Internationalization and Its Discontents: Help-Seeking Behaviors of Students in a Multicultural Environment Regarding Acculturative Stress and Depression
Round 1
Reviewer 1 Report
The subject under study is of great relevance in the current contexts of globalization and internationalization. These types of studies are very important, since the phenomenon of student mobility is relatively recent. I congratulate the authors for the subject worked and for its scientific rigor in the methodology used. The paper is easy to read and the bibliography used is current and relevant. The methodology heading contains all the necessary information for the reader.
However, the initial paper structure could be improved (it is not necessary to include more information but to restructure it).
My recommendations and suggestions are:
- Abstract: It is very extensive and complicated to read when containing references to statistical results. It is advisable not to divide it into sections and in the results to eliminate references to B, the results must be brief and are the main conclusions of the investigation. The objective, could be described more clearly, in the abstract it is difficult to get a clear idea of what it is. In the methodology of the abstract it would be more correct not to put the scales (it makes reading difficult) but to briefly expose the statistical techniques to be used; Anova and polynomial regression.
- In the introduction the authors expose the theoretical framework of the research. It would be more correct to put two sections:
1. Introduction: in it contextualize briefly the subject matter of study, which was studied on the subject other researchers? and thus detect the gap that justifies the completion of the study. What is the novelty of the study? For whom will the results be valuable? Include in this section the objective / s, mention very briefly who the target population is, the sample obtained and the statistical techniques to be used to fulfill the objective. Include a final paragraph describing the sections into which the work is divided.
2. Theoretical framework: with the rest of the information, contained in the introduction, build the theoretical framework.
It is not necessary to include more information than the one already existing in the current paper status. But if it is advised to reorder it to facilitate the reading and clarify the investigation.
Author Response
Letter of detailed responses to Reviewer 2
Dear Sir/Madam,
Thank you very much for spending a great amount of time and effort you have put in to reviewing our manuscript. Your detailed comments have helped us improve the quality of our paper.
We have addressed your points in our revised version. Please notice that in the revised paper, the parts that are highlighted in yellow is for correction on the old text, the parts highlighted in green is written anew. Below are our answers to your comments (in italic). Also, the line numbers in the text refer to the revised paper.
Abstract
please adjust the information: in the title the authors focus on students in a multicultural environment. In the conclusion of the abstract it is mentioned that " This study points out the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked. The study also provides empirical evidences for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress" and in Results section it is analysed both domestic and international students. The authors should adjust the title, the abstract in order to perfectly reflect the content of the manuscript.
please revise the manuscript in order to clearly present if it is about domestic students in a multicultural environment, international students in the Japanese culture or a comparative study.
Thank you for your suggestions. We have edited the abstract for better fitting with the title and the manuscript as follows (line 17 – 34):
“Abstract: Stress and depression can be seen as the major obstacles for sustained education and attainment of foreign students, and in turn, the sustainability of an education system as a whole. However, the mainstream consideration of scholars that follow Berry’s model on acculturation does not take into account whether students of the host countries are immune to these problems. This study aims to examine the prevalence and predictors of help-seeking behaviors among international and domestic students in a multicultural environment by employing ANOVA and polynomial regression. Some significant results from this study are: (1) Informal sources are the most prevalent sources of help-seeking among international and domestic students, while formal help-seeking sources were not popular; (2) international students are more likely to overcome emotional difficulties alone and seek help on Internet than domestic students; (3) acculturative stress was a positive predictor of formal, informal, and miscellaneous help-seeking behaviors among international students and informal help-seeking behave or among domestic students; and (4) depression is negatively correlated with the willingness of international students to seek help from informal sources. From these findings, the current study points out the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked and the lack of help-seeking sources for international students. The study also provides empirical evidences for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress.”
Methodology
please revise: lines 227-228: " Second, the questionnaire has been used in studies of university students in many countries around the world, such as United States, Japan, China, New Zealand, Ethiopia and Trinidad and Tobago". This is not " many", so please add also some other studies all over the world.
Thank you for pointing this out. We have revised the statement as follows (line 228 – 230)
“Second, the questionnaire has been used in studies of university students in some countries around the world, such as United States, Japan, China, New Zealand, Ethiopia and Trinidad and Tobago [59,61–63,7].”
Results
please explain "professionals" because the authors considered "doctors" as a separate category.
Thank you for pointing this out. Because we already explained “mental health professionals” in section 2.5.1, we have added “mental health” before the “professionals” which is confusing to enhance the clarity. For example (line 322 – 324):
“Even though the percentage of international students looking to mental health professionals and doctors for emotional help were higher than domestic students, the difference was negligible (see Figure 1).
some interpretations of the results are logical, like: international students are less likely to look for help of their parents. It is an obvious fact because they are away from their family (ex: see page 11 and others).
considered the previous comment also for the following result: "Within formal sources, mental health professionals, such as psychologist, social worker, and counselor, seemed to be a more popular emotional help-seeking source than doctor and GP among both international students"" (lines 322-324). It is quite logical to look for emotional help to the psychologist, social worker or counselor, than doctors or GP. So, I recommend to carefully interpret/resent the results (this is not an extraordinary finding, but a normal one).
Thank you for your recommendation. As we wish to carefully explain all the findings in the Results section and indicate only extraordinary findings in the Abstract and Discussion sections, we would like to present the result as it is. On the other hand, to enhance the interpretation, we have added a paragraph explaining the structure and our intention in each section (line 67 – 71).
“In next sub-sections, the literature review on help-seeking behaviors among international and domestic students is conducted to clarify the objectives of the current study. Materials and methods being employed in this study is described in section 2, while all findings from the statistical analysis are carefully and clearly explained in section 3. In the Discussion section, most important findings are highlighted and discussed on the basis of other theoretical frameworks and empirical results.”
some issues related to Japanese culture should be taken into consideration when it comes about acculturative stress and depression among international students.
socio-demographic data considered for this research are not enough. are only these variables important for the level of accculturative stress or depression: religion or the time spent? Gender, age English proefficiency and having a intimate partner. Some other variables are more important for depression and acculturative stress.
Thank you very much for your comments. In this study, we would like to concentrate on thoroughly examining the prevalence and the predictors of the help-seeking behaviors. Level of acculturative stress and depression were used as independent variables in our analysis, so including the impact of socio-demographic data on depression and acculturative stress might make the study become confusing. However, we have carefully explained the effects of socio-demographic factors on help-seeking behaviors in the Discussion section as follows:
“The impact of socio-demographic factors on help-seeking behavior was also examined in this study. English proficiency, having intimate partner, gender, and age were significant predictors of several informal and miscellaneous sources of help-seeking. English proficiency was found to have positive effect on intention to seek help from friends and intimate partner, since it helps students to communicate more coherently and effectively with their friends and intimate partner. Male domestic students were less likely to seek help from parents. Japanese males do not want to express their emotions [94] and are expected to act according to traditional constructs of masculinity [95], so whenever facing emotional difficulties Japanese males are less likely to seek help from their family, specially their parents.
Age was also a significant predictor of help-seeking behavior in this research, but it showed opposite effects on international and domestic student samples. Older international students were less willing to deal with emotional problems alone, while older domestic students were more preferable to overcome emotional difficulties alone and less likely to seek help from friends. The correlation between age and willingness for self-help among international students might be hard to explain due to the dynamic of cultural difference, but that among domestic students, it might be explained by Japanese culture. In Japan, the pressure of “growing up” makes teenagers want to stay alone and isolated and spend more time with keitai (phone) [96]. This might explain the positive association between age and willingness to deal with emotional problems alone and the negative association between age and likeliness to seek help from friends, among domestic Japanese students.”
Limitations and Recommendations
please insert all limitations of the study: the fact that there is a big difference in the number of the investigation domestic and international students (25% to 75%)...also related to the results considering gender. Also, the study was not considered aspects related to the mental health (except depression) - very important for the level of acculturative stress or seeking-help behaviors (or personality traits that were not investigated and could be an important variable for depression, acculturative stress and help-seeking behavior). So please add strengths and limitations of the study (including the fact that students are coming from Asian countries and not from very different cultures)
Explain the context, so the results cannot be generalized. The international students considered for this research are coming from Asian countries.
Thank you very much for your useful guidance. We have added the Limitations and Recommendations at the end of the paper based on your suggestion.
“This study has several limitations. The sampling method of this study is not random sampling; therefore, it cannot provide an equal selection chance for everyone, which might potentially lead to bias. Moreover, the mental health conditions were self-reported.
The results of this research should be used as a recommendation and should not be generalized for the following reasons: (1) the difference between the proportion of international and domestic students is large; (2) there are more males than females in the sample; (3) most of international students originating from Asian countries. This, in turn, suggest later meta-analysis for confirmation and generalization like the following work [97].
Except for depression and acculturative stress, other mental health conditions have not been included in the scope of this study. Further studies could take other types of mental health problems into account, such as anxiety, panic disorder, eating disorder, e.g. [98].”
We appreciate the hard work and time that you have spent on this manuscript. Your comments and suggestions have helped us improve the quality of our paper. We hope that the revised paper has met your requirements.
Please accept our sincere thanks for your great contributions to the improvement of higher studies on public health and the overall advancement of sciences in the world.
Shall you have further comments, we look forward to hearing from you.
Best regards,
Author Response File: 
Author Response.docx
Reviewer 2 Report
Thank you for the opportunity to review this article. This is a interesting topic and many studies focused on this subject, in all over the world, with the purpose to increase the help-seeking behaviors among internationals students.
Some comments in order to be considered for the next review of the manuscript:
please explain "professionals" because the authors considered "doctors" as a separate category.
some interpretations of the results are logical, like: international students are less likely to look for help of their parents. It is an obvious fact because they are away from their family (ex: see page 11 and others).
considered the previous comment also for the following result: "Within formal sources, mental health professionals, such as psychologist, social worker, and counsellor, seemed to be a more popular emotional help-seeking source than doctor and GP among both international students"" (lines 322-324). It is quite logical to look for emotional help to the psychologist, social worker or counselor, than doctors or GP. So, I recommend to carefully interpret/resent the results (this is not an extraordinary findings, but a normal one).
please adjust the information: in the title the authors focus on students in a multicultural environment. In the conclusion of the abstract it is mentioned that " This study points out the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked. The study also provides empirical evidences for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress" and in Results section it is analysed both domestic and international students. The authors should adjust the title, the abstract in order to perfectly reflect the content of the manuscript.
some issues related to Japanese culture should be taken into consideration when it comes about acculturative stress and depression among international students.
socio-demographic data considered for this research are not enough. are only these variables important for the level of accculturative stress or depression: religion or the time spent? Gender, age English proefficiency and having a intimate partner. Some other variables are more important for depression and acculturative stress.
please insert all limitations of the study: the fact that there is a big difference in the number of the investigation domestic and international students (25% to 75%)...also related to the results considering gender. Also, the study was not considered aspects related to the mental health (except depression) - very important for the level of acculturative stress or seeking-help behaviors (or personality traits that were not investigated and could be an important variable for depression, acculturative stress and help-seeking behavior). So please add strengths and limitations of the study (including the fact that students are coming from Asian countries and not from very different cultures)
Explain the context,s o the results cannot be generalized. The international students considered for this research are coming from Asian countries.
please revise: lines 227-228: " Second, the questionnaire has been used in studies of university students in many countries around the world, such as United States, Japan, China, New Zealand, Ethiopia and Trinidad and Tobago". This is not " many", so please add also some other studies all over the world.
a presentation of comparative results is necessary - as a literature review in Introduction or in Discussion section.
please revise the manuscript in order to clearly present if it is about domestic students in a multicultural environment, international students in the Japanese culture or a comparative study.
Author Response
Letter of detailed responses to Reviewer 2
Dear Sir/Madam,
Thank you very much for spending a great amount of time and effort you have put in to reviewing our manuscript. Your detailed comments have helped us improve the quality of our paper.
We have addressed your points in our revised version. Please notice that in the revised paper, the parts that are highlighted in yellow is for correction on the old text, the parts highlighted in green is written anew. Below are our answers to your comments (in italic). Also, the line numbers in the text refer to the revised paper.
Abstract
please adjust the information: in the title the authors focus on students in a multicultural environment. In the conclusion of the abstract it is mentioned that " This study points out the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked. The study also provides empirical evidences for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress" and in Results section it is analysed both domestic and international students. The authors should adjust the title, the abstract in order to perfectly reflect the content of the manuscript.
please revise the manuscript in order to clearly present if it is about domestic students in a multicultural environment, international students in the Japanese culture or a comparative study.
Thank you for your suggestions. We have edited the abstract for better fitting with the title and the manuscript as follows (line 17 – 34):
“Abstract: Stress and depression can be seen as the major obstacles for sustained education and attainment of foreign students, and in turn, the sustainability of an education system as a whole. However, the mainstream consideration of scholars that follow Berry’s model on acculturation does not take into account whether students of the host countries are immune to these problems. This study aims to examine the prevalence and predictors of help-seeking behaviors among international and domestic students in a multicultural environment by employing ANOVA and polynomial regression. Some significant results from this study are: (1) Informal sources are the most prevalent sources of help-seeking among international and domestic students, while formal help-seeking sources were not popular; (2) international students are more likely to overcome emotional difficulties alone and seek help on Internet than domestic students; (3) acculturative stress was a positive predictor of formal, informal, and miscellaneous help-seeking behaviors among international students and informal help-seeking behave or among domestic students; and (4) depression is negatively correlated with the willingness of international students to seek help from informal sources. From these findings, the current study points out the risk of acculturative stress faced by domestic students in a multicultural environment being overlooked and the lack of help-seeking sources for international students. The study also provides empirical evidences for policy-planners to design a sustainable education system better at supporting students dealing with depression and acculturative stress.”
Methodology
please revise: lines 227-228: " Second, the questionnaire has been used in studies of university students in many countries around the world, such as United States, Japan, China, New Zealand, Ethiopia and Trinidad and Tobago". This is not " many", so please add also some other studies all over the world.
Thank you for pointing this out. We have revised the statement as follows (line 228 – 230)
“Second, the questionnaire has been used in studies of university students in some countries around the world, such as United States, Japan, China, New Zealand, Ethiopia and Trinidad and Tobago [59,61–63,7].”
Results
please explain "professionals" because the authors considered "doctors" as a separate category.
Thank you for pointing this out. Because we already explained “mental health professionals” in section 2.5.1, we have added “mental health” before the “professionals” which is confusing to enhance the clarity. For example (line 322 – 324):
“Even though the percentage of international students looking to mental health professionals and doctors for emotional help were higher than domestic students, the difference was negligible (see Figure 1).
some interpretations of the results are logical, like: international students are less likely to look for help of their parents. It is an obvious fact because they are away from their family (ex: see page 11 and others).
considered the previous comment also for the following result: "Within formal sources, mental health professionals, such as psychologist, social worker, and counsellor, seemed to be a more popular emotional help-seeking source than doctor and GP among both international students"" (lines 322-324). It is quite logical to look for emotional help to the psychologist, social worker or counselor, than doctors or GP. So, I recommend to carefully interpret/resent the results (this is not an extraordinary finding, but a normal one).
Thank you for your recommendation. As we wish to carefully explain all the findings in the Results section and indicate only extraordinary findings in the Abstract and Discussion sections, we would like to present the result as it is. On the other hand, to enhance the interpretation, we have added a paragraph explaining the structure and our intention in each section (line 67 – 71).
“In next sub-sections, the literature review on help-seeking behaviors among international and domestic students is conducted to clarify the objectives of the current study. Materials and methods being employed in this study is described in section 2, while all findings from the statistical analysis are carefully and clearly explained in section 3. In the Discussion section, most important findings are highlighted and discussed on the basis of other theoretical frameworks and empirical results.”
some issues related to Japanese culture should be taken into consideration when it comes about acculturative stress and depression among international students.
socio-demographic data considered for this research are not enough. are only these variables important for the level of accculturative stress or depression: religion or the time spent? Gender, age English proefficiency and having a intimate partner. Some other variables are more important for depression and acculturative stress.
Thank you very much for your comments. In this study, we would like to concentrate on thoroughly examining the prevalence and the predictors of the help-seeking behaviors. Level of acculturative stress and depression were used as independent variables in our analysis, so including the impact of socio-demographic data on depression and acculturative stress might make the study become confusing. However, we have carefully explained the effects of socio-demographic factors on help-seeking behaviors in the Discussion section as follows:
“The impact of socio-demographic factors on help-seeking behavior was also examined in this study. English proficiency, having intimate partner, gender, and age were significant predictors of several informal and miscellaneous sources of help-seeking. English proficiency was found to have positive effect on intention to seek help from friends and intimate partner, since it helps students to communicate more coherently and effectively with their friends and intimate partner. Male domestic students were less likely to seek help from parents. Japanese males do not want to express their emotions [94] and are expected to act according to traditional constructs of masculinity [95], so whenever facing emotional difficulties Japanese males are less likely to seek help from their family, specially their parents.
Age was also a significant predictor of help-seeking behavior in this research, but it showed opposite effects on international and domestic student samples. Older international students were less willing to deal with emotional problems alone, while older domestic students were more preferable to overcome emotional difficulties alone and less likely to seek help from friends. The correlation between age and willingness for self-help among international students might be hard to explain due to the dynamic of cultural difference, but that among domestic students, it might be explained by Japanese culture. In Japan, the pressure of “growing up” makes teenagers want to stay alone and isolated and spend more time with keitai (phone) [96]. This might explain the positive association between age and willingness to deal with emotional problems alone and the negative association between age and likeliness to seek help from friends, among domestic Japanese students.”
Limitations and Recommendations
please insert all limitations of the study: the fact that there is a big difference in the number of the investigation domestic and international students (25% to 75%)...also related to the results considering gender. Also, the study was not considered aspects related to the mental health (except depression) - very important for the level of acculturative stress or seeking-help behaviors (or personality traits that were not investigated and could be an important variable for depression, acculturative stress and help-seeking behavior). So please add strengths and limitations of the study (including the fact that students are coming from Asian countries and not from very different cultures)
Explain the context, so the results cannot be generalized. The international students considered for this research are coming from Asian countries.
Thank you very much for your useful guidance. We have added the Limitations and Recommendations at the end of the paper based on your suggestion.
“This study has several limitations. The sampling method of this study is not random sampling; therefore, it cannot provide an equal selection chance for everyone, which might potentially lead to bias. Moreover, the mental health conditions were self-reported.
The results of this research should be used as a recommendation and should not be generalized for the following reasons: (1) the difference between the proportion of international and domestic students is large; (2) there are more males than females in the sample; (3) most of international students originating from Asian countries. This, in turn, suggest later meta-analysis for confirmation and generalization like the following work [97].
Except for depression and acculturative stress, other mental health conditions have not been included in the scope of this study. Further studies could take other types of mental health problems into account, such as anxiety, panic disorder, eating disorder, e.g. [98].
We appreciate the hard work and time that you have spent on this manuscript. Your comments and suggestions have helped us improve the quality of our paper. We hope that the revised paper has met your requirements.
Please accept our sincere thanks for your great contributions to the improvement of higher studies on public health and the overall advancement of sciences in the world.
Shall you have further comments, we look forward to hearing from you.
Best regards,
Author Response File: Author Response.docx
