The four main objectives of Te Rau Hinengaro: The New Zealand Mental Health Survey were, for the total New Zealand, Maori and Pacific populations living in New Zealand, to:
- describe the one-month, 12-month and lifetime prevalence rates of major mental disorders among those aged 16 and over living in private households, overall and by sociodemographic correlates
- describe patterns of and barriers to health service use for people with mental disorder
- describe the level of disability associated with mental disorder
- provide baseline data and calibrate brief instruments measuring mental disorders and psychological distress to inform the use of these instruments in future national health surveys.
Te Rau Hinengaro literally translates as ‘the many minds’ and is a reference to how the mind may be thought of as having many different states or levels. It is used to capture the objective of the survey to measure mental disorder.
This report, Te Rau Hinengaro: The New Zealand Mental Health Survey: provides important and not previously available information about the prevalence of mental disorders and their patterns of onset and impact for adults in New Zealand
- explores the relationship between mental disorders and physical disorders
- provides information about the patterns of health and non-health service use by people with mental health problems
- examines the relationship between sociodemographic correlates and the probability of people meeting criteria for a mental disorder or accessing care
- describes the prevalence and correlates of suicidal behaviour.
This report has been written to meet the aims of the survey and to interpret findings; it does not advocate actions or policies.
Chapter 1: Introduction
This chapter provides the background to the report. It briefly describes relevant mental health policy and strategic planning initiatives, presents the findings from previous community mental health surveys in New Zealand and from other countries, and presents other New Zealand research and service provision data.
Chapter 2: Prevalence and Severity across Aggregated Disorders
This chapter presents results for period prevalence; the distribution of severity and the percentage of people with a mental health visit in the past 12 months; correlates of the prevalence of any disorder, serious disorder and a mental health visit in the past 12 months ; and ethnic comparisons.
Chapter 3: Twelve-month Prevalence
This chapter reports on 12-month prevalence for individual disorders and disorder groups, severity and interference with life, age and sex difference and ethnic differences in disorder rates.
Chapter 4: Lifetime Prevalence and Lifetime Risk of DSM-IV Disorders
This chapter contains information on lifetime prevalence; the distribution of the age of onset for each disorder and disorder group; separate lifetime risk estimates for each birth cohorts to explore whether lifetime risk is highest for those born more recently; and the relationship between lifetime risk of mental disorder and age, sex and ethnicity.
Chapter 5: Comorbidity
This chapter reports results relating to the co-occurrence of multiple disorders or conditions within individuals. The chapter covers the extent to which individuals who experience mental disorder have more than one mental disorder as well as the co-occurrence of mental disorders with chronic physical conditions (such as diabetes, heart disease and cancer) and with the risk factors for physical disease.
Chapter 6: Disability
This chapter contains information on the levels of disability associated with one-month mental disorders and chronic physical conditions.
Chapter 7: Suicidal Behaviour
This chapter includes information about lifetime and 12-month prevalences of suicidal ideation, making a suicide plan and making a suicide attempt; onset distributions for suicidal ideation, suicide plan and suicide attempt; sociodemographic correlates of suicidal ideation, suicide plan and suicide attempt; ethnicity and prevalences of suicidal behaviours; DSM-IV mental disorders and suicidal behaviours; health services use among people with suicidal behaviour.
Chapter 8: Health Services
This chapter provides information on the patterns of 12-month mental health treatment in New Zealand across the four service sectors: mental health specialist service; general medical sector; human services sector; and Complementary and Alternative Medicine (CAM) sector. These four service sectors are further grouped into a health care sector and a non-health care sector. Results are presented on the percentage of participants treated in the four service sectors; the distributions of patients by number of visits and the proportion of all visits by treatment sector and professional group; participants’ satisfaction with, and perceptions of helpfulness of, treatment and services received; the average duration of visit by professional group; and sociodemographic correlates of mental health treatment.
Reports of treatment ever received indicate the proportions of treatment contacts in the year of disorder onset and median duration of delay among cases that subsequently make treatment contact.
Participants’ reasons for delaying seeking help, stopping treatment early and not seeking help in the past twelve months are also presented.
Chapter 9: Maori
This chapter provides information for Maori on participation in the study; the epidemiology of mental disorders; the profiles of participants; the prevalence of mental disorders; comorbidity; the severity and impact of aggregated disorders; health service use; severity, days out of role and treatment in the past 12 months; suicidal behaviour; and key findings compared with Pacific people and the Other composite ethnic group.
Chapter 10: Pacific People
This chapter provides information for Pacific people on Pacific participation; methodological issues for the Pacific analysis; the prevalence of mental disorders for Pacific people; comorbidity; the use of health services by Pacific people; disability related to mental disorder and Pacific people; correlates of mental disorder relevant to Pacific people; findings from intra-Pacific comparisons; findings for suicidal behaviour among Pacific people; and findings for Pacific people compared with Mäori and the Other composite ethnic group.
Chapter 11: The Study in Perspective
Chapter 11 places the survey in a policy context and explains its strengths and limitations.
Chapter 12: Methods
Chapter 12 explains the methods, including the survey design; the sampling frame; the interview; the conduct of the field work; data management and data analyses. This chapter also explains the key terms used in the report.
The Survey Interview
The New Zealand interview was based on the Composite International Diagnostic Interview* (CIDI 3.0). The CIDI can be viewed on the World Mental Health Survey website, but cannot be used without training. Completion of training ensures that the interview is administered correctly and is required before access to diagnostic algorithms is provided.
The CIDI is a fully structured interview suitable for use by trained lay interviewers. Diagnoses of mental disorders were made from responses to the symptom questions. Laptops were used for Computer Assisted Personal Interviews; interviewers read questions off the laptop screen and entered responses. Not all people were asked all questions. For full details of the long and short form questions logic and sections see Fig 12.1 in the Methods Chapter.
This section includes a series of introductory questions about the respondent's general health.
This is followed by the diagnostic questions for the primary disorders assessed in the survey.
Four groups of mental disorders are then assessed: anxiety disorders (panic disorder, agoraphobia without panic, specific phobia, social phobia, generalised anxiety disorder, post-traumatic stress disorder and obessesive-compulsive disorder), mood disorders (major depressive disorder, dysthymia and bipolar disorder), substance use disorders (abuse or dependence on alcohol or other drugs) and eating disorders (anorexia and bulimia). These are based on the following modules:
Other modules assess suicidal behaviours, health service use, chronic physical conditions, disability, psychological distress (K10) and alcohol use and its consequences in the past 12 months (AUDIT). The AUDIT is embedded within the substance module. There is also a screener for psychosis.
Demographic information is contained in the following modules:
A number of the questions were supported by showcards giving prompts for answers or a response booklet for the participant to have in front of them the answers they have given to a question.