Editorial OPEN ACCESS Mental health and wellbeing of Pacific students starting University in New Zealand
Faafetai SOPOAGA,*
1Jacques VAN DER MEER,
2Shyamala NADA-RAJA,
3Tim WILKINSON,
4Sarah JUTEL
1ABSTRACT
Aim : To explore mental health status and factors that impact on the wellbeing of Pacific students in their first year at University.
Methods : Twenty Pacific students who enrolled to study in the Health Sciences First Year at a University in New Zealand in 2015 were randomly selected to participate in this research. Participants were interviewed three times during their first year at University. The Pacific research methodology Talanoa was used for the data collection process. Of the 60 planned interviews, 59 were able to be completed.
Interviews were recorded, transcribed and uploaded to NVivo to assist data management. Data was analysed using a thematic approach.
Results
Pacific students reported on their experiences of various stresses during the year. Some stress was related to their own personal expectations and others due to expectations of others. Students experienced a range of emotions and symptoms in response to these stresses. Many had developed skills or effective management strategies to deal with these stresses. For many, resilience contributed to maintaining wellbeing. In addition, families, friends, peers, mentors, supportive staff and targeted Pacific support services played critical roles in supporting the mental health and wellbeing of Pacific students in the first year at University.
Conclusion
There is increasing concern worldwide about students’ mental health and wellbeing in higher education.
Pacific students felt stressed for many reasons which affected their mental health in the first year at University. Their resilience and other coping skills and connecting to a wide support network enabled them to maintain wellness. Pacific students or those from minority groups are likely to require different and or more support to enable them to adapt to the higher education environment. Strengthening and facilitating access to support networks and culturally relevant services, and increasing connectedness and sense of belonging, are important for Pacific students’ mental health and wellbeing in the tertiary environment.
KEY WORDS: Mental health, Well-being, Pacific students, New Zealand
INTRODUCTION
There is increasing international concern about the mental health and wellbeing of students in higher education. Wellbeing is a reflection of an individual’s assessment of life in a positive manner, and the result of an individual’s response to challenges and opportunities in life. 1 There are increasing stresses and emotional problems faced by tertiary students internationally 2-12, along with rising demands on student health services.
2,10 Additionally, the types of issues for which
students are seeking help have changed from minor concerns to more severe psychological problems. 10 The prevalence of depression is 15%
in North American medical students 11,13, similar to 14% in undergraduate tertiary students in Malaysia. 14 Research suggests that students in higher education have poorer wellbeing compared to the general population. 2
*Corresponding author: Faafetai Sopoaga [email protected]
1. Centre for Pacific Health, Va’a o Tautai, Division of Health Sciences, P.O. Box 913, Post Code 9054, University of Otago, Dunedin, NZ
2. College of Education, P.O. Box 913, Post Code 9054, University of Otago, Dunedin, NZ
3. Department of Preventive and Social Medicine, P.O. Box 913, Post Code 9054, University of Otago, Dunedin, NZ 4. Otago Medical School, P.O. Box 913, Post Code 9054,
University of Otago, Dunedin, NZ
Received: 28.7.2018 Published : 30.09.2018 Citation: Sopoaga F, et al. Mental health and wellbeing of Pacific students starting University in New Zealand. Pacific Health Dialog 2018;21(2):71-79. DOI: 10.26635/
phd.2018.916
Copyright: © 2018 Sopoaga F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Mental disorders are a significant health concern and an increasing burden for Pacific peoples particularly among youth in NZ. 15-19 The NZ Health Research Strategy identified mental health as a priority area of concern. The NZ Mental Health Survey for adults 16 years and over reported the prevalence of mental illness in Pacific peoples to be 25% compared to 21% for the total NZ population. 20 The most common hospital admissions for young Pacific people in the 15-24 years age group (2007-2011) included depression and bipolar disorders. 21 Data from the Ministry of Health (MoH) reported the suicide rates for Pacific youth aged 15-24 years were significantly higher compared to all other ethnic groups 17. Research looking at suicide mortality (1996-2013) reported the prevalence of suicide in Pacific youth to be a significant concern. 22 The Youth’12 report on the Health and Wellbeing of Secondary School Students in NZ found approximately 13% of Pacific students had experienced clinical depressive symptoms 23. These students were more likely to report self- harm, and three times more likely to have attempted suicide compared to their NZ European peers. Young people in the Pacific Youth Leadership and Transformation (PYLAT) Council are now speaking out about the importance of their mental health and specific needs within the education sector. 19
There is sparse information about tertiary students’ mental health and wellbeing in New Zealand (NZ). The New Zealand Union of Students’ Associations published recently a report on the state of mental health of students in higher education. 24 The report was based on the findings of an online survey completed by 1762 respondents from more than 13 different
institutions. The Kessler Psychological Distress Scale 25 mean score for all students was 28.1 (moderate level of psychological distress). Other studies in New Zealand have also reported psychological distress or stress amongst University students. 26,27 First year Health Sciences students at the University of Otago reported experiencing stresses which impacted on their engagement and involvement in university life. 27 Researchers at the University of Auckland reported sleep disorders in undergraduate students, and 17% and 20%
reporting depression and anxiety, respectively. 28 In another study psychological distress in students was found to be associated with alcohol use and alcohol-related harms. 26
There is even less information about Pacific youth in tertiary institutions. Previous research found Pacific students experienced stress and anxiety in their first year at university. 29 Pacific peoples migrated from the Pacific Islands to New Zealand for better education and employment opportunities. 30 However, they are disproportionately represented in poor health and education outcomes. 31 Understanding how best to support Pacific students’ health and wellbeing in higher education is likely to contribute to better education outcomes and employment opportunities.
The aim of this study was to explore the mental health status and factors that impact on the wellbeing of Pacific students in their first year at University.
METHODS
Students are able to nominate up to three ethnic groups they identify with when they enrol at the University. All students who identified with at least one Pacific ethnic group and enrolled to study the Health Sciences First Year (HSFY) programme in 2015 were eligible to participate.
The data on all eligible students (n=106) was obtained and randomised stratified by gender and ethnicity. Twenty Pacific students from the randomised list were identified and invited to participate in three interviews at different time points during their first year. The University calendar year is divided into two semesters. The first interview was held during the Orientation period, the second six weeks into Semester 1 and the third two weeks into Semester 2.
The University offers an Early Orientation Programme for all Pacific HSFY students prior to the official University-wide student orientation programme. Of the 20 participants, 15 had participated in the Pacific Early Orientation Programme and 5 had not. Of all students
approached, two declined to participate, and a further two were selected who agreed to be involved. For those who were selected and wished to participate, specific times and venues were organised for their interviews. All participants were given an information sheet with opportunities for questions, before completing the consent form prior to the first interview.
During the recruitment process, it was emphasised that it was important for them to be available for all interviews. The interviews focussed on exploring students’ experiences, expectations and views about their health and wellbeing during their first year at University.
The Talanoa methodology 32 was used as the approach for data collection. Talanoa means to share through conversations. It is the pathway through which Pacific knowledge and traditions have been passed down through generations.
Talanoa provides the cultural context and environment where participants feel able to share stories and experiences in a meaningful way.
Interviews were conducted by a Pacific researcher and lasted approximately one hour. All interviews were audio-recorded and transcribed.
The transcripts were returned to each student for checking. The final data from each interview was uploaded to NVivo for data management purposes. Data were analysed thematically and chronologically to determine key emerging ideas and themes. The data was initially coded into subthemes, which were further analysed to determine the main themes. Interviews from each participant were also analysed chronologically across the three interview periods to explore any changing patterns across key themes identified.
Ethics approval was granted by the University of Otago Human Ethics Committee. Reference : 15/007.
RESULTS
This research is part of a doctoral study exploring the journey of Pacific students in their first two years at University. The results presented here focus on their mental health and wellbeing, a sub- theme within the broader key theme of Health and Wellbeing.
Twenty participants were evenly divided in terms of gender and represented nine Pacific ethnic groups. Eleven participants had sole Pacific ethnicity. All except one mature student were aged between 19-20 years. Most were staying in a University Residential College. Three participants had entered Health Sciences First Year through the University Foundation programme, two were from overseas, and the rest entered directly from
NZ secondary schools. Five participants were from low decile schools, five from high decile schools, and ten from mid-decile schools. All had left their home environments for tertiary studies.
Of the 60 possible interviews, 59 were able to be completed.
The results below are organised into four areas and are from data across the three time points;
Experience and Expectations, Mental Health and Wellbeing, Personal Development, and Support Networks.
Experience and Expectations
Participants reported a range of causes of stress, and many started the year with mixed emotions.
Some of the stressors were a result of their own expectations of themselves, while others were due to the expectations of others. Following are some illustrative examples of how participants shared about their experiences:
“It’s quite overwhelming, feel exciting, that’s why I’m like “oh my gosh I’m the first one to get into Uni” so I feel like the pressure is on me to do better, for others to come, yeah…the other thing that’s on my mind coming…. (is) for a better future of my family, so I try to accomplish the best for my family to uplift the standard of living, as well and help our community.” P15, male
“I don’t feel pressured by my family to get in, but it’s just like myself, it’s something that I know I’ve always wanted to do. I know I have other courses but it’s not really where I want to go. Med’s really what I want to get into, so it’s more like self- pressure if that makes sense to you.” P16, female
“I grew up with my Dad always like after I got a test or an exam saying “oh what happened to the other 1%” and you know like typical Island parent… “why didn’t you get 100?” it’s like “I got 99 Dad” that sort of thing, it really messed my mind up at one point but it also made me want to get that 100%.” P3, male
The cause of the most stress experienced by students, was directly related to the academic work. They described the workload as being heavy, the challenges of adjusting to the new learning environment, and awareness of the implications of their academic achievements for their future career pathways.
“The first couple of weeks was overwhelming like I was calling Mum saying “I don’t know how I’m going to do this! I don’t know how it’s going to be
possible for me to like get through the year
because in one lecture we would cover what we do in School in a month!” you know, it was just a completely different standard and even though I’d heard so much about how hard it is, I don’t think you could ever understand until you are actually doing it like how full on it is.” P1, female
“Yeah, when I say that it feels like two weeks, I think it’s just because everything has gone so fast.
I noticed that in one of my classes we covered a topic that back in High School took us an entire term (so 12 weeks) and we did it in two, so things just go really really fast.” P8, female
“I did this in the Chemistry mid-term, I was thinking the whole time, “this is meaning whether you are going to be a Doctor or not – this test right now is meaning whether you are going to be a Doctor or not” and then that is just sooo bad when you are taking the test because then I couldn’t… it just got so much.” P1, female
There was also stress related to social integration, adjusting to living in a different environment and getting to know new people.
“So I think it was just before the Orientation Programme kind of thing. I was with my parents inside my room and I was sitting there. I was pretty scared and I said to them “I’m scared”…I can’t remember what my parents said, they just said parenty things you know, like “ah it’ll be alright.” P9, male
“I remember the first few days. It was like, it was really really scary because I still didn’t know anyone that well, and so I like sort of just sat in my room at my hall, like wondering what to do.” P6, male.
In addition, there was stress related to developing and managing relationships in a new environment. Others felt stressed by observing stress in others.
“I’d been living with my friend and then like the second test came along, and then she’s like been playing up, so like I couldn’t say it wasn’t really comfortable going home …and then it just like went downhill and downhill and downhill. The place was mine so I told her she has to go if she’s going to be like this because I can’t study, so she’s leaving today.” P13, female
“Oh yeah, the hall is good but it’s just like my friends…’coz like I have to catch up on work and most of the time I focus on school work that I don’t
notice that I’m going further away from them yeah. So sometimes they’d like go to dinner or do things …and they don’t let me know” P15, female
“It (exam) was horrible. Probably because the chick next to me was crying, and then I go to the bathroom to have a bit of a break and someone was vomiting so I was like “ah….!!” So it was real, I don’t know if it was anxiety or everything I just felt like I didn’t know anything.” P5, female
Mental Health and Wellbeing
Students described their experiences over the year as like being in a roller coaster or in the midst of a storm. Emotional responses to these experiences varied between students. For some this affected their ability to respond in the way they would normally approach a difficult situation, while others were able to respond in a considered way to their circumstances.
“It was a bit of a roller coaster really, because I felt like we studied hard. I don’t know if we over did it. I couldn’t figure out what was important, what was not. For me it was like “everything is important, you need to know this and this and this” and I just panicked. I think and did
everything rather than what I should have been doing.” P5, female
“It’s like you’re on the edge of craziness but your still sort of like, you’re strangely calm. I feel like you’re standing in the eye of the storm you know.
There’s like things happening around you and it’s like you can either join the storm, or you can be calm and just go on and sort of have your own plan.” P18, female
The symptoms students described in relation to their mental wellbeing were mainly related to concerns over academic integration and achievement. These included feeling overwhelmed, depressed, fear of failure, lack of confidence and self-doubt. In addition, some developed physical symptoms such as tiredness, over-eating and insomnia.
“I was just really overwhelmed in the lectures.
Beginning of the year I didn’t know what was needed, like they were just talking really fast and a lot of stuff they were talking about I was like
“What is that? What do I need to know?.” P10, female
“The majority of my friends want to get into Med, so they feel like “Ah my gosh! you know, someone got this amount of points. I know we did the same
amount of study yet they did so much better, so what’s wrong with me?” It’s getting them down.”
P16, female
“Failing does scare me, it’s one of my biggest driving factors but also one of my biggest fears, and that is one of the only things that will make me crumble, is failing.” P3, male
“Last semester I actually had really bad insomnia and so that like messed me up a lot. I’ve had it on and off for like a few years. What happens is like I’ll be good but if I stuff it up, my sleeping pattern once it kind of triggers, I just can’t sleep for like ages.…like you are really tired so I’d go to bed and then I’d just be lying there and then next thing you know the sun’s coming up and you’re just like “I still haven’t slept!” (chuckle).” P6, male
Personal Development
Despite the challenges students faced adjusting to a new learning environment, living away from their usual support networks, the heavy workload and a high stakes academic year, many were resilient and relevant coping skills that enabled them to complete the year successfully.
“I’ve grown up to be independent and have a strong sense of understanding about who I am, and when I am surrounded by people that don’t understand me, I’ll go find someone that does kind of thing.” P8, female
“ I don’t really get stressed in a way. When I’m in stressful situations I’m the sort of person that says
“Well ok that’s happened, what am I going to do about it?.” P18, female
“I’m generally a pretty optimistic person. I’m not the type of person who just feels they have to just sleep all the time because you are so low about...
“oh I’m so behind and I feel down.” P16, female Many shared about the need to find the balance between academic, social and personal lives.
They had various ways to do this, which included doing things they enjoyed.
“What I find the most enjoyable is also the most challenging. So I love learning stuff all the time, but it’s also the most challenging part because there’s always something new to learn. I think that’s where the balance comes in. Like you have to be able to find a balance between…your enjoyment and your challenges.” P8, female
“You don’t just study full time and get sick of it.
Like you still want time to go for a walk, or chat with your friends or just sit outside, go to the museum or just walk around campus. Because if you are in the library every day, like every time,
you’ll just get sick and lose motivation. So like having the balance of being able to do things that you like, just keeps you a bit more sane.” P12, female
“I find like exercising helps but then sometimes it doesn’t. Then I kind of have to address what’s making me stressful and how I can decrease that chance of it happening again.” P2, female
Support Networks
Support from families, friends and peers was a critical factor in maintaining students’ mental health and wellbeing during the year.
“I manage stress calling my family and they’re like
“how’s it going?” just being honest with everyone,
“I’m feeling stressed, I’m feeling like I’m stuck, I need help.. ” P10, male
“My friend on my floor has a car and sometimes we go out to beaches. So that’s been really cool this year and just hanging out with my friends is probably the highlight” P1, female
“Mentoring was my favourite part (chuckle). I think because you’re so stressed during the week, the mentoring was just kind of an opportunity to relax and gather your thoughts again. The mentors were really good in just calming you down and talking you through things. It’s like having that older brother or older sister there, just giving you advice. It’s good just to have someone to talk to and have someone there that’s been through it, that understands the stress but they also know what’s about to come. So they were able to tell you, “yes I know you are stressed at the moment, but it gets better, it’s not going to be like this forever.” P8, female
Other factors identified as playing an important role in maintaining students’ wellbeing during the year included the support provided by Pacific staff and through accessing support services.
“I had an Academic Health Check about two weeks ago I think and that was really good. Just getting some things out that otherwise would just stay bottled up kind of thing, and being able to talk about where I am, like emotionally as well as mentally and stuff like that.” P8, female
“I really love going to POPO. I love, love going to those because I’ve just met sooo many people, and I think that’s really helped … to be honest I don’t think I could have done it without it, without POPO there. Because when I do feel a bit low, there’s always someone there to talk to, helping
me out, giving me some advice. Just friends here that you know, tease you up so, I always feel better when I’m around them. I honestly think that yeah…definitely made a big different, BIG difference.” P16, female
“Having people my own age, all in the same situation from both the POPO programme as well as back in the (Residential) College really helps.
Because if someone is feeling one way then you are almost guaranteed that someone else is going to be feeling something similar. So you can talk it out with people and it’s a good support system.
Sometimes you can feel lost, but there’s always someone there to help like pick you up, and it’s quite good.” P8, female
DISCUSSION
This is an in-depth study to explore the mental health and wellbeing of Pacific students in New Zealand, during their first year of study at university. All of these students had left their cultural and family support networks to undertake tertiary studies. Many are the first in their families to study at university. All were adapting to new study approaches, adjusting to an increase in class size from 30 to 500 students, in addition to enrolling in a high stakes programme which determines eligibility for entry into health professional programmes such as medicine and dentistry.
This research found that Pacific students experienced a number of stresses which affected their mental health and wellbeing in their first year at University. These stemmed primarily from their own expectations of themselves or the expectations of others on them. Those who were the first in their families to attend university had the added pressure to do well as role models for others in their families. Their hopes for success in education was not just for themselves, but also to benefit their families and wider community.
Previous research suggested that students from non-traditional backgrounds may require different or more support to enable them to transition well and be successful in higher education. 2
There are specific areas institutions can target to minimise stress. For example, ensuring the academic workload for first year students is manageable. The HSFY programme has since been review with changes to the programme planned. In addition, careful consideration about how best to provide support for students is helpful. For non-traditional students, this may require different or additional approaches to meet their needs.
The University runs a targeted support programme, the Pacific Orientation Programme
@ Otago (POPO), for Pacific students transitioning into the first year in Health Sciences.
33,34 POPO is the Samoan word for coconut and has three meanings. POPO is a young coconut that is ready for planting. PŌPŌ means to nurture and POPŌ is to capture. POPO encapsulates the essence of what this support programme seeks to do. It supports Pacific students to thrive in the new learning environment, nurtures their growth in a culturally helpful manner, and enables students to capture and utilise what the institution has to offer them to achieve their own aspirations. This support programme delivered within a Pacific cultural framework with support from the NZ Ministry of Health, has enabled Pacific students to “feel at home” quickly and contributed to marked academic success for students at the University. 35
This research also identified a number of factors that supported students’ mental health and wellbeing. These included their own personal skills and strengths as well as connecting with the support from their families, friends, peers and staff. The Pacific population is a young and rapidly growing migrant population in NZ, making up 7.4% of the total population. 36 Pacific families migrated to NZ for better employment and education opportunities. Education is a key determinant of health and a predictor of economic wellbeing through better employment opportunities 37 Pacific peoples however are disproportionately represented in poor health and education outcomes, and have higher unemployment. 17,31,38 Despite these challenges, this research suggests that Pacific students are resilient. They are independent, optimistic, understand the need for balance and have various approaches to reduce stress in their lives. In addition they realise the importance of interdependence and interaction with other students and staff.
The Fonofale model of health 39 identifies family as an important aspect of Pacific peoples’ health.
For these students their families were critical in maintaining their mental health and wellbeing.
Friends and peer mentors were a vital part of their support network. Previous research had identified peers 40,41 and mentors 42 as having an important role in supporting students’ transition to university. This helped with social integration, provided a sense of connectedness and belonging, and contributed to their overall health and wellbeing. Senior Pacific students functioned as peer mentors for the POPO programme. This had a positive impact on the mentees, who felt encouraged simply by connecting with other successful Pacific students who were fully
integrated into university life as their role models.
Furthermore, the support from Pacific and other academic staff was also appreciated by students.
Tinto 43 also articulated the importance of the role of faculty or staff for student support.
Of the 20 students who participated in this research, 4 have since graduated, 8 are studying medicine, 3 are studying pharmacy, and 4 are working towards completing other degrees. Of those who have graduated, all are completing a second degree (two are in the medical programme). Three have since left the University.
One has enrolled in engineering in another institution, and the other two in fulltime employment.
CONCLUSION
There is increasing concern worldwide about students’ mental health and wellbeing in higher education. Pacific students felt stressed for a number of reasons which affected their mental health and wellbeing in their first year at University. Resilience and connectedness to a Pacific support network enabled students to maintain wellness. Tertiary institutions have a responsibility to provide effective support for students’ transitioning into higher education.
Pacific students or those from minority or under- represented groups are likely to require different or more support to enable them to succeed in tertiary institutions. Strengthening and facilitating access to support networks and culturally relevant services, and increasing connectedness and sense of belonging, are important for Pacific students’ mental health and wellbeing in the tertiary environment.
Funding: This research was funded by the NZ Health Research Council.
Competing interests: The authors declare that they have no competing interests.
Authorship: FS is the lead author and was responsible for the overall structure and development of the manuscript. JvM, SN, TW and SJ were all involved in the write up of the manuscript. All authors read and approved the final manuscript.
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