Culture Matters:
What prevents Chinese international students from seeking mental health support?
Over the past two decades, there’re millions of students overseas flooding into United States to seek higher education.
Origin of International Students Seeking Higher Education in the US
Among them, international student from China emerged as the largest group, now compromising 31% of the total (or 274,439 students) up from 11% in 2001, a near 5-fold proportional increase over the past 20 years.
However, among the prosperity, the mental health chanllenges facing the Chinese international students have become a significant crisis due to profound cross-cultural differences. As the minority on campus, they may face challenges and stress when living and studying far from their home country.
😢 Chinese International Students Reported Higher Depression & Anxiety Rate but Lower Support Seeking Rate
Source: American College Health Association (2010). National College Health Assessment II: Reference Group Data Report Fall 2009.
Han, X., Han, X., Luo, Q., Jacobs, S., & Jean-Baptiste, M. (2013). Report of a Mental Health Survey Among Chinese International Students at Yale University. Journal of American College Health, 61(1), 1–8.
Han, X., Han, X., Luo, Q., Jacobs, S., & Jean-Baptiste, M. (2013). Report of a Mental Health Survey Among Chinese International Students at Yale University. Journal of American College Health, 61(1), 1–8.
Compared to local U.S. students and Chinese students who do not travel abroad for their studies, Chinese international students are facing more impediments to maintaining their mental health.
Whereas the general rate of depressive symptoms among US college students is 12.8%, Chinese international students reported markedly higher rates of depressive symptoms to 45.4%.
Additionally, research showed that the COVID pandemic may exacerbate the psychological distress.
COVID Impact on Chinese International Students Mental Health Condition
Compared to the pre COVID period, Chinese international students exhibited both greater depression and anxiety level after the pandemic.
The depression rate increased from 45.4% to 72%, while anxiety rate more than doubled from 29.2% to 65.3%.
Researchers believed that this may be the result of a combination of pre-existing (e.g., culture shock, homesickness) and new stressors (e.g., surge in discrimination during COVID-19, attending online courses midnight in Beijing time zone, self-isolation in host country) that students in Chinese colleges do not face.
A more worrying fact is that although mental health challenges are more prevalent among Chinese international students on average, they underutilize campus mental health care services.
There are multiple factors that are believed to contribute to mental health challenges faced by international students; for example, homesickness, isolations, linguistic and communication barriers, academic roadblocks, culture shock, and potential racial discriminations, etc.
Most Common Factors Affecting International Students’ Mental Health Conditions and Help-Seeking Intentions
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However, except for those common factors shared by international students from all over the world, Chinese students are specifically affected by unique Asian cultures and values.
For example, many collectivistic Asian cultures emphasize hard work and academic achievement, not only as a personal accomplishment, but also as a family honor.
The traditional Confucian values also de-emphasize individual desires, and instead promote the fulfillment of family duties and expectations as a demonstration of maturity and filial piety.
Since many Chinese international students are funded by their families, they have to strive for perfection to meet their parents' wishes and justify the family’s financial sacrifice.
Therefore, Asian international students often experience higher pressure in their academic careers.
When they met difficulties in their academic performance or not passed exams, it is hard to accept the result different from their self-expectations. Shame, guilt, and worries arise quickly, and this "failure" can be hard to bear.
Another significant cultural factor is the saving face concern. Some Asian cultures believe that the symptoms of mental illness result from weaknesses in personality, and seeking counseling means exposing personal weaknesses (losing face) to others and bringing shame to the family.
Therefore, a large majority of these students from collectivistic culture would avoid seeking help from family or acknowledging problems so as not to cause disappointment or shame.
Instead, they may choose to keep problems to themselves and internalize their stress, contributing to depression, social anxiety, hopelessness, and suicidality.
Additionally, the common social stigma of mental illness also greatly hinders international students from seeking counseling services.
Many Asian cultures have equated mental disorders with severe illnesses, such as schizophrenia. Seeing a psychiatrist may mean admitting to a diagnosis of a severe psychiatric problem, and having a relative with a psychiatric diagnosis has been shown to have negative implications for potential marriages in China.
Given this, many international students are concerned about whether the information they share in counseling will be put on their records or affect their immigration statuses. This confidentiality issue also becomes a significant barrier for these students to seek professional help.
The linguistic barrier still makes it challenging for Chinese international students to utilize mental health services properly. Many Chinese international students choose not to call on- or off-campus offices out of the second language anxiety, including those that can offer resources for addressing mental health issues.
Significance of Cultural Factors
Researchers have found that self-stigma greatly suppressed Chinese international students’ mental health help-seeking intentions, while face concerns resulted in increasing mental health problems.
It is also found that student's perceived English proficiency had a significant influence on help-seeking intentions. When they are not confident in their English proficiency, they are less likely to seek help.
So these group of students are trapped in such a dilemma:
The low intention to seek help due to stigma resulting from face concerns may cause more incompetence in their academic progress and thus loses more face. Seeking help rather makes them feel incompetent, especially when they have self-stigma.
Let's hear some of their stories.
"It's really tough to get an appointment with the school’s counseling services – it’s always overcrowded, and you usually have to wait for one or two months. But the funny thing is, because I was dealing with harassment from my neighbor, the school gave me a special fast-track option. Whenever I needed it, I could see a counselor right away.
I told them that I wanted a counselor who’s a minority woman, and they found me a Latina female therapist. She’s actually quite nice, but I always feel exhausted after talking to her because she really doesn’t understand East Asians. For instance, one time, I had just finished my classes and then went for a job interview.
Afterward, I told her how tired I was. She said, “Why do you want this job? What attracts you to this company?” After I finished explaining, I felt completely drained. It was partly because of speaking in English and partly because her questions felt like another round of interviews, which was exhausting. So, I haven’t seen her again, but the doctor who prescribed medication for me is a very kind Taiwanese woman. She’s been a great help, and I’m truly grateful.
Now I believe that when it comes to work, you can go to a place where there are no Chinese people, and you can live in a place without any Chinese people. However, when it comes to counseling, you absolutely must find someone who speaks your language."
- A Chinese student posted on social media
"Just thinking of going for counseling and struggling to express my feelings and troubles in a second language makes me burn out."
- Comment by a Chinese student
"It's a hassle for me to get medicine abroad. Chatting with my personal tutor about academic issues is also tough. I haven't even thought about finding a foreign mental health doctor, even if it's free."
- Comment by a Chinese student
What can we do? Try out the dashboard to track the mental health challenges among international students.
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