Stranded overseas students need psychological help – Study

One of the first academic studies on the mental state of international students enrolled in Chinese universities but stranded outside the country for over two years due to the COVID-19 pandemic has found a widespread prevalence of mental health problems.

The students were of different nationalities registered at different universities in China, but “most participants reported psychological and social factors associated with mental health symptomology or risk”, according to the paper published this month in BioMed Central’s BMC Psychology journal.* The researchers used indicators to assess levels of stress, anxiety and depression.

The researchers, mainly based at Soochow University in Suzhou, eastern China, said “adequate intervention for this group is strongly recommended”.

“We built this research on the urgent need to investigate the mental health status of stranded international students during the pandemic. The significant finding of the current study was that the international travel restrictions were adversely affecting our participants’ mental health,” the research group led by Shandana Iftikhar at Soochow University said.

Hopelessness and uncertainty

The long break in studies led to a rise in risk factors, including a rise in hopelessness and levels of uncertainty. Other factors included worry, loss of interest and focus, lack of support, unemployment and financial hardships and social pressure. There were also behavioural and mood changes and sleep disorders, among other symptoms.

Hopelessness was identified as a risk factor for mental health. Other studies have shown that a high level of hopelessness in youngsters increases the risk of suicide and depression.

“These mental health problems will affect concentration and deep learning, thereby increasing academic stress,” according to the authors. “In addition, we found that the outbreak of the Delta variant in China [in July] led to a further increase in these mental health risk factors,” the authors added.

The participants reported a loss of interest and focus due to the prolonged interruption to their studies. Some stated that they were initially motivated, but their enthusiasm had waned since they were stranded in their countries. Even if they return, concentrating on their studies will be tough for them, and it will take some time for them to do so, the researchers noted.

The researchers received responses from more than 1,900 non-Chinese international students currently enrolled in Chinese universities but who had returned home during the outbreak and had been stranded for over two years. While China has allowed a limited number of students to return, mainly on specially chartered flights, the vast majority of international students are still outside the country.

The China International Student Union (CISU), which has been campaigning for them to return, found that more than half of the respondents (53%) in an online survey of 1,470 students in January reported experiencing “serious mental health issues” due to the Chinese visa ban, as well as hopelessness, stress, depression and anxiety.

Empirical evidence

The Soochow University study provides empirical evidence of this. Although responses were received from more than 1,900 non-Chinese international students currently enrolled in Chinese universities, due to time constraints, extensive individual interviews were limited to the students currently on scholarships, according to the Soochow researchers.

Among these students, Chinese government scholarships (CSC Scholarships) were awarded to 1,052, while 848 students had university scholarships. Some 34 stranded international students, 22 male, and 12 female, expressed an interest in participating, and longer interviews were conducted with some “until it was decided that the data information was rich and deep enough to successfully capture the study’s aims of diversity and depth”.

They included students from Pakistan, Vietnam, Indonesia, Russia and several countries in Africa including Nigeria and Sudan, with students at universities such as Shenzhen University, Soochow University, Dalian University of Technology, Hebei Normal University, Gansu Agricultural University, Donghua University Shanghai, Lanzhou University of Technology and Northwest Normal University.

Participants were mainly enrolled in engineering masters and PhD courses but also included students in subjects like business administration, environmental science, Chinese culture and social sciences. Only some were able to continue classes online.

Delta-variant impact

Participants said with the increased number of Delta-variant cases, their level of uncertainty was increased and their hopes of returning to China were dampened. They reported becoming more prone to negative thoughts.

“Their responses gave the impression that circumstances would probably never get better for them, and they would hardly be able to return. Negative future expectations might be described as hopelessness,” according to the researchers.

The level of uncertainty increased over time.

“It appears like I squandered four years of my life for no reason. I hoped before [that] things would get better, but now the virus [Delta variant] has come again, so I may never be able to return,” said a female PhD student from Pakistan, who added: “I am worried about my future; it looks like my future slipped out of my hands, and I cannot handle it … [I am] feeling helpless now.”

A female masters student from Nigeria said: “I am distraught with this entire situation. It seems like I lost my future. I do not think this will end soon.”

Financial and career concerns

Other factors contributing to participants’ mental stress were family, financial, study concerns and, most importantly, concerns about the future. Students were worried about completing their studies on time and believed they would be unable to achieve their goals, which would harm many of their other goals in the future, according to the researchers.

“Of course, future worries are growing day by day. There is a total despondency,” a male PhD student from Sudan said. “There are also a slew of other concerns, including finances, family, and obviously, our studies.”

“Everyone’s mental state is in shambles. We have heard that new cases are on the rise in various countries,” said a male masters student from Pakistan, adding: “It appears like our studies are getting longer, which is becoming unbearable.”

Some participants indicated suffering from mental stress due to the challenges in graduating and a lack of resources.

Some participants reported having stable employment before moving to China to commence their studies. Participants faced difficulties finding new jobs on returning to their home countries during the pandemic.

The participants associated their mental health with financial difficulties and unemployment.

“I was head of the department in a university when I got the scholarship [to China]. I quit my job and moved to China. I stayed there for only five months and came back due to the COVID-19 pandemic,” a student from Yemen said. “It is very challenging to get a job again in this [pandemic] circumstance.”

Students who returned to their homeland found their scholarship suspended temporarily, which became a cause of suffering. “The biggest challenge for me right now is my financial situation. It caused me mental distress. Due to the pandemic, there are not enough opportunities to work. I work online now, but I do not get paid well,” a male PhD student from Sudan said.

“Honestly, my current mental situation is very bad. Before going to China, I used to teach in a college. I signed a contract with them to re-join when I finished my studies. As long as I was getting the stipend, my financial condition was fine, but I have been in financial difficulties since our stipend was withheld,” said a female PhD student from Vietnam who is also a single parent. “Can you imagine my mental state in this situation? Moreover, the pandemic situation in my country is dire. It is tough to find a job here.”

Mood changes and aggression

After returning home, the students said they noticed mood changes and reported aggressiveness and irritability.

“Yes, I feel a change in my behaviour. I have never shouted at my siblings before, but now I do it often,” a female masters student from Tunisia said. “Yes, you can say that my attitude is very aggressive now.”

Students also reported sleep disorders and sleep disruption due to online classes. “They identified that sleep disorders and their associated mental illnesses are linked to changes in online class schedules and sleep-wake patterns,” the researchers found.

Participants also said lack of institutional support increased their stress.

“I would not be so depressed if I knew what would happen next. The situation is very unpredictable. If the pandemic remains like this, what will be the strategy for international students?” said a male PhD student from Yemen. “Due to the lack of information from the university side, I have now given up hope and [am] now looking for other opportunities,” he said.

Increased vulnerability of international students

The impact of COVID-19 on local university students’ mental health has been studied in several nations, including Bangladesh, China, the United States, Australia, Canada, Jordan and Germany. According to one study, 69.31% of university students in Bangladesh experienced mild to severe psychological effects as a result of the pandemic, as measured by an event-specific distress scale.

However, compared to domestic students, international students were found to be more vulnerable to mental health problems during the pandemic.

A study of international students at South Korean universities during the COVID-19 pandemic showed that the prevalence rates of sleep problems, anxiety and depression among international students were 47.1%, 39.6% and 49%, respectively.

Even under normal conditions, international students tend to be more vulnerable to mental health problems such as depression, according to researchers. International students also struggle with the local medical systems, and are less inclined to seek psychological help.

The Soochow researchers said their findings “highlight the need for mental health support services to be made available to promote these students’ emotional and psychological well-being in their home countries”. Phone-based counselling was one option, they said.

* Iftikhar, S, Perceval, G, Fu, Y et al. “Prevalence of mental health problems among stranded international students during the COVID-19 pandemic.” BMC Psychology 10, 211 (2022).