When did you become cognizant of the mental health challenges facing Chinese international students and how did you become interested in this particular issue?
It happened quite organically, quite naturally, as I taught, advised, and supervised research with students. I encountered international Chinese students both as an instructor in the classroom and as an advisor, which is much more emotionally intimate, and they would talk about their dreams, their career goals, and some of the obstacles that they face. As a faculty member who engages in research, I also had students who wrote their master's thesis or doctoral dissertation with me, which is a long-term relationship. I learned a lot about their interests. Several students in the past were interested in researching mental health, mostly because of their own experiences and they wanted to know more.
Do you believe that Chinese international students face more mental health challenges in the US than students hailing from other countries? If so, what are the cultural elements that may contribute to this phenomenon?
I'm not sure they experience more mental health challenges, but they do have unique challenges that have a lot to do with their cultural, political, and social contexts. As with any group of people, it’s important to understand their environment and ecosystem. There are some unique aspects to being from mainland China, but most importantly, there are many mainland Chinese students here. So, they lend themselves well to research because we can get a large enough number of participants for a study.
Many international students, whether from the Pacific Rim, South America, Europe, or Africa, deal with issues of acculturation and acculturative stress. Mainland Chinese students experience that, but there are other issues too. One is this idea of maladaptive perfectionism that doesn't really come up a lot in investigating the mental health issues for other international students. Clearly, that's something that may be associated with cultural values, cultural world view, and so on. Under stressful conditions, it becomes a hazard for students and it can lead to all kinds of things like depression, anxiety, and eating disorders. It prevents students from accomplishing what they came for—to be successful in their educational pursuits. This problem is exacerbated by their underutilization of mental health services compared to other international students and US students. They're already experiencing these intense kinds of reactions and then they're less likely to seek assistance, which is problematic. In sum, I don’t think they have more challenges, but they do have some unique challenges that we need to pay attention to in our research, in terms of mental health interventions and outreach and in terms of how university administrators respond and provide support for these students.
What are some of the causes or specific triggers of these mental health challenges Chinese students face when they come to study in the United States?
I'll go back to the issue of acculturation and acculturative stress. We know from some of the research around acculturation in general, and specifically for mainland Chinese international students, that it is important for these students to understand what is it that they will be facing. Universities do a poor job of preparing students for coming to the US. They experience culture shock; they must learn how to be flexible and realize that things are different, but manageable. Also, there are ways for them to be able to manage some of the stressors that they're having.
There are also some issues related to acculturation that make a difference. The research suggests that Chinese students have an expectation for their relationships with their faculty that is different from many US students. They expect to establish a close relationship—sort of a pseudo parent relationship. If that's their expectation for education and they come to the US and they are invisible, not getting any special attention, and they are unable to develop a relationship with their professor, it can be very alienating. It could cause a depressive mood. Whatever the current preparation is for informing students what to expect, it overlooks the nuances of being here in the US. There is so much optimism about coming and getting an education in the US that there isn't a lot of conversation about how people are going to view them. Now, that's even more complicated in the political world that we live in within the US right now, where we actually have this hyper racism against Asian people. This racism has been exacerbated by political leaders making statements that are derogatory toward Chinese people in particular. Because of the lack of literacy around culture and diversity, people can't distinguish between Asians, which is another layer that students have to deal with in terms of being here.
Unfortunately, a lot of international students don't have a good understanding of race as a construct. They may be targeted. Without there being some kind of orientation before getting here, it becomes very difficult. It complicates the acculturation process for these students. The anxiety associated with that maladaptive perfectionism only gets worse.
What we know from the literature is that there's a lot of emotional fatigue because a lot of times there are language issues. I've seen students who, even though they have been amazing English speakers at home, find it really difficult to talk about complex issues in another language. I've seen that in my experience as a counselor educator. We talk about very complex intellectual issues, like how people think about human behavior. I can't even imagine trying to do that in another language. I literally see the students in the classroom with their little translation gadgets and they're listening and trying to translate what's going on. It’s very, very difficult. That can also cause emotional fatigue for them. When we look at the prevalence rates in studies, mainland Chinese international students are twice as likely to experience depression, and their depression rates are much higher, sometimes three times higher than other students. The same thing is true for anxiety, and their utilization rates for mental health resources are extremely low. According to one study, about 17 percent of the student population use the counseling services, whereas for mainland Chinese international students, it was around 3 percent. I will give a caveat, which is that behavioral science researchers may be culturally encapsulated. Those numbers need to be seen with a cultural lens, meaning that it's possible that some constructs are culturally embedded and culturally constructed. How students answer surveys may be complicated by a misunderstanding in terms of language. We need to do a better job with our research to feel more confident about the outcomes when we're crossing over cultures.
How were these challenges exacerbated by the Covid-19 pandemic?
Besides the politicization of our society, I would also add the issue of social isolation. Students are already disinclined to go for help with being socially isolated. I just can't see students using tele-therapy if they already weren’t going to go to an office and talk to people in person. Whatever rates we're seeing with the general population are probably going to be higher for the student population. We really do need to reach out and pay attention to these students.
Research indicates that Chinese international students demonstrate low levels of help-seeking behaviors when it comes to their mental health. What are the resources Chinese students can draw on to deal with their mental health challenges? What do you think can be done to improve the mental health experience for Chinese international students in the United States?
It's really important to take a good look at peer matching programs. When students are saying they want to come to the US to study, even before they get here, they should be matched with someone who is already studying in the US. The new students can ask informal questions and get questions answered that they might not have even thought of. They really need nuanced information about how to prepare. It is also important that there are support groups because these students are more likely to talk to a peer than they are to go to a formal office. I know that students develop groups together on their own, but universities have a responsibility as well. They should anticipate this and have programs to give these students a space on campus and opportunities to have speakers come. Universities need to do a better job of educating the US students about being more inclusive. Studies have shown that US students are not very warm and welcoming. They don't reach out. They don't really pay attention to understanding that these students might need to have more relationship building because of their expectation for what schooling is all about. There needs to be liaison officers. When students are on campus, there needs to be a whole ambassador group that serves as liaisons. They should be reaching out to these students and translating not the language, but the culture.
It’s also important to educate family members because there are some gender issues in terms of gender role identity. This is true particularly for women who often struggle with whether they are going to be more traditional and selfless in the ways they give to their families, or if they are going to be a little more feminist in the sense that they're going to prioritize their education. That becomes a struggle in their marital relationships and also in their intergenerational relationships with their mothers-in-law who often live with them in their homes. Without there being some discussion and some outreach to the family members, the students are not getting the support they oftentimes need from their family. It's important that family members are educated.
This happens in a lot of groups. For example, Xavier University where I currently teach is a historically Black university. Although I've taught at predominantly white institutions, I find a difference here. I see students are struggling because of family expectations and gender roles, male and female. Sometimes I have to reach out and say, “Mom and Dad, I know that you expect those things. Just give the student a year or two to finish the program and they'll be back providing that service or role in your family. Allow them the opportunity to be flexible and free to engage in their studies.” This also may be a cultural issue that isn't common in mainstream Eurocentric values, but other students do have these family and intergenerational responsibilities.
In addition, faculty need to be educated. Whether they want to provide it or not, they need to understand that Chinese students want to develop a closer relationship with them than other students may want to do. It’s a combination of the family, friends, social networks, the university, faculty, peers in classrooms, and counseling centers. There's been a move toward counseling centers doing more outreach on campuses. I've seen some amazing things that they've done to reach out to students, like having peer counselors sit on benches. It becomes a place where students can come and just sit with them and talk. They're the first line, and if it seems severe, then that student would refer them for more assistance. I've seen schools develop little kiosks where students can go. No one else would know and they can just answer questions on a little kiosk like an ATM machine. Again, counseling centers can find ways to reach out to students beyond just waiting for them to show up and ask. There's a host of things that we could do to be more proactive about reaching out to the student population.
What practical advice would you give to the parents of Chinese international students in supporting them in their studies in the US and their mental health?
If I were to talk to the parents of these students, I would say, first, make sure that your child has a list of five people whom he or she could reach out to easily and right away. That's a good number to have as resources. That's number one. Number two is to allow them to make mistakes and be able to talk about those mistakes and not think that they have to work so hard, and that there's no one that they could talk to if they're having difficulty. Three is that they find an activity that allows them to turn off the student identity and go bicycling or walking or whatever it is that they do to be able to relax or be mindful. They need something that is a counterbalance to just engaging in an inordinate amount of studying in order for them to recharge and rejuvenate from the stressors of school and being away from home.
What specifically might you attribute the low levels of help seeking behaviors to? Is it a cultural phenomenon that stems from mainland China or a result of what happens when students are struggling here in the US?
Some of it has to do with this propensity to have intense relationships with people in their system and not others. We talk about that with other groups, but it's more strained culturally for Chinese students. They are more likely to talk to a friend or relative period, and they're just not going to talk to someone else. Another reason has to do with the idea of China itself and its history. There are many families with only one child, so they're growing up pretty isolated. Research shows that students who are only children are even less likely than other mainland Chinese students to go and seek help. They're more apt to deal with problems independently, and are much more independent than their peers who have siblings. Third, there may be these issues around not doing well and being ashamed of imperfection, and of having difficulty and not performing at a level that's expected of them.
MissLunaRose12, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons