Study Abroad Angst: A Literature Review on the Mental Health of International Students During COVID-19
Abstract
:1. Introduction
2. Methods
2.1. Overview
2.2. Search Strategy
- Two terms for the population:
- international studen*
- foreign studen*
- Four terms for the circumstance:
- pandemic
- COVI*
- Coronavirus
- SARS-CoV-2
- Five terms concerning the mental-health-related dimensions:
- depress*
- stres*
- anxiety
- psychological
- mental health
2.3. Inclusion and Exclusion Criteria
- Studies that directly examined mental health outcomes during the COVID-19 pandemic, such as depression, anxiety, and psychological stress, empirically among international higher education students.
- Empirical research that treated international students as a distinct group.
- Peer-reviewed articles published in English between March 2020 and June 2024.
- Research that did not articulate the COVID-19 pandemic as a focus when discussing mental health.
- Studies that did not provide sufficient differentiation between international and domestic university students (e.g., studies that noted that the participants included both domestic and international students but did not differentiate them otherwise when reporting results).
- Non-empirical publications (e.g., perspective papers, editorials, letters to the editor, etc.).
- Studies that did not explicitly analyze dimensions concerning mental health among the variables.
2.4. Results of the Literature Screening
2.5. Thematic Analysis Framework
- Familiarization with the data: The selected studies were examined closely to ensure a proper understanding of the content. Notes were taken on recurring concepts related to international students’ mental health during the pandemic.
- Generating a coding scheme: A coding scheme was developed to identify notable aspects of the data related to the mental health impacts on international students during the pandemic. The codes captured key themes such as “social isolation”, “academic stress”, “financial insecurity”, and “discrimination”.
- Identifying themes: The codes were then clustered into broader themes. Codes related to “financial stress” and “paying for groceries”, for instance, were clustered together to constitute a theme of “financial concerns and food insecurity”.
- Reviewing themes: The themes were then reviewed and refined by the authors to ensure they accurately represented the data in a logically sound manner. At this stage, certain themes were merged or eliminated based on relevance. Cross-checking was performed between the themes and the original articles, based on the article summaries created, so that no key elements were overlooked.
- Defining and naming themes: Upon the themes being firmly established, clear definitions were created for each theme to ensure fair characterization of the results being reviewed. For example, “social isolation” entailed feelings of loneliness, lack of peer support, and difficulty in maintaining social connections due to lockdowns and digital conversions. Each theme was then named succinctly for ease of reference in the final analysis and reporting.
- Report production: Finally, the themes were interpreted and integrated into the narrative, providing a coherent synthesis of the literature. The analysis focused primarily on how these themes reflected the unique challenges faced by international students during the pandemic as they pertained to their mental health, offering insights and potential implications for student care.
- Expectation 1: Specific factors, such as social isolation, financial insecurity, and discrimination, contributed to the relationship between the COVID-19 pandemic and mental health outcomes in international students.
- Expectation 2: International students experienced a greater decline in mental health during the COVID-19 pandemic compared to domestic students.
- Expectation 3: The negative mental health effects of the COVID-19 pandemic on international students persisted beyond the acute phase of the pandemic.
3. Results
3.1. Overview and Analytical Strategy
- Theme 1. Academic and professional challenges
- Theme 2. Visa and residency concerns
- Theme 3. Social isolation and loss of support networks
- Theme 4. Living arrangements
- Theme 5. Financial and food insecurity
- Theme 6. Health concerns for self and loved ones
- Theme 7. Actual, anticipated, or vicarious discrimination and xenophobia
3.2. Summary of the Results
4. Discussion
- Theme 1. Academic and professional challenges
- Enhanced communication: Establish robust, transparent, regular, and timely communication channels to keep international students informed about changes in student visa requirements, academic policies, graduation requirements, and available support services. Regular updates and clear guidelines can help reduce uncertainty, frustration, and anxiety.
- Flexible academic policies: Introduce and widely disseminate more flexible academic policies that accommodate the academic challenges that international students may face, such as extended deadlines and pass/fail options, keeping in mind that international students’ eligibility to stay in their destination countries usually hinges heavily on their successful and uninterrupted academic progress as full-time students. These policies, when announced swiftly, can help students manage stress linked to their academic responsibilities more effectively during uncertain times without diluting their learning experiences.
- Career services, professional development, and online learning support: Enhance career services to support students in finding internships and job opportunities, even remotely. This includes virtual job fairs, resume-building workshops, and networking events. Since many international students find it essential to secure internships or employment upon graduation in the host country, this is critical in addressing the concerns widely cited by these students. Additionally, offer comprehensive training and technical support for online learning platforms to help students navigate the environment effectively, alleviating the frustration associated with remote learning. Both faculty and administrative staff should be briefed on these matters, so as to provide cohesive and comprehensive student support for international students.
- Theme 2. Visa and residency concerns
- Develop clear and proactive communication strategies specifically aligned with evolving government policies and the often chaotic flow of information regarding such relevant issues as visa regulations and travel restrictions, along with other information of particular interest to international students—all consolidated in one location (such as a special website). Ensuring that international students receive timely and accurate information in response to these changing circumstances can alleviate anxiety and uncertainty related to their legal status and academic progress—in clear language.
- Advocating for realistic, flexible and equitable student visa policies: Universities should actively engage with government bodies to advocate for more realistic, flexible and equitable student visa policies that recognize the unique challenges faced by international students during global crises. This advocacy should explicitly oppose measures such as those proposed in 2020 in the US, which mandated in-person course enrollment for international students to maintain their visa status, regardless of public health concerns or institutional capacity. Such policies disregard the realistic needs and circumstances of international students, potentially jeopardizing their academic progress. Universities can support students by providing documentation and evidence of academic progress and individual needs to immigration authorities, facilitating a more adaptable and compassionate approach to visa and residency requirements. This advocacy requires long-term planning and commitment to ensuring that student visa policies are responsive to the realities of international education and prioritize the well-being and academic success of international students.
- Specialized support services: Establish specialized support services focused on the legal and logistical challenges faced by international students. Providing resources such as legal advice on visa issues, assistance with travel arrangements, and guidance on navigating bureaucratic processes can help students maintain their residency status and academic standing more effectively.
- Theme 3. Social isolation and loss of support networks
- Fostering virtual communities and affinity-based support networks when face-to-face interactions are difficult: Develop robust virtual platforms that facilitate social interactions and peer support among international students, even when in-person events are impractical. This intervention is particularly promising, as recent research has demonstrated how digital platforms could serve to promote mental health among university students [16]. These platforms should support the formation of affinity-based groups based on shared hobbies, professional interests, support needs, race/ethnicity, culture, and other relevant dimensions. Informal and formal virtual events, online clubs, and peer mentoring programs can help mitigate feelings of isolation by fostering a sense of community and belonging tailored to the diverse backgrounds and interests of students. Although the findings around engagement in physical exercise are mixed in the current context, basing social interactions around exercising could serve to minimize the adverse psychological consequences of social isolation.
- Improving mental health care access and reducing stigma: Establish comprehensive mental health services that are easily accessible and culturally responsive, not only in its practice but also in reach-out efforts. Provide virtual counseling, mental health hotlines, with multilingual considerations, and peer support groups to ensure that students receive the help they need. Additionally, implement campaigns to reduce the stigma associated with seeking mental health care, promoting a supportive environment where students feel comfortable reaching out for help.
- Theme 4. Living arrangements
- Universities should provide flexible housing options for international students, including single-occupancy rooms for those who are concerned about health risks and prefer to live alone. Similarly, group living options with enhanced health and safety protocols should also be explored to accommodate students who prefer to avoid living alone.
- Institutions should also consider offering virtual social activities and mental health resources, especially to students living alone, to reduce the negative impact of isolation. Tailored housing support based on individual needs: Given the mixed research findings regarding the benefits of living alone versus living with others, provide flexible housing options that accommodate the potentially varied preferences of international students. Offer both shared and private living arrangements and ensure that students are sufficiently well informed about these options to make choices that best suit their individual needs and expectations. Commuter universities, too, could establish housing support programs to address international students’ off-campus living needs, preferences, and expectations.
- Provide the means for safe and healthy living environments: Inform and implement measures to promote safe and healthy living conditions in shared accommodation, such as clear guidelines for regular sanitation, suggested methods of preventing the spread of infections, and providing personal protective equipment (PPE; such as disposable gloves, disinfectant cleaners, room dividers, and face shields). These measures can help alleviate concerns about health risks associated with shared living spaces.
- Theme 5. Financial and food insecurity
- Actively disseminating information on financial assistance, food-access programs, and flexible tuition and fee payment options: Provide clear and comprehensive information on potential assistance available to international students, including scholarships, grants, external funding sources, and community programs. Additionally, offer flexible payment deadlines, fee waivers, and installment plans to help students manage their financial obligations more effectively during crises.
- Ensuring access to food and basic necessities: Establish food pantries and meal programs on campus that are accessible to students, even during lockdowns, to the greatest extent possible. Partner with local food vendors and transportation services to ensure students have reliable access to affordable and nutritious food, regardless of their financial situation or logistical challenges.
- Financial literacy workshops: Offer workshops tailored to the specific financial challenges and needs of international students. These workshops can cover topics like budgeting, negotiating with landlords, managing debt, understanding the US credit system, accessing banking services, and navigating financial aid options.
- Connect with cultural organizations: Partner with cultural organizations and consulates that serve international student populations. These organizations might offer additional financial or food-access resources or support programs specifically for students from certain countries.
- Theme 6. Health concerns for self and loved ones
- Providing comprehensive health information and preventive strategies: Ensure that international students have access to accurate and practical information about COVID-19 and other health concerns, especially recognizing that they may be overwhelmed with the amount of information gathered through a wide range of sources. This should include succinct guidance on preventive measures, realistic expectations about symptoms, and updates on vaccination and testing. Additionally, offer online health workshops and telehealth services to provide ongoing support and information, especially given that many international students are reluctant to seek such help.
- Reducing stigma and promoting mental health support: Implement campaigns to reduce the stigma associated with contracting COVID-19 and promote a supportive environment. This includes reach-out efforts by mental health support services, such as counseling and peer support groups, that are sensitive to the cultural and social needs of international students.
- Facilitating communication with family and support networks: Inform international students about effective strategies for maintaining regular communication with their families and support networks to minimize the psychological toll. Provide resources, such as information on free or subsidized internet access and communication tools, and emphasize the importance of staying connected to reduce anxiety and stress related to the health of their loved ones.
- Health insurance navigation: Assist international students in understanding their health insurance plans, navigating the healthcare system, and finding affordable healthcare options off-campus if needed. This could involve workshops, individual consultations, or online resources.
- Theme 7. Actual, anticipated, or vicarious discrimination and xenophobia
- Promoting cultural competency and raising awareness about xenophobia: Develop and disseminate information pertaining to comprehensive cultural competency designed to inform the university community about the harmful effects of racism and xenophobia, as well as the misdirected nature of hate toward specific groups. These programs should promote inclusivity, provide tools for recognizing and combating subtle forms of bias, and raise awareness about the specific challenges, in the case of the COVID-19 pandemic, faced by East Asian students during public health crises.
- Establishing support networks and facilitating open conversations: Universities should create a multifaceted support system. This begins with establishing clear and accessible reporting channels for incidents of discrimination and xenophobia, ensuring that students feel safe and empowered to report these incidents without fear of retaliation. Once reported, incidents must be followed up with robust support networks specifically for students from impacted backgrounds, such as those from East Asian communities. These networks can offer peer support, counseling services, and safe spaces for students to discuss their experiences and process their emotions. While local governments and community centers may offer similar resources, it is crucial that universities integrate these supports into their own systems to ensure accessibility, relevance, and a sense of institutional accountability. Beyond reactive support, universities should proactively facilitate open conversations and workshops on effectively dealing with xenophobia and hostility. These programs should empower students with strategies to navigate and cope with these challenges, fostering resilience and self-advocacy.
4.1. Additional Nuances and Considerations
4.2. Limitations and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Year | University Locations |
---|---|---|
Alam, M.D., Lu, J., Ni, L., Hu, S., and Xu, Y. [1] | 2021 | China |
Al-Oraibi, A., Fothergill, L., Yildirim, M., Knight, H., Carlisle, S., O’Connor, M., Briggs, L., Morling, J. R., Corner, J., Ball, J. K., Denning, C., Vedhara, K., and Blake, H. [13] | 2022 | UK |
Antwi, C. O., Belle, M. A., Ntim, S. Y., Wu, Y., Affum-Osei, E., Aboagye, M. O., and Ren, J. [32] | 2022 | China |
Cairns, D., França, T., Calvo, D. M., and De Azevedo, L. F. [11] | 2022 | Portugal |
Chen, Y., Shimamoto, K., Bando, T., and Tsuchiya, H. [33] | 2024 | Japan |
Collins, C., Haase, D., Heiland, S., and Kabisch, N. [34] | 2022 | Germany |
Collins, F. E. [18] | 2021 | Australia |
Dong, F., Hwang, Y., and Hodgson, N. A. [35] | 2023 | US |
Elemo, A. S., Ahmed, A. H., Kara, E., and Zerkeshi, M. K. [36] | 2022 | Turkey |
Gao, N., Eissenstat, S. J., Wacha-Montes, A., and Wang, Y. [37] | 2022 | US |
Ge, L. [38] | 2021 | Canada |
Iftikhar, S., Perceval, G., Fu, Y., Zhou, C., and Cao, Y. [2] | 2022 | China |
Jamshaid, S., Bahadar, N., Jamshed, K., Rashid, M., Imran Afzal, M., Tian, L., Umar, M., Feng, X., Khan, I., and Zong, M. [15] | 2023 | China |
Jamshaid, S., Olorundare, A., Wang, L., Lo-Ngoen, N., Afzal, M. I., and Bibi, M. [27] | 2022 | China |
Ke, T., Li, W., Sanci, L., Reavley, N., Williams, I., and Russell, M. A. [39] | 2023 | Australia |
Kim, H. R., and Kim, E. J. [40] | 2021 | South Korea |
King, J. A., Cabarkapa, S., Leow, F. H., and Ng, C. H. [41] | 2020 | Australia |
Kivelä, L., Mouthaan, J., Van Der Does, W., and Antypa, N. [42] | 2022 | The Netherlands |
Kwak, M., Kwon, E., Lo, L., and Jung, G. [43] | 2024 | Canada |
Lai, A. Y., Lee, L., Wang, M., Feng, Y., Lai, T. T., Ho, L., Lam, V. S., Ip, M. S., and Lam, T. [26] | 2020 | UK and US |
Lai, A. Y., Sit, S. M., Lam, S. K., Choi, A. C., Yiu, D. Y., Lai, T. T., Ip, M. S., and Lam, T. [6] | 2021 | UK and US |
Lin, C., Tong, Y., Bai, Y., Zhao, Z., Quan, W., Liu, Z., Wang, J., Song, Y., Tian, J., and Dong, W. [44] | 2022 | US |
Lu, G., Hu, S., Zhang, Y., Chen, J., Yuan, Y., Gong, X., and Zhang, Y. [45] | 2022 | China |
Lu, L., Wang, X., Wang, X., Guo, X., and Pan, B. [46] | 2022 | China |
Lynch, J., Gesing, P., and Cruz, N. [47] | 2023 | US |
Maleku, A., Kim, Y. K., Kirsch, J., Um, M. Y., Haran, H., Yu, M., and Moon, S. S. [48] | 2022 | US |
Martirosyan, N. M., Van De Walker, D., and Saxon, D. P. [49] | 2022 | US |
Mbous, Y. P. V., Mohamed, R., and Rudisill, T. M. [50] | 2022 | US |
Mihrshahi, S., Dharmayani, P. N. A., Amin, J., Bhatti, A., Chau, J. Y., Ronto, R., Turnip, D., and Taylor, M. [19] | 2022 | Australia |
Nadareishvili, I., Syunyakov, T., Smirnova, D., Sinauridze, A., Tskitishvili, A., Tskitishvili, A., Zhulina, A., Patsali, M. E., Manafis, A., Fountoulakis, N. K., and Fountoulakis, K. N. [21] | 2022 | Georgia (the nation of) |
Park, C., and Shimada, S. [12] | 2022 | US |
Prasath, P. R., Xiong, Y., Zhang, Q., and Jeon, L. [51] | 2022 | US |
Reena, I., Hebert, E., Das, K., Doe, R., Hebert, S., and Gope, N. [52] | 2023 | US |
Reid, C., Beckstead, J., and Salinas-Miranda, A. [53] | 2022 | US |
Rekenyi, V., Garbóczy, S., Szemán-Nagy, A., Al-Tammemi, A. B., Sayed-Ahmad, M., and Kolozsvári, L. R. [24] | 2023 | Hungary |
Russell, M. A., Reavley, N., Williams, I., Li, W., Tarzia, L., Chondros, P., and Sanci, L. [20] | 2023 | Australia |
Shek, D. T. L., Dou, D., and Zhu, X. [22] | 2022 | Hong Kong |
Song, B., Zhao, Y., and Zhu, J. [54] | 2020 | US |
Tan, S., and Sekercioglu, F. [55] | 2022 | Canada |
Tan, Y., Wu, Z., Qu, X., Liu, Y., Peng, L., Ge, Y., Li, S., Du, J., Tang, Q., Wang, J., Peng, X., Liao, J., Song, M., and Kang, J. [56] | 2022 | EU, Hong Kong, Macao, North America, Oceania, and Taiwan |
Tran, T. X., Vo, T. T. T., and Ho, C. [57] | 2023 | Taiwan |
Um, M. Y., Maleku, A., Haran, H., Kim, Y. K., Yu, M., and Moon, S. S. [58] | 2022 | US |
Wang, L. [59] | 2023 | Australia, Canada, EU, Hong Kong, Japan, Malaysia, UK, and US |
Wilczewski, M., Gorbaniuk, O., and Giuri, P. [25] | 2021 | Poland |
Xiong, Y., Prasath, P. R., Zhang, Q., and Jeon, L. [60] | 2022a | US |
Xiong, Y., Prasath, P. R., Zhang, Q., and Jeon, L. [61] | 2022b | US |
Yang, L., Kandasamy, K., and Na, R. [62] | 2021 | Canada |
Younis, I., Longsheng, C., Zulfiqar, M. I., Imran, M., Shah, S. A. A., Hussain, M., and Solangi, Y. A. [63] | 2021 | China |
Yu, L., Cao, Y., Wang, Y., Liu, T., MacDonald, A., Bian, F., Li, X., Wang, X., Zhang, Z., Wang, P. P., and Yang, L. [64] | 2023 | Canada |
Yuan, L., Lu, L., Wang, X., Qu, M., Gao, Y., and Pan, B. [23] | 2023 | China |
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Akiba, D.; Perrone, M.; Almendral, C. Study Abroad Angst: A Literature Review on the Mental Health of International Students During COVID-19. Int. J. Environ. Res. Public Health 2024, 21, 1562. https://doi.org/10.3390/ijerph21121562
Akiba D, Perrone M, Almendral C. Study Abroad Angst: A Literature Review on the Mental Health of International Students During COVID-19. International Journal of Environmental Research and Public Health. 2024; 21(12):1562. https://doi.org/10.3390/ijerph21121562
Chicago/Turabian StyleAkiba, Daisuke, Michael Perrone, and Caterina Almendral. 2024. "Study Abroad Angst: A Literature Review on the Mental Health of International Students During COVID-19" International Journal of Environmental Research and Public Health 21, no. 12: 1562. https://doi.org/10.3390/ijerph21121562
APA StyleAkiba, D., Perrone, M., & Almendral, C. (2024). Study Abroad Angst: A Literature Review on the Mental Health of International Students During COVID-19. International Journal of Environmental Research and Public Health, 21(12), 1562. https://doi.org/10.3390/ijerph21121562