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.

Deconstruction-reconstruction of Computer Game and Immersive Environment Semiotics

Computer game technology produces compelling ‘immersive environments’ where our digitally-native youth play and explore. Players absorb visual, auditory and other signs and process these in real time, making rapid choices on how to move through the game-space to experience ‘meaningful play’. How can immersive environments be designed to elicit perception and understanding of signs? In this paper we explore game design and gameplay from a semiotic perspective, focusing on the creation of meaning for players as they play the game. We propose a theory of game design based on semiotics.

Do Psychosocial Interventions Improve Quality of Life and Wellbeing in Adults with Neuromuscular Disorders? A Systematic Review and Narrative Synthesis

Background: Quality of life and well-being are frequently restricted in adults with neuromuscular disorders. As such, identification of appropriate interventions is imperative. Objective: The objective of this paper was to systematically review and critically appraise quantitative studies (RCTs, controlled trials and cohort studies) of psychosocial interventions designed to improve quality of life and well-being in adults with neuromuscular disorders. Method: A systematic review of the published and unpublished literature was conducted. Studies meeting inclusion criteria were appraised using a validated quality assessment tool and results presented in a narrative synthesis. Results: Out of 3,136 studies identified, ten studies met criteria for inclusion within the review. Included studies comprised a range of interventions including: cognitive behavioural therapy, dignity therapy, hypnosis, expressive disclosure, gratitude lists, group psychoeducation and psychologically informed rehabilitation. Five of the interventions were for patients with Amyotrophic Lateral Sclerosis (ALS). The remainder were for patients with post-polio syndrome, muscular dystrophies and mixed disorders, such as Charcot-Marie-Tooth disease, myasthenia gravis and myotonic dystrophy. Across varied interventions and neuromuscular disorders, seven studies reported a short-term beneficial effect of intervention on quality of life and well-being. Whilst such findings are encouraging, widespread issues with the methodological quality of these studies significantly compromised the results. Conclusion: There is no strong evidence that psychosocial interventions improve quality of life and well-being in adults with neuromuscular disorders, due to a paucity of high quality research in this field. Multi-site, randomised controlled trials with active controls, standardised outcome measurement and longer term follow-ups are urgently required.

Towards Empowerment: Narrative Study of Counselling Psychology Trainees and How They Make Sense of Their Personal and Professional Development in the Context of Their Past Experiences

The discipline of counselling psychology continues to grow and change in response to social, economic and political pressures. It has been argued that its quest for a coherent and distinct identity, which emphasises the possibility of the coexistence of multiple approaches, creates an inherently uncertain and dilemmatic training environment that may hinder the development of trainees’ professional identities. In order to gain a deeper understanding of the issue at hand, the aim was to explore how final year trainees and newly qualified counselling psychologists constructed and made sense of their emerging professional identities and what experiences, past and present, they drew upon in the context of their training to shape those identities. Applying narrative inquiry to analyse eight open-ended interviews, eight preliminary themes were originally identified in participants’ narratives, which with further refinements lead to stories of struggle and marginalisation, growth and discovery, and power and resilience. Participants’ stories of struggle and marginalisation emerged in reference to early family dynamics and stressful life experiences, which seemed to also foster a strong identification with the counselling psychology profession, while stories of growth and discovery focused on the importance of having supportive figures, who helped to instill a sense of security and create an atmosphere of openness. It was in this learning environment that participants felt it was possible to develop a more resilient, empowered professional self, which allowed them to shed an earlier sense of struggle and vulnerability. However, where more of an emphasis was placed on power and resilience, there seemed to be less room for participants to express other feelings that came into conflict with their preferred sense of professional self. While there seems to be a need for a ‘safer’ climate, in which trainees could voice and acknowledge anxieties, vulnerabilities and limitations, addressing concerns around power and vulnerability that may be contributing to the silencing of particular voices and identities may be equally important if trainees are to develop coherent and distinct counselling psychologist identities.

Constructing Personal and Couple Narratives in Late Stage Cancer: A Narrative Analysis

An increasing number of people with terminal cancer are being cared for at home, often by their partner. This study explores the identity, experiences and relationships of people caring for their partner at the end of life and how they construct their experience through personal and couple narratives. It draws upon dialogical approaches to narrative analysis to focus on caring partners and the care relationship. Six participants were recruited for the study. Two methods of data collection are used: narrative interviews and journals. Following individual case analysis, two methods of cross-narrative analysis are used: an analysis of narrative themes and an identification of narrative types. The key findings can be summarised as follows. First, in the period since their partner's terminal prognosis, participants sustained and reconstructed self and couple relationship narratives. These narratives aided the construction of meaning and coherence at a time of major biographical disruption: the anticipated loss of a partner. Second, the study highlights the complexity of spoken and unspoken narratives in terminal cancer and how these relate to individual and couple identities. Third, a typology of archetypal narratives based upon the data is identified. The blow-by-blow narratives illustrate how participants sought to construct coherence and meaning in the illness story, while champion and resilience narratives demonstrate how participants utilised positive self and relational narratives to manage a time of biographical disruption. The study highlights how this narrative approach can enhance understanding of the experiences and identities of people caring for a terminally ill partner.

Narrative Matters: ‘The third space’ in Adolescent and Young Adult Fiction

In his article ‘Narrative Matters’, Gordon Bates (Bates, 2016) discusses the relevance of the humanities, and in particular that of fiction, in helping us to understand the experiences and problems of adolescents suffering men- tal health problems. Notably, the number of novels pub- lished for children and adolescents that focus on mental health problems has risen considerably since the begin- ning of this century. The ‘Goodreads’ (Goodreads, 2016) website lists more than 1000 fiction titles on matters pertaining to mental illness published for the UK and US markets since 2000.

Horæ evangelicæ : or, the internal evidence of the Gospel history, being an inquiry into the structure and origin of the four Gospels, their historical consistency, and the characteristic design of each narrative /

Mode of access: Internet.

Speech and narrative: characterisation techniques in the "Aeneid"

The thesis provides a comprehensive analysis of the characterisation of two of the major figures in the Aeneid, Aeneas and Turnus. Particular attention is paid to their direct speeches, all of which are examined and, where relevant, compared to Homeric models and parallels. To this purpose considerable use is made of the indices in Knauer's Die Aeneis und Homer. A more general comparison is made between the dramatic (direct speech) role of Aeneas and those of Homer's Achilles (Iliad) and Odysseus (Odyssey). An appraisal is made (from the viewpoint of depiction of character) of the relationship between the direct and indirect speeches in the Aeneid. Reasons are given to suggest that it is not mere chance, or for the sake of variety, that certain speeches of Aeneas and Turnus are expressed in oratio obliqua. In addition, the narrative portrayal of Aeneas and Turnus is considered in apposition to that of the speeches. A distinction is drawn between Vergil's direct method of characterisation (direct speeches) and his indirect methods (narrative/oratio obliqua). Inevitably, the analysis involves major consideration of the Roman values which pervade the work. All speeches, thoughts and actions of Aeneas and Turnus are assessed in terms of pietas, impietas, furor, virtus, ratio, clementia, humanitas (etc.). It is shown that individual concepts (such as pietas and impietas) are reflected in Vergil's direct and indirect methods of characterisation. The workings of fate and their relevance to the pietas concept are discussed throughout.

The Great Irish Famine in history-writing and prose fiction : "the mutual interplay of two narrative genres"

Denna tvärvetenskapliga studie kontextualiserar den skönlitterära framställningen av hungersnöden i Irland i mitten av 1800-talet i förhållande till tre olika faser av irländsk historieskrivning ‒ den nationalistiska, den revisionistiska, och den postrevisionistiska ‒ med syfte att granska i vilken mån prosafiktionen antingen återspeglar eller motsäger historikernas tolkningar. År 1845 drabbades landet av en dittills okänd potatispest som förstörde skörden helt eller delvis under de följande fem åren. Missväxten ledde till utbredd svält och epidemiska sjukdomar som dödade åtminstone en miljon människor, medan ytterligare en och en halv miljon flydde, huvudsakligen till Förenta Staterna, England, och Kanada. I sina försök att hitta en rationell förklaring till hur potatispesten kunde utvecklas till den värsta svältkatastrofen i Europa under modern tid, har historiker påvisat ett antal bidragande faktorer, till exempel överbefolkning, de fattigaste jordlösa småbrukarnas och lantarbetarnas beroende av potatisen som sitt baslivsmedel, underutveckling inom jordbruket, det rådande jordegendomssystemet, och den dåvarande brittiska regeringens misslyckande att tillhandahålla effektiv och tillräcklig nödhjälp. Historiska förklaringar är naturligtvis nödvändiga för att vi skall kunna bilda oss en uppfattning om hungersnödens orsaker och konsekvenser, men svårigheten med att skildra offrens situation i en historiografisk analys baserad på fakta är uppenbar då deras egna vittnesmål till största delen saknas i källmaterialet. Följaktligen finns det en risk att historieskrivningen förmörkar det som onekligen var centrala realiteter för de värst drabbade, nämligen svält, vräkning, sjukdom och död. Här kan skönlitteraturen bidra till att komplettera historien. Genom att fokusera på ett specifikt (fiktivt) samhälle och dess (fiktiva) individer, kan skönlitterära verk ge en inblick i hur hungersnöden inverkade på olika samhällsskikt, vad människorna gjorde för att överleva, hur nöden och fasorna påverkade deras psyke, och vad eller vem de höll ansvariga för katastrofen. Å andra sidan kan denna fokusering innebära att författaren misslyckas med att ge en helhetsbild av hungersnödens enorma omfattning och att redogöra för alla faktorer som orsakade och förlängde den. Paul Ricoeurs teori om samspelet mellan historia och fiktion (the interweaving of history and fiction) är därför ett nyckelbegrepp för att bättre förstå denna traumatiska period i Irlands historia. Avhandlingen omfattar en textanalytisk, komparativ kritik av ett antal historiska och skönlitterära verk. Genom närläsning av dessa texter granskar jag vilka aspekter av hungersnöden (politiska, ekonomiska, sociala) de olika författarna valt att behandla, och på vilket sätt, samt hur deras synvinklar har format tolkningarna i sin helhet. I detta sammanhang tar jag också upp skillnaderna mella fakta och fiktion, och speciellt de etiska problem som är förknippade med skildringen av traumatiska händelser och mänskligt lidande. Samtidigt undersöker jag, med hänvisning till Roger D. Sells kommunikationsteori, huruvida vissa författare anslår en påstridig ton i sina verk och hur detta påverkar dialogen mellan författare och läsare. Med utgångspunkt i Ricoeurs teori argumenterar jag för att historia och fiktion inte bör ses som ömsesidigt antitetiska diskurser i skildringen och tolkningen av det förflutna, och att skönlitteraturen genom fokuseringen på offren, som ofta tenderar att reduceras till statistik i historieskrivningen, kan förmedla en bättre förståelse och en djupare känsla för den mänskliga dimensionen av den tragedi som utspelades under hungeråren.

Religion and narrative in the "Metamorphoses" of Apuleius

In this thesis I explore the narratological paradigm of conversion and its usefulness in interpreting the Metamorphoses of Apuleius. I believe that this paradigm is not useful in exploring the novel. However, a closely related paradigm - which I call a "narrative of metamorphosis" - can in fact help us interpret the novel and make sense of the final book of the novel known as the Isis book, which has generated much scholarly debate.