Report of a mental health survey among Chinese international students at Yale University

Mental health help-seeking intentions & coping strategies of Chinese international students in the United States

BACKGROUND

Chinese international students (CIS) in the United States may face unique mental health challenges that are often overlooked in discussions about mainstream college student needs.

OBJECTIVE

This study aims to investigate the predictors of mental health (MH) professional help-seeking intentions among CIS at a large public Midwestern university, as well as the obstacles that hinder their use of professional MH services.

METHODS

The study used quantitative and qualitative approaches to gather data on CIS' help-seeking attitudes. Quantitative analysis focused on the association between specific factors and help-seeking intentions. Qualitative coding of open-ended questions provided additional insights into obstacles and suggestions for improving mental health support.

RESULTS

The study identified several factors influencing the mental health help-seeking intentions of Chinese international students. Two primary negative predictors were a preference for emotional self-control and concerns about the questionable quality of treatment. Conversely, having previous experience with professional mental health services, both in China and the United States, was found to be a positive predictor of help-seeking intentions. Additionally, qualitative analysis of open-ended responses revealed further obstacles to seeking help and provided useful suggestions for enhancing mental health support for Chinese international students in college settings.

CONCLUSIONS

The study identifies key factors that influence CIS' attitudes toward seeking professional mental health services. Understanding these factors can help in developing strategies to better support the mental health of CIS in college settings.

LIMITATIONS

Several limitations must be acknowledged in this study. The cross-sectional design limits the ability to draw causal inferences from the data. Additionally, the sample may not be fully representative of the broader population of Chinese international students, which may affect the generalizability of the findings. Self-reported data may also introduce response biases. Future research should consider longitudinal approaches and a more diverse sample to validate and expand on these findings.

Memorable Messages About Mental Health Among International Students in the United States: A Mixed-Method Study

This study investigated the memorable messages about mental health that international students (N = 199) received from various sources since arriving on campus in the U.S. Utilizing the memorable messages framework, we examined the types of messages (normalizing, strategizing, minimizing) they received and their association with message satisfaction, mental health stigma, and attitude toward help-seeking. The most frequently recalled messages were normalizing messages (49.2%), followed by strategizing messages (31.7%), and minimizing messages (9.5%). Participants who recalled normalizing and strategizing messages reported higher satisfaction and a more favorable attitude toward help-seeking compared to those who recalled minimizing messages. These findings offer theoretical implications for memorable messages and immigrant populations, as well as practical implications for campaign messaging and design. These results can guide university officials in tailoring their efforts to meet the mental health needs of this vulnerable population.

Sociocultural adjustment and social support as predictors for international medical sciences students' anxiety during COVID-19

BACKGROUND

The prevalence of anxiety is high among international medical sciences students and it increased even more during the COVID-19 pandemic due to different restrictions and social isolation. Successful sociocultural adjustment and social support could be important factors in overcoming those challenges, however, there is a lack of studies which would investigate the role of those factors among inter- national medical students. This study aimed to assess the role of sociocultural adjustment and social support as predictors for international medical students' anxiety during COVID-19.

METHODS

Two measurements were conducted via self-reported questionnaires which consisted of three scales - SCAS, MSPSS and GAD-7. In total, 82 international medical students participated in both measurements in this longitudinal study.

RESULTS

The findings indicated that 37% of international students had symptoms of moderate or severe anxiety during their first year of studies at university. In the second year, during the COVID-19 pandemic and an official lockdown, 35% of international students had symptoms of moderate or severe anxiety. In addition, this study showed that gender and sociocultural adjustment did not play a role as predictors of students' anxiety during the second year of studies. However, this study revealed that social support provided by family during the first year of studies, as well as having friends or family members who had been ill with COVID-19 predicted higher levels of anxiety at second measurement, while sociocultural adjustment was an even stronger predictor of anxiety in the second year of studies of international medical students.

CONCLUSIONS

This knowledge can help to better understand how international medical students felt during the COVID-19 pandemic and what role the above- mentioned factors played in the students' anxiety. As the anxiety level is quite high among international medical students, universities and mental health service providers should take it into consideration and help them to overcome those challenges.

To Know all is to Forgive all: The Effect of Foreign Experiences on Forgiveness

By going abroad, individuals get the opportunity to explore a new country and to immerse themselves in a new culture. Despite being personally and professionally rewarding, little is known about interpersonal attitudes and behavior change that accompany living abroad experiences. The current research examines whether foreign experiences influence forgiveness. Drawing on the Structure-Appraisal Model of Multicultural Experiences and literature examining the positive effect of foreign experiences on self-control related to the suppression of impulsive retaliation, we propose that international experiences lead to a greater tendency to forgive. As predicted, we found that foreign experiences correlated positively with forgiving motivations toward transgressors across different measures of forgiveness and diverse samples (Studies 1-2). Study three compared forgiveness of individuals who had lived abroad with forgiveness of individuals who had plans to live abroad but had not done so yet. We found consistent support for the hypothesis that living abroad has an impact on forgiveness. By employing an experimental design, Study four established the causal effect of international experiences on forgiveness. Taken together, these findings suggest that when individuals experience foreign cultures, they learn to understand interpersonal conflicts from different perspectives and show greater leniency and forgiveness toward transgressions.

Relationships between racial discrimination, social isolation, and mental health among international Asian graduate students during the COVID-19 pandemic

Objectives: Racial aggression against Asians and the implementation of state-wide stay-at-home orders during the COVID-19 pandemic may have negatively impacted mental health in Asian international graduate students in the United States, yet these relationships are unknown. Therefore, this study was conducted to investigate these relationships. Participants: Data were collected from 177 participants from four universities. Methods: On-line survey was used to assess perceived racial discrimination related to the COVID-19, daily racial discrimination during the pandemic, home boundness and loneliness, and depression and anxiety. Results: Daily racial discrimination was associated with an increased risk for depression. Home boundness was related to fewer depression symptoms (B = -0.728) and fewer anxiety symptoms (B = -0.558). Higher symptoms of loneliness (B = 0.377) were related to more depression symptoms. More loneliness (B = 0.257) was related to more anxiety symptoms. Conclusions: The findings can help university stakeholders to create a guideline for the development and implementation of resource programs for Asian international graduates.

Poor health disparities among racialized students in a Canadian university

OBJECTIVE

The short report aims to examine differences in self-rated general health across racialized post-secondary students at a university in Ontario, Canada.

METHODS

Binary logistic regression analysis was used to examine poor health as an outcome among racialized students as whole, as well as across Asian, South Asian, Afro-Caribbean and Middle Eastern student groups in comparison to white Caucasian post-secondary students.

RESULTS

After adjusting for several covariates, racialized students as a whole had 2.43 times the odds of reporting poor general health compared to white Caucasian students. Asian (OR = 2.77; CI = 1.84-4.18; p < 0.05) and South Asian (OR = 2.52; CI = 1.56-4.08; p < 0.05) students were significantly more likely to report poor health compared to white Caucasian students.

CONCLUSION

The findings call for further attention to the health needs of racialized post-secondary students living in Canada and creating campuses where diverse student populations feel safe and systemically included.

Psychological distress and everyday discrimination among Chinese international students one year into COVID-19: a preregistered comparative study

BACKGROUND AND OBJECTIVES

During the COVID-19 pandemic, Chinese international students (CISs) experienced distress associated with both unique and universal stressors, among which everyday discrimination may be especially harmful.

DESIGN

Cross-sectional design.

METHODS

We compared distress between CISs (N = 381) and Chinese students in Chinese colleges (CSCCs; N = 305) and examined correlates of distress including the association between everyday discrimination and distress as well as moderators on this link.

RESULTS

Compared to CSCCs, CISs reported greater depression and anxiety. Sensitivity analyses - multiple regressions controlling for covariates and coarsened exact matched (CEM) comparisons - replicated the results. 28.6% CISs reported suicidal ideation (PHQ-9 item 9) at least several days during the past two weeks. Within CISs, depression was associated with being older, female, non-heterosexual, increased everyday discrimination, decreased self-esteem, coping flexibility, perceived social support, and satisfaction with online learning. Anxiety was associated with being in undergraduate years, female, increased discrimination, decreased self-esteem, coping flexibility, and satisfaction with online learning. High perceived social support and being heterosexual weakened the association between discrimination and anxiety and depression, while high self-esteem strengthened the association between discrimination and anxiety.

CONCLUSIONS

Our study underscored the distress experienced by CISs and highlighted risk/protective factors that may warrant attention.

Insomnia severity and its correlates among English as a second language (ESL) college students

OBJECTIVE

Little is known about insomnia characteristics among the English as a second language (ESL) student population. This study compared insomnia severity between ESL students and English native-speaking students and identified correlates of insomnia in the ESL population.

PARTICIPANTS

College students (N = 352) from a private university in the Northeastern United States, including 22.4% (N = 79) ESL students.

METHODS

For this cross-sectional study, participants completed the Insomnia Severity Index and indices of common risk factors of insomnia along with acculturation and language anxiety.

RESULTS

ESL students reported higher insomnia severity than their US counterparts after controlling for depression, anxiety, and demographics. General anxiety, language anxiety, and cognitive pre-sleep arousal were selected as the strongest predictors of insomnia among the ESL population.

CONCLUSIONS

Findings suggest that ESL college group is vulnerable to greater insomnia, and language anxiety is unique and important correlate of insomnia in this population.

Mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use among students who intend to spend a semester abroad - a cross-sectional study

Aim

Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group.

Method

Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study.

Results

Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students.

Conclusion

The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review

BACKGROUND

Immigrant students face various challenges in high-income countries that can contribute to the decline of their mental well-being upon arrival in their host country. Despite the growing population of these students in several high-income countries, there is inadequate attention given to their mental health needs and their access to mental health services. Thus, this systematic scoping review aimed to identify gaps in existing research relating to the barriers and facilitators associated with access to and use of mental health services in high-income countries.

METHODS

Following the PRISMA-ScR checklist as guidance we systematically searched Ovid Medline, APA PsycInfo, Education Source, CINAHL, Web of Science databases for peer reviewed articles related to barriers and facilitators of mental health service use among immigrant students. We conducted a narrative evidence synthesis to highlight barriers and facilitators to the use of mental health services.

RESULTS

Out of the 2407 articles initially found, 47 studies met the inclusion criteria and were considered for this review. The increasing attention towards the mental health concerns of immigrant students and their access to mental health services is evident. However, various barriers like stigma, insufficient knowledge, or adherence to traditional gender roles (such as masculinity) hinder their utilization of these services. On the other hand, factors such as being a woman, having a strong sense of cultural adaptation, or possessing adequate mental health literacy serve as facilitators for accessing mental health services.

CONCLUSION

These students have unique experiences, and their needs are often unmet. To improve their mental health and use of mental health services, it is important to consider the barriers they face and their unique experience in their specific life context and to develop tailored prevention and intervention programs.

Can we buffer them? Supporting healthy levels of stress and anxiety in first year international students

First-year international tertiary students face numerous challenges, with the COVID-19 pandemic shifting many to online learning. These challenges can lead to higher than ideal stress and anxiety, negatively impacting mental health. Applying a 'writing across curriculum' approach this study examines whether a 'writing in discipline' intervention influences stress/anxiety for such students studying Tourism, Hospitality and Events in Australia. A modified DASS was administered to four cohorts during 2020 and 2021, and pre-post-tests conducted. The intervention helped buffer significant increases in stress, promoted skill development, and enhanced academic confidence. This scaffolded-learning approach is applicable at course/subject, degree, and university levels.

How does social support relate to emotional availability for learning during COVID-19? A multi-group structural equation model of university students from the U.S. and Israel

Given the social and emotional tolls of the COVID-19 pandemic on college and university students, many students have become academically disengaged during the pandemic. Although some colleges and universities have the capacity to promote social support for their students, research has yet to comprehensively demonstrate the relationship between social support and academic engagement. To fill this gap, we leverage survey results from four universities across the United States and Israel. Through multi-group structural equation modelling, we explore (a) how perceived social support relates to being emotionally unavailable for learning, (b) how this relationship is partially explained through coping and COVID-19 concerns, and (c) how these relationships can differ across countries. We find that students who perceived higher levels of social support had lower rates of being emotionally unavailable for learning. Part of this relationship occurred through greater rates of coping and, subsequently, fewer concerns about the pandemic. We also noticed significant differences in these relationships between countries. We conclude with a discussion of study implications for higher education policies and practices.

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.

Mental Health Conditions of Chinese International Students and Associated Predictors Amidst the Pandemic

The current study aims to examine the mental health conditions and the associated predictors among Chinese international students. A sample of 256 Chinese international students aged 16 or above living primarily in Canada were asked to complete an online survey. Mental health conditions were assessed with the Depression, Anxiety, and Stress Scale-21 and the Physical and Mental Health Summary Scales. 15.3%, 20.4%, and 10.5% of respondents reported severe to extremely severe depression, anxiety, and stress levels, respectively. Univariate analysis of variance models and multiple linear regression models identified education and financial status as significant sociodemographic predictors while controlling for the effect of physical health status. Higher financial status and lower level of education were associated with better mental health conditions. These findings shed light on our understanding of mental health conditions and the risk factors among Chinese international students during the COVID-19 pandemic.

The role of social support and sociocultural adjustment for international students' mental health

The study aims to assess the role of social support, sociocultural adjustment, and other social and demographic factors in international students' mental health. In total, 193 international first-year students studying Health and Technology Sciences in Lithuania filled out a self-report questionnaire. The study revealed that overall 59% of international students had symptoms of depression and 36%-of anxiety. Students' well-being was sufficient in 56% of the cases. The regression analyses were conducted to test the role of sociocultural adjustment, social support, English reading skills, and the study field for mental health and well-being. The multivariate regression model revealed that sociocultural adjustment is a stronger predictor compared to social support for depressiveness (βs = 0.42), anxiety (βs = 0.30), psychosomatic symptoms (βs = - 0.24), and subjective health (βs = 0.16), though social support was a stronger independent predictor for well-being (βs = 0.37). Moreover, sociocultural adjustment and social support were stronger predictors than gender, while English reading skills and study field were non-significant indicators.

Measurement invariance and psychometric properties of the CCAPS-62 and -34 for international student clients

OBJECTIVES

International students attending universities in the United States may encounter psychological distress related to their adjustment and experiences studying in a new context and seek services from university counseling centers. Many centers use the Counseling Center Assessment of Psychological Symptoms (CCAPS) to measure psychological distress in college counseling centers. However, this scale has not been tested for measurement invariance with international students. Our purpose was to explore the measurement invariance of the CCAPS-62 and -34 for international students.

METHODS

We tested measurement invariance for both versions of the scale using data from over 107,000 university students in psychotherapy at university counseling centers. We also examined construct validity and internal consistency.

RESULTS

Invariance testing indicated the measurement models of the CCAPS-62 and -34 are equivalent between both groups.

CONCLUSION

These findings are discussed in light of utilizing this widely-used scale in United States university/college counseling centers with international student clients.

Intercultural sensitivity as a mediator in the relationship between implicit intercultural identification and emotional disturbance-An exploratory study of international high school students

Background

Intercultural adaptation is always associated with emotional disturbances. Intercultural communication competence, as an important competence of intercultural adaptation, involves implicit intercultural identification and intercultural sensitivity. Competence in these areas promotes the process of intercultural adaptation. Little is known about the relationship between intercultural communication competence and emotional disturbances in new students attending international high schools. The intercultural adaptation process of this population requires attention because of the increasing number of high school students attending international schools, and the fact that most of these teenagers are immersed in intercultural contexts for the first time.

Objective

This study aimed to investigate the prevalence of emotional disturbance in new students in an international high school and confirm the relationship among implicit intercultural identification, intercultural sensitivity, and emotional disturbances.

Methods

Study 1 was an investigation of the prevalence of emotional disturbance in 105 students in their 1st year at an international high school using the Self-rating Depression Scale and Self-rating Anxiety Scale. Of these students, 34 were invited to participate in Study 2 to further explore the relationship between intercultural sensitivity, implicit intercultural identification, and emotional disturbances using the Intercultural Sensitivity Scale and Single Category Implicit Association procedure.

Results

Study 1 indicated that 15.24% of students were affected by apparent depression and 10.48% had anxiety symptoms. Study 2 revealed that emotional disturbances significantly correlated with intercultural sensitivity (p < 0.01) and implicit intercultural identification (p < 0.01). The openness factor from intercultural sensitivity mediated the relationship between implicit intercultural identification and depression (ratio of indirect effect = 41.04%, p < 0.05) and anxiety symptoms (ratio of indirect effect = 34.65%, p < 0.05).

Conclusion

The study revealed that a significant proportion of students in the 1st year of international high school are affected by emotional difficulties. However, intercultural communication competence is a protective factor. Enhancing the international communication competence of senior students in international high schools is important to mitigate mental health challenges.

Towards a health promoting university: descriptive findings on health, wellbeing and academic performance amongst university students in Australia

BACKGROUND

Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students.

METHODS

The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent.

RESULTS

Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online.

CONCLUSIONS

This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.

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.

Prevalence and correlates of mental health symptoms and disorders among US international college students

Objective: This study assessed the prevalence and correlates of mental health (MH) symptoms and diagnoses in international college students in the United States. Participants: The sample included 44,851 degree-seeking undergraduate students (42,428 domestic students and 2,423 international students). Methods: Logistic regression analyses were conducted using international student status to predict MH symptoms and diagnoses from the Spring 2017 administration of the ACHA-National College Health Assessment (ACHA-NCHA). Results: International students were less likely than domestic students to report a diagnosis of anxiety, comorbid depression and anxiety, or other psychiatric diagnoses. International students were more likely to report suicide attempts and feeling overwhelmingly depressed. Conclusions: Among international students studying in the US, lower rates of MH diagnoses despite higher rates of depressive symptoms and suicide attempts mirror similar trends seen in American-born minority students. University campuses should consider culturally sensitive and targeted psychoeducation, mental health services, and outreach programming.

Chinese International Students' Face Concerns, Self-Stigma, Linguistic Factors, and Help-Seeking Intentions for Mental Health

Chinese international students (CIS) in American universities encounter serious mental health issues, and they also underutilize campus mental health care services. The current study examined several factors which result in this phenomenon, such as Chinese face concerns, self-stigma of seeking help for mental health services, as well as English proficiency and language discrimination. A survey with 433 CIS in multiple U.S. universities was conducted to analyze the relationships between these factors above, help-seeking intentions, and mental health problems (depression and anxiety). The SEM results suggested that face concerns increased the risk of mental health problems such as depression and anxiety and also increased self-stigma toward seeking mental health services. However, face concerns positively influenced help-seeking intentions. The self-stigma had a negative effect on help-seeking intentions. Perceived English discrimination increased mental health problems while English proficiency increased help-seeking intentions. Meanwhile, both linguistic factors above were significantly associated with face concerns. The theoretical and practical implications are discussed to investigate how to address mental health problems among Chinese international students.

Mental health, coping strategies, and social support among international students at a Canadian university

Objective. This study aimed to explore the mental health status, coping strategies, and social support of international students in Canada. Participants. Undergraduate and graduate international students studying at one Canadian university participated in an online survey. Methods. The survey consisting of four assessments-the Mental Health Continuum-Short Form, Kessler Psychological Distress Scale, the Carver Brief-Cope Inventory, and the Multidimensional Scale of Perceived Social Support-was distributed during the winter and spring terms of 2020. Results. Of the 338 participants from 53 countries, 76% demonstrated optimal mental health without mental disorders; 86% used approach coping strategies. Those who are women, married, and Ph.D. students showed better mental health and lower psychological distress. Coping skills and social support significantly predict participants' psychological distress and subjective well-being. Conclusions. This study findings address the gaps in meeting the mental health needs of international students and raise awareness of this population's unique mental health status.

Chinese international students’ conceptualizations of wellbeing: A prototype analysis

Wellbeing can mean different things to different people, even in the same culture with the same language. People living at the intersection of two languages and cultures, such as Chinese students studying in an English-speaking nation, not only speak a different language than their host country, but also may have different conceptualizations of wellbeing itself. This study investigated Chinese international students’ (aged 18–39, N = 123) conceptualizations of wellbeing using a modified prototype analysis, which provided insights on people’s underlying structure of the construct as revealed through language. Chinese international students’ conceptualizations of wellbeing were prototypically structured; key components of wellbeing included positive relationships, security, positivity/optimism, physical health, and self-strength. The findings broaden the understanding of layperson wellbeing conceptualizations, provide insights into the wellbeing related concepts and language that are most used by international Chinese students, and inform strategies that tertiary education institutions might adopt to effectively support Chinese international students’ wellbeing.

International students’ psychosocial well-being and social media use at the onset of the COVID-19 pandemic: A latent profile analysis

This study examined the link between the psychosocial well-being and social media use of international students in the US at the onset of the COVID-19 pandemic, when social isolation was mandated. Unlike prior research, which has typically focused on a single aspect of psychosocial well-being, we conceptualized international students' well-being as a multidimensional construct including internalizing symptoms (i.e., depression, anxiety, loneliness) as well as markers of intercultural difficulties. We then investigated social media use as a function of international students’ idiosyncratic well-being vulnerabilities. A latent profile analysis revealed four groups with distinctive psychosocial profiles: well-adjusted students, interculturally adjusted students with internalizing symptoms, students with low internalizing symptoms but high intercultural difficulties, and maladjusted students with high internalizing symptoms and high intercultural difficulties. Supporting the social compensation perspective, maladjusted international students reported the highest engagement with social media compared to the other groups. These findings shed light on the unique and heterogenous experiences of international students at the onset of the pandemic. They also add nuance to the social compensation hypothesis by delineating person-specific associations between psychosocial well-being and social media use.

Influencing Factors of International Students’ Anxiety Under Online Learning During the COVID-19 Pandemic: A Cross-Sectional Study of 1,090 Chinese International Students

Objective

We conducted the following cross-sectional study to comprehensively assess the anxiety among Chinese international students who studied online during the COVID-19 pandemic and its influencing factors.

Methods

Questionnaires were distributed through “Sojump,” and a total of 1,090 valid questionnaires were collected. The questionnaire was divided into two parts: general situation and anxiety assessment of students. The former used a self-made questionnaire, and the international general GAD-7 scale was used to measure anxiety. Chi-square test was used to analyze the differences between groups, and logistic regression analysis was performed for the factors with differences.

Results

Anxiety was found in 707 (64.9%) of 1,090 international students. Chi-square test and multivariate Logistic regression analysis showed that the incidence of anxiety was higher in the group under 22 years of age than in the group over 22 years of age (68% vs. 61%, p = 0.015; OR = 1.186, 95% CI 1.045–1.347, p = 0.008); International students living in big cities had a higher incidence of anxiety than those living in rural areas (67% vs. 60%, p = 0.022; OR = 1.419, 95%CI 1.038–1.859, p = 0.011); international students who socialized 3 times or less monthly had a higher incidence of anxiety than those who socialized more than 3 times per month (68% vs. 58%, p = 0.003; OR = 1.52, 95%CI 1.160–1.992, p = 0.002); international students who expected purely online teaching had a higher incidence of anxiety than those who expected purely offline teaching or dual-track teaching (72% vs. 64%, p = 0.037; OR = 1.525, 95%CI 1.069–2.177, p = 0.02); international students with a subjective score of online learning experience of 6 or less had a higher incidence of anxiety than those with subjective scores of more than 6 (70% vs. 60%, p = 0.001, OR = 1.25, 95%CI 1.099–1.422, p = 0.001). However, gender, emotional status, BMI, major of study, vaccination status, and degree type had no significant difference in the incidence of anxiety among international students who studied online during the COVID-19 pandemic.

Conclusion

During COVID-19, international students who were younger, came from big cities, had low social frequency, expected purely online teaching, and had poor experience of online classes were risk factors for anxiety during online classes.

Enhancing Racial/Ethnic Equity in College Student Mental Health Through Innovative Screening and Treatment

Although college campuses are diversifying rapidly, students of color remain an underserved and understudied group. Online screening and subsequent allocation to treatment represents a pathway to enhancing equity in college student mental health. The purpose of the current study was to evaluate racial/ethnic differences in mental health problems and treatment enrollment within the context of a largescale screening and treatment research initiative on a diverse college campus. The sample was comprised of n = 2090 college students who completed an online mental health screening survey and were offered either free online or face-to-face treatment based on symptom severity as a part of a research study. A series of ordinal, binomial and multinomial logistic regression models were specified to examine racial/ethnic differences in mental health problems, prior treatment receipt, and enrollment in online and face-to-face treatment through the campus-wide research initiative. Racial/ethnic differences in depression, anxiety and suicidality endorsed in the screening survey were identified. Students of color were less likely to have received prior mental health treatment compared to non-Hispanic white students, but were equally likely to enroll in and initiate online and face-to-face treatment offered through the current research initiative. Rates of enrollment in online therapy were comparable to prior studies. Online screening and treatment may be an effective avenue to reaching underserved students of color with mental health needs on college campuses. Digital mental health tools hold significant promise for bridging gaps in care, but efforts to improve uptake and engagement are needed.

A Bibliometric Review of Research on International Students' Mental Health: Science Mapping of the Literature from 1957 to 2020

The mental health of university students is not only a predominant topic for psychology and education researchers but also a source of interest for policymakers and various stakeholders. Although there has been a lot of research on higher education students’ mental health, we have little understanding on the mental health of international students (MHIS). Despite their distinctive characteristics compared to native students, the mental health issues of international students only started receiving attention very recently. So far, the literature on this topic lacks a comprehensive overview of its sub-topic and trending issues. By using bibliometric analysis, this research aims to fulfil this gap and provide a review of the extant literature about MHIS. Specifically, this study aims to (i) draw the growth trajectory and geographic distribution of the literature on MHIS; (ii) identify the documents and authors that have the greatest impact, generally and locally, within the major topic clusters of the literature on MHIS; and (iii) identify the most researched keywords in the literature on MHIS over time. The results have shown that academic documents about international students’ mental health are increasing in number and becoming more extensive content-wise. The research’s findings provide implications for stakeholders and identifies some prominent research avenues for the future.

Comparing the effects of emotional disclosure and peer helping writing on psychological distress among Chinese international students: The moderating role of rumination

OBJECTIVES

This study tested the effects of emotional disclosure writing and peer helping writing in reducing psychological distress among Chinese international students. This study also examined whether rumination and ambivalence over emotion expression moderated the effects of emotional disclosure and peer helping writing.

METHOD

One hundred forty-four Chinese international students were randomly assigned to one of three conditions: emotional disclosure, peer helping, or neutral control writing. Participants completed two 20-min writing sessions and questionnaires at baseline, 2-month follow-up, and 4-month follow-up.

RESULTS

We found no significant differences across the three writing conditions in levels of psychological distress over time. However, rumination emerged as a significant moderator in both emotional disclosure and peer helping intervention conditions. High ruminators generally experienced significant reductions in depressive symptoms, whereas low ruminators experienced increased depressive symptoms.

CONCLUSIONS

These findings demonstrate that the benefits of writing interventions may vary as a function of rumination.

The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study

BACKGROUND

Anxiety disorder is one of the most common mental health problems worldwide, including Malaysia, and this issue has gained concern and attention from many, including experts and authorities globally. While average levels of stress and worry may help to motivate students to perform well in their studies, excessive feelings will increase their level of anxiety.

METHODS

A cross-sectional study was conducted at selected government and private universities throughout Malaysia. A total of 1851 students participated in this study. The students were asked to complete self-administered questionnaires, including socio-demographic, academic, and psychosocial characteristics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the prevalence risk of anxiety among the students. Chi-square analysis was conducted to find the relationship between the variables and anxiety, and multivariate logistic regression analysis was used to identify the predictors.

RESULTS

The response rate was 97.90%, where 1821 out of 1860 students participated in the study. The prevalence risk of anxiety in this study was recorded at 29%. The data revealed that academic year, financial support for the study, alcohol consumption, poor sleep quality, body mass index (BMI), having a good friend in the university, having doubt regarding the future, actively involved in the society, and having problems with other students and lecturer(s) were significantly associated with risk of anxiety; with the academic year as the primary predictor.

CONCLUSIONS

The findings highlight the current prevalence risk of anxiety among university students in Malaysia. The outcome of this study can serve as the evident baseline data and help with the development of specific interventions in addressing and managing the issue appropriately.

Depression, anxiety and stress in different subgroups of first-year university students from 4-year cohort data

BACKGROUND

Limited studies have been conducted to investigate the mental health status of subgroups of university students. This study hypothesized that there would be differences among student subgroups in the prevalence of depression, anxiety and stress; and association of age, gender, academic performance and mental health status.

METHODS

This was a cross-sectional survey study. Since 2014, first-year university students in a university in Hong Kong were invited to complete the Depression Anxiety Stress Scale (DASS-21) before the commencement of their study. These DASS data were then merged with objectively measured data from university records. 9,479 students completed the DASS survey, this being 56.5% of the total student population in the records. Kruskal-Wallis Tests were applied to compare the differences among student subgroups.

RESULTS

Community college transfer (CCT) students were the highest-risk group for depression, anxiety and stress, and their study load was the highest as well. Unexpectedly, mainstream students ranked after the CCT students in the prevalence and levels of depression, anxiety and stress. Student athletes had the highest prevalence of depression. Although there were declining trends for depression, anxiety and stress, it was only a slight drop. Overall, age, gender, study load and academic performance were associated with the mental health profile (p<0.05).

LIMITATIONS

After admission, students' mental health conditions could have changed. Further studies are needed to measure mental health during their study.

CONCLUSIONS

Mental health problems were not distributed evenly across different student subgroups, psychological support should be designed according to the needs of each student subgroup.

The impact of a health education intervention on health behaviors and mental health among Chinese college students

Objective: This study aimed to assess the impact of a health education intervention on health behaviors, self-efficacy, and well-being among college students. Participants: Between March and October 2016, a total of 532 undergraduates participated. Methods: A theory-based intervention was conducted at Wuhan University, China. Participants were assigned to a control or intervention group (IG). The IG attended a 7-week health education class on knowledge, attitude, and practice of health behaviors. Results: Participants in the IG, compared with those in the control group (CG), reported significantly increased prevalence of high physical activity and regular breakfast, as well as lower screen time, sugar beverage intake, and Internet addiction tendency. Furthermore, intervention students improved in health behavior scores (p = 0.040), compared with the CG, while the changes in subjective well-being and self-efficacy remained similar between the two groups. Conclusions: Health education may promote health behaviors among Chinese college students.

Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students

Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.

Feasibility, acceptability and future adaptation of the Chinese translated Behavioural activation (C-BA) treatment for depression: A pilot study

BACKGROUND

Although depression is prevalent among Chinese international students (CIS), only 4% of CIS seek treatment. Behavioural activation (BA) has been suggested as a culturally sensitive treatment for depression that has the potential to meet the clinical needs of CIS. The current pilot study tested the feasibility, acceptability and themes for future cultural adaptations of a Chinese translated BA treatment (C-BA) among CIS.

METHODS

Six CIS with elevated depressive symptoms (Beck Depression Inventory, BDI ≥ 14) completed a six-session individual C-BA treatment and assessments at pre- and post-treatment and a 1-month follow-up. Primary outcome measures included treatment feasibility, acceptability and qualitative interview data informing future adaption of C-BA. Exploratory analyses examined group changes in depressive symptoms over time and clinically significant symptom changes on individual levels.

RESULTS

All participants found the treatment to be highly feasible and culturally acceptable, and were highly engaged in the treatment. Themes of future cultural adaptions were generated from the qualitative interviews. Significant decreases in depressive symptoms were observed at a one1-month post-treatment follow-up assessment.

CONCLUSIONS

Preliminary evidence suggests that C-BA has the potential to be a culturally sensitive treatment for depression among CIS. CIS demonstrated openness to psychotherapy and high treatment engagement.

Mind the Gap: The Relation Between Identity Gaps and Depression Symptoms in Cultural Adaptation

Personal-enacted identity gaps, defined as the difference between an individual’s self-view and the self that one expresses in communication, affect depression levels of international students living in the United States. Thus, identity gaps are an important construct for understanding the relation between identity and health outcomes. The present research examined the relation between personal-enacted identity gaps formed through communication with Americans and depression, extending previous work by considering the roles of acculturative stress and self-construal and providing one of the first tests of the relation between identity gaps and acculturative stress. A sample of 171 undergraduate and graduate international students studying in the United States was recruited to participate in an online study consisting of self-report questionnaires. Results indicated that as hypothesized, higher levels of personal-enacted identity gaps were associated with depression symptoms and that acculturative stress mediates this relation. However, independent self-construal did not moderate the relation between these variables. Testing additional models revealed multiple ways in which these factors could affect each other. Overall, results suggest that personal-enacted identity gaps, acculturative stress, and depression symptoms are important to consider in tandem in order to understand the emotional experiences of the international students and identify who is at risk for poor mental health. Future longitudinal research is needed to further understand the relations amongst these factors.

Prevalence of past-year mental disorders and its correlates among Chinese international students in US higher education

Objective: This study examined the prevalence of past-year mental disorders and its correlates among Chinese international students in US higher education. Participants: A total of 222 Chinese international students participated in the study. Methods: Participants were recruited via a social marketing campaign and participated in an online survey. Results: The majority of the participants were female (65.3%) and graduate students (84.7%) with a mean age of 23.75 years. Of the sample, 77.9 and 74.3% reported having experienced depression and anxiety symptoms in the past year, respectively. Predictors of a higher past-year global mental health status were: not having a steady partner; being more likely to return China after graduation; a higher level of stress about the returning plan; and, a lower rating of cultural humility of key college/university personnel. Conclusions: These results suggest that mental health is a pressing issue facing Chinese international students and correlated with other psychosocial factors.

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.

The moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life among international students in Korea

We examined the moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life (HRQoL) in international students. This cross-sectional study enrolled a convenience sample of 147 international students at a university in Korea. Participants' overall HRQoL was moderate (mean = 57.2 of 80). The main and interaction effects of depressive symptoms and selected acculturation modes explained 39.9% of the variance in HRQoL. For all acculturation modes except the integration mode, as depressive symptom scores increased, HRQoL decreased. Specifically, at high depressive symptoms levels, participants with the marginalization, separation, and assimilation modes had worse HRQoL than did the integration mode, while HRQoL was similar for all acculturation modes at low depressive symptom levels. These findings suggest that future prospective intervention strategies should be considered for not only depressive symptoms levels, but also for different acculturation modes to enhance HRQoL in this population.

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.

University Students' Self-Rated Health and Use of Health Services: A Secondary Analysis

BACKGROUND

University students belonging to various ethnic groups have specific health needs that influence their self-rated health and health service use.

PURPOSE

To examine which determinants of health serve as key predictors of self-rated health and health service use in a sample of ethnically diverse undergraduate students.

METHODS

Data were abstracted from the 2012 Maritime Undergraduate Student Sexual Health Services Survey (N = 10,512). Logistic regression was used to explore the predictors of self-rated health and use of university-based health services according to ethnicity.

RESULTS

Social support (Caucasian: odds ratio (OR) = 1.018; 95% confidence interval (CI) [1.008, 1.028]; African: OR = 1.890; 95% CI [1.022, 1.160]; Other: OR = 1.096; 95% CI [1.023, 1.175]), and depression risk (Caucasian: OR = .899; 95% CI [.844, .914]; Indigenous: OR = .904; 95% CI [.844, .969]; Asian: OR = .894; 95% CI [.839, .953]; Multiracial: OR = .892; 95% CI [.812, .980]) were the most frequent predictors of self-rated health across the different ethnic groups; while year of study (Caucasian: OR = 1.855; 95% CI [1.764, 1.952]; African: OR = 2.979; 95% CI [2.068, 4.291]; Indigenous OR = 1.828; 95% CI [1.371, 2.436]; Asian: OR = 1.457; 95% CI [1.818, 1.797]; Middle Eastern: OR = 1.602; 95% CI [1.088, 2.359]; Other: OR = 1.485; 95% CI [1.093, 2.018]; Multiracial: OR = 2.064; 95% CI [1.533, 2.778]) was found to be the most significant predictor of health service use.

CONCLUSION

Findings from this research shed light on the various factors that impact university students belonging to different ethnic groups, their health, and their access to healthcare that addresses their distinct health needs. Nurses can advocate for the development of health promotion and illness prevention strategies that target the needs of the diverse student population.