Experience of Ethnic Discrimination, Anxiety, Perceived Risk of COVID-19, and Social Support among Polish and International Students during the Pandemic

Background: Our research aimed to assess the experiences of ethnic discrimination among students in Poland (Polish and international) during the COVID-19 pandemic. We also tested the prevalence of anxiety symptoms and their relationship with perceived COVID-19 risk, the severity of discrimination, and social support. Methods: The data from Polish (n = 481) and international university students (n = 105) were collected online (November–January 2020). Participants completed measures of ethnic discrimination (GEDS), anxiety scale (GAD-7), COVID-19 risk perception index, and perceived social support scale (MSPSS) questionnaires. Results: The results showed that international students reported being much more discriminated than Polish students during the first year of the COVID-19 pandemic. Contrary to our expectation, a higher risk of anxiety disorders (GAD) was observed in 42% of Polish students compared to 31% of international students. The predictors of higher anxiety symptoms among both groups were the perceived risk of COVID-19 and the greater severity of ethnic discrimination. In both groups, the perceived social support had a protective role in anxiety symptomatology. Conclusions: The high prevalence of discrimination, especially among international students, simultaneously with high symptoms of anxiety, requires vigorous action involving preventive measures and psychological support.


Introduction
Data collected in various countries worldwide document the negative impact of the COVID-19 pandemic on the mental health of university students [1][2][3][4][5]. Rapid changes in learning and lifestyle are accompanied by severe stress. Particular stressors contributing to mental health deterioration are remote learning, maintaining physical distance, job loss, a sedentary lifestyle, skipping meals, not taking care of order and hygiene, and many others [6][7][8]. High indicators of psychopathological symptoms fundamentally resulted from the reaction to numerous stressors the students experienced [4,5,9].
Many studies have focused on assessing depression and anxiety symptoms [10][11][12][13]. A meta-analysis of cross-sectional studies on anxiety and depression in China showed that the overall prevalence of anxiety and depression symptoms in students during the COVID-19 pandemic was 24% and 22%, respectively [12]. Researchers also noted increases in anxiety and depression in European countries. For example, 46.0% of students in Portugal were at risk for anxiety disorders in 2019, before the pandemic, and 64.5% one year later in 2020 [11]. Significant changes in the intensity of harmful mental health symptoms, anxiety, and depression were observed at the beginning of the pandemic in Switzerland [10]. Student participants showed a significant decrease in moderate-to-severe anxiety scores of 20.2% and 15.6% at T0 and T1, respectively. Polish students reported a high risk of anxiety The experience of ethnic discrimination is conceptualized as a type of stress leading to significant psychological and even physiological reactions (e.g., hypertension). It increases the likelihood of passive and other maladaptive forms of coping with stress (e.g., anger) [29,30]. Many studies in Poland have focused on the student population, but few have focused on discrimination issues. The studies published at that time focused on high rates of anxiety, the explanation of which we sought primarily in the situation of a pandemic. Perceived social support was chosen because it is a well-known factor protecting against stress.
Therefore, our study aimed to examine the prevalence of ethnic discrimination among students in Poland (international and Polish) during the COVID-19 pandemic. We also examined the prevalence and intensity of anxiety symptoms and their relationship with risk factors, including perceived COVID-19 risk, the severity of ethnic discrimination, and the protective role of perceived social support.

Study Design and Procedure
The study was based on data from a cross-sectional online survey prepared using Google Forms. The survey in Poland (November 2020 to January 2021) was directed at all university students, including international, from every research discipline. The online questionnaire was delivered in Polish and English so that international students who do not speak Polish well could complete it. However, only eight (1.4%) people completed the survey in English. Our measurement tools had proven psychometric properties in Polish and English [15,[34][35][36]. To reach as many Polish and international students as possible, the researchers and several engaged students from the science club used various recruitment strategies, such as sharing a link to the survey on social media, mailing lists for student groups, and sending links to employees of other universities with a request to disseminate. Participants had to give informed consent before participating; at the end, they were asked to send the survey link to their friends.

Statistical Analysis
First, we examined means (M), standard deviations (SD), and percentage proportions in terms of the sociodemographic characteristics of the study participants.
Next, we estimated the percentage prevalence of ethnic discrimination in the two groups according to the established measuring tool [29].
We used chi-square values and Sommer's d-effect sizes to compare Polish and international student groups separately for each item of the General Ethnic Discrimination Scale (GEDS).
The severity of anxiety symptoms was assessed using the GAD-7 scale [35]. Next, we used the one-way ANOVA F tests to compare the Polish and international student groups' variances regarding continuous variables: the severity of ethnic discrimination, anxiety symptoms, perceived risk of COVID-19, and perceived social support. The measure of effect size is (partial) eta squared (η 2 ).
We also compared the response scores to each COVID-19 risk perception question and differences in the groups, measured by the Mann-Whitney U test with eta (total) effect size (η).
The hierarchical regression analysis was performed separately among each group of the study participants; the aim was to identify the significant predictors of anxiety symptom severity characteristics in Polish vs. international students.
All statistical analyses were performed with IBM Statistics, version 28.

Ethnic Discrimination
The General Ethnic Discrimination Scale (GEDS) is an 18-item self-report inventory of recognized ethnic discrimination used in health research with any ethnic group. The GEDS results were related to psychiatric symptoms among people of ethnic minorities and white people, with the stronger relationships for people of ethnic minorities [29]. The scale reported good internal consistency (94-95), and additionally, the GEDS has a confirmed equal effectiveness in modeling the factor structure of perceived ethnic discrimination across diverse racial and ethnic groups [29]. The scale is composed of three unidimensional subscales: (1) Recent Discrimination; (2) Lifetime Discrimination; (3) Appraised Discrimination. However, this study only used the Recent Discrimination scale, relating to the participants' experience in the last years. For this purpose, 18 items were translated into Polish and back-translated as required [34]. Respondents rate the frequency of perceived discriminatory and racist events during the past year on a 6-point Likert-type scale: 1 = Never; 2 = Once; 3 = Sometimes; 4 = A Lot; 5 = Most of the Time; and 6 = Almost All the Time. The range for the whole scale was 18 to 108. Higher scores indicate a higher level of ethnic discrimination. The Cronbach's α for the GEDS in this study was 0.93.

Anxiety
The severity of anxiety symptoms was assessed using the 7-item generalized anxiety disorder (GAD-7) scale [35]. The GAD-7, a brief measure of anxiety symptoms, is a popular scale to measure the generalized level of persistent worry according to DSM-5 criteria. Respondents rate the frequency of their experienced anxiety during the last two weeks on a 4-point Likert-type scale: 0 = Not at all; 1 = Several days; 2 = More than half the days; and 3 = Nearly every day. A higher score indicates a higher general anxiety disorder (GAD) risk. The range for the whole scale was 0 to 21. The Cronbach's α for the GAD-7 in this study was 0.92.

COVID-19 Risk Perception
The COVID-19 risk perception index is a general risk-perception measure, covering affective, cognitive, and temporal-spatial dimensions and including six items relating to respondents' perceived severity of the pandemic over the next six months [26]. The items concern worry about the virus, the perceived likelihood of contracting the COVID-19 virus, and the likelihood of their family and friends catching it. Respondents rate the frequency of the perceived risk of COVID-19 on a 7-point Likert scale (three items: 1, 2, 3) or a 5-point scale (three items: 4, 5, 6). Item examples: 1. How worried are you personally about the following issues at present?-Coronavirus/COVID-19? From 1 = Not at all worried to 7 = Very worried. 5. How much do you agree or disagree with the following statements?-I will probably get sick with the coronavirus/COVID-19. From 1 = strongly disagree to 5 = strongly agree. The total risk perception measure is calculated as the mean value of all six items, ranging from 0 to 36. A higher score indicates a higher perceived risk of COVID-19. The Cronbach's α for this measure in this study was 0.60.

Perceived Social Support
Perceived Social Support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) [36]. It is a 12-item scale comprising perceived social support from family, friends, and significant others. Each item is measured on a Likert-type scale ranging from 1 to 7: 1 = Very strongly disagree to 7 = Very strongly agree. Each subscale item relates to practical help, emotional support, availability to discuss problems, and help in decision making. The range for the whole scale was 12 to 84, showing that the higher the score, the higher the perceived social support. The Cronbach's α for this measure in this study was 0.93.

Sociodemographic Variables
The following sociodemographic characteristics are included in the analyses: gender (male/female), age in years, ethnic origin, subject of study, year of study, work, and student status (Polish vs. international).

Participants
The data include a total of 586 university students, 481 Polish and 105 international, currently studying in Poland. The group of foreign students included 67 Ukrainian (64.8%), 8 Vietnamese (7.6%), 4 German (3.8%), and 2 Belarusian (1.9%) students. In addition, our data included individuals from Ethiopia, Nigeria, Greece, Mexico, Iran, Palestine, Czechia, and Russia (7.6%). Due to missing data, we were unable to determine the origin of 15 (14.3%) foreign students. Table 1 presents the sociodemographic characteristics of the study participants. Participants' ages were primarily in the range of 17-22 (81%), and most (70%) were women. Most Polish participants studied humanities and social sciences (26% and 19%, respectively). Most international students studied economics and technical studies (28% and 27%, respectively). The majority of our respondents were undergraduates (Polish 90%; international 67%) and were not currently employed (67% vs. 57%).

Discrimination Experiences
The authors of the GEDS scale suggest that the discrimination scores can be re-coded into the lowest, middle, and highest thirds. These were scores ≤ 20, 21-27, and >28 [29] (p. 87). Figure 1 demonstrates the proportion of individuals who experienced ethnic discrimination in the first year of the COVID-19 pandemic, broken down into three levels. The cross-Table 2 × 3 (two groups of students vs. three intervals) showed that the difference between Polish and international students was statistically significant, chi-square = 22.76 (df = 2), p < 0.001, and small Sommer's d effect size = 0.14. Low levels of discrimination were reported by 62.1% (n = 364) of Polish students and 43.8% (n = 46) of international students. A higher percentage of discrimination at the middle level was also observed among international students, 26.7% (28), compared to Polish students, 20.8% (n = 100). A much higher percentage of international students, 29.5% (n = 31), perceived high levels of discrimination compared to Polish students, 13.1% (n = 63).

Discrimination Experiences
The authors of the GEDS scale suggest that the discrimination scores can be re-coded into the lowest, middle, and highest thirds. These were scores ≤20, 21-27, and >28 [29] (p. 87). Figure 1 demonstrates the proportion of individuals who experienced ethnic discrimination in the first year of the COVID-19 pandemic, broken down into three levels. The cross-Table 2 × 3 (two groups of students vs. three intervals) showed that the difference between Polish and international students was statistically significant, chi-square = 22.76 (df = 2), p < 0.001, and small Sommer's d effect size = 0.14. Low levels of discrimination were reported by 62.1% (n = 364) of Polish students and 43.8% (n = 46) of international students. A higher percentage of discrimination at the middle level was also observed among international students, 26.7% (28), compared to Polish students, 20.8% (n = 100). A much higher percentage of international students, 29.5% (n = 31), perceived high levels of discrimination compared to Polish students, 13.1% (n = 63).     Table 2 presents the means, standard deviations, chi-square values, and Sommer's d-effect sizes. Differences between the Polish and international students were calculated separately for each of the 18 items of the Discrimination Scale (GEDS) listed in the table. We used the cross-table to calculate each item's chi-square value (df = 5) and Sommer's d-effect size. We can see that the severity of discrimination against international students occurred significantly more frequently, i.e., in 14 out of 17 listed items, than against Polish students. A positive and small effect size characterized the observed differences. No statistically significant differences were found in terms of the three listed items (6,9,16) between the two analyzed groups.

Prevalence of Anxiety
In further calculations, we focused on estimating the risk of a generalized anxiety disorder (GAD) as measured by the GAD-7 scale [35]. It turned out that in the high-risk group (GAD-7 ≥ 10), there is a much higher percentage of Polish (42%, n = 202) than foreign students (31%, n = 33). This difference is statistically significant p < 0.02 (Chi-square = 4.01, Phi = 0.08). Table 3 compares Polish and international students using the one-way ANOVA test regarding the severity of anxiety symptoms, discrimination, perceived risk of COVID-19, and perceived social support. It shows that international students felt less anxiety than Polish students but were much more discriminated against during the last year. Furthermore, international students perceived a statistically significantly lower risk of coronavirus than Polish students. A small effect size characterized all differences observed. There were no differences in perceived social support between the analyzed groups of respondents. Since the study was carried out during the COVID-19 pandemic, it was interesting to examine the detailed differences regarding the sense of threat related to the pandemic between groups of students. To this end, we compared the average response scores to each question of the COVID-19 risk index. Table 4 shows the means, standard deviations, and differences measured by the Mann-Whitney U test for each of the six questions. The presented results show significant differences with a medium effect size between the assessment of Polish and international students regarding possible coronavirus cases in the country where they are currently staying. International students rated the risk of seriously getting sick with the coronavirus significantly higher than Polish students.

Hierarchical Regression Analyses
Separate regression analyses were conducted due to the expected differences between Polish and international student groups in terms of explanatory variables and the percentage of explained total variance. Therefore, two hierarchical regression equations were performed separately for each group to examine the effects of gender, age, perceived risk of COVID-19, perceived ethnic discrimination, and perceived social support for anxiety symptoms (Table 5). Gender and age were introduced in the first step to check what percentage of the variance of the dependent variable is related to the constant characteristics of the respondents. We then introduced two independent variables into the equation, the perceived risk of COVID-19 and perceived ethnic discrimination, which were defined as factors related to the risk of anxiety (stressors) depending on the external situation. In the third and final step, we introduced a variable measuring perceived social support to check what percentage, above and beyond the other variables, is associated with social support, which we define as a protective factor. Note. R = Reverse-coded; *** p < 0.001, * p < 0.05.
All predictors entered into the equations explained the statistically significant part of the variance in anxiety symptoms both in the group of Polish (R 2 = 0.22, p < 0.001) and international students (R 2 = 0.29, p < 0.001). All independent variables separately predicted a significant part of the variance of the dependent variable in the Polish group. Female gender, younger age, higher perceived COVID-19 risk, and higher severity of ethnic discrimination were associated with greater anxiety symptoms. In the group of international students, greater severity of anxiety was associated only with a greater perceived risk of COVID-19 risk and greater severity of discrimination. In both groups, the lower the perceived social support, the greater the severity of anxiety observed in students. Table 5. Hierarchical regression analysis of variables predicting anxiety symptoms (GAD-7).

Discussion
Our study aimed to examine the prevalence of ethnic discrimination among Polish and international students during the COVID-19 pandemic. The results of the online survey across universities in Poland confirmed that a high percentage of students report experiencing ethnic discrimination during the first year of the pandemic. Moreover, we observed that the severity of discrimination was much higher towards foreign students than towards Polish ones. Similar results were collected in other countries. Attention is drawn to the sense of cultural disconnection and to facing the prevailing sociopolitical climate [6,7,[37][38][39]. However, the main grounds of discrimination are considered to be foreign status, speaking with a foreign accent, and belonging to a visible racial or ethnic minority. No matter the reason, experiencing discrimination harms mental health, lowers self-esteem, and hinders international students' acculturation [22,25,28,[40][41][42]. The ongoing COVID-19 pandemic is believed to have increased stigma and prejudice against people of foreign nationalities due to the lack of knowledge about the COVID-19 virus and the fear of the consequences. Fear about the virus has caused the social need to blame someone for the pandemic. The psychological process of scapegoating is a control mechanism updated in the face of medical uncertainty [42][43][44].
The objective of our study was also to assess the prevalence of anxiety symptoms and its predictors among Polish and international students. Our study shows that anxiety levels among the surveyed students were high, similar to the results of other studies during the pandemic [4,5,[8][9][10][11][12][13][14]16,18]. However, contrary to our expectations, the risk of a generalized anxiety disorder (GAD) was significantly higher in Polish than in international students (42% vs. 31%, respectively). This result seems paradoxical; however, the data suggest that international students can cope with stress better than Polish students. Integrating with a group of similar people (i.e., other international students) may protect their mental health and reduce the exacerbation of harmful anxiety symptoms. Research indicates that solid intragroup ties could reduce anxiety during the pandemic and serve as a "social medicine" [24].
International students perceived the threat of the spreading viral disease as greater than Polish students did. It can be assumed that among international students, the fear of COVID-19 and its consequences was related to a greater misunderstanding of the pandemic situation and the counteractive actions by various responsible institutions in Poland. In addition, the policy of counteracting the pandemic in different countries worldwide was significantly distinct, which could also increase uncertainty and a sense of threat [44,45]. Greater fear of the coronavirus may have been also intensified by the separation of international students and distance from family and loved ones [1][2][3]5]. It can be supposed that the sense of danger was related to the excessive death rate in the first year of the pandemic. The high death rate in 2020 in Poland, compared to the 2016-2019 average, was 194 per 100,000 inhabitants. Therefore, it was a tragic year, especially in the region of Silesia, a precise local "hot spot" of the pandemic [33,46], where the University of Opole is located.
As expected, the significant predictors of the severity of anxiety symptoms among Polish and international students were stressors related to the perceived risk of COVID-19 and discrimination experiences. Thus, our study confirmed the role of stress factors in the development of anxiety in students caused by the pandemic [10,[13][14][15]. The study results also emphasized the harmful mental health role of the stress of discrimination among students, which has not been often reported by the Polish researchers, even before the pandemic [47,48].
Finally, our outcomes suggest that a generalized sense of social support during the pandemic alleviated symptoms of anxiety among university students. Researchers from other countries observed comparable results [19,20]. The findings confirm the existing knowledge that the perception of support from family and friends improves coping effectiveness, reduces distress, improves mood, and buffers the development of psychopathology symptoms [21]. Most of our respondents continued their education in family homes during the pandemic, which made direct contact with friends and acquaintances difficult. These difficulties were partly overcome through contacts in the network [47][48][49][50].

Limitations
One limitation of this study is its cross-sectional nature, making it impossible to infer causality. However, the biggest drawback is the small number of international students, which makes it challenging to draw generalized conclusions. In the subsequent study, other approaches should be used to encourage international students to participate in the survey. Additionally, more women than men participated in the survey, making it difficult to draw conclusions about the entire student population. The online survey may have also attracted people with psychological problems during the pandemic who wanted to share them with researchers. The disadvantage of the online survey methodology is the need for more control over who completes it. Moreover, only self-report questionnaires were used. Therefore, our results only indicate risk and cannot replace a reliable psychological diagnosis. The limitations of the quantitative study did not allow us to collect in-depth, detailed data on student discrimination. In the future, qualitative research is proposed to more accurately answer our research questions, so we can gain better insights into the issues explored.

Conclusions
In summary, the results of the presented study confirmed some existing findings regarding the mental health of university students in Poland during the coronavirus pandemic revealed new relationships and neglected research areas, and led to important conclusions. First, far more support is needed from universities hosting foreign students [47]. The high prevalence of ethnic discrimination experiences, especially among international students, and the high level of anxiety symptoms require vigorous action. Among the most important trends nowadays is the so-called student exchange between countries and internationalization of universities. From this perspective, it seems obvious that students moving to a foreign country need help adapting to the new culture [48,49]. Positive adaptation to a foreign culture is conducive to students' well-being. Thus, introducing more antidiscriminatory educational programs for universities, including students and lecturers, is recommended. Well-designed programs improve the understanding of the problems faced by students, help them cope with discrimination and prejudice better, and allow them to enjoy all aspects of student life [50].