Prevalence of common mental concerns and service utilization among international students studying in the U.S

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students

BACKGROUND

Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia.

METHODS

Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels.

RESULTS

Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information.

CONCLUSIONS

Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Culturally contextualized suicide prevention for international students: new opportunities for research and practice

The rising incidence of suicide-related thoughts and behaviors among international students presents a significant public health challenge and growing concern among college campuses. Current intervention strategies often rely on Western-centric and colonized approaches developed and tested with primarily Western, Educated, Industrialized, Rich and Democratic (WEIRD) samples. Exclusion and historical underrepresentation of ethnoracially minoritized groups in suicide prevention treatment trials create gaps in advancing our science because they often miss the cultural contextualization crucial for effective prevention and intervention in diverse groups from different countries of origin. To address the limitations of these Western-centric strategies, we explored existing prevention recommendations and approaches through the lens of an expanded version of the newly developed Protective Factors Framework, tailored for non-Western cultural perspectives. We propose significant opportunities for enhancing current practices and point to promising future directions. The primary areas for development include: (1) bolstering community empowerment and ownership, (2) refining mechanisms of change to encompass multicultural viewpoints, and (3) focusing on effective implementation and thorough evaluation for ongoing refinement. This methodology not only shows promise for enhancing international student suicide prevention but also offers insights for broader application in suicide prevention among other culturally diverse populations.

International student stressors and mental health during the COVID-19 pandemic: a qualitative study

OBJECTIVE

To identify stressors affecting international students' mental health during the COVID-19 pandemic.

PARTICIPANTS

Twenty-two international students from 10 countries and 17 US institutions participated.

METHODS

Participants were recruited from a larger study examining the wellbeing of young adults during the pandemic.

RESULTS

Four main stressors were identified: (1) Uncertainty and anxiety induced by decisions and policies in response to COVID-19; (2) Fears regarding xenophobia; (3) Limited understanding by educators and school staff of international students' unique challenges; (4) Greater awareness of racial and cultural identity.

CONCLUSION

The pandemic has contributed to additional stressors for international students. Educators and mental health professionals may help support international students' mental health by gaining basic knowledge about common stressors and directly acknowledging the challenges, educating international students on race and racism and supporting anti-racism efforts, and encouraging the creation of shared affinity spaces and increasing psychoeducation to promote resilience.

Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review

BACKGROUND

Immigrant students face various challenges in high-income countries that can contribute to the decline of their mental well-being upon arrival in their host country. Despite the growing population of these students in several high-income countries, there is inadequate attention given to their mental health needs and their access to mental health services. Thus, this systematic scoping review aimed to identify gaps in existing research relating to the barriers and facilitators associated with access to and use of mental health services in high-income countries.

METHODS

Following the PRISMA-ScR checklist as guidance we systematically searched Ovid Medline, APA PsycInfo, Education Source, CINAHL, Web of Science databases for peer reviewed articles related to barriers and facilitators of mental health service use among immigrant students. We conducted a narrative evidence synthesis to highlight barriers and facilitators to the use of mental health services.

RESULTS

Out of the 2407 articles initially found, 47 studies met the inclusion criteria and were considered for this review. The increasing attention towards the mental health concerns of immigrant students and their access to mental health services is evident. However, various barriers like stigma, insufficient knowledge, or adherence to traditional gender roles (such as masculinity) hinder their utilization of these services. On the other hand, factors such as being a woman, having a strong sense of cultural adaptation, or possessing adequate mental health literacy serve as facilitators for accessing mental health services.

CONCLUSION

These students have unique experiences, and their needs are often unmet. To improve their mental health and use of mental health services, it is important to consider the barriers they face and their unique experience in their specific life context and to develop tailored prevention and intervention programs.

Measurement invariance and psychometric properties of the CCAPS-62 and -34 for international student clients

OBJECTIVES

International students attending universities in the United States may encounter psychological distress related to their adjustment and experiences studying in a new context and seek services from university counseling centers. Many centers use the Counseling Center Assessment of Psychological Symptoms (CCAPS) to measure psychological distress in college counseling centers. However, this scale has not been tested for measurement invariance with international students. Our purpose was to explore the measurement invariance of the CCAPS-62 and -34 for international students.

METHODS

We tested measurement invariance for both versions of the scale using data from over 107,000 university students in psychotherapy at university counseling centers. We also examined construct validity and internal consistency.

RESULTS

Invariance testing indicated the measurement models of the CCAPS-62 and -34 are equivalent between both groups.

CONCLUSION

These findings are discussed in light of utilizing this widely-used scale in United States university/college counseling centers with international student clients.