International student health and wellbeing: an excerpt from the 2018 ISANA NZ Annotated Bibliography

Developed with the support of International Student Wellbeing Strategy (ISWS) funding

Introduction

This Annotated Bibliography builds on the NZ International Education Literature Review commissioned by ISANA NZ and prepared by Chandra Leenher in 2011. The two documents at the same time are different in purpose and scope. The 2011 literature review was broad in its sweep encompassing a range of foci that incorporated both the demand-side and supply-side of the international education sector. The 2108 Annotated Bibliography is organised according to the four components in the ISWS: Education; Health and wellbeing; Inclusion and Economic wellbeing. It is not designed to be exhaustive and is selectively prepared for international education practitioners, policy analysts and academics interested in export education’s coalface. Although not exhaustive, the limited number of New Zealand studies cited is a reflection of the limited amount of New Zealand research investigating the international student experience. This is significant short-coming for a lead export sector that inevitably impacts the development of evidence-based practice that provides local education providers with a competitive advantage.

The choice and range of summarised articles listed under separate headings reflect ISANA NZ’s interest in occupying and exploring the dynamic centre that integrates theory and practice. There are several articles that pre-date 2011. These are seminal studies in their respective disciplines that ISANA NZ believes provide key insights in relation to the international student experience. There are a number of comments highlighted by an asterisk which discuss the significance of the article’s findings for IE practitioners. The length of some summaries reflect the study’s practice implications.

This Annotated Bibliography is designed to be just the beginning. It is ISANA NZ’s intent to develop this work in an ongoing capacity to provide IE practitioners, policy analyst and researchers with a body of literature that provides cross-disciplinary insights that enable theory-to-practice innovation.

Chris Beard, ISANA NZ Executive Officer, January 2019

International student health and wellbeing

Mesidor, J., K. & Sly, K., S. (2016). Factors that Contribute to the Adjustment of International Students. Journal of International Students, 6 (1), 262-282.

In their review of literature investigating the international student experience Mesidor and Sly outline a plethora of adjustment stressors. Depression, anxiety, loneliness, culture shock and somatic complaints emerged as common health-related issues along with a myriad of socio-cultural adjustment challenges: “language barriers, financial problems, adjustment to the new

educational system, … adjustment to social customs and norms, and racial discrimination”(p.269). The authors note that depression and anxiety are well-documented in international student experience literature (Hwang, Bennet, & Beauchemin, 2014; Wang, et al., 2015; Zhang & Goodson, 2011). Capacity to deal with these challenges often depended on individual coping strategies, availability of social support and target language proficiency.

Mesidor and Sly highlight a study by Han, Han, Jacobs, and JeanBaptiste (2013) which found that approximately 45% of Chinese international students studying at Yale University exhibited symptoms of depression and 29% showed symptoms of anxiety. Han et al note that in contrast 12.8% are diagnosed with depression and 13% with anxiety within the general university student population in the US. Individual differences such as coping strategies and resilience were among key predictors of the levels of depression and anxiety experienced by international students.

Another study found that that limited English language proficiency prevented students from adequately comprehending lectures which compounded their acculturative stress. Mesidor and Sly argue that assessment and grading methods appear to disadvantage international students and recommend university departments offer academic services that are interculturally tailored, particularly as ‘the first encounter or the first impression that the student has of the university can have a long lasting effect on his or her adjustment’ (p.269).

The authors cite studies that show a pattern of international students underutilising counselling services and recommend that universities and colleges develop outreach strategies to support international students’ transition. They note Smith and Khawaja’s findings in A review of acculturation experiences of international students (2011) which shows students adjust more readily by adopting integration strategies that seek ways to participate.

Demes, K. A., & Geeraert, N. (2015). The Highs and Lows of a Cultural Transition: A Longitudinal Analysis of Sojourner Stress and Adaptation Across 50 Countries. Journal of Personality and Social Psychology, 109 (2), 316–337. doi.org/10.1037/pspp0000046. This article reports on the findings of a survey of 2,480 high school students on an exchange programme led by AFS, a US-based organisation that coordinates cross-cultural exchanges for high school students. Results showed that students did not experience either a honeymoon period or substantive culture shock, which is the pattern predicted by the U-curve. Rather 40% experienced a relatively stable level of ‘mild stress’ within their first nine months. 3.2% experienced a revers J-curve change of stress which showed stress levels diminishing on arrival then rising slightly at around six months. 4.9% demonstrated an inverse U-curve pattern which showed a rise and spike in stress levels in the first three to six months followed by a steady decline.

The results of this study suggest that it would be prudent for education providers to support the new international students’ integration in the first six months, particularly for young people more susceptible to increased stress levels as student sojourners. It should be noted that degree level student may experience a different range of stress trajectories given the likelihood that only a minority will be living in homestay circumstances.

Ramia, G., Marginson, S., and Sawir, E. (2013). Regulating international students’ wellbeing. Bristol: Policy Press at the University of Bristol.

Ramia, Marginson and Sawir discuss the findings of semi-structured interviews with 270 Australian and New Zealand students from 2003-2006. One of the strongest findings highlighted the difficulties international students face trying to form friendships with local students, which was largely due to the preferences of local students to self-segregate.

70 New Zealand students were interviewed and asked questions about their knowledge of the (then) Code of practice for the pastoral care of international students. The researchers found that the students’ knowledge of the Code of practice was limited with 63% of their interviewees unaware that the Code existed.

Almost half the New Zealand-based students interviewed (46 per cent) encountered language difficulties that impeded their studies, 36% reported financial difficulties at some point during their sojourn and 47% encountered problems in workplaces. Over 66% had experienced a prolonged period of loneliness usually in the initial stages of their stay, and they turned to close friends in the host country or friends/family members in their home country for support (p.114).

The authors found that the gaps in student welfare provision reflected similar gaps in Australia and that international students relied strongly on informal welfare such as (co-national) friends in the host country and family at home. They conclude the Code appears to

be used as a consumer protection framework to help New Zealand compete in the export education market and that it was insufficient as a welfare mechanism.

Chen, J. A., , Liu, L., MD, Zhao, X., , Yeung, A. (2015). Chinese international students: An emerging mental health crisis. Journal of the American Academy of Child & Adolescent Psychiatry, 54 (11). 879-880.

Chen, Liu Zaho and Yeung discuss what they view as an emerging mental health crisis among Chinese international students. The numbers of Chinese students studying in the United States have risen steadily in the last twenty years. The authors note that many are crossing borders at an age when they are more susceptible to the onset of common psychiatric disorders that impact adjustment and academic performance. This is compounded for Chinses students by culture-specific factors such as the one-child family structure, Confucian values and parental pressure to succeed. Chen et al compare the 2013 survey of Chinese international students at Yale, which found 45% reporting symptoms of depression and 29% showing signs of anxiety, with a study conducted among university students in Harbin showing a significantly lower rate of depression of just 11.7%. This, according to the authors, suggests that Chinese international students experience higher levels of psychological distress than their peers who stay home. They argue that more research is needed to investigate the susceptibility to mental illness and suicidal thoughts among Chinese international students.