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Item Protective factors in potential trauma for adolescent surf lifesavers(Elsevier Limited, United Kingdom, 2025-12) Lawes JC; Fien S; Ledger J; Drummond M; Simon P; Joseph N; Daw S; Best T; Stanton R; de Terte IIntroduction: Surf lifesavers form a key part of Australia's first responder workforce. Patrolling members can start from 13 years old, with potential exposure to traumatic incidents. Protective factors may mitigate the trauma exposure. This study investigated protective factors associated with mental health outcomes among adolescent surf lifesavers (13–17 years), including in response to exposure to potentially traumatic events. Methods: An online survey was developed to collect data from Australian surf lifesavers (13–17 years). Measures included demographic factors, stressful life events, post-traumatic stress symptoms (PTSS), self-efficacy, social support, and attitudes toward mental health problems. Hierarchical regressions and moderation analyses explored the relationships between variables. Results: There were 118 responses collected with overall mean age 15.4 years (SD = 1.3). PTSS was moderately to strongly positively correlated with all trauma domains. Higher self-efficacy and social support scores were correlated with lower PTSS. Hierarchical regression showed that Trauma within SLS, social support, self-efficacy and attitudes toward mental health were significantly associated with the outcome in the final regression model (F(5,110) = 17.87, p < 0.001), with the protective factors collectively explaining 28% of the variance in PTSS. Negative attitudes were positively associated with PTSS, while social support and self-efficacy scores were both negatively associated with PTSS. Conclusions: This study highlights the critical and protective interplay between social support, self-efficacy, mental health attitudes and trauma exposure among adolescent surf lifesavers. The findings will guide the development of targeted interventions to support younger patrolling members with an emphasis on supportive interventions to improve resilience and wellbeing in young emergency service personnel exposed to trauma. Practical applications: This study highlights the importance of encouraging protective factors with young individuals in emergency service roles, with practical implications for mental health professionals, emergency service agencies, surf lifesaving organizations, and policymakers interested in promoting the wellbeing of adolescent emergency service personnel.Item Mental health conceptualisations and perspectives on mental health services of Black Sub-Saharan African migrants and refugees in Aotearoa New Zealand : a doctoral thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu Campus, New Zealand(Massey University, 2025-08-22) Musakwa, MichelleThe number of African migrants and refugees is increasing in Aotearoa-New Zealand (A-NZ). However, there is still limited understanding regarding the mental health experiences of Black Sub-Saharan Africans. Without adequate knowledge of the experiences of this population, it is difficult for mental health professionals to provide culturally appropriate services. As such, it is prudent to develop an understanding of the way this population conceptualises, experiences, and manages mental health and mental distress. This study explores how Black Sub-Saharan Africans in A-NZ conceptualise and manage mental health and their perspectives on mental health services in A-NZ. A qualitative approach was employed, with data collected through nine semi-structured individual interviews and two focus groups (each with four Black Sub-Saharan African women). Individual interview data were analysed using Interpretative Phenomenological Analysis, highlighting the role of identity in mental health conceptualisation and the intergenerational and gender differences that exist. Focus group data were analysed through Reflexive Thematic Analysis and key themes identified included barriers to accessing services and participants’ preferences regarding mental health services. Overall, this study found that culture and identity play a critical role in how Black Sub-Saharan Africans perceive mental health. These factors also influence people's experiences with mental health services. Understanding the cultural nuances of Black Sub-Saharans in A-NZ can help mental health clinicians develop an ethos of engagement that promotes better quality of care.Item An exploration into gender and generational differences in mental health literacy in Aotearoa New Zealand and Australia : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand(Massey University, 2025-07-25) Dodge, AndrewMental distress touches the lives of many. Society could benefit from enhancing the public’s ability to effectively assist in its identification, management, and prevention. Mental health literacy is a concept that assesses this capacity in the general population. Prior international research indicates that both gender and generational differences for this construct exist, with men and older adults typically exhibiting lower levels of mental health literacy. However, we currently lack an accurate understanding of why such patterns have emerged and an evaluation of whether these differences may be influenced by measurement bias. This study seeks to enhance our understanding of these differences. Using a cross-sectional quantitative study design, a total of 830 participants aged 18 to 76 from Aotearoa New Zealand and Australia completed an online questionnaire measuring their mental health literacy and restrictive emotionality. Men demonstrated lower levels of mental health knowledge and attitudes than women, while partial support was found for a linear pattern of differences across generations for mental health attitudes (with older generations exhibiting lower mental health attitude scores than younger generations). However, given the lack of evidence to support measurement invariance, it is possible that these observed differences were influenced by differences in measurement properties. The results did not support the assertion that younger generations would be more likely to falsely detect the presence of a mental health disorder when presented with a vignette describing normal levels of distress in a difficult situation. Additionally, the study did not find evidence that restrictive emotionality mediates the relationship between gender and mental health attitudes. Overall, this study raises the possibility that gender and generational differences in mental health literacy may be influenced by measurement bias. The findings also suggest that the broad conceptualisation of mental health literacy as a multidimensional construct may fail to adequately capture the nature and strength of the relationships between the variables that it is comprised of. Additionally, these results contrast voices from concept creep literature suggesting an expanding concept of harm concerning mental health terminology among younger generations. Rather, this study suggests that perceived generational differences within this area may be exaggerated.Item The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative(Elsevier B V, 2025-08-01) Mortier P; Yang X; Altwaijri YA; Holdcraft JA; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud NK; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Covarrubias Díaz Couder MA; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Felez-Nobrega M; García Forero C; Gili M; Gutiérrez-García RA; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Jansen L; Langer ÁI; Liu Y; Mac-Ginty S; Martínez V; Mason A; Mathai M; McLafferty M; Miranda-Mendizabal A; Murray EK; Musyoka CM; O'Neill SM; Papasteri CC; Piqueras JA; Popescu CA; Rapsey C; Robinson K; Rodriguez-Jimenez T; Scarf D; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vereecke S; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaboratorsObjective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.Item Exposure to Traumatic Events and Shame in Adolescent Surf Lifesavers: An Australian Perspective(Springer Nature Switzerland AG, 2024-10-10) Fien S; Lawes JC; Ledger J; de Terte I; Drummond M; Simon P; Joseph N; Daw S; Kelly S; Hillman W; Stanton R; Best TEmergency service personnel experience high levels of psychological distress, with increasing evidence of associations with shame and trauma. Additionally, adolescence is a critical time in social and cognitive development, in which shame plays an important role. In Australia, adolescent volunteer surf lifesavers (SLS) are particularly vulnerable due to exposure to potentially traumatic experiences (PTEs) such as rescues and resuscitation of human lives. The aim of this study was to investigate the association between direct or indirect PTEs, and the relationship PTSS and shame may have in adolescent surf lifesavers. This cross-sectional study surveyed patrolling adolescent SLS, aged 13–17 years, recruited via internal communications and social media groups. Complete responses from patrolling adolescents (n = 118; 59% female; mean age 15.4 years) were used to determine exposure to PTEs across global, direct, and within SLS trauma domains. Associations between demographics, PTEs, post-traumatic stress symptoms (PTSS), with shame as a moderator were assessed for each trauma domain. PTEs and PTSS were positively associated across trauma domains. Shame was identified as a significant predictor of PTSS and as an important moderator of PTSS for experiences within SLSA, but not global or direct trauma. By exploring links between PTEs, PTSS, and shame, these findings contribute to the development of strategies and interventions for adolescents during stressful times. Responsiveness to adolescents via feedback and genuine, reassuring relationships that acknowledge the complexity of coping with stressful situations, may be potentially effective approaches to support coping with experiences of shame following PTE’s in adolescent surf lifesavers.Item Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men(BMC, part of Springer Nature, 2024-07-10) Lelutiu-Weinberger C; Filimon ML; Zavodszky AM; Lixandru M; Hanu L; Fierbinteanu C; Patrascu R; Streinu-Cercel A; Luculescu S; Bora M; Filipescu I; Jianu C; Heightow-Weidman LB; Rochelle A; Yi B; Buckner N; Golub SA; van Dyk IS; Burger J; Li F; Pachankis JEBACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania. METHODS: This study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania's implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials. DISCUSSION: The knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts. Trial registration This study was registered on ClinicalTrials.gov, identifier NCT05323123 , on March 25, 2022.Item Buffering and facilitative factors for posttraumatic stress and flourishing among New Zealand Defence Force personnel : a longitudinal study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu, New Zealand(Massey University, 2024-11-01) Bryson (Allen), DanielSubstantial heterogeneity exists in individual responses to trauma. Reactions to operational deployments by service personnel appear to be no exception. The present research has sought to explore the links that potentially traumatic deployment experiences (PTDEs) have with posttraumatic stress (PTS) and flourishing. Further, the impacts of adaptive health behaviours (physical activity, nutrition, and sleep) and social support (from close others or from military leadership) upon the relationships that PTDEs have with PTS and flourishing were explored. Surveys were conducted 3 years apart with 313 New Zealand Defence Force (NZDF) postdeployment personnel and reports were analysed. A positive relationship was found between PTDEs and PTS, and a nonsignificant relationship between PTDEs and flourishing. Significant associations were also found between 1) adaptive health behaviours, social support, and leadership support, and 2) PTS and flourishing, both cross-sectionally and longitudinally. Mixed support was found for the moderating effects of social support and adaptive health behaviours on the relationships that PTDEs had with PTS and flourishing. Finally, PTS was found to moderate the relationship between PTDEs and flourishing. Conclusions on how the present findings converge and build upon past research, and the unique contributions of leadership support, as well as the effects of PTS on the relationship between PTDEs with flourishing, are discussed.Item Loto Malie (Contented Heart) : understanding Pacific youth mental wellbeing : a thesis by publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand(Massey University, 2024) Auva'a-Alatimu, Taulaga MonicaThe voices and perspectives of Pacific young people can often be overlooked, yet they are instrumental in shaping the future of today’s society; their voices need to be amplified. Pacific youth, a diverse and vibrant group in Aotearoa New Zealand, are facing growing mental health concerns and are less likely than youth of other ethnicities to seek psychological help due to stigma and a lack of mental health awareness. The paucity of culturally appropriate psychological interventions may contribute to Pacific youth’s reluctance to seek help. The Ministry of Health has encouraged the implementation of Pacific worldviews when promoting the wellbeing of Pacific youth. This study aimed to contribute to the development of new knowledge in Pacific Mental health research and psychological interventions for Pacific youth. To date, there has been limited published research on psychological approaches which integrate spirituality, culture and a digital intervention for promoting mental wellbeing in Pacific youth. This research explores Pacific youth’s experiences of engaging with mental health tools, specifically a Pacific mental health intervention developed for the very purpose of meeting the needs of Pacific youth, Loto Malie (contented heart). In exploring youth experiences and perspectives on mental health, prioritising Pacific-Indigenous knowledge in the research methodology was fundamental. Consequently, the Fa’afaletui and Talanoa frameworks, which draw on Pacific-Indigenous methodologies, provided culturally sound processes for engagement with Pacific youth which allowed them to share their stories and experiences authentically. The findings highlight the key themes that formulate and conceptualise the Loto Malie therapeutic framework, revealing the importance of interweaving culture and spirituality within the therapeutic environment, especially as this strengthened Pacific youth engagement with this approach. At the outset, the aim of this PhD was to explore digital mental health tools with youth, given the low uptake of such tools specifically among Pacific youth. The primary researcher developed an innovative cultural digital mental health intervention, Loto Malie 2.0 Mukbang + mental health, as an interim measure during the pandemic. This innovative approach was shared privately (upon invitation) via YouTube and Facebook. Loto Malie 2.0 aimed to provide accessible cultural and clinical examples that promoted mental health awareness and meaningful connections with the viewers, who were predominantly young adults. Overall, developing the Loto Malie programme and Loto Malie 2.0 allowed young people to attain mental health knowledge and equipped them with relevant tools for wellbeing improvement. Therefore, this newfound knowledge and wisdom provided initial evidence that Pacific youth engage effectively with mental health tools when they are grounded in a Pacific therapeutic approach embedded within their worldviews. The Loto Malie therapeutic framework aims to serve as a guide for Pacific therapeutic approaches to enhance the overall wellbeing of Pacific youth.Item What goes on TOA : lessons from Tāne Ora o Aotearoa (TOA) in high-performance : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Te Pūtahi-a-Toi, School of Māori Knowledge, Massey University, Palmerston North, New Zealand. EMBARGOED to 2 October 2026.(Massey University, 2023-12-01) Rowe, LukeDisproportionately high burden of disease, social exclusion and deprivation among Māori men are well documented across most health and social indices, and they are reflected within a broad range of policy, strategy, and service delivery initiatives. The reasons underpinning these inequities are certainly complex though clear, as they are connected to a suite of social, cultural, environmental, historical, and structural factors that each coalesce to undermine the overall health status of Māori men. Despite this, there is a growing population of tāne (Māori men) who continue to buck these trends. They are referred to in this thesis as, “tāne ora.” The focus on tāne ora, rather than on Māori men’s health, is deliberate and emphasises the fact that while these two concepts share similar goals and objectives, they are founded on different principles and philosophies. Like the renowned Gould et al (2002) study which interviewed 10 Olympic gold medallists revealing a number of common characteristics between them, this research is about What Drives Tāne Ora focusing on a specific subset of tāne who operate within high-performance environments. Grounded in Kaupapa Māori and Mana Tāne theories, a phenomenological and qualitative research design provided the framework for exploring the journeys of eight tāne within professional rugby aged between 20 and 36 years old. This thesis presents findings of the relationship between high-performance (one phenomena) and tāne ora (another phenomena). By taking this approach, these tāne offer insights into their childhood through to their present-day high-performance endeavours as current All Blacks and/or Māori All Blacks. Three seminal findings were established from this research. Firstly, research into the health and wellbeing of tāne requires broader emphases and attention. Not to simply perpetuate health disparities and deprivation, but to cast a light on where opportunities for gains exist and how more bespoke solutions can be developed. Secondly, health and wellbeing of tāne should be informed by research methodologies which are equally as nuanced and framed. The need for a Mana Tāne Research methodology is overdue if not desirable. Lastly, what drives tāne ora involves a complex interplay of conditions referred to in an acronym format as, MANA TANE. Notably, that any pursuits related to tāne ora needed to be mātauranga-informed, and activated by mana in the first instance. MANA TANE highlights that while all conditions are important, there are some (i.e., MANA) that are essential and others (TANE) that are complimentary. These illustrate the convergence of the conditions as an alternative pathway towards achieving tāne ora. One in which the rules of the sporting and Māori worlds are different with one being more transient and the other, enduring. And that those who are most successful are likely to be those that can have a positive relationship with both modes seamlessly.Item Evaluating Te Reo Tuakiri : acceptance and commitment therapy in a schools-based resilience programme in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Auckland, New Zealand(Massey University, 2024-08-08) Burt, ReganThe mental health of Aotearoa’s (New Zealand) rangatahi (young people) has received considerable attention in recent years due to increasing rates of psychological distress and suicidality. Evidence shows these difficulties are greater for Māori and Pacific rangatahi and those living in low socioeconomic areas. The New Zealand government’s 2018 inquiry into mental health recommended implementing early intervention programmes in schools to help rangatahi learn about mental health and develop skills to build their resilience. One such intervention is Te Reo Tuakiri, a new resilience programme offered to rangatahi in secondary schools across Aotearoa. Run by the bi-lingual social impact organisation M3, the content of Te Reo Tuakiri is informed by Te Ao Māori (Māori worldview) models of wellbeing and acceptance and commitment therapy (ACT). The programme utilises a tuakana-teina (relationship between an older person and a younger person) approach, whereby the rangatahi learn resilience skills and pūrākau (Māori legends) which they then go on to teach to tamariki (children) at a nearby kindergarten. This thesis evaluated the Te Reo Tuakiri programme’s inaugural offerings in two secondary schools in Tamaki Makaurau (Auckland). The aims of this evaluation were to investigate the effect the Te Reo Tuakiri programme was having on participant resilience and psychological flexibility and to investigate participants’ experiences, understandings, and practices of ACT processes as taught in the programme, alongside their cultural applicability. To achieve these aims this research took a mixed-methods approach to evaluation and involved the quantitative analysis of measures of resilience and psychological flexibility at three time points, alongside thematic analysis of focus groups with students and facilitators following completion of the programmes. The main findings of this study showed improvement in participants resilience from pre- to post-programme with a medium effect size. However, the participants did not see a significant difference in their psychological flexibility across the programme (pre to post), though there was a medium effect size from pre- to mid-programme. Further, no significant correlation was found between measures of resilience and psychological flexibility at any of the three time points. The qualitative portion of this study helped to provide some context to these findings. The themes generated highlighted instances where students provided evidence of several ACT-congruent perspectives that were beneficial in helping rangatahi better manage their private experiences and act on these newly developed skills. However, there were also instances where students expressed ACT-incongruent perspectives. The qualitative analysis also provided support for the programmes cultural applicability and demonstrated the successful adaptation of ACT processes for a Māori cultural context. Taken together, these findings demonstrate support for the Te Reo Tuakiri programme as an effective resilience intervention and adds to a small pool of research indicating ACT may be an appropriate intervention for addressing the mental health needs of rangatahi in Aotearoa. Limitations of the present study as well as recommendations for Te Reo Tuakiri and areas of future research are also presented.
