Liggins graduate leads groundbreaking mental health research

Metua Daniel-Atutolu’s research journey into the mental health of Cook Island adolescents highlights the importance of Indigenous voices in research and sheds light on a deepening crisis.

Metua Daniel-Atutolu stands surrounded by her husband and children with her graduation flowers and dissertation
Metua Daniel-Atutolu with her family at graduation. "This research is not mine, it is ours."

The first thing Metua Daniel-Atutolu thought when senior nursing colleagues contacted her about a critical mental health research project focussing on adolescents in the Cook Islands was not “Can I really fit this into my life?” but “Am I the right person for this role?”. 

Metua already had a Masters of Nursing, as well as a full time clinical position, and significant family responsibilities to her husband and four adult children, but also as the nurse in her large Pacific family and wider Cook Islands community.

But those other commitments weren't what concerned her when deciding whether to take on the Masters research, to undertake a baseline survey of the mental health of young Cook Islanders. 

Instead, what she asked herself was: Shouldn’t this research be done by someone living in the Cook Islands?

I wanted to make sure our Cook Island ways of doing and our voices weren’t lost ... I also knew I needed to be respectful of those who are back home and of those who came before me.

Metua Daniel-Atutolu Liggins Institute graduate

“My father’s background is from Aitutaki, Penrhyn and Palmerston and my mother is from Mangaia. I was born in New Zealand but always had connections to the homeland. So in my mind I knew it was a privilege to be able to do this research, but I wished it had been someone, a nurse or clinician, from back home. 

“I wanted to make sure our Cook Island ways of doing and our voices weren’t lost, and I was grateful for the opportunity, but I also knew I needed to be respectful of those who are back home and of those who came before me.”

Metua Daniel-Atutolu and Professor Mark Vickers in graduation regalia
Metua Daniel-Atutolu with her supervisor, Professor Mark Vickers

Two years later, Metua has graduated with a Masters in Health Science, first class honours. More importantly, her research – the first in its field in the Cook Islands – has highlighted the need for attention to be focused on mental health among adolescents. It has also signalled a way forward for education and health agencies.

“There is anecdotal evidence around young people experiencing poor mental health, including anxiety, depression and engaging in risky behaviours, but there was no measure. Researchers have come in before and they’ve looked at different factors influencing our young people’s lives – like drinking alcohol, smoking, and what they are eating – but they’ve never focussed purely on adolescents’ mental health.”

And without research data it was difficult for the authorities to develop a health and wellbeing strategy around young people’s mental health.

But that wasn’t what worried her when deciding whether to take on the Masters research to undertake a baseline survey of the mental health of young Cook Islanders.
From left: Some members of the research team, Christine Porio, Metua Daniel-Atutolu, Dr Neti Tamarua-Herman, Celeste Barret-Watson and Professor Mark Vickers

Now they have that evidence, however confronting that might be: it appears today's Cook Islands teenagers are experiencing high rates of mental health distress. Although the sample size in Metua's study was relatively small, she says, data was gathered using the global and well-validated mental health screening tool, the Strengths and Difficulties Questionnaire, or SDQ, which means Cook Island adolescent mental health can now be benchmarked internationally.

And those early comparisons are worrying. In fact, following some alarming numbers in the initial stages of the research, Metua, together with a Cook Islands-based team including Dr Evangelene Daniela-Wong and Christine Porio, helped set up a clinical pathway and support guidelines for how the young study participants would be followed up. 

With the knowledge she has provided through the project’s partnership with the ministries of Education and Health, she’s hopeful the SDQ mental health tool will become part of the Cook Islands’ annual school health checks.

Metua says it was important that the research findings be presented in the Cook Islands first, and this was done at the Pacific Medical Association and Te Marae Ora (Ministry of Health) annual conference in the Cook Islands in September last year.

Metua Daniel-Atutolu wearing a ei katu flower garland speaking into a microphone
Metua Daniel-Atutolu presenting her research findings in the Cook Islands in 2023.

“Part of giving back to our people was to ensure my research was presented back home first, because it belongs to us. On presentation day my room was completely full; I felt overwhelmed by support. And I knew it was because people wanted to hear about this research; it’s about our young people.”

And the future? Metua hasn’t closed the door on a PhD. She says if an opportunity presents itself and the topic is right, then she will step in. But if there is someone living back home in the Cook Islands who would be able to take on the research, she would be happy for this.

“I feel that whenever you’re doing research in the Pacific, Indigenous knowledge carried by Indigenous people is so important. If you do research on a population of people, like mine from the Cook Islands, then it’s important to have a researcher who is from that population. You know the people and you can work more collaboratively.

“I’m really grateful it was a Cook Islander who undertook this research.”

Part of giving back to our people was to ensure my research was presented back home first, because it belongs to us.

Metua Daniel-Atutolu Liggins Institute graduate

Metua’s thesis title was “Baseline assessment of mental health in Cook Island adolescents”. It was supervised by Professor Mark Vickers and Dr Jacquie Bay and supported via an ongoing collaboration with the Ministries of Health and Education in the Cook Islands as part of a Pacific Research Project led by Dr Neti Tamarua-Herman and funded by the Health Research Council of New Zealand. 

Professor Mark Vickers describes Metua as someone with “a passion for supporting the mental health of young people”.

“She combined her clinical experience and cultural knowledge to complete a highly successful project in the Cook Islands that has provided key baseline data indicative of a current significant mental health burden in Cook Island adolescents and therefore identified an urgent need to develop scaffolded resources to support these students, their families, the schools and wider community.”

Metua is one of four Liggins Institute students graduating in May. Amy Barker and Georgia Wansink have gained Bachelor of Medical Imaging degrees, with Honours, and Zahlee Buckley a Bachelor of Biomedical Science with Honours.

Media contact

Nikki Mandow | Research communications
M: 021 174 3142