Eating disorders in New Zealand: Implications for Maori and health service delivery.

OBJECTIVE: Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Maori population as the non-Maori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this study was to describe the population undergoing specialist mental health treatment for eating disorders and compare Maori and non-Maori clinical characteristics and service use. METHOD: This study uses the Programme for the Integration of Mental Health Data data set, managed by the New Zealand Ministry of Health to describe the characteristics of people with eating disorders and their use of specialist mental health services from 2009 to 2016. RESULTS: There were 3,835 individuals with a diagnosed eating disorder who had contact with specialist mental health services in this time period, 7% of whom were Maori. Within the cohort, Maori had a higher prevalence for a bulimia nervosa diagnosis, fewer diagnosed with anorexia nervosa, and a higher prevalence of other psychiatric comorbidity than non-Maori. DISCUSSION: There is discrepancy between the proportion of service users accessing specialist mental health services who are Maori and the assessed crude prevalence of eating disorders for Maori in national estimates. Once Maori are in specialist services; however, their use of services is comparable to non-Maori. Further research is needed to highlight the experiences of those Maori with eating disorders and address barriers to accessing services for Maori with eating disorders.

Is there systemic bias for Maori with eating disorders? A need for greater awareness in the healthcare system.

The New Zealand Mental Health Survey, Te Rau Hinengaro, indicated that eating disorders are at least as common in Maori as non-Maori, which is consistent with international findings that eating disorders exist in other indigenous and ethnic minority groups. Specific factors may be relevant to the development and treatment of eating disorders in the Maori population. We suggest this may include differential exposure to risk factors, the impact of acculturation, changing body image ideals and systemic bias reducing access to treatment and research participation. However, an absence of high-quality research regarding eating disorders in Maori makes it difficult to be certain about this. We suspect that Maori do not receive treatment in specialist eating disorders services at a level commensurate with comparable prevalence data in New Zealand and that a significant contributory factor to the apparent unmet need for Maori with eating disorders is likely to be systemic bias. Urgent attention to this area of research is required.