The physical health of Māori with bipolar disorder

Abstract

Aims: There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. Methods: A cohort of Māori and non-Māori with a current bipolar disorder diagnosis at 1 January 2010 were identified from routine mental health services data and followed up for non-psychiatric hospital admissions and deaths over the subsequent 5 years. Results: Māori with bipolar disorder had a higher level of morbidity and a higher risk of death from natural causes compared to non-Māori with the same diagnosis, indicating higher levels of physical health need. The rate of medical and surgical hospitalisation was not higher among Māori compared to non-Māori (as might be expected given increased health needs) which suggests under-treatment of physical health conditions in this group may be a factor in the observed higher risk of mortality from natural causes for Māori. Conclusion: This study provides the first indication that systemic factors which cause health inequities between Māori and non-Māori are compounded for Māori living with severe mental illness. Further exploration of other diagnostic groups and subgroups is needed to understand the best approach to reducing these inequalities.

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…Higher levels of cardiovascular risk factors such as metabolic abnormalities have been seen among those from minority ethnic populations who experience severe mental illness (Carliner et al, 2014; De Caluwé et al, 2019). A recent study also suggests that in New Zealand, Māori with bipolar disorder had a higher level of physical morbidity and a higher risk of death from natural causes compared with non-Māori with bipolar disorder (Cunningham et al, 2020). These data indicate a particular need to focus on physical health in indigenous people with bipolar disorder and to be aware of the interaction between ethnicity, bipolar disorder and the metabolic risks associated with some medications for bipolar disorder.…”

The Right to Equal Health: Best Practice Priorities for Māori with Bipolar Disorder from Staff Focus Groups

“…There is evidence that inequities include higher rates of BD in some Indigenous community samples, including Māori, the Indigenous peoples of New Zealand, yet limited consideration has been given to the role of structural factors in the expression and reduction of those inequities [7][8][9]. While New Zealand clinical guidelines for BD acknowledge the importance of providing culturally appropriate services that consider Māori needs, including reducing barriers to access and discriminatory care, and increasing physical health monitoring, evidence indicates that Māori do not receive best practice let alone culturally responsive care in New Zealand [2,[10][11][12]. The call for change to the design and delivery of mental healthcare by redressing the social conditions and colonial institutions that maintain the status quo of Indigenous mental ill health internationally is also widespread [4,[13][14][15].…”

“…This phase utilised the quantitative and qualitative findings from the two earlier phases of the project and distributed them to focus group participants. Focus groups were then undertaken with staff involved in the design and delivery of healthcare services for Māori patients with BD in New Zealand [10,11,[25][26][27]. This component of the study aimed to discuss the evidence about patterns of health service use and Māori patient experiences with focus group participants, and to draw on their expertise as healthcare professionals to develop guidelines for best practice for Māori with BD and generate strategies for change to address areas of unmet need.…”

Culturally competent, safe and equitable clinical care for Ma¯ori with bipolar disorder in New Zealand: The expert critique of Ma¯ori patients and Wha¯nau

“…Indigenous peoples are affected by pervasive health inequities through the ongoing effects of colonisation, in which health and other social systems privilege non-Indigenous ethnic groups ( Anderson et al, 2016 ; Reid et al, 2019 ; United Nations, 2016 ). BD research is needed in communities with higher prevalence, because it is a chronic condition that has significant impacts and requires high health system resource ( Angst, 2004 ; Cunningham et al, 2020a , 2020b ; Merikangas et al, 2011 ; Rowland and Marwaha, 2018 ). BD research with Māori has the potential to inform knowledge about many other serious and chronic mental health conditions affecting Indigenous peoples ( United Nations, 2016 ; World Health Organization, 2013 ).…”