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PredictorsofDepressionandAnxietyAmongInternationalStudents.pdf
Journal of Counseling & Development ■ Fall 2008 ■ Volume 86 429 © 2008 by the American Counseling Association. All rights reserved.
One of the most important goals of U.S. higher education is to encourage the enrollment of international students for academic, economic, and cultural purposes. The successful recruitment of these students comes with the responsibility to welcome, serve, and maintain the well-being of international students, and also to create an environment for multicultural interaction with stu- dents in the United States (hereinafter referred to as American students; Peterson, Briggs, Dreasher, Horner, & Nelson, 1999). Marion (1986) suggested that international students may act as great resources for increasing global understanding and the perspectives of American students. Peterson et al. found that American students learned about different cultures, their histo- ries, and international issues from foreign students. In addition, they learned to acknowledge and respect cultural and individual differences and broaden their perspectives, thereby preventing stereotypical thinking. Marion also suggested that international students play an important role in providing technological knowl- edge to less developed countries. In the United States, enrollment of international students has been encouraged for the economic contribution of nearly $13.5 billion every year that they spend on tuition, living expenses, and related costs (Institute of Inter- national Education, 2007).
The United States has the largest number of international students who represent many countries. During the academic year of 2005–2006, there were approximately 600,000 inter- national students from several nations, with Asian students representing 58% of all international students, followed by students from Europe (15%), Latin America (11%), Africa (6%), the Middle East (4%), and 6% from North America and Oceania (Institute of International Education, 2007).
Adjustment to a new educational and social environment can be a stressful process. Most college students experience stress throughout this process. However, many international students ex- perience even more serious stress because of the additional culture shock factor (Church, 1982) and various sociocultural factors that are involved in the adjustment process of international students (Luzio-Lockett, 1998). It is not surprising that international stu- dents often face language barriers, immigration difficulties, culture
shock, social adjustment, and homesickness. During this period of adjustment, international students may experience isolation and loneliness. Mori (2000) reported that these negative experiences can cause the students to feel hopeless, and an intensive sense of hopelessness may be the manifestation of depression. Consider- ing the cultural differences and misunderstandings of the new and diverse experiences, it is likely that international students will experience feelings of estrangement, anxiety, and depression as a part of their adjustment process (Adler, 1975). Spielberger (1966) reported that anxiety is related to stress, and Furukawa (1997) reported that people who are exposed to foreign cultures may become depressed or anxious and display maladaptive behaviors as a result of this acculturative stress.
Understanding the experiences of international students has important implications for creating and implementing programs that provide academic and personal support. Therefore, it is cru- cial to increase awareness about international students’ problems and to recognize the students’ individual perspectives regarding the factors that are involved in the adjustment and adaptation process (Luzio-Lockett, 1998). Because of these concerns, a number of studies have focused on the academic, psychological and social effects on international students of studying and liv- ing in the United States (Marion, 1986). In one of these studies, Kilinc and Granello (2003) found that students who were less acculturated experienced significantly more difficulty in their academic life, with language, and with medical/physical health than did the students with higher levels of acculturation.
A close examination of the literature reveals that although depression and anxiety are frequently manifested symptoms of stress (Arthur, 1998), these symptoms were not studied among the international student population in the United States. Con- sidering the fact that there is limited research on depression and anxiety among international students in the United States, the purpose of our study is to contribute further to the literature by examining these variables in relation to a set of other vari- ables retrieved from the literature: gender, age, race/ethnicity, proficiency in English, pattern of social contact, academic achievement, social support, and length of stay in the country.
Predictors of Depression and Anxiety Among International Students Seda Sümer, Senel Poyrazli, and Kamini Grahame
The role of gender, age, race/ethnicity, length of stay, social support, and proficiency in English in the variance in depres- sion and anxiety among international students revealed that social support was a significant predictor of depression and anxiety among international students. Age significantly contributed to the variance in anxiety, and self-rated English proficiency uniquely contributed to the variance in both depression and anxiety. Latino/a students had significantly higher levels of depression than did Asian students.
Seda Sümer, Department of Counseling and Psychological Services, Georgia State University; Senel Poyrazli and Kamini Grahame, School of Behavioral Sciences and Education, Penn State Capital College. Correspondence concerning this article should be addressed to Senel Poyrazli, School of Behavioral Sciences and Education, Penn State Capital College, 777 West Harrisburg Pike, W157 Olmstead Building, Middletown, PA 17057 (e-mail: [email protected]).
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This study also attempted to integrate some of these variables in the accurate prediction of depression and anxiety levels of international students. In the following sections, a literature review that is focused on certain variables (i.e., gender, age, race/ethnicity, social support, English proficiency, and length of stay) in relation to depression and anxiety and international students’ adjustment experiences is presented.
Gender Literature about gender supported a relation between social support and American female college students’ anxiety and depressive symptoms. Swift and Wright (2000) found that social support was negatively correlated with female students’ anxiety and depression levels. Hawkins (1995), on the other hand, found that female students with higher levels of social support experienced lower levels of anxiety and depressive symptoms, whereas male students’ anxiety levels did not cor- relate with social support.
Other studies that examined international students showed that female students had higher emotional, physiological, and behavioral reactions to stressors (Misra, Crist, & Burant, 2003) and also were more likely to feel homesick and lonely than were male students (Rajapaksa & Dundes, 2002). In contrast, Poyrazli, Arbona, Nora, McPherson, and Pisecco (2002) reported that male international students scored higher on the UCLA Loneliness Scale than did female international students. In the same study, there were no differences among men and women regarding general adjustment. A reason for the discrepant findings of these two studies might be that the former study used a snowballing technique, whereas the latter used a random sample approach. In addition, these studies used different scales to measure loneliness.
Furthermore, the gender differences reported in previous research could be a result of international students’ cultural background and the socialization process both genders go through. Therefore, it is important to study international students from different ethnicities to see if gender is related to their experiences of anxiety and depression.
Age Oei and Notowidjojo (1990) studied the impact of life change on adjustment of international students and found that age was a significant predictor of depressive symptoms. In par- ticular, older international students in Australia scored higher on depressive symptoms than younger students. However, Furukawa’s (1997) study with Japanese teenage exchange stu- dents, who were enrolled in 1-year placements with volunteer host families in various countries, showed that age was not a predictor of depressive symptoms among this international student group. The discrepancy between the findings of Oei and Notowidjojo’s and Furukawa’s studies could be a result of researchers using a different scale to measure depression and including students from different educational levels.
Therefore, it is important to conduct additional studies with international college students to see if age is related to anxi- ety and depression levels of students attending college in a foreign country.
Race/Ethnicity Research on the effects of race/ethnicity and the adjustment to a new culture indicated that the adjustment process becomes more stressful as the differences between the two cultures increase (Kinoshita & Bowman, 1998; Surdam & Collins, 1984; Yang & Clum, 1994). Yang and Clum suggested that for a foreigner, entering into a new culture might cause stress if that individual lacks information regarding appropriate behavior in that culture.
Tafarodi and Smith (2001) conducted a study that compared Malaysian and British students at a British university. This study addressed individualism-collectivism as a dimension of cultural factors that produced differential sensitivity to life events. The results of the study showed that Malaysian students displayed higher levels of depressive symptoms than did British students. For Malaysian students, positive social life events were inversely related, and negative social life events were directly related to increased levels of depression. On the other hand, positive achievement-related events indicated a smaller increase in de- pression among British students, but there was no association between negative achievement-related events and depression. Overall, collectivist cultural orientation was associated with greater vulnerability to social experiences, whereas individualist cultural orientation was associated with greater sensitivity to personal achievement-related experiences. Other research about the impact of collectivist and individualist cultural orientations on international students’ adaptation, satisfaction with life, and anxiety levels showed similar results, indicating that students from collectivist cultural orientations had lower levels of adap- tation and satisfaction with life and higher levels of anxiety as compared with students from individualist cultures (Kinoshita & Bowman, 1998; Sam, 2001; Surdam & Collins, 1984). These studies indicated that when an international student from a collectivist culture attends college in an individualist culture, he or she might experience higher levels of anxiety because of cultural dissimilarities.
Social Support Huang (1977) suggested that it may be difficult for inter- national students to replace the social network of family, neighbors, and friends that they had in their home country. Research in this area has shown that stressful life situations might lead individuals to evaluate their social support. In those circumstances, individuals with poor support might pay more attention to the weakness of their support. Rudd (1990) suggested that this might lead to increased hopelessness; indi- viduals with poor support may be more sensitive to life stress and, therefore, experience higher levels of distress.
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Predictors of Depression and Anxiety Among International Students
Several studies (Furukawa, 1997; Jou & Fukada, 1995; Misra et al., 2003; Rajapaksa & Dundes, 2002; Wethington & Kessler, 1986; Yang & Clum, 1994; Yeh & Inose, 2003) have shown that social support and related variables such as social network satisfaction, perceived social network, and needed support are related to international students’ adjustment levels, life satisfaction, acculturative stress, reactions to stressors, and depressive symptoms. In particular, students with higher social support tended to experience higher adjustment levels and lower levels of depression and acculturative stress. Results suggest that social support might serve as a buffer and help students cope more effectively with challenges they encounter.
English Proficiency Language difficulties, in particular, appear to be a challenge for the majority of international students. According to Mori (2000), the lack of English language skills is likely to affect in- ternational students’ academic and social performances, which, in turn, may affect their psychological adjustment to the new culture (p. 138). Surdam and Collins (1984) studied the adapta- tion of international students upon their arrival in the United States in relation to their English language skills. Their results showed that the students who believed that their English was adequate on arrival were significantly better adapted than those who believed that it was inadequate. In support of this finding, Yeh and Inose (2003) reported that English language fluency was a significant predictor of acculturative stress. In particular, participants who reported higher levels of English fluency, higher frequency of English use, and higher comfort level in communicating in English experienced less acculturative stress. Proficiency in English was also found to be significant in predicting adjustment among international students (Poyrazli et al., 2002). Findings from Poyrazli et al.’s study suggested that English proficiency affects international students’ ability to discuss educational issues and to form social relationships with Americans. Therefore, lower levels of English proficiency were associated with lower levels of adjustment.
Length of Stay The relation of length of stay to international students’ ad- justment experiences has been the focus of a major theory developed by Lysgaard (1955). He indicated that the adjust- ment processes of international students in a host culture follow a U-shaped curve over time. Initially, the adjustment process starts with excitement about being abroad and seeing new things. However, during this period, the person is not involved in any special friendship group. After some time, the excitement of the first stage loses its attraction when the need for more intimate personal contact and interaction with friendship groups becomes important. If this need is not satisfied, the individual might experience feelings of loneli- ness and depression. In time, however, foreigners may learn to resolve the adjustment difficulties they experience in this
“loneliness” stage (Lysgaard, 1955). They may get involved with other individuals at a more intimate level, make friends, and have a satisfactory social life.
Literature about the impact of length of stay on interna- tional students’ adaptation and depression levels supported the U-curve hypothesis (Oei & Notowidjojo, 1990; Surdam & Collins, 1984). Specifically, international students staying in another country for more than 1 year were more depressed than were native-born students; those with less than 1 year in another country did not become frustrated as easily and were less worried about future misfortunes when compared with native-born students. Also, international students who had been in the United States from 2 to 4 years showed lower adaptation than those who had been in the United States more than 4 years.
In summary, the literature indicates that several variables affect adjustment and acculturation levels of international students to a new culture. Among these variables, gender, age, race/ethnicity, social support, pattern of social contact (i.e., with whom do students socialize mostly?), English proficiency, and length of stay have been studied in relation to students’ general adjustment experiences or level of accul- turative stress, but not in relation to depression and anxiety. However, there is some evidence in the literature indicating that gender is related to anxiety and depression among non- international college students. Therefore, the purpose of this study was to fill a gap in the literature by examining these variables and their relation to the depression and anxiety levels of international students. We were specifically interested in the following research questions.
1. What are the correlations among gender, age, length of stay, academic achievement, social support, pattern of social contact, English proficiency, and international students’ depression and anxiety levels?
2. What are the contributions of gender, age, length of stay, social support, English proficiency, and race/ ethnicity to the variance in international students’ depression and anxiety levels?
Method Participants
A total of 440 international students who held either F-1 or J-1 student visas participated in the study. They were studying at two different college campuses located in the eastern portion of the United States. Fifty-seven percent of the participants were men and 43% were women. The age of the students ranged from 18 to 49 years, with an average of 26.15 (SD = 4.78). Educational levels represented by the students were doctoral (50%), master’s (28%), undergraduate (21%), and other (1%). Students’ grade point averages ranged from 1.50 to 4.00 (M = 3.60, SD = .37). Regarding race/ethnicity, 68% of the participants were Asian, followed by 16% White/non- Latino/a, 4% Latino/a, 3% Middle Eastern, 2% Black, and
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7% who identified themselves as “other.” A breakdown of Asian students by region was as follows: India, 38%; China, 28%; Korea, 13%; Taiwan, 8%; Japan, 3%; Singapore, 3%; Thailand, 2%; 1% each from Malaysia, Nepal, Pakistan, and Sri Lanka; and less than 1% each from Indonesia, Philippines, and students who did not indicate their country of origin.
Only 26% of the participants were married. Among those who were married, 49% reported residing with their spouse in the United States. Seventy-three percent of the participants were single and 1% were divorced. Participants’ length of stay in the United States ranged from 2 months to 10 years, with an average of 2.9 years (SD = 1.82).
Variables
Depression. The Goldberg Depression Scale (GDS; Goldberg, 1993; Holm, Holm, & Bech, 2001) was used to measure depres- sion. Participants respond to this 18-item measure using a 6-point Likert-type rating scale; responses range from 0 (not at all) to 5 (very much). The highest score on this scale, 90, indicates the most severe depression, and the lowest score, which is zero, indicates the complete absence of depressive symptoms. Factor analysis was used to measure the internal validity of this scale; one general factor was identified, which explained 50% of the variance. The results indicated that the 18 items on the GDS have a valid rank order and structure. In addition, external validity was measured by comparing the responsiveness of GDS with the Hamilton Depression Scale (HAM-D). The correlation of the total GDS and HAM-D scores was .74 (p < .001; Holm et al., 2001). The internal reliability, measured by Cronbach’s alpha, of the scale for the sample used in this study was .93, indicating that GDS was a reliable measure for our sample.
Anxiety. The State Anxiety scale (Form Y-1) of the State- Trait Anxiety Inventory (STAI; Spielberger, 1983) was used to measure anxiety. This scale is a 20-item, 4-point self-report scale. Responses range from 1 (not at all) to 4 (very much so). The items on the scale measure a temporary condition of anxiety, called state anxiety, which consists of feelings of tension, nervousness, and worry that vary in intensity and fluctuate over time according to perceived threat (Spielberger, Sydeman, Owen, & Marsh, 1999). High scores indicate high levels of state anxiety. The stability coefficients for the State Anxiety scale were low, with a median of .33. However, Spiel- berger et al. reported that this lack of stability was expected and considered essential because a valid measure of state anxiety should reflect the influence of situational factors at the time of testing. On the other hand, internal consistency of the State Anxiety scale was .93 (Spielberger et al., 1999). Spielberger (1983) reported that the construct validity of the State Anxiety scale was demonstrated when college students were administered the scale following a classroom examina- tion. Participants’ scores were higher at that time than when they were tested during a relatively nonstressful class period. Cronbach’s alpha reliability coefficient of this subscale for the current sample was .94.
Social support. The Social Provisions Scale (SPS; Cutrona & Russell, 1987) was used to measure social support. This scale consists of 24 questions, 4 for each of the following variables: attachment, social integration, reassurance of worth, reliable alliance, guidance, and opportunity for nurturance. The items are rated on a 4-point Likert-type scale, with responses ranging from 1 (strongly disagree) to 4 (strongly agree). A high score indicates a greater degree of perceived support. Test–retest reli- ability coefficients for this scale were reported to range from .37 to .66 (Cutrona & Russell, 1987). However, because the scale consists of items that measure the individual’s mood, the time of testing might have influenced the test–retest reliability analysis. On the other hand, internal consistency reliability for this scale was reported to be excellent (α = .93). The convergent validity of this scale was measured by comparing the scores on the Social Integration, Reassurance of Worth, and Guidance provisions on the SPS with scores on the UCLA Loneliness Scale for the same sample. The results of this comparison in- dicated that the deficits in the social provisions explained 66% of the variance in the UCLA Loneliness scores. Cutrona and Russell reported that the predictive validity measure of SPS indicated that social provisions scores were predictive of loneli- ness, depression, and health status among teachers. In addition, discriminant validity measure showed that the intercorrelations among the six provisions ranged from .10 to .51, with a mean intercorrelation of .27. The internal reliability of the instrument in the current study was .94.
Demographics. We developed a questionnaire to ascertain students’ age, gender, race/ethnicity, and length of stay in the United States. We added four more questions to the question- naire to measure students’ English proficiency. Students were asked to rate their skills in the areas of speaking, reading, under- standing, and writing; responses ranged from poor to excellent on a 4-point Likert-type scale. Another item measured students’ pattern of social contact by asking them to state with whom they socialized most—Americans or non-Americans (i.e., other international students or people from their own country).
Procedure The participants were recruited from two different campuses of a university located in the eastern portion of the United States. Approximately 3,000 international students were contacted via e-mail through International Student Office representatives. This e-mail included information about the purpose of the study and the compensation for participation. Students were asked to go to a designated Web site address to complete the surveys. Of the 3,000 students who were e-mailed, we could not determine how many actually received the information. However, we received a total of 440 responses, which represented a return rate of 15%. Although this rate is low for a traditional mailed survey, we cannot determine what this number represents for a Web-based survey.
Web-based data collection procedures must take into con- sideration Internet accessibility by the targeted population
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Predictors of Depression and Anxiety Among International Students
(Gosling, Vazire, Srivastava, & John, 2004). However, because international students are often frequent users of the Internet for communicating with their family and friends in their home countries and have easy access to the Internet on their cam- puses (e.g., in computer labs, libraries), this concern might not be as significant, particularly, for the current sample.
To minimize the effects of repeat responders, we matched consecutive responses on key demographic characteristics such as age, gender, degree sought, and race/ethnicity (Gos- ling et al., 2004). We also compared the set of item responses to identify duplicate or near-duplicate entries. When such a match was detected, we kept only the first entry.
Data Analysis This project was a cross-sectional, exploratory study in which depression and anxiety were measured among international students. Cronbach’s alpha was calculated to determine the in- ternal reliability of the measures for the current sample. Pear- son product–moment correlational analyses were performed to examine the relationship between interval variables.
Gender, age, length of stay, social support, English profi- ciency, and race/ethnicity were investigated for their contribu- tions to both depression and anxiety levels of international students. Two hierarchical multiple regression analyses were used to explore the contributions of these variables. To en- ter the race/ethnicity variable into regression analyses, we dummy-coded this variable.
Results Correlational Analyses
Pearson product–moment correlation analyses were per- formed to look at the relation between the interval vari- ables used in the study (see Table 1). The means, standard deviations, and range of scores for these variables are also
presented in Table 1. Analyses indicated that depression was negatively correlated with social support (r = –.57, p < .01) and English proficiency (r = –.24, p < .01). Students with higher levels of social support and English proficiency reported lower levels of depression. Similarly, anxiety was found to be negatively correlated with social support (r = –.59, p < .01) and English proficiency (r = –.25, p < .01). Stu- dents who had lower levels of social support and proficiency in English reported higher levels of anxiety. It was also found that depression and anxiety were intercorrelated (r = .76, p < .01). Students who scored high on the GDS, which was used to measure depression, also scored high on the State Anxiety scale, which was used to measure anxiety.
English proficiency was negatively correlated with age (r = –.24, p < .01) and pattern of social contact (r = –.25, p < .01), and positively correlated with social support (r = .29, p < .01). In other words, younger students reported higher English proficiency than did older students, and students who socialized primarily with non-American students reported lower English proficiency than did students who socialized primarily with American students. It was also found that students with higher levels of social support reported higher levels of proficiency in English.
Finally, length of stay correlated with pattern of social contact (r = –.10, p < .05). As the students’ length of stay in the United States increased, so did their level of socialization with Americans. The relationship, however, was too low to reach any practical significance.
Multiple Regression Analyses
Two hierarchical regression analyses were performed using the following predictor variables in the first block: gender, age, length of stay, social support, and English proficiency. In the second block, race/ethnicity was entered as dummy-coded variables for European, Middle Eastern, Latino/a, African, and Other. The Asian group served as the reference group.
Table 1
bivariate Correlations, Means, Standard Deviations, and Range of Scores
Variable
1. Gender 2. Age 3. Grade point average 4. Pattern of social
contacta
5. Depression 6. Anxiety 7. Social support 8. English proficiency 9. Length of stay
M SD Range
—
9
aStudents’ pattern of social contact was dummy coded and entered into the correlational anaysis. Thus, means, standard deviations, and range of scores are not reported here. *p < .05. **p < .01.
87654321
–.03 —
26.15 4.78
18–49
–.12* .32**
—
3.60 0.37 1.50–4.00
.03 .04 .09
—
.02 .05 –.12*
.06 —
14.26 13.47
0–90
–.05 .08 –.06
.09 .76**
—
39.23 12.09
20–80
–.06 .00 .01
–.15** –.57** –.59**
—
77.90 11.61
24–96
–.01 –.24** –.02
–.25** –.24** –.25** .29**
—
13.11 2.75
4–16
–.01 .25** –.04
–.10* .03 .01 .09 .05
—
2.90 1.82
.17–10
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Sümer, Poyrazli, & Grahame
Depression. When the first set of variables were regressed on depression, results indicated that this model accounted for 35% (R² = .35) of the variance in depression (see Table 2). The F value for the model in predicting depression was significant, F(5, 380) = 40.56, p < .01. However, among the predictor variables, only length of stay, social support, and English proficiency had significant standardized beta coefficients. When race/ethnicity variables were added to the model, R² increased to .36, F(10, 373) = 21.16, p < .01. Interestingly, although length of stay significantly contributed to students’ level of depression in the first model, with the addition of race/ ethnicity variables, the contribution became nonsignificant. This indicated that race/ethnicity groups differed from each other based on their length of stay in the United States. An examination of means for length of stay showed that Africans had been in United States longer than any other group (M = 3.61), whereas Asians had been here for a shorter time than the other groups (M = 2.74 years). The second model also indicated that Latino/a students had higher levels of depression than Asians. However, these findings are tentative because of the small number of Latino/a students in our sample. Overall, the findings showed that lower levels of social support and English proficiency and being Latino/a were associated with higher levels of depression.
Anxiety. When the first set of variables were regressed on anxiety, the R² value of this model was .38, indicating that the combination of these variables accounted for 38% of the vari- ance in anxiety (see Table 3). It was found that these variables significantly predicted anxiety, F(5, 361) = 44.66, p < .01. The standardized beta coefficients, however, indicated that only age, social support, and English proficiency significantly
contributed to the variance in anxiety. The signs of the stan- dardized beta coefficients showed that higher social support and better English skills were associated with lower anxiety, whereas older age was associated with higher levels of anxiety. When race/ethnicity variables were entered into the equation as the second block, the R² of the model increased to .39, F(10, 356) = 22.84, p < .01. Age, social support, and English proficiency remained significant. Gender, length of stay, and race/ethnicity were not significant in predicting anxiety.
Discussion In this study, international students were examined in terms of the depression and anxiety levels they might experience as a result of their adjustment to living and studying in the United States. We investigated the contribution of a model for explaining the variance in depression and anxiety. Results showed that social support had a significant contribution to the model in predicting depression. Students with lower levels of social support reported higher levels of depression. This result is consistent with the results of several studies that in- vestigated reactions to stressors, adjustment, and depressive symptoms of international students (Furukawa, 1997; Jou & Fukada, 1995; Misra et al., 2003; Wethington & Kessler, 1986; Yang & Clum, 1994; Yeh & Inose, 2003). Besides depression, social support also contributed significantly to the variance in anxiety. In particular, students with lower levels of social support were more likely to have higher levels of anxiety, suggesting that higher levels of social support might enable international students to be more socially active and interact with people more often and, as a result, reduce the feelings of depression and anxiety.
Table 2
Summary of Hierarchical Regression analysis for Variables Predicting Depression (N = 385)
Variable
Step 1 Gender Age Length of stay in U.S. Social support English proficiency
Step 2 Gender Age Length of stay in U.S. Social support English proficiency Race/ethnicity European Middle Eastern Latino/a African Other
b
–0.95 0.11 0.67 –0.64 –0.50
–0.84 0.10 0.57 –0.66 –0.60
2.33 0.58 6.15 2.30 3.47
1.14 0.13 0.32 0.05 0.22
1.15 0.13 0.32 0.05 0.23
1.68 3.39 2.72 4.03 2.47
–.03 .04 .09* –.55** –.10*
–.03 .03 .08 –.57** –.12**
.06 .01 .10* .02 .06
SE B
Note. R 2 = .35 for Step 1; DR 2 = .36 for Step 2. Reference group for race/ethnicity variables = Asian. *p < .05. **p < .01.
B
Table 3
Summary of Hierarchical Regression analysis for Variables Predicting anxiety (N = 366)
Variable
Step 1 Gender Age Length of stay in U.S. Social support English proficiency
Step 2 Gender Age Length of stay in U.S. Social support English proficiency Race/ethnicity European Middle Eastern Latino/a African Other
b
–1.59 0.28 0.23 –0.60 –0.44
–1.60 0.27 0.23 –0.61 –0.47
5.13 1.63 –2.58 –0.62 2.07
1.03 0.12 0.29 0.05 0.20
1.03 0.12 0.29 0.05 0.21
3.49 2.46 3.55 2.28 1.52
–.06 .10* .03 –.57** –.10*
–.06 .10* .03 –.59** –.11*
.06 .03 –.03 –.01 .06
SE B
Note. R 2 = .38 for Step 1; DR 2 = .39 for Step 2. Reference group for race/ethnicity variables = Asian. *p < .05. **p < .01.
B
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Predictors of Depression and Anxiety Among International Students
The age variable contributed uniquely to the variance in anxiety. Older students were more likely to report higher levels of anxiety. This finding suggests that younger students may be more open and flexible to a new culture and to environmental differences. This might be due to globalization, which gives younger students the opportunity to have more exposure than older students to American culture through media. As a re- sult, they may feel more familiar with American culture, and, therefore, might experience less anxiety toward the cultural, educational, and social changes, making their adjustment easier. However, older students may be more traditional, more resistant to change, and have more difficulties in accepting the host culture’s norms and values and, therefore, experience higher levels of anxiety during their adjustment period.
Results showed that students with lower levels of Eng- lish proficiency reported higher levels of depression and anxiety. This finding supports the findings of previous stud- ies (Poyrazli et al., 2002; Surdam & Collins, 1984; Yeh & Inose, 2003) indicating that English proficiency is related to acculturation, adaptation, and adjustment of international students. However, this result contradicted the finding of Furukawa’s (1997) study, in which no relation was found between English fluency and depressive symptoms among Japanese high school exchange students. One explanation for this discrepant finding might be that the experiences of high school exchange students might be different from the experiences of international college students. Other results of the current study showed that English proficiency was negatively correlated with age and pattern of social con- tact. Specifically, younger students reported higher levels of English proficiency, and students with higher levels of English skills reported socializing mostly with Americans, not with their conationals or other international students. These results imply that younger students might have an easier time learning another language as compared with older students; having better English skills might help students to form relationships with Americans, which in turn might further improve these students’ English skills. Another finding indicated that Latino/a students had higher levels of depression than Asian students. However, these findings are tentative because we had a small number of Latino/a students in our sample; thus, there is a strong likelihood of chance variation.
The results of our study do not support the findings of previous studies regarding international students’ length of stay in the host culture and their adaptation and depression levels (Oei & Notowidjojo, 1990; Surdam & Collins, 1984). Previous literature, which investigated length of stay in rela- tion to adjustment and adaptation levels among international students, found significant differences among groups. On the contrary, our findings showed no group differences in terms of length of stay for international students’ levels of depression and anxiety. There might be two reasons for this discrepant finding. First, some of the previous studies used samples that
included only one race/ethnic group and examined differ- ences among these students. Second, the remaining studies included sufficient numbers of students from different cultural and ethnic backgrounds and investigated the impact of length of stay for various ethnic groups. However, in our study, the percentage of students representing different race/ethnic groups was not equal.
Unlike the studies that showed significant gender dif- ferences for anxiety, reactions to stressors, and feelings of loneliness (Hawkins, 1995; Poyrazli et al., 2002; Rajapaksa & Dundes, 2002; Swift & Wright, 2000) among college students, in this study no relation was found between gender and international students’ depression and anxiety levels. Research studies examining American college students’ anxi- ety in relation to their gender (e.g., Hawkins, 1995) found that social support was related to female students’ anxiety levels. The reason that we did not find a relation between gender and levels of depression and anxiety among inter- national students might first reflect the fact that we studied a non-American sample. Second, even though female and male students react differently to stressors or feel different levels of loneliness (Misra et al., 2003; Rajapaksa & Dundes, 2002), the level of their depression and anxiety might not differ because of many other factors that contribute to de- pression and anxiety.
Implications In this study, we found that social support was related to depression and anxiety; students who scored higher on the social support measure scored lower on the depression and anxiety measures. Regarding counseling services that can be provided, a social support group for international students might be offered to serve as a buffer against depression and anxiety. Students in such a group may be taught to utilize stress-management techniques to release the tension and anxiety that they might experience. Counseling centers might also assign bilingual or international counselors to work with students whose English proficiency levels are not adequate. This approach may promote more frequent and easier use of counseling services among international students, while helping these students learn how to cope with depression or anxiety.
Implementing programs like “host family,” or programs that match international students with more experienced international students, can help the students have smoother adjustments by providing social support upon their arrival to the United States. Peer programs, in which an American student is paired up with an international student, might also serve as a great resource to promote international students’ interaction with American students, thus helping them expand their social support network. It is important to have American students become an essential part of these programs for international students because socializing
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with American students also positively affects English proficiency of international students.
Limitations and Suggestions for Further Research
The data for this study were collected online. Although the current sample represents the total international student population at the university where the data were collected, the return rate was only 15%. As a result of the policy of the international student office, we were unable to send out a reminder e-mail to the international students to participate in the study, and this might have contributed to not having a higher return rate. However, because of a lack of information on Internet surveys and return rate, we could not determine if our return rate was low or normal. Also, most of the data were collected just before students began their spring break, a time when they were possibly stressed, working on class as- signments, and taking tests. During that period, the students’ perceptions of their anxiety levels might have been higher than they would normally have been.
The results of this study were correlational in nature and, as a result, no causal conclusions can be drawn about depres- sion and anxiety. We also need to interpret the results of this study in light of the average level of depression and anxiety students reported. For the depression measure (i.e., the GDS), our sample, on average, answered 2 on a 0- to 5-point scale, and also responded with 2 on a 4-point scale for anxiety (i.e., STAI State Anxiety Scale). These numbers indicate that stu- dents did not experience high levels of depression or anxiety. However, this might also indicate that less depressed students might be more likely to volunteer for a research project on the Internet; it could also be that the students with high depres- sion or anxiety might have chosen not to participate. Although the internal reliability level for the GDS in the current study indicated that this scale was a reliable measure for our sample, previous research did not specify the racial/ethnic background of the participants studied, making it difficult to show that this scale has been used with other cultures effectively. To measure anxiety, we used the State Anxiety scale of the STAI, which measures a temporary condition of anxiety. The Trait Anxiety scale was excluded because this scale measures an individual’s anxiety-proneness, and we were interested in measuring temporary anxiety that could be caused by being in a new culture or unfamiliar environment. However, future research could examine trait anxiety before students leave their country and examine the effects of this type of anxiety on students’ experiences while abroad.
Moreover, the race/ethnicity groups in our sample did not have an equal number of students. Therefore, future research could include equal numbers of participants in each category and examine the group differences in terms of depression and anxiety. Further research might also attempt to examine depression and anxiety levels of international students in a longitudinal study.
Measuring the depression and anxiety levels of students prior to their arrival in the United States and following them up with periodic assessments after their arrival would provide a better understanding of the impact of cultural change and the accultura- tion process. The small number of married students who reported residing with their spouses did not allow us to determine whether living with a spouse in the United States contributed to the levels of depression and anxiety among international students. There- fore, further research could be conducted with married students with and without their spouses in the United States to determine how these students’ psychological well-being is affected by the presence or absence of the spouse.
Although we had a large sample of students, it was a highly self-selected group. Future research could replicate this study or compare the results with another college sample. Future research could also examine depression and anxiety among international students with an ecological perspective that emphasizes the impact of the interaction between inter- national students and their environment (Bronfenbrenner, 1979; Kelly, Ryan, Altman, & Stelzner, 2000). This approach is based on the assumption that an individual’s behavior and psychosocial health are influenced by his or her social and physical contexts (Kelly, 1990). Therefore, examining the community context and physical setting of international students might play an important role in understanding the environmental factors that contribute to these students’ depression and anxiety levels. The way that international students (or foreigners, in general) are welcomed and treated in the community and the lack of important resources (e.g., transportation, financial support) might be factors in inter- national students’ depression and anxiety levels. Therefore, in order to understand underlying factors of depression and anxiety among international students, it might be useful to assess attitudes of American students and others in the local community toward different cultures and countries and to examine the resources provided to this population. Finally, depression and anxiety might negatively affect academic achievements of international students. This concern could be addressed through a longitudinal study that examined whether or not depression and anxiety are related to academic success among international students.
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