RESUMO
Background: Rangatahi Maori, the Indigenous adolescents of Aotearoa New Zealand (NZ), have poorer health outcomes than Pakeha (NZ European /other European/"White") adolescents. We explored the influence of policies for Indigenous youth by presenting health trends, inequities and contrasting policy case examples: tobacco control and healthcare access. Methods: Cross-sectional representative surveys of NZ secondary school students were undertaken in 2001, 2007, 2012 and 2019. Health indicators are presented for Maori and Pakeha adolescents (relative risks with 95% CI, calculated using modified Poisson regression) between 2001-2019 and 2012-2019. Policy examples were examined utilising Critical Te Tiriti Analysis (CTA). Findings: Rangatahi Maori reported significant health gains between 2001 and 2019, but an increase in depressive symptoms (13.8% in 2012 to 27.9% in 2019, RR 2.01 [1.65-2.46]). Compared to Pakeha youth there was a pattern of persistent Maori disadvantage, particularly for racism (RR 2.27 [2.08-2.47]), depressive symptoms (RR 1.42 [1.27-1.59]) and forgone healthcare (RR 1.63 [1.45-1.84]). Tobacco use inequities narrowed (RR 2.53 [2.12-3.02] in 2007 to RR 1.55 [1.25-1.93] in 2019). CTA reveals rangatahi Maori-specific policies, Maori leadership, and political support aligned with improved outcomes and narrowing inequities. Interpretation: Age-appropriate Indigenous strategies are required to improve health outcomes and reduce inequities for rangatahi Maori. Characteristics of effective strategies include: (1) evidence-based, sustained, and comprehensive approaches including both universal levers and Indigenous youth-specific policies; (2) Indigenous and rangatahi leadership; (3) the political will to address Indigenous youth rights, preferences, priorities; and (4) a commitment to an anti-racist praxis and healthcare Indigenisation. Funding: Two Health Research Council of New Zealand Project Grants: (a) Fleming T, Peiris-John R, Crengle S, Parry D. (2018). Integrating survey and intervention research for youth health gains. (HRC ref: 18/473); and (b) Clark TC, Le Grice J, Groot S, Shepherd M, Lewycka S. (2017) Harnessing the spark of life: Maximising whanau contributors to rangatahi wellbeing (HRC ref: 17/315).
RESUMO
OBJECTIVE: This study examines the reliability and validity of the Mood and Feelings Questionnaire (MFQ) and Short Mood and Feelings Questionnaire (SMFQ) for measuring depression in New Zealand help-seeking adolescents. METHOD: A sample of 183 adolescents completed the 33-item MFQ, which includes all 13 items on the SMFQ, at three time points during a trial of a computerized intervention for depression. RESULTS: Both the MFQ and SMFQ demonstrated good to excellent Cronbach's alphas, moderate to strong item-total score correlations, moderate to strong correlations with quality of life and anxiety measures, and strong correlations with the clinician-rated Children's Depression Rating Scale-Revised and the Reynolds Adolescent Depression Scale 2 at all time points, indicating good reliability and content, convergent, and concurrent validities, respectively. Favoring sensitivity over specificity, the optimal cut-off value for differentiating depressed from nondepressed cases for the MFQ was ≥28 and for the SMFQ was ≥12. Both instruments demonstrated satisfactory diagnostic accuracy and sensitivity to change. CONCLUSION: The MFQ and SMFQ are free and simple instruments that can be used to identify depression and measure symptom change in New Zealand help-seeking adolescents.
