Trends between 2001, 2007, and 2012. J Paediatr Child Health. 2013;49(111):925-934.
51. Nada-Raja S. International students psychological wellbeing: Findings from an exploratory study. Otago Global Health Institute 9th Annual conference 2017.
52. Zou G. A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology. 2004;159(7):702-706.
53. Sarah Derrett, Wilson S, Ari Samaranayaka, et al. Prevalence and Predictors of Disability 24 Months after Injury for Hospitalised and Non-hospitalised Participants: Results from a Longitudinal Cohort Study in New Zealand. PLoS ONE. 2013;8(11):e80194.
54. Vaioleti TM. Talanoa Research Methodology : A developing position on Pacific research. Waikato Journal of Education. 2006;12(21-24).
55. Spencer L, Ritchie J, O'Çonnor W, Morrell G, Ormston R. Analysis in Practice. In: Ritchie J, Lewis J, Nicholls CM, Ormston R. Qualitative Research Practice. A Guide for Social Scientist Students and Researchers2013.
56. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation. 2006;27:237-246.