Indigenous youth mental health: an ecological approach to understanding risk and protective factors for Māori youth in Aotearoa New Zealand.

BACKGROUND: Māori (Indigenous) youth of Aotearoa New Zealand are experiencing widening inequities in mental health when compared to Pākehā (New Zealand European/other European/"White"; cultural majority) youth. This study used an ecological approach to investigate key risk and protective factors for Māori to help prioritise actions. METHODS: A subsample of Māori participants (N = 1,528) from a large representative cross-sectional secondary dataset on secondary school students' health and wellbeing (Youth'19) were used to examine the effects of explanatory variables selected from five domains (individual, and their wider social ecosystem, including whānau/family, school, and community) on four mental health outcomes (wellbeing, depressive symptoms, suicide thoughts, suicide attempts). Descriptive statistics (percentages and 95% CIs) were used to examine the equity of these variables between Māori and Pākehā/White youth. RESULTS: Overall, individual risk factors included female sex, functional disability, and sexual abuse. Wider adverse social ecosystems included housing precarity, household deprivation, bullying, and racial discrimination. Key protective factors included the Indigenous concept of whanaungatanga (relationships/connection) with whānau (family), and feelings of safety in social ecosystems including home, school, and neighbourhoods. These risk and protective factors were broadly similar across the four mental health outcomes. Compared to Pākehā/White youth, Māori youth were exposed to greater risk-conferring ecosystems, including socioeconomic deprivation, discrimination, and violence-related harms. CONCLUSIONS: Addressing inequitable mental health harm requires not only intervening at the individual level, but also addressing the wider social ecosystems that disproportionately harm Māori youth, including colonial systems that consistently impact Indigenous youth mental health, particularly housing precarity, poverty, violence, bullying, and racism. Culturally and developmentally appropriate approaches with a focus on creating safe and inclusive societies are urgently required to reduce Indigenous youth mental health inequity.