Surveys Find Significant Mental Distress In Samoa And Tonga

Research in Samoa and Tonga highlights an urgent need to improve mental health services in the Pacific, says University of Auckland Professor Sir Collin Tukuitonga.

Surveys conducted in 2023 offer the first comprehensive national data on mental health in Samoa and Tonga, says Sir Collin, who is director of Te Poutoko Ora a Kiwa - Centre for Pacific and Global Health at the University.

Working alongside Pacific health and research professionals in Samoa and Tonga, Sir Collin co-led the research with Te Poutoko Ora a Kiwa co-directors Professor Judith McCool and Dr Roannie Ng Shiu.

About 1000 participants were surveyed from across four villages in Samoa and four villages from Tonga.

The New Zealand Ministry of Health Polynesian Health Corridors funded the research, which uncovered “significant” levels of mental distress in Samoa and Tonga.

About eight percent of the participants in Samoa and six percent in Tonga experienced psychological distress, in comparison to four to six percent of Pacific peoples in Aotearoa over recent years.

A 2013 World Health Organisation report on several Pacific Island countries indicated more than 90 percent of people with diagnosed mental disorders had received no care or treatment in the previous year. The 2023 survey in Tonga showed 96 percent of participants had never visited a mental health professional.

In both Tonga and Samoa, the research found two percent could be diagnosed with depression. None of the people with depression in Tonga had seen a mental health professional before the survey.

Sir Collin says the research highlights the inadequacy of mental health services for Tonga and Samoa, and the difficulty for people to access care.

“There’s a severe shortage of trained mental health workers in the islands. There’s only one psychiatrist in Samoa for more than 225,000 people and one psychiatrist in Tonga serving more than 100,000 people.

“We have raised with the New Zealand Ministry of Foreign Affairs and Trade the need for training and workforce support to increase the numbers of mental health workers in Samoa and Tonga.

“It’s important to get better services there as fast as possible,” he says.

The lack of mental health services means many people with severe mental health disorders are initially picked up by the criminal justice system, says Sir Collin.

“People with less severe disorders, such as anxiety and depression, are basically left to box on alone. They might get help from friends, family or the church.”

About eight percent of the research participants in Tonga and five percent in Samoa reported high alcohol use, compared with a notably higher 20 percent among Pacific peoples in New Zealand.

“One possible explanation for the elevated alcohol use among Pacific peoples in New Zealand could stem from the cultural shift experienced upon relocating from their homelands,” the Tonga Mental Health Survey report states.

About six percent of the participants in Tonga and four percent in Samoa had a clinically diagnosed alcohol use disorder.

Binge drinking is a problem that needs to be addressed in the Pacific, says Sir Collin.

“There’s often harm related to binge drinking, such as traffic accidents, violence against women and girls, and violence generally,” he says.

One to three percent of Pacific people in Aotearoa suffer post-traumatic stress disorder, while the study found two percent with PTSD in Tonga and one percent in Samoa. The higher rate in Tonga could be associated with extreme storms caused by climate-change, the 2022 volcanic eruption and subsequent tsunami that displaced people from Ha’apai, and chronic conditions of poverty, under-employment, and violence, the survey report states.

The study in Samoa found people in the Apia urban area were 32 times more likely to suffer psychological distress than those in Savai’i, despite better access to health services in Apia. This suggests urban life is more stressful and connections with family and culture in less developed areas might help protect against distress, the survey report states.

Women in Samoa were more than twice as likely as men to suffer major depression, and four times more likely to have generalised anxiety disorder.

However, men in Samoa were five times more likely than women to have alcohol use disorder.

Stigma around mental health problems remains “deep and pervasive” in Samoa, an issue which needs to be addressed, the Samoa survey report states.

The research highlighted the need for more public health campaigns, community workshops, and school-based programs to reduce stigma and promote early intervention for mental health issues.

The report from Tonga recommends mental health screening and treatment be carried out in primary healthcare settings, to improve access.

In Samoa, no mental health helplines or telehealth options are currently available, so this was recommended to improve services, particularly for those in outlying areas.

The Mental Health Act in Samoa also needs to be updated, to improve care for people with mental health problems, the report states.

Further mental health surveys are planned in Tokelau and Niue this year.

© Scoop Media