title: Vaikoloa: Understanding depression in Tokelauan people in New Zealand.
abstract: BACKGROUND The Tokelauan language lacks a word for 'depression' and this can make diagnosing and treating depression in Tokelauan patients difficult for general practitioners. AIMS To describe the experience of depression in Tokelauans and thereby assist diagnosis and treatment of the illness. METHOD Ten semi-structured in-depth interviews were conducted. The transcripts were thematically analysed using an immersion crystallisation technique. RESULTS An illness involving profound sadness exists in the Tokelauan culture. Tokelauans recognise isolation and withdrawal from family and community activities as indicators of extreme sadness. Privacy and pride are important cultural characteristics, which may be barriers to recognising sadness. Often the smiling Tokelauan face becomes the mask hiding sadness. CONCLUSION This research demonstrates the complexity of relationships between patients, their illness and their culture, that impacts on how depression manifests. This research indicates that therapy must have a whole person approach involving family, church, community and patients' spiritual beliefs. KEYWORDS Depression; Pacific health.
authors.affiliation: General Practitioner, Taupo and MGP student, Department of General Practice and Rural Health, University of Otago, NewZealand.
authors.forename: Iain
authors.initials: I
authors.lastname: Loan
authors.affiliation: Professor, Department of Family Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Al Muharraq, Bahrain.
authors.forename: Wayne
authors.initials: W
authors.lastname: Cunningham
authors.affiliation: Associate Professor, Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand. Email: chrystal.jaye@otago.ac.nz.
authors.forename: Chrystal
authors.initials: C
authors.lastname: Jaye
mesh_terms: D003466:Cultural Characteristics; D054521:Cultural Competency; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology*; D005195:Family Relations; D005260:Female; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D057545:Social Stigma