Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted university teaching globally. The mental health impacts on international university students have been overlooked.Aims: This study examined the differences in COVID-19-related stressors and mental health impacts between international university students studying in the UK or USA who returned to their home country or region (returnees) and those who stayed in their institution country (stayers), and identified COVID-19-related stressors and coping strategies that were predictors of mental health.Method: An online questionnaire survey was conducted from April 28 through May 12, 2020 using an exponential, non-discriminative snowball sampling strategy (registered at the National Institutes of Health: NCT04365361).Results: A total of 124 full-time international university students (36.3% male) were included: 75.8% had returned to their home country or region for reasons related to COVID-19; 77.4% were pursuing a bachelor's program, and 53.2% were in programs with practicum component. 84.7% of all students had moderate-to-high perceived stress, 12.1% had moderate-to-severe symptoms of anxiety and depression, and 17.7% had moderate-to-severe symptoms of insomnia. Compared with returnees, stayers had significantly higher stress from COVID-19-related stressors such as personal health and lack of social support (Cohen's d: 0.57–1.11), higher perceived stress [10-item Perceived Stress Scale (PSS-10)] {22.6 ± 6.2 vs. 19.1 ± 6.1, β [95% confidence interval (CI)]: 4.039 (0.816, 7.261), Cohen's d: 0.52}, and more severe insomnia symptoms [Insomnia Severity Index (ISI)] [11.8 ± 6.1 vs. 7.6 ± 5.2, β (95% CI): 3.087 (0.262, 5.912), Cohen's d: 0.45], with moderate-to-large effect sizes. Compared with males, females reported significantly higher stress from uncertainties about academic program (Cohen's d: 0.45) with a small effect size. In the total sample, stress related to academics (e.g., personal attainment, uncertainties about academic program, and changes in teaching/learning format), health (including personal health and health of family and friends), availability of reliable COVID-19-related information, and lack of social support predicted more negative mental health impacts. Resilience, positive thinking, and exercise were predictors of less severe mental health impacts.Conclusions: Stayers experienced more adverse mental health impacts than returnees. We call on educators and mental health professionals to provide appropriate support for international students, particularly the stayers, during the pandemic.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has aroused fear and anxiety globally, which may lead to an upsurge in the incidence and severity of mental health problems [1]
The current study focused on international students, some of whom stayed in their institution country and some of whom returned to their home country or region during the COVID-19 pandemic during the COVID-19 outbreaks
Of the 124 students included, 36.3% were males, 86.3% were aged 18–25 years, and 41.9% were final-year students; 77.4% were pursuing a bachelor’s program, 46.0% were pursuing medical or health-related programs, and 53.2% were in programs with practicum component; 75.8% had returned to their home country or region for reasons related to COVID-19
Summary
The coronavirus disease 2019 (COVID-19) pandemic has aroused fear and anxiety globally, which may lead to an upsurge in the incidence and severity of mental health problems [1]. Up to now (mid-June 2020), many universities are still uncertain about how long such measures will continue, and it is unclear how these changes have affected students. Such disruptions due to the COVID-19 pandemic can exert unique additional pressures, adversely affecting students’ mental health, with impacts including increased stress, anxiety, and depression [3, 4]. Ongoing stress can affect academic performance as well as mental well-being [7] Such stress may have a disproportionate impact on females compared with males. The mental health impacts on international university students have been overlooked
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