The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

Background
First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.
Methods
Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.
Results
One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8–12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1–2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.
Conclusion
First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

L'Asse Tripartito Italia-Germania- Giappone e la Cina

Germany, Italy and Japan were engaged in China from the turn of the 20th century to WWII. However, they formed an anti-Chinese alliance only at the final stage of their presence there, when Japan assumed an undisputed role of leader in the region. Despite its alliance with the Axis powers, Japan never implemented racial laws against the Jews in China. All of them took part in the Boxer Upraising suppression and received as a consequence extraterritorial rights and concessions. Moreover, Japan won the war against China in 1895 and transformed itself from a tributary country of China into an imperialistic power. It took possession of Taiwan and in the 1930s established a puppet government in Manchuria.Germany followed different route obtaining as indemnity for the murders of two missionaries the control of the Shandong province, which was later expanded thanks to the anti-Boxer coalition's victory. However, Germany lost all possessions when China entered WWI. The issue of Shandong was finally resolved at the Conference for Disarmament hold in Washington in 1921-2. Japan failed to gain ex-Germany territories. Finally, Italy arrived in the Far East at the turn of the century but was not very interested in the oriental colonialism to the same extent it was interested in Africa. Tianjin was its only concession in China, and it took almost a decade before a subvention to arrive from the Italian government for its development.In the 1920s and 1930s Germany and Italy engaged in successful diplomatic, commercial and military relationships with China. In fact, both were considered China's partners thanks to their experts at the service of the Chinese government. On the other hand, Japan position was opposite to them, because of its plans of aggression towards China which was to be transformed into “the natural extension” of the mainland. In 1935 Italy declared war on Ethiopia and abandoned the seat at the League of Nations. China interpreted the Italian aggression as the endorsement of Japan's politics towards China in Manchuria, and the relations between the two countries were broken off. After that Italy supported Wang Jingwei's puppet government during the Japanese occupation of China. Germany followed the same path in 1937, when it was evident that the Japanese were playing the leading role in the region, and decided to ally with Wang Jingwei too. Both Italy and Germany decided also to recognise the Manzhuguo and established diplomatic relations, definitively turning their backs on the old Chinese ally.The Rome-Berlin-Tokyo Axis sealed the alliance among the three countries, and it confirmed Japan as the leading power in the region. Nevertheless Japan did not apply the racial law against the Jews in China.

Identity Text: an educational intervention to foster cultural interaction

Background: Sociocultural theories state that learning results from people participating in contexts where social interaction is facilitated. There is a need to create such facilitated pedagogical spaces where participants share their ways of knowing and doing. The aim of this exploratory study was to introduce pedagogical space for sociocultural interaction using ‘Identity Text’.
Methods: Identity texts are sociocultural artifacts produced by participants, which can be written, spoken, visual, musical, or multimodal. In 2013, participants of an international medical education fellowship program were asked to create their own Identity Texts to promote discussion about participants’ cultural backgrounds. Thematic analysis was used to make the analysis relevant to studying the pedagogical utility of the intervention.
Result: The Identity Text intervention created two spaces: a ‘reflective space’ helped
participants reflect on sensitive topics like institutional environments, roles in
interdisciplinary teams, and gender discrimination. A ‘narrative space’ allowed
participants to tell powerful stories that provided cultural insights and challenged cultural hegemony; they described the conscious and subconscious transformation in identity that evolved secondary to struggles with local power dynamics and social demands involving the impact of family, peers and country of origin.
Conclusion: Whilst the impact of providing pedagogical space using Identity Text on
cognitive engagement and enhanced learning requires further research, the findings of
this study suggest that it is a useful pedagogical strategy to support cross-cultural
education.