Sleep, mental distress, and support in mothers in Aotearoa New Zealand : a mixed methods thesis : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand

Abstract

Sleep health, mental distress, and support are closely linked in mothers’ lives, yet these relationships are not well understood within the social and structural context of Aotearoa New Zealand. Existing research has often examined sleep, mental distress, or support in isolation, with limited attention to how they interact and are shaped by inequities in social determinants of health. To address these gaps, secondary data from the Wāhi Kōrero online story-sharing platform and the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study were analysed using a convergent parallel mixed methods design to examine relationships between maternal sleep health, mental distress, and support. The qualitative component drew on 181 Wāhi Kōrero sleep-related stories to explore mothers’ experiences of sleep and professional support within the Well Child Tamariki Ora service. Reflexive thematic analysis identified three themes: maternal instinct as a guide in navigating child sleep practices; shifting from deficit-focused messaging to strength-based approaches; and moving beyond rigid, monocultural service models. The quantitative component used cross-sectional Moe Kura data from 294 Māori and 618 non-Māori mothers of 3 to 4-year-old children. Highlighting social and health inequities, Māori mothers were disproportionately affected by socioeconomic deprivation, social jetlag, and mental distress. Multivariable logistic regression models examined associations between unmet social support needs across emotional, advice, concrete, and financial domains, cumulative support adequacy, maternal sleep health, and mental distress. Findings indicate domain-specific associations between unmet social support and sleep outcomes, alongside a dose-response relationship whereby cumulative unmet support needs were associated with progressively poorer sleep health and higher mental distress. Integrated mixed methods findings showed that maternal sleep health, mental distress, and support occur within constrained socioecological contexts and are shaped by cumulative unmet needs, relational safety, and service fit. Support was not a unitary construct, and its meaning depended on both how it was measured and whether mothers felt safe to disclose need. Overall, this thesis demonstrates that improving maternal sleep and mental wellbeing requires coordinated, relational, culturally safe, whānau-centred and needs-responsive support systems that address both immediate support needs and the broader structural conditions shaping inequities in Aotearoa New Zealand.