Encounter mental health in Tuvalu: The prior study

To the Editor

Tuvalu is a Polynesian island country located in the Pacific Ocean, about midway between Hawaii and Australia. It has a total land area of 26 square kilometres across nine coral atolls, with a population of 11,192 (Commonwealth Health Online, 2019; The World Bank, 2017). A limited medical service is provided by the only hospital, Princess Margaret Hospital (PMH); no psychiatric specialist services are available.

Cooperative projects between PMH and the Chung Shan Medical University Hospital (CSMUH) of Taiwan have operated since 2006. In 2016, at the request from PMH, between October 18 to 27, a mobile team provided the first psychiatric intervention in Tuvalu. One psychiatrist who is also a board-certified child and adolescent psychiatrist from CSMUH began to conduct assessments and interventions, including the use of medication and psychotherapy.

During six working days in this period, 31 patients made a total of 62 visits to psychiatric services. The majority were female (64.5%), single (64.5%), educated to elementary school level or below (48.3%) and were aged between 4 and 66 years (mean age of 30.5). As shown in Table 1, the major psychiatric disorders seen included psychosis, depressive disorders, adjustment disorder/sleep disorders, anxiety disorders, autism spectrum disorder, attention deficit/hyperactivity disorder and developmental delay. Special issues such as intellectual disability, a history of brain injury/neurological illness, domestic violence/child abuse, alcohol-related disorders/problems and Internet gaming disorder were also noted.

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Table 1.

Distribution of psychiatric disorders.

	Case (N = 31)	%
Psychosis, schizophrenia, delusional disorder	7	22.6
Depressive disorder/mood disorders	7	22.6
Adjustment disorder/sleep disorders	5	16.1
Anxiety disorder/panic disorder/social phobia	5	16.1
Autism spectrum disorder	3	9.7
Attention deficit/hyperactivity disorder	2	6.5
Developmental delay	2	6.5
Special issues
Intellectual disability	11	35.5
History of head injury/epilepsy/meningitis/cerebral palsy	10	32.3
Domestic violence/child abuse/rape	4	12.9
Alcohol-related disorders/problems	3	9.7
Internet gaming disorder	1	3.2

First, local PMH medical staff referred 23 patients with potential psychotic symptoms, impaired cognitive functions or alcohol-use problems. These individuals were being cared for within the wider family/society, where there is a local culture of sharing. The successful referral rate was about 60.9%. After this, other patients who suffered from neurotic symptoms or family issues came by themselves. These patients were repressing their symptoms in their daily lives.

It is difficult to conduct cross-cultural diagnosis and interventions, especially in island countries with limited resources and relevant literature (Allan and Hunter, 1985). To our knowledge, this is the first report concerning mental health conditions in Tuvalu. Since 2000, the threat of rising sea levels has caused about a third of Tuvalu’s population to resettle to New Zealand (Commonwealth Health Online, 2019). With the current growth in globalization and migration, it is important to understand more about mental health conditions in Tuvalu, where alcohol use, Internet/electronic gaming and Westernization are complicating local mental health problems which then require further intervention.