Mental Health Impacts of the COVID-19 Pandemic on International University Students, Related Stressors, and Coping Strategies

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted university teaching globally. The mental health impacts on international university students have been overlooked.Aims: This study examined the differences in COVID-19-related stressors and mental health impacts between international university students studying in the UK or USA who returned to their home country or region (returnees) and those who stayed in their institution country (stayers), and identified COVID-19-related stressors and coping strategies that were predictors of mental health.Method: An online questionnaire survey was conducted from April 28 through May 12, 2020 using an exponential, non-discriminative snowball sampling strategy (registered at the National Institutes of Health: NCT04365361).Results: A total of 124 full-time international university students (36.3% male) were included: 75.8% had returned to their home country or region for reasons related to COVID-19; 77.4% were pursuing a bachelor's program, and 53.2% were in programs with practicum component. 84.7% of all students had moderate-to-high perceived stress, 12.1% had moderate-to-severe symptoms of anxiety and depression, and 17.7% had moderate-to-severe symptoms of insomnia. Compared with returnees, stayers had significantly higher stress from COVID-19-related stressors such as personal health and lack of social support (Cohen's d: 0.57–1.11), higher perceived stress [10-item Perceived Stress Scale (PSS-10)] {22.6 ± 6.2 vs. 19.1 ± 6.1, β [95% confidence interval (CI)]: 4.039 (0.816, 7.261), Cohen's d: 0.52}, and more severe insomnia symptoms [Insomnia Severity Index (ISI)] [11.8 ± 6.1 vs. 7.6 ± 5.2, β (95% CI): 3.087 (0.262, 5.912), Cohen's d: 0.45], with moderate-to-large effect sizes. Compared with males, females reported significantly higher stress from uncertainties about academic program (Cohen's d: 0.45) with a small effect size. In the total sample, stress related to academics (e.g., personal attainment, uncertainties about academic program, and changes in teaching/learning format), health (including personal health and health of family and friends), availability of reliable COVID-19-related information, and lack of social support predicted more negative mental health impacts. Resilience, positive thinking, and exercise were predictors of less severe mental health impacts.Conclusions: Stayers experienced more adverse mental health impacts than returnees. We call on educators and mental health professionals to provide appropriate support for international students, particularly the stayers, during the pandemic.

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“…It has been reported that psychological distress influences the people with higher education because research school career is more difficulty. In addition to the stresses of the pandemic, those with D/M degrees have an already existent drive to be successful [ 21 , 22 ], which adds to the pressure on them and could have contributed to our findings. However, it should be noted that some researchers disagree with the idea that those with D/M degrees have an inherent need to succeed [ 23 ].…”

“…Also, family relationship affects the physical, social, and emotional health of individuals. Thus keeping in touch with family members is a good way to enhances individual adaptation [ 22 ]. Furthermore, exercise and positive social activities (including discussing and sharing experience with colleagues) may effectively reduce the milder clinical mood symptoms or sub-threshold syndromes before they evolve to more complex and enduring psychological responses [ 18 ].…”

“…In addition, social support network should be established to reduce the pressure on healthcare workers, for example, sending more medical staff to reduce work intensity, adopting strict infection control, providing personal protective equipments, offering practical guidance [ 24 ], and providing a range of psychological services [ 24 ], including training for professionals on identifying risk factors and symptoms of mental distress, and psychotherapy [ 22 ].…”

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“…Further research is needed to better understand this difference and implications linked to possible misuse. Changes in teaching/learning format, personal health and that of family and friends, lack of reliable and consistent COVID-19 information, and diminished social contact and support tend to be predictors of high stress levels, depression, anxiety and other psycho-emotional problems among university students, especially females (Fitzpatrick et al 2020;Gritsenko et al 2020;Lai et al 2020;Liu et al 2020;Yehudai et al 2020). Insignificant differences were found among the survey respondents based on gender status.…”

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“…Morever, age, housing conditions, previous history of mental issues, anxiety, and fear significantly predicted psychological distress (Saravanan et al, 2020 ). Moreover, stress related to academics (e.g., personal uncertainties about academic program, distance teaching), health, and lack of social support predicted more negative mental health impacts (Lai et al, 2020 ).…”