Self-concealment, social self-efficacy, acculturative stress, and depression in African, Asian, and Latin American international college students

Culture shock among international students in Turkey: an analysis of the effects of self-efficacy, life satisfaction and socio-cultural adaptation on culture shock

In this study, we investigated whether the interaction effects of self-efficacy, life satisfaction, and sociocultural adjustment have significant negative effects on culture shock. The data were collected from 323 international students in Turkey, and the sample comprised 197 undergraduates (61%) and 126 graduates (39%). We administered the "Culture Shock Questionnaire," "General Self-Efficacy Scale", "The Satisfaction with Life Scale", and "Sociocultural Adaptation Scale" through an online survey. Of the participants, 86 were female (26.6%), and 237 were male (73.4%). The ages of the participants ranged from 18 to 32 (M = 22.11; SD = 4.23). In this study, we identified three structural models to test the relationships between culture shock, self-efficacy, life satisfaction, and sociocultural adjustment. The results supported our hypothesis (H1) that there would be a significant negative relationship between self-efficacy and culture shock. One-way MANOVA revealed that students with lower self-efficacy scores experienced greater culture shock. Conversely, students with higher self-efficacy scores experienced lower culture shock and interpersonal stress. Additionally, a multigroup analysis was conducted to test the assumed relationships in structural models for Muslim (such as Turkey, where the research was conducted, which is 90% Muslim) and Christian students. The results indicated that self-efficacy has a significantly greater negative impact on culture shock for Christian students than for Muslim students. Our study confirmed the hypothesis (H4) that life satisfaction and sociocultural adjustment serve as mediating variables between self-efficacy and culture shock. Both life satisfaction and sociocultural adjustment were found to have significant direct impacts on culture shock, and a meaningful mediating effect on the relationship between self-efficacy and culture shock was identified. Based on these findings, we concluded that self-efficacy may be particularly beneficial for coping with culture shock for people who do not embrace dominant religious beliefs in a local culture.

New in Town-An internet-based self-efficacy intervention for internal migrants: A randomized controlled trial

OBJECTIVE

Migration is a profound life transition that may threaten migrants' well-being and mental health. Results of several studies suggest that social self-efficacy beliefs may be beneficial for the psychological adjustment of migrants, buffering the effect of specific stressors related to migration, helping them reduce anxiety levels, and providing support in forming of new social bonds and better integration with a new community or culture. The primary purpose of this randomized controlled trial was to examine the effectiveness of the New in Town internet-based self-efficacy intervention for internal migrants in Poland.

METHODS

Participants were 158 internal adult migrants who had changed residence in the last 6 months. They were randomized into two groups: an experimental group (receiving an internet-based self-efficacy intervention), and a waiting list control group. We examined if the intervention was effective in enhancing participants' social self-efficacy (primary outcome), general self-efficacy, social support, satisfaction with life, and reduced reported loneliness (secondary outcomes). Outcome measures were assessed at baseline (Time 1) and 3-weeks later (Time 2). The dropout rate was 50.6%. Initially, we planned to gather follow-up data also 8-weeks after baseline (Time 3). However, due to health and safety reasons related to the COVID-19 pandemic, we decided to stop the trial. Finally, we included in our analysis only data gathered before the COVID-19 pandemic at Time 1 and Time 2.

RESULTS

A total of 159 individuals who met the study's inclusion criteria and completed the baseline assessment were randomly assigned to either the experimental group (n = 80) or the waiting list control group (n = 79). Nevertheless, one participant assigned to the control group was excluded from the analyses because they withdrew their consent to participate after being randomized. The study results suggest that compared to the waitlist control group (n = 78), participants in the experimental group (n = 80) reported a higher level of general self-efficacy beliefs at Time 2 (Cohen's d = 0.47; 95% CI: 0.15-0.79). However, there were no statistically significant effects on social self-efficacy, social support, satisfaction with life, and loneliness.

CONCLUSION

The study offers preliminary support for the effectiveness of an internet-based self-efficacy intervention designed for internal migrants on general self-efficacy beliefs.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.

Exploring homesickness among international students in China during border closure

It is nearly three years since the World Health Organization (WHO) declared the COVID-19 crisis as a pandemic. Since its inception, border closures have been subscribed to by many countries as an extreme policy tool to curb the rate of infection amid emerging variants. China, one of the earliest countries to implement this measure just opened its borders to international students for inbound and outbound travel with several preconditions. Homesickness, a grave discomfort because of its cognitive hallmark of destabilizing the affective states and routine activities of individuals has been underexplored in many studies on the COVID-19 impact on education. This phenomenological study is the first to explore the level of border-closure-induced homesickness among international students in an Asian context (China). International students (n = 20) sampled from five universities in China were interviewed on how the COVID-19-engineered border closures have prompted homesickness among them and their development of coping skills. The thirteen (13) themes that emerged from the study suggest that the students suffered from somatic and psychological symptoms of homesickness. The social and academic life of students were negatively affected. Participants in the study relied on frequent phone calls, entertainment, and indoor and outdoor activities such as exercise and campus excursions as coping strategies against homesickness. It is advocated that higher education leaders in China put in measures to hasten the acculturation of international students to minimize their homesickness. Further research areas such as taking a keen focus on maladaptive symptoms of homesickness are also discussed.

Sport participation, acculturative stress, and depressive symptoms among international college students in the United States

Introduction

The distinctive social nature of sport in its capacity to promote immigrants' adaptation to the new society has been regarded as a vehicle to cope with adverse mental health outcomes derived from acculturative stress (AS) and feelings of marginalization. However, the evidence on the relationship between sport participation (SP), AS, and mental health have been lacking and fragmented. Recognizing this challenge, we examined the mediating effect of AS on the relationship between SP and depressive symptoms (DS) among international college students in the USA.

Methods

A total of 203 international college students in the USA were recruited via Prolific. The instrumentation included previously validated measures: SP (SLIM-18), AS (ASSIS), DS (CES-D-10), sense of coherence (SOC-13), and demographic characteristics.

Results

Mediation analysis showed a significant association between (1) SP and DS (ß = -0.030, p < 0.05) and (2) AS and DS (ß = 0.053, p < 0.001), while (3) no significant indirect effect of AS was found [ß = -0.001, SE = 0.0003, 95% CI (-0.008, 0.004)].

Discussion

Even though several previous scholars have argued that SP is an effective tool to cope with AS among international students, the present study implies this may not be applied to all international students. Specifically, AS and DS among European participants were lower than those from non-European countries, including Asia. Future studies using meta-analysis could be beneficial to examine the external validity of the previous studies on the relationship between SP, acculturation, and mental health to address this potential heterogeneity on the level of AS based on their origin countries or continents. The current study provides meaningful implications for adopting the transformative marketing perspective, which is a marketing approach that pursues positive social outcomes by promoting positive behavior of the target population.

Intolerance of Uncertainty, Acculturative Stress, Gratitude, and Distress: A Moderated Mediation Model

Based on Berry’s (1997) model of acculturation, the current study examined whether gratitude would moderate the association between intolerance of uncertainty (IU) and acculturative stress (i.e., moderation hypothesis), and mitigate the positive association between IU and psychological distress through acculturative stress (i.e., moderated mediation hypothesis). Participants were 171 international students with Chinese heritage from a Midwest public university. Results from PROCESS supported these hypotheses. First, the positive association between IU and acculturative stress was attenuated to a greater extent at higher compared to lower levels of gratitude. Second, the mediation effect of IU on psychological distress through acculturative stress was weaker among those with higher compared to lower levels of gratitude. Findings demonstrate the protective role of gratitude and the role of IU as a risk factor for psychological distress through acculturative stress. Implications for practice, training, and research are discussed.

The benefits of career adaptability on African international students' perception of social support and quality of life in China during the COVID-19 pandemic

With economic globalization, there has been a rapid increase in the number of sojourners in the workforce and in international education. However, little is known about the impact of career adaptability (a key psychosocial resource for managing career transitions) on international students' adaptation in cross-cultural contexts, particularly their quality of life during the COVID-19 pandemic. Based on career construct theory, this study examined how career adaptability directly and indirectly enhances international students' quality of life through perceived online and offline social support, and how the COVID-19 pandemic affected their adaptation in cross-cultural context. With a sample of 328 African international students in China, we found that career adaptability and perceived online/ offline social support were positively related to the quality of life during the COVID-19 pandemic. Furthermore, perceived offline social support, but not perceived online social support, was an adapting response through which career adaptability enhances international students' quality of life in cross-cultural context. The mediating effect of perceived offline social support diminished when the self-rated COVID-19 impact on international students was severe. These findings provide a basis for future psychosocial interventions to enhance international students' adaptation to cross-cultural contexts during and after the COVID-19 pandemic.

Identity Distress among Immigrant Students during COVID-19

The process of identity formation is complex for many; however, for immigrant populations experiencing acculturation and acculturative stress, the process may be particularly difficult. The current study examined the impact of immigration, acculturation, social support, and acculturative stress on identity formation and identity distress during the added stress of COVID-19. Late-adolescent college students from large enrollment psychology courses completed an anonymous online survey battery for course credit (N = 462). Results indicate that identity distress was higher among first-generation immigrants than second- and third-generation; however, it was highest for those with mixed parentage (one immigrant and one native-born parent). Further, acculturative stress and COVID-19 anxiety better predicted identity distress than identity development factors alone, and acculturative stress appeared to mediate the relationship between social support and identity distress. This study highlights the need for additional resources for immigrant students, especially during the current pandemic.

Perceived Behavioral Control as a Mediator between Attitudes and Intentions toward Marine Responsible Environmental Behavior

The marine environment has plunged into crisis with the growth of human activities. The enhancement of responsible environmental behavior (REB) requires policy and education to cultivate social awareness and actions to sustain marine resources. Several studies revealed that the intention serves as an effective predictor of actual behaviors. Furthermore, researchers generally acknowledge that attitudes and perceived behavioral control are potential factors toward behavior intention. However, some research has found that a positive attitude toward the environment does not translate into responsible environmental behavior. Additionally, the model of behavior in the marine context, especially the relationships between attitudes, perceived behavioral control, and the intention of responsible environmental behavior, are still not clear. Students’ attitudes, perceived behavioral control, and intentions toward responsible marine environmental behavior (M-REB) were evaluated via questionnaires. The data from a total of 79 undergraduate students were analyzed. The results suggest that perceived behavioral control is the mediator between attitudes and intentions toward M-REB. This finding reveals the potential benefits of reconsidering the importance of perceived behavioral control in promoting M-REB and provides empirical evidence for future policy-makers in society and education.

Acculturative Stress Among Female Saudi College Students in the United States

Despite their increasing numbers, Saudi Arabian international students in the United States have been the focus of few research studies. We examined acculturative stress among 84 female Saudi Arabian students enrolled in US colleges and universities in the vicinity of Washington, DC. Most participants experienced low levels of depression and anxiety, as measured by the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Furthermore, smooth acculturation in the United States was strongly related to respondents' confidence in their English-language competence. Interestingly, English-language proficiency and other sociodemographic variables (e.g., marital status, religiosity) were not related to psychological stress, as measured by the BAI and BDI-II. In contrast, the study found a statistically significant relationship between cultural mistrust and respondents' psychological stress. We conclude that initiatives sponsoring international student-study in the United States and host universities should provide incoming international students with enhanced support for developing English-language proficiency, as well as a more expansive toolkit for cultural understanding.

Internet-based self-help intervention aimed at increasing social self-efficacy among internal migrants in Poland: Study protocol for a randomized controlled trial

BACKGROUND

Migration is a challenging life transition that may be a source of various problems related to well-being and mental health. However, the psychological adaptation of migrants may be potentially facilitated by social self-efficacy-the beliefs in one's ability to initiate and maintain interpersonal relationships. Previous research suggests that social self-efficacy is positively related to adjustment and negatively related to loneliness, depression, and psychological distress. Research also confirms that self-efficacy beliefs can be effectively enhanced using Internet-based interventions. These results served as a background for creating the New in Town, a self-help Internet-based intervention for internal migrants in Poland that aims at increasing social self-efficacy. Exercises in the intervention are based on the principles of Cognitive Behavioral Therapy and relate to sources of self-efficacy beliefs: mastery experiences, vicarious experiences, verbal persuasions, and emotional and physiological states. Users complete increasingly challenging tasks that encourage them to interact with their environment. The aim of this trial was to investigate the efficacy of the New in Town intervention.

METHODS

The efficacy of the New in Town intervention will be tested in a two-arm randomized controlled trial with a waitlist control group. Social self-efficacy will be the primary outcome. Secondary outcomes will include loneliness, perceived social support, and satisfaction with life. Additionally, we will measure user experience among participants allocated to the experimental group. We aim to recruit a total of N = 280 participants aged at least 18 years who have changed their place of residence in the last 6 months and have an Internet connection. Participants will be assessed at baseline, 3-week post-test, and 8-week follow-up.

DISCUSSION

The trial will provide insights into the efficacy of Internet-based self-help interventions in increasing social self-efficacy. Given that the intervention works, New in Town could provide an easily accessible support option for internal migrants in Poland.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.

Factors Associated with Acculturative Stress among International Medical Students

There is an array of reasons why acculturation can be stressful, and acculturative stress can be triggered by a plethora of factors. The aim of the study was to identify factors associated with acculturative stress among international students enrolled in a public medical university from Romania. 265 students were included in the research. Sociodemographic, academic, and family data, comfortability with living in study city, satisfaction with administrative staff, colleagues, and professors and Acculturative Stress Scale for International Students were gathered. Data have been processed using SPSS Statistics v23.0.0 for MAC.OSX. Female students are more prone to experience homesickness and stress due to change compared to male students. International students with Romanian origins had lower scores on perceived hate and stress due to change/culture shock compared to those with no Romanian origins. Students with relatives or friends enrolled in the same university had significantly lower levels of acculturative stress, perceived discrimination, perceived hate/rejection, and general/nonspecific concerns. Age and year of study are associated with homesickness and stress due to change/culture shock. The existence of factors associated with acculturative stress demand institutional, social, and psychological support for international students.

Limited English Proficiency and Trajectories of Depressive Symptoms Among Mexican American Older Adults

BACKGROUND AND OBJECTIVES

This study examined the effect of limited English proficiency (LEP) on trajectories of depressive symptoms among Mexican American older adults in the United States.

RESEARCH DESIGN AND METHODS

The sample was drawn from Waves 1 to 6 (1993-2007) of the Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE). A total of 2,945 Mexican American older adults were included in the analyses. A latent growth curve modeling was conducted.

RESULTS

After adjusting for covariates, results show that Mexican American older adults with LEP had higher levels of depressive symptoms than those with English proficiency (EP) at baseline as well as over a 14-year period. Differential trajectories were observed between those with LEP and EP over time, indicating that those with LEP had a significantly steeper curve of depressive symptom trajectories over time than those with EP.

DISCUSSION AND IMPLICATIONS

These results suggest that LEP is a risk factor not merely for greater depressive symptomatology at each time point, but for an accelerated trajectory of depressive symptoms over time among Mexican American older adults. Overall, the findings emphasize the need to assist not only the informal support system of Mexican American older adults with LEP, but also the formal system.

The Relationships between Loneliness, Social Support, and Resilience among Latinx Immigrants in the United States

Globally, international migrants are at elevated risk for experiencing loneliness due to separation from social networks in their countries of origin. In the United States, the political rhetoric has been particularly exclusionary against Latinx immigrants, exposing them to discrimination and fear of deportation. Such environments may result in heightened levels of social isolation, which may contribute to greater risk of poor mental and physical health outcomes. Latinx immigrants, however, may access social support in their destination communities that buffers against these negative outcomes. This study sought to examine how social support and loneliness shape Latinx immigrants' abilities to address the challenges related to migration. Multivariate linear regression analyses were conducted with survey data collected from Latinx immigrants in New York City (n=306). Results revealed that Latinx immigrants with greater social support and less feelings of loneliness were more resilient. Specifically, findings suggest that social support may partially protect against the negative impact of isolation on Latinx immigrants' capacity to thrive. Clinical social workers who work with immigrant groups may consider how migration during the life course affects immigrants' social supports and experiences of loneliness. Social work interventions that integrate strategies to increase social support may provide opportunities to address social isolation and other obstacles associated with migration. Such approaches acknowledge loneliness not only as a psychological symptom, but also as a consequence of unfavorable social environments towards immigrant populations. Future research may develop and assess culturally relevant strategies to promote social support and reduce loneliness among marginalized immigrants.

Effectiveness of an Educational Intervention in Reducing New International Postgraduates' Acculturative Stress in Malaysian Public Universities: Protocol for a Cluster Randomized Controlled Trial

Background

Universities around the world, including Malaysia, have attracted many international students from different countries. Research has reported that acculturative stress resulting from international students’ attempts to adjust to the cultures of host countries is one of the most challenging issues that affects their lives in general and academic lives in particular.

Objective

This study aims to examine the effectiveness of an educational intervention on acculturative stress among new postgraduate international students joining Malaysian public universities.

Methods

A cluster randomized controlled trial design with Malaysian public universities as the unit of randomization will be used in this study. Public universities will be randomized in a 1:1 ratio to be either in the intervention (educational program) or control group (waiting list). Participants in the intervention group will receive 7 sessions in 9 hours delivered by an expert in psychology and the researcher. The control group will receive the intervention once the 3-month follow-up evaluation is completed.

Results

The data will be analyzed using the generalized estimation equation with a confidence interval value of 95%; significant differences between and within groups are determined as P<.05. The results of the study underlie the effectiveness of educational program in decreasing acculturative stress of new international students and enabling them to cope with a new environment. The results of this study will contribute to previous knowledge of acculturative stress, acculturation, and adjustment of international students. Furthermore, such results are expected to play a role in raising university policy makers’ awareness of their postgraduate international students’ acculturative stress issues and how they can help them avoid such stress and perform well in their academic life.

Conclusions

We expect that the intervention group will score significantly lower than the wait-list group on the immediate and 3-month postintervention evaluation of acculturative stress and achieve a higher level of adjustment. Results will have implications for international students, policy makers at universities, the Malaysian Ministry of Higher Education, and future research.

Trial Registration

Clinical Trials Registry India CTRI/2018/01/011223; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1= 21978&amp;EncHid=&amp;userName=Muhamad%20Hanafiah%20Juni

International Registered Report Identifier (IRRID)

PRR1-10.2196/12950

A Scientometric Study on Depression among University Students in East Asia: Research and System Insufficiencies?

Given that mental health issues are acute in Asian countries, particularly Japan and Korea, and university students are more vulnerable to depression than the general population, this study aims to examine the landscapes of scientific research regarding depressive disorders among university students and evaluate the effectiveness of international collaboration and funding provision on the scientific impact in Korea, Japan, and China. Based on articles retrieved from the Web of Science database during the period 1992–2018, we found that the number of scientific publications, international collaborations, and allocated funds regarding depressive disorder among university students in China (97 articles, 43 international collaborations, and 52 funds provided, respectively) overwhelmingly surpassed the case of Korea (37 articles, 12 international collaborations, and 15 funds provided, respectively) and Japan (24 articles, 5 international collaborations, and 6 funds provided, respectively). The differences in collaboration patterns (p-value < 0.05) and the proportion of allocated funds (p-value < 0.05) among Korea, Japan, and China were also noted using Fisher’s exact test. Based on the Poisson regression analysis, China’s associations of scientific impact with international collaboration (β = −0.322, p-value < 0.01) and funding provision (β = −0.397, p-value < 0.01) are negative, while associations of the scientific impact and scientific quality with funding provision and international collaboration were statistically insignificant. These findings hint that Korea and Japan lacked scientific output, diversity in research targets, international collaboration, and funding provision, compared to China, but the quality of either China’s internationally collaborated or funded articles was contentious. As a result, policymakers in Korea and Japan are suggested to raise the importance of mental health problems in their future policy planning and resource distribution. Moreover, it would be advisable to establish a rigorous system of evaluation for the quality of internationally collaborated and funded studies in order to increase scientific impact and maintain public trust, especially in China.

Acculturative stress and binge drinking among international students in the United States: Resilience and vulnerability approaches

Objective: While international students frequently face behavioral health risks due to the stress of adjusting to new cultures, many demonstrate effective coping skills that minimize negative outcomes. The current study tested the mediating effects of resilience and mental health on the relationship between acculturative stress and binge drinking. Participants: International students (N = 322) in the United States. Methods: A cross-sectional design using both online and paper-based survey was implemented. Structural equation modeling was conducted to test the hypothesized mediation model. Results: The results showed good model fit, with resilience mediating the relationship between acculturative stress and binge drinking in the conceptual model. Conclusions: Behavioral health problems and needs of international students are prevalent themes in social work practice; this study, therefore, has practical implications for U.S. colleges and universities as they make decisions about programs and services.

A Dataset of Students’ Mental Health and Help-Seeking Behaviors in a Multicultural Environment

University students, especially international students, possess a higher risk of mental health problems than the general population. However, the literature regarding the prevalence and determinants of mental health problems as well as help-seeking behaviors of international and domestic students in Japan seems to be limited. This dataset contains 268 records of depression, acculturative stress, social connectedness, and help-seeking behaviors reported by international and domestic students at an international university in Japan. One of the main findings that can be drawn from this dataset is how the level of social connectedness and acculturative stress are predictive of the reported depression among international as well as domestic students. The dataset is expected to provide reliable materials for further study of cross-cultural public health studies and policy-making in higher education.

Internationalization and Its Discontents: Help-Seeking Behaviors of Students in a Multicultural Environment Regarding Acculturative Stress and Depression

Stress and depression can be seen as the major obstacles for sustained education and attainment of foreign students, and in turn, the sustainability of an education system as a whole. However, the mainstream consideration following Berry’s model on acculturation does not take into account whether students of the host countries are immune to these problems. This study aims to examine the prevalence and predictors of help-seeking behaviors among international and domestic students in a multicultural environment by employing ANOVA and polynomial regression. Some significant results from this study are: (1) Informal sources were the most prevalent sources of help-seeking among international and domestic students, while formal help-seeking was not popular; (2) international students were more likely to overcome emotional difficulties alone and seek help on the Internet than domestic students; (3) acculturative stress was a positive predictor of formal, informal, and miscellaneous help-seeking behaviors among international students and informal help-seeking behaviors or among domestic students; and (4) depression was negatively correlated with the willingness of international students to seek help from informal sources. The findings hint at the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked and the lack of help-seeking sources for international students. The study also provides empirical evidence for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress.

Depression, Acculturative Stress, and Social Connectedness among International University Students in Japan: A Statistical Investigation

(1) This study aims to examine the prevalence of depression and its correlation with Acculturative Stress and Social Connectedness among domestic and international students in an international university in Japan. (2) Methods: A Web-based survey was distributed among several classes of students of the university, which yielded 268 responses. On the survey, a nine-item tool from the Patient Health Questionnaire (PHQ-9), the Social Connectedness Scale (SCS) and Acculturative Stress Scale for International Students (ASSIS) were used together with socio-demographic data. (3) Results: The prevalence of depression was higher among international than domestic students (37.81% and 29.85%, respectively). English language proficiency and student age (20 years old) showed a significant correlation with depression among domestic students (β = −1.63, p = 0.038 and β = 2.24, p = 0.048). Stay length (third year) also displayed a significant correlation with depression among international students (β = 1.08, p = 0.032). Among international and domestic students, a statistically significant positive correlation between depression and acculturative stress, and negative associations of social connectedness with depression and acculturative stress were also found. (4) Conclusions: The high prevalence of depression, and its association with Acculturation stress and Social Connectedness, among the students in this study highlight the importance of implementing support programs which consider the role of Acculturation and Social Connectedness.

The Optimal Starting Model to Search for the Accurate Growth Trajectory in Latent Growth Models

This simulation study aims to propose an optimal starting model to search for the accurate growth trajectory in Latent Growth Models (LGM). We examine the performance of four different starting models in terms of the complexity of the mean and within-subject variance-covariance (V-CV) structures when there are time-invariant covariates embedded in the population models. Results showed that the model search starting with the fully saturated model (i.e., the most complex mean and within-subject V-CV model) recovers best for the true growth trajectory in simulations. Specifically, the fully saturated starting model with using ΔBIC and ΔAIC performed best (over 95%) and recommended for researchers. An illustration of the proposed method is given using the empirical secondary dataset. Implications of the findings and limitations are discussed.

Determinants of health-related quality of life in international graduate students

INTRODUCTION

International graduate students often experience additional levels of stress due to acculturation. Given the impact of stress on health outcomes (both physical and mental), this study examined the health-related quality of life (HRQoL) in international graduate students to determine its association with acculturative stress, perceived stress, and use of coping mechanisms.

METHODS

A cross-sectional, self-administered survey was designed and sent to 38 student chapters within the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) student network. HRQoL [physical component summary (PCS) and mental component summary (MCS)] was measured using the 12-item Short Form (SF-12) while coping mechanisms were assessed using the Brief COPE Scale. Acculturative and perceived stress were assessed using the Acculturative Stress Scale for International students [ASSIS] and Graduate Stress Inventory-Revised (GSI-R), respectively. Demographic and personal information (e.g. age, religion) were also collected. Descriptive statistics (mean ± SD and frequency) and hierarchical multiple regression analysis were conducted.

RESULTS

The average PCS and MCS were 60 ± 9 and 44 ± 13, respectively, indicating that while the physical health was above the United States (US) general population norm (50), mental health scores were lower. Findings from the hierarchical multiple regression showed that perceived and acculturative stress significantly predicted mental health. Acculturative stress was also a significant predictor of physical health.

CONCLUSION

The results from this study support the hypothesis that international students in the US experience both perceived and acculturative stress that significantly impacts their HRQoL. Universities should consider providing education on stress reduction techniques to improve the health of international graduate students.

Unique trajectories of anxiety among Chinese-Canadian women across the first postpartum year: A longitudinal cohort study

BACKGROUND

Our objectives were to identify subtypes of Chinese-Canadian women with unique trajectories of anxiety symptomatology over the first postpartum year, investigate covariates associated with group membership, and determine if mental healthcare utilization varies by group membership.

METHODS

This was a longitudinal cohort study of 570 Chinese immigrant and Canadian-born women in Toronto, Canada with live births in 2010-2014. Covariates were age, immigrant status, income, fatigue, social support, acculturative stress, and depression. Mental healthcare utilization included visits at 4-24 weeks postpartum. Anxiety symptomatology was measured using the State-Trait Anxiety Inventory-State. Growth mixture modeling was used to identify latent classes corresponding to trajectories of anxiety symptomology at 4-52 weeks.

RESULTS

Three groups were identified: "consistently non-anxious" (74%, stable low levels of anxiety), "consistently anxious" (19.5%, clinically meaningful anxiety at baseline and across time), and "anxious-improving" (6.5%, high anxiety at baseline followed by decline). Compared to consistently non-anxious women, consistently anxious women were more likely to report baseline fatigue, depression, and acculturative stress; anxious-improving women were more likely to report baseline fatigue, depression, and history of depression before pregnancy. At 12-24 weeks, 13.8% of anxious-improving women sought mental healthcare compared to 8.6% of consistently-anxious women and 4.7% of non-anxious women (p = .06).

LIMITATIONS

Our sample comprised Chinese immigrant and Canadian-born women; results should be replicated in other groups.

CONCLUSIONS

We identified three subtypes of postpartum anxiety trajectories. These groups of women may respond differently to interventions due to exposure to various combinations of risk factors.

Determinants of comorbid depression and anxiety postnatally: A longitudinal cohort study of Chinese-Canadian women

BACKGROUND

Women with comorbid depression and anxiety in the postpartum period experience more complex and severe symptoms than women with depression or anxiety alone; however, little is known about what influences these symptoms, especially among women from specific ethnic backgrounds. The objective of this study was to identify determinants of comorbid depression and anxiety symptomatology by 24 weeks postpartum in a cohort of Chinese-Canadian women.

METHODS

A longitudinal cohort study was completed where 549 Chinese immigrant and Canadian-born women in Toronto were followed to 24 weeks postpartum. Questionnaires included risk factors measured at 4 weeks. Logistic regression was used to develop a model of comorbidity (Edinburgh Postnatal Depression Scale score > 9; State-Trait Anxiety Inventory score > 40) up to and including 24 weeks.

RESULTS

Previous history of postpartum (AOR 2.42, 95% CI 1.42-4.14) and non-postpartum (AOR 4.20, 95% CI 2.21-7.98) depression, maternal age < 26 years (AOR 1.83, 95% CI 1.04-3.22), perception of support (AOR 0.97, 95% CI 0.94-1.00), acculturative stress (AOR 1.03, 95% CI 1.01-1.04), maternal fatigue (AOR 1.12, 95% CI 1.07-1.17), and perceived infant sleep problems (AOR 2.06, 95% CI 1.27-3.43) were significantly associated with comorbid depression and anxiety in the first 24 weeks postpartum.

LIMITATIONS

Our sample consisted of Chinese-Canadian women; this study should be replicated in other ethnic groups to see if and how risk factors of postpartum comorbidity differ.

CONCLUSION

The factors identified herein offer insight into groups of Chinese-Canadian women who might benefit most from early identification and treatment and suggest targets for prevention.

Prevalence, Incidence, and Persistence of Postpartum Depression, Anxiety, and Comorbidity among Chinese Immigrant and Nonimmigrant Women: A Longitudinal Cohort Study

OBJECTIVE

Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status.

METHOD

We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated.

RESULTS

Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants.

CONCLUSION

Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.

Demographic and Socioeconomic Determinants of Self-Efficacy: An Empirical Study of Korean Older Adults

This study conceptualizes the dimensions of older adults' self-efficacy and identifies its determinants by using panel data collected by the National Pension Research Institute in Korea. The analysis supported the conceptualization of older people's self-efficacy as a multidimensional construct and found strong support for the three subscales. For older adults in Korea, general self-efficacy was condensed into a sense of competence. Older adults' social self-efficacy was delineated into two subscales: inward social self-efficacy and interactive social self-efficacy. Inward social self-efficacy could be characterized as a set of inward-looking social capabilities, whereas interactive self-efficacy could be considered as a set of relation-oriented capabilities with various groups of individuals. Of the three regression models representing dimensions of older people's self-efficacy, each model uncovered its own set of variables that played a decisive role in perceived self-efficacy. Demographic variables were more effective determinants of older adults' self-efficacy than socioeconomic factors.

Path Analysis of Acculturative Stress Components and Their Relationship with Depression Among International Students in China

Acculturative stress prevents international students from adapting to the host culture, increasing their risk for depression. International students in China are a growing and at-risk population for acculturative stress and depression. With data from the International Student Health and Behaviour Survey (Yu et al., ) in China, seven acculturative stress components were detected in a previous study (Yu et al., ), including a central component (self-confidence), three distal components (value conflict, identity threat and rejection) and three proximal components (poor cultural competence, opportunity deprivation and homesickness). The current study extended the previous study to investigate the relationship between these components and depression with data also from International Student Health and Behaviour Survey. Participants were 567 students (59% male, 40.4% African, mean age = 22.75, SD = 4.11) recruited in Wuhan, China. The sample scored high on the Acculturative Stress Scale for International Students (M = 92.81, SD = 23.93) and Center for Epidemiologic Studies Short Depression Scale (M = 0.97, SD = 0.53). Acculturative stress was positively associated with depression; the association between the three distal stress components and depression was fully mediated through self-confidence, while the three proximal components had a direct effect and a self-confidence-mediated indirect effect. These findings extended the value of the previous study, highlighted the central role of self-confidence in understanding acculturative stress and depression and provided new data supporting more effective counselling for international students in China. Copyright © 2016 John Wiley & Sons, Ltd.

Clashing Cultures

Although researchers have noted that interactions among people from different cultural backgrounds can result in interpersonal conflict, little is known about the nature of this conflict and its effects on the individuals involved. The current study attempts to address this gap in the literature. It conceptualizes interpersonal, intercultural conflict as a stressor and proposes and tests a model of conflict experiences, using data from graduate students representing approximately 50 countries. Results of path analyses of the model indicate that although cultural distance does not predict interpersonal, intercultural conflict, conflict strongly predicts poor work-related and sociocultural adaptation, and these negative effects occur over and above the baseline effects of work stress. Work-related and sociocultural adaptation in turn predicts poor psychological adaptation, which mediates the negative effects on health-related adaptation.

Cultural Adjustment Difficulties and Career Development of International College Students

This study examined the extent to which two dimensions of cultural adjustment difficulties (i.e., acculturative distress and intercultural competence concerns) predicted two specific career development outcomes (i.e., career aspirations and career outcome expectations) in a sample of 261 international college students from Africa, Asia, and Latin America. Although no significant differences among the participants were found by region of origin and gender, multivariate multiple regression analyses indicated that higher levels of acculturative distress were predictive of lower levels of career outcome expectations among these international students. Furthermore, findings revealed that greater intercultural competence concerns were predictive of lower career aspirations and lower career outcome expectations. Implications of the findings for career counseling with African, Asian, and Latin American international students are discussed.

Belonging on Campus

With the rise of Asian international students choosing to pursue higher education in the United States, research that identifies ways to promote Asian international students’ sense of belonging on campus is needed. We used consensual qualitative research methodology to examine factors that contribute to university belonging in a sample of Asian international students ( N = 11) from a large university in the Midwestern United States. Through data analysis, we identified 14 categories across five domains (i.e., Interpersonal Interactions, Experiences of Acculturation, Campus Environment, Emphasis on Academic Achievement, and Intrapersonal Factors) that contributed to university belonging. Our findings highlight the importance of within-group social connection, acculturative stress, and academic success on Asian international students’ sense of university belonging. We discuss differences between Asian international and domestic students’ sense of belonging as well as implications for counseling psychologists, including interventions at the individual and institutional levels.

Prevalence and related risk factors of anxiety and depression among Chinese college freshmen

Anxiety, depression, and even suicidal ideation are becoming the most common mental health problems affecting Chinese college students. The present study investigated the prevalence of mental health problems and their predictors in a sample of 1048 Chinese college freshmen from Shanghai. We used following brief screening instruments to measure symptoms of anxiety and depression, as well as self-control and suicidal ideation: the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), a mental health and mental health knowledge questionnaire (MK), a mental disease-related attitude questionnaire (MA), questionnaires about the knowledge of psychological services and utilities, the Mini International Neuropsychiatric Interview (MINI) Suicide module, the Self-Rated Health Measurement Scale (SFHMS), the Self-Esteem Scale (SES), the Simplified Coping Style Questionnaire (SCQ), and the Perceived Stress Scale-10 (PSS-10). Over half of the students suffered from at least one mental health problem. Approximately 65.55% of freshmen had depression, and 46.85% had anxiety. Minority status, low family income, and religious belief were significantly associated with current mental health problems. These findings indicate that mental disorders are highly prevalent among the freshman student population. The prevalence of such mental disorders was greater than that of the general population, and the majority of students with mental health problems require treatment.

Factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory

Using a national data set, this study examined the factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory (MASI) across Latino and Asian Americans, gender, and nativity (U.S.- vs. foreign-born). Results showed that a 4-factor model of acculturative stress provided good fit to the data. Tests of factorial invariance provided evidence of measurement equivalence across all of the groupings tested. These findings suggest that the MASI operationalizes acculturative stress in an equivalent manner across Latino and Asian American students, gender, and nativity.

Collectivistic orientation, acculturative stress, cultural self-efficacy, and depression: a longitudinal study among Chinese internal migrants

The current study examined the longitudinal relationship of collectivistic orientation and depression and the mediating effects of acculturative stress and cultural self-efficacy between collectivistic orientation and depression. We expect that collectivistic orientation would decrease acculturative stress and increase cultural self-efficacy, and in turn, improve depression. Using data from 641 Chinese internal migrants during a 1-year period, the results supported the hypothesis that collectivistic orientation predicted decreased depression. Moreover, collectivistic orientation alleviated depression through reducing acculturative stress. Although cultural self-efficacy was also a significant mediator, collectivistic orientation relieved depression through decreasing cultural self-efficacy. Implications for future research directions and counseling are discussed.

Social Factors in Cross-National Adjustment

We examined how social factors (i.e., social connection, social self-efficacy, and comfort with disclosing distress) and English proficiency predicted two subjective well-being trajectories (i.e., negative affect and satisfaction with life). The sample of this four-wave longitudinal study (across pre-arrival and first three semesters) included 411 Chinese international students studying in the United States. Four distinct trajectory classes were identified for negative affect and satisfaction with life. The classes generally included individuals who had (a) consistently high well-being, (b) experienced some degree of culture shock, (c) enhanced well-being, and (d) low well-being. Social connection with mainstream society was a better predictor of satisfaction with life trajectories than social connection with one’s ethnic community. Comfort with disclosing distress and self-perceived English proficiency were significant predictors only for the satisfaction with life trajectories. The important role of social factors and English proficiency in international students’ adjustment and practical implications are also discussed.