Objective: A systematic review aiming to identify and critically appraise evidence for the validity and reliability of the Strengths and Difficulties Questionnaire in pre-school children (aged 3-5). Method:The review followed the Preferred Reporting Items for Systematic Reviews and Meta- Results: 41 studies were included (56 manuscripts). Two qualitative studies examined content and cultural validity, revealing issues with some questions. Six studies discussed language validations and recommended some changes to the wording. Evidence for discriminative validity was good (Area Under the Curve ≥ 0.80) as was evidence for convergent validity (weighted average correlation coefficients ≥0.50), except for the Pro-social scale. There was limited support for discriminant validity but good evidence for the 5-factor structural validity of the tool. One study demonstrated measurement invariance across ethnicity. Sensitivity was below 70% and specificity above 70% in most studies that examined this. One study showed that caseness indicators varied between countries. Internal consistency of the total difficulty scale was good (weighted average Cronbach's alpha parents' and teachers' version 0.79 and 0.82) but weaker for other subscales (weighted average parents' and teachers' range 0.49-0.69 and 0.69-0.83). Inter-rater reliability between parents was moderate (correlation coefficients range 0.42-0.64) and between teachers strong (range 0.59-0.81). Cross-informant consistency was weak to moderate (weighted average correlation coefficients range 0.25-0.45).Test-retest reliability was mostly inadequate. One study demonstrated moderate size effect sizes.Conclusions: Evidence for a number of psychometric properties is strong. However, the lack of evidence for test-retest reliability, cultural validity and criterion validity should be addressed given the wide-spread implementation of the tool in routine clinical practice, including in New Zealand. Furthermore, the moderate level of consistency between different informants indicate that an assessment of a pre-schooler should not rely on a single informant.

BackgroundMothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy.MethodThis study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge.ResultsForty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent.ConclusionsThe experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings.

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Background: International research identifies indigeneity as a risk factor for traumatic brain injury (TBI). Aotearoa New Zealand studies show that mokopuna (grandchildren; used here to encompass the ages and stages of infant, child and adolescent development and those in young adulthood) are significantly overrepresented in TBI populations. The important role of whānau (family) is also well established in child and adolescent TBI scholarship. Despite awareness of these factors, no studies have been identified that explore whānau knowledge about mokopuna TBI. The aim of this study was to explore two questions: (1) What do Māori people say about mokopuna TBI in the context of the Māori cultural belief that the head is the most sacred part of the body? and (2) How could this information be used to build theory that could inform addressing the rehabilitation needs of this group?Method: Eighteen marae wānanga (culture-specific fora in traditional meeting houses) were held. The wānanga typically lasted approximately 2 hours. Footage and written transcripts were analysed using Rangahau Kaupapa Māori (Māori indigenous research methods).Results: The wairua theory of mokopuna TBI proposes that TBI not only injures brain anatomy and physiology but also injures wairua (defined here as a unique connection between Māori and all aspects of the universe). Injury to wairua means that culturally determined interventions are both indicated and expected. The wairua theory of mokopuna TBI thereby provides a guide to intervention.Conclusion: A Māori theory of mokopuna TBI has been identified which describes a culture-specific aspect of TBI. This theory proposes that pre-existing whānau knowledge salient to TBI is critical to optimising recovery. Further research is needed to test this theory not only in TBI but also in other areas such as in mental illness, neurodegenerative disease and addiction.

Aim: The aim of this study is to investigate Māori (Indigenous peoples of Aotearoa New Zealand) understandings of dementia ( mate wareware) and develop a framework to inform assessment of cognitive impairment. Method: Qualitative, kaupapa Māori (M āori approach) research with 241 older Māori ( kaumātua) involving 17 focus groups across Aotearoa New Zealand (NZ) and eight families ( whānau) from one region. We thematically analyzed transcribed data from audio-recorded interviews. Results: Two overarching themes, namely, connection ( Tūhononga) and self ( Whaiaro), and eight subthemes in particular mind ( hinengaro), spirit ( wairua), body ( tinana), family ( whānau), social connection ( whanaungatanga), identity and role ( tuakiri), place ( wāhi), and ancestors ( tūpuna) emerged. Māori language ( Te Reo Māori) was important for cognitive health. Conclusion: The findings embedded in cultural values improve understanding of dementia ( mate wareware) in Māori. These themes can inform the assessment of older Māori with cognitive impairment. For those without cognitive impairment, the Tūhononga Whaiaro framework suggests factors potentially crucial for healthy aging in Māori.