issue 1 09 - APS Member Groups - Australian Psychological Society

States of Micronesia114activity setting is opposed to the identityencouraged in another setting, elevatedpsychosocial stress is likely. In the context ofMicronesia, social change that creates newsettings which reward the construction of aparticular identity and are incongruent with thereward system of other ‘traditional’ settings isa significant cause of problems. For example,the demands to support and be supported bythe family may conflict with the demands toengage in wage jobs or deviant behaviour withpeers. In support of this idea is the finding thatperi-urban areas, with a higher proportion ofconflicting settings, had higher suicide ratesthan urban or rural areas, which are morelikely to have consistency between settings.Studies have also suggested thatpsychosis is not a likely factor in suicide(Rubenstein, 1995). Of the total number ofsuicide victims, only 5 to 10% had psychotichistories. However, evidence shows thatpsychotics are much more likely to commitsuicide than the general Micronesianpopulation (Hezel, 1993).Rubenstein’s (1983, 1987) analysis ofsuicides in Truk also complements theseexplanations and reviews the findings that inthe period from the mid 1960’s to the early1980’s suicides have reached epidemicproportions. Although initially appearing to bea cohort effect, as post World War II childrenexperienced substantial societal changes,Rubenstein had to reject this hypothesis. Evenin the early 1990’s, he reported that suicideshad become the primary cause of death amongyoung Micronesian men, and their rates hadbeen among the highest in the world(Rubenstein, 1995) with rates in some areas,such as Truk, exceeding 200 per 100,000annually during the period 1978 to 1987(Rubenstein, 2002). In his most recent article,he stated that the youth suicide epidemic iscurrently in its third decade with no signs ofdiminishing (Rubenstein, 2002).Another area of concern is the possibleincreasing rate of psychosis. Compared to arate of 34 per 10,000 for the entire Micronesiain the period 1978-1980, Hezel (1993) foundthat the rate was 54 per 10,000 in 1990. Most ofMicronesia at the time had a rate lower thanother industrialized nations, although the nearbystate of Palau’s rate was considerably higher at167. Seventy-three percent of treated cases werediagnosed as schizophrenia. Over three quarters(77%) of these severe cases were male.Dale’s (1981) analysis revealedsubstantial differences in the prevalence ofschizophrenia among the populations ofMicronesia between the years 1978 and 1979.While Yap had a rate of 9.7 cases per thousand(over the age of 15), the Kapingamarangi andNukuoro people of similar Polynesian descenthave yet to identify a single case ofschizophrenia. Dale noted that theKapingamarangi mostly keep to themselves andpreserve their traditional ways, while theNukuoro have been more likely to mix withother populations. Also, the rates ofschizophrenia show a general increase frommore eastern islands (near Kapingamarangi andNukuoro) to western islands – a noteworthyphenomenon worth exploring further.Examining 2004 rates of variousdiagnosed cases of mental illness and substanceabuse, Gonzaga-Optaia (2006) reported thatschizophrenia (297 cases) and depressiveepisodes (100 cases) were the most frequent.The most recent data in 2005 found a similarpattern, but with continued increases, with 325cases of schizophrenia and 114 cases ofdepressive episodes. Because of the geographicchallenges inherent in a diffuse island nationand lack of resources for identifying all cases ofmental illness, investigators have cautioned thatfindings are not conclusive. However, becauseall psychotic cases that were included in theirprevalence rates were highly indisputable, anyerrors would most likely be underestimates.Upon inquiries with villagers, manyperceived increases in mental illness andattributed it to travelling abroad, highereducation, and drug use (Hezel, 1993). Hezel’sstudy found that 47% of the psychoticpopulation had lived more than 6 monthsThe Australian Community Psychologist Volume 21 No 1 June 2009