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The Experiences and Impact on Wellness among International Students in the United States during the COVID-19 Pandemic

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Title: The Experiences and Impact on Wellness among International Students in the United States during the COVID-19 Pandemic
Language: English
Authors: Ni Gao, SunHee J. Eissenstat (ORCID 0000-0002-4317-6984), Annmarie Wacha-Montes, Yushi Wang
Source: Journal of American College Health. 2024 72(2):361-365.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 5
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: COVID-19, Pandemics, Foreign Students, Wellness, College Students, Student Experience, Stress Variables, Access to Health Care, School Role, Health Behavior, Mental Health, Physical Health, Student Attitudes
DOI: 10.1080/07448481.2022.2052077
ISSN: 0744-8481
1940-3208
Abstract: Objective: Assessing experiences and impact on wellness among international students during the COVID-19 pandemic. Participants: 405 undergraduate and graduate international students from 65 countries studying at a large public university. Methods: An online, voluntary and anonymous survey consisting of 50 quantitative and qualitative questions was conducted through Qualtrics. Descriptive and frequency analyses were used. Results: 27% of the students had concerns about the changes in student visa status that could seriously disrupt their studies in the U.S. 66.2% of them reported a moderate level, 18.8% reported a high level of stress related to the pandemic. Students identified the highest confidence in getting tested for infection but the lowest confidence in getting treatment if infected. They preferred telehealth for mental health services. Conclusions: Universities can best help international students by assisting with student visa and international travel issues, access to treatment for COVID-19 infection and developing telehealth for mental health services.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1419756
Database: ERIC
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  Value: <anid>AN0176405469;acl01feb.24;2024Apr05.04:37;v2.2.500</anid> <title id="AN0176405469-1">The experiences and impact on wellness among international students in the United States during the COVID-19 pandemic </title> <p>Objective Assessing experiences and impact on wellness among international students during the COVID-19 pandemic. Participants: 405 undergraduate and graduate international students from 65 countries studying at a large public university. Methods: An online, voluntary and anonymous survey consisting of 50 quantitative and qualitative questions was conducted through Qualtrics. Descriptive and frequency analyses were used. Results: 27% of the students had concerns about the changes in student visa status that could seriously disrupt their studies in the U.S. 66.2% of them reported a moderate level, 18.8% reported a high level of stress related to the pandemic. Students identified the highest confidence in getting tested for infection but the lowest confidence in getting treatment if infected. They preferred telehealth for mental health services. Conclusions: Universities can best help international students by assisting with student visa and international travel issues, access to treatment for COVID-19 infection and developing telehealth for mental health services.</p> <p>Keywords: COVID-19; international students; pandemic; wellness</p> <hd id="AN0176405469-2">Introduction</hd> <p>International students enrich the learning experiences for all students and contributed nearly 41 billion dollars to the U.S. economy and supported 458,290 jobs during the 2018–2019 academic year.[<reflink idref="bib1" id="ref1">1</reflink>] According to the 2020 report from Institute of International Education,[<reflink idref="bib2" id="ref2">2</reflink>] over one million students worldwide were studying in the United States during the 2019 to 2020 academic year. The COVID-19 pandemic brought drastic changes to the experience of international students studying in the U.S.</p> <p>Due to the rapid increase of COVID-19 cases in March 2020 and Stay Home Orders in multiple states, many U.S. colleges and universities switched in-person classes to virtual learning, closed many dormitories and other in-person campus services. In general, most domestic students returned to their families. International students faced additional challenges, including travel restrictions that limited returning to the home countries, lack of support from families afar, increased sentiment of xenophobia, and less access to in-person services both on and off campus while rapidly adapting to remote learning and maintaining academic performance.[<reflink idref="bib3" id="ref3">3</reflink>],[<reflink idref="bib4" id="ref4">4</reflink>]</p> <p>Studies have begun investigating the effect of the pandemic on the general population as well as college students. Two studies investigated the population in China during the early period of the pandemic outbreak. One study[<reflink idref="bib5" id="ref5">5</reflink>] surveying over 1,200 people from 194 cities in China reported more than 50% of respondents experienced moderate to severe levels of psychological stress including having symptoms of anxiety and depression. The other study[<reflink idref="bib6" id="ref6">6</reflink>] found a similar prevalence rate of psychological distress among college students in China. Additional studies identified two main aspects that affected people's mental health status during pandemics. One was the fear of infection or the virus, and the other was the changes in routine and habits due to social isolation.[<reflink idref="bib7" id="ref7">7</reflink>],[<reflink idref="bib8" id="ref8">8</reflink>] There was a positive correlation between time in isolation and the level of reported stress.[<reflink idref="bib9" id="ref9">9</reflink>] Common psychological reactions to epidemics include intensive health concerns, anxiety-related behaviors, sleeping disturbance, feeling of anger, depression and helplessness.[[<reflink idref="bib10" id="ref10">10</reflink>], [<reflink idref="bib12" id="ref11">12</reflink>]] Additionally, long-term infectious epidemics were linked to symptoms of post-traumatic stress disorder. Without timely treatment and support, many can experience prolonged psychological stress that seriously impairs the ability to perform daily activities.[<reflink idref="bib14" id="ref12">14</reflink>],[<reflink idref="bib15" id="ref13">15</reflink>]</p> <p>Among college students, additional concerns were identified including increasing concerns about academic performance, decreased interactions with peer students and friends, significant changes in financial status, more difficulties to access mental health services, and increased risk of alcohol and drug use.[[<reflink idref="bib16" id="ref14">16</reflink>], [<reflink idref="bib18" id="ref15">18</reflink>]]</p> <p>However, few studies have focused on the experience and impact of the COVID-19 pandemic among international students. A recent study surveyed 261 all native Chinese students attending U.S. colleges and universities found that 37% of respondents reported having a moderate or severe level of post-traumatic stress disorder (PTSD) symptoms measured by the PTSD Checklist Civilian Version, and half of them also had experienced symptoms of anxiety and depression. They expressed financial stress related to continuing their studies in the United States.[<reflink idref="bib3" id="ref16">3</reflink>]</p> <p>The current study surveyed 405 international undergraduate and graduate students from more than 65 countries studying at a large public university in the northeastern region of the U.S. The study reported the student experiences during the pandemic from March to October 2020, and explored the impact of COVID 19 on their wellness, and self-identified health and support needs. Specifically, the study examined international student's self-perceived stress level, the risk level of being infected, the confidence of getting COVID test and treatment if infected, as well as their physical and mental health support needs, and preference of support modalities including tele-counseling options.</p> <hd id="AN0176405469-3">Method</hd> <p>An online, voluntary and anonymous survey consisting of 50 quantitative and qualitative questions was conducted through Qualtrics. The survey link was distributed via a social network post that was exclusively shared among the international students in the university. The survey was conducted in October of 2020. A total of 859 students responded. Each participant was provided with a five-dollar e-gift card for participating in the study. The study was approved by the Institutional Review Board (IRB) of the university.</p> <p>Some examples of the survey questions about the student experience and support needs were: "What do you think is your personal percentage risk (from 0 to 100) of being infected with COVID-19 virus in the next month?"[<reflink idref="bib19" id="ref17">19</reflink>]; "From February to May of 2020, did you leave the U.S.?"; "If you left the U.S., do you have any concerns about coming back?"; "Do you think that your academic achievement was suffered or might be suffered if there was no pass/fail option?" Other questions included perceived confidence in receiving mental health services and being tested and/or treated for COVID-19. The answers to the questions were either dichotomous (yes or no) or selection from a range of 0 to 100. Additionally, Short form-12 Health Survey[<reflink idref="bib20" id="ref18">20</reflink>] and Perceived Stress Scale (PSS)[<reflink idref="bib21" id="ref19">21</reflink>] were used to measure their physical and mental health. PSS was adapted by adding "COVID-19" to the scale item of its original PSS version guided by Cohen et al.[<reflink idref="bib22" id="ref20">22</reflink>] for this study.</p> <p>Among 859 survey responses, 165 respondents completed less than 50% of the survey items and spent less than 200 seconds. Among those who completed more than 50% of the survey items, 289 students spent less than 200 seconds. A closer investigation was conducted for these respondents. Those who showed consistent patterns in their responses, such as answering "yes"s or "a"s to all survey questions, were excluded from the data analysis. In the end, 454 responses were excluded from the study, and 405 responses were used for the analysis. Survey data were analyzed using SPSS v.25.[<reflink idref="bib23" id="ref21">23</reflink>]</p> <hd id="AN0176405469-4">Results</hd> <p>Four hundred and five participants were from 64 countries around the world. Two hundred and sixteen were undergraduate (53.3%) and 185 were graduate (45.7%) students. The largest groups by country of origin were from China (<emph>n</emph> = 96, 23.7%), followed by India (<emph>n</emph> = 86, 21.1%), and United Kingdom and Canada (<emph>n</emph> = 29, 7.2% from each). This partially accords with international students' national data in the U.S., which indicate the greatest number of students come from China, followed by India and South Korea.[<reflink idref="bib24" id="ref22">24</reflink>] At the time of the survey, 246 (60.7%) were living on campus or near campus, 85 (21%) were living in other locations in the United States away from campus, and 59 (14.6%) students were in their home countries. 64 (15.8%) participants reported that they left the U.S. between February and May of 2020. Eight-eight (21.7%) answered that they had concerns about returning if they would have left the U.S. 27% worried about their visa status or changes in U.S. immigration policy during the pandemic. 59% (<emph>n</emph> = 239) answered that their academic performance would have suffered without having the grading option of pass or fail. The decreased interactions with classmates and instructors due to remote learning, and less favorable learning environment at home were reported as contributing factors.</p> <p>The participants answered that they believed they had an average 36.58 percent (<emph>SD</emph> = 23.44) risk of getting infected with COVID-19 in the next month. On average, undergraduate students answered from 45.6 to 55.2 percent of confidence (of a range score of 0 to100) in survey items related to getting services to cope with the pandemic. Graduate students answered from 40.0 to 64.4 percent, higher than the undergraduate students except for getting treatment if infected. Getting tested for infection showed the highest confidence but getting treatment showed the lowest confidence in both groups. See Figure 1(A) for details.</p> <p>PHOTO (COLOR): Figure 1. (A) Confidence in receiving COVID-19 Pandemic related services. (B) Preferences of receiving COVID-19 Pandemic related services.</p> <p>For both undergraduate and graduate students, the mental health score was lower than physical health (see Table 1). Moreover, the PSS findings highlight that a majority of students reported experiencing a moderate level of stress during the pandemic. More graduate students reported a high level of stress (<emph>n</emph> = 49, 26.5%) than undergraduate students (<emph>n</emph> = 27, 12.5%).</p> <p>Table 1. Perceived health and stress during pandemic.</p> <p> <ephtml> <table><thead><tr><td /><td>Undergraduate students</td><td>Graduate students</td></tr></thead><tbody valign="top"><tr><td>Perceived health</td><td char=".">56.0 (<italic>SD</italic> = 19.1)</td><td char=".">59.8 (<italic>SD</italic> = 20.8)</td></tr><tr><td>Physical health</td><td char=".">61.7 (<italic>SD</italic> = 23.7)</td><td char=".">70.7 (<italic>SD</italic> = 22.5)</td></tr><tr><td>Mental health</td><td char=".">50.4 (<italic>SD</italic> = 19.4)</td><td char=".">48.8 (<italic>SD</italic> = 24.5)</td></tr><tr><td>Perceived stress</td><td /><td /></tr><tr><td>High level of stress</td><td><italic>n</italic> = 49 (26.5%)</td><td><italic>n</italic> = 27 (12.5%)</td></tr><tr><td>Moderate level of stress</td><td><italic>n</italic> = 155 (71.8%)</td><td><italic>n</italic> = 113 (61.1%)</td></tr><tr><td>Low level of stress</td><td><italic>n</italic> = 12 (1.7%)</td><td><italic>n</italic> = 45 (24.3%)</td></tr></tbody></table> </ephtml> </p> <p>For the questions about using mental health and counseling services, the participants could choose multiple options from a list of services (Figure 1B). Almost half of both undergraduate and graduate students chose to use brief videos to learn how to manage the challenges related to the pandemic effectively. The Mobile app for teaching coping skills was also a popular choice. They were also interested in one-session individual informal support with a counselor by phone or video.</p> <hd id="AN0176405469-5">Discussion</hd> <p>This study examined the experiences and impact of the COVID-19 pandemic on international students. It focused on physical and psychological wellness, perceptions on academic performance, and confidence and interest in services and support. Findings indicated that, among the students who left the U.S.A. during the early phase of the pandemic, many were concerned about coming back in the future. The students who stayed in the U.S. also reported the same concern. They worried they would not be allowed to return if they had left. This is consistent with findings from another study that many students remained in the U.S. during the pandemic.[<reflink idref="bib3" id="ref23">3</reflink>] One likely explanation was the frequent, inconsistent and confusing executive orders about student visa and international travel restrictions. Another explanation could be the students felt that they would have fewer opportunities to interface with faculty and classmates from abroad which may negatively affect their academic performance.</p> <p>This study also reiterated that a high percentage of international students experienced moderate (71.8%) or high (18.8%) levels of stress during the pandemic. This supports the growing literature that has found an increase in overall stress and health anxiety relating to the pandemic within the general population[<reflink idref="bib5" id="ref24">5</reflink>],[<reflink idref="bib6" id="ref25">6</reflink>],[<reflink idref="bib10" id="ref26">10</reflink>] as well as among college students.[<reflink idref="bib3" id="ref27">3</reflink>],[<reflink idref="bib16" id="ref28">16</reflink>],[<reflink idref="bib17" id="ref29">17</reflink>] Therefore, it was not a surprise that almost 60% of the students in this study reported concerns of negative effects on academic performance.</p> <p>Additionally, international students perceived their physical health to be better than their mental health during the pandemic. The difference might be related to the Stay Home Order that enforced social distancing and decreased risk of being infected. However, the Stay Home Order could have elicited academic stress of remote online learning, concerns related to visa status, and a decrease in social interactions with peers and faculty, and impacted their mental health to a greater degree than physical health.</p> <p>There are positive findings regarding student confidence in receiving services and support for coping with the COVID-19 pandemic. More than half of undergraduate and graduate students were confident in getting tested for COVID-19, although less confident in getting treatment if infected. Given this study's time frame, testing services had been increased and promoted, but treatment and vaccination were not yet identified. Furthermore, around half of the students would use mental health services due to issues caused by the pandemic and around 40% were confident in general advice from the international student office.</p> <p>The study revealed the student's preferences for mental health counseling and support services. They had a high interest in a single virtual session of individual and group support, and a short-term support group. The students also favored using mobile apps and other telehealth for support. These findings reflect a rapid growth of tele-mental health (TMH) support, which 52.2% of counseling centers endorsed in 2019[<reflink idref="bib25" id="ref30">25</reflink>] in comparison to 10% in 2016.[<reflink idref="bib26" id="ref31">26</reflink>] These efforts increase accessibility to services, elicit real-time support as well as expand resources beyond traditional on-campus support and promote self-efficacy to cope with mental health concerns.</p> <p>In summary, this study revealed that international students were concerned about the travel restrictions and the possibility of not being able to return to the U.S. A. This may suggest the need for the office of international student services to assist with navigating travel arrangements in a timely and clear fashion in the future. The students also reported higher levels of mental health stress and concerns than physical health concerns. They worried about the negative effects on academic performance because of the lack of in-person interactions with instructors and peers in the environment of virtual classes. They felt more isolated and less supported after the Stay Home Orders and preferred using mobile apps and other virtual means to stay connected and getting mental health counseling support. Telehealth is an area that is rapidly growing due to the lack of other options, but the research on its effectiveness is limited. Even fewer studies have included international students. Given the number of international students in U.S. colleges and universities as well as certain unique characteristics, future studies should include this student group. Improving the experience of international students also enriches the learning environment and experience of all students.</p> <hd id="AN0176405469-6">Limitations</hd> <p>The study participants were only recruited in one university, located at the northeast region of the U.S.A. The racial composition of international students accords with the national data, but the findings might be different in the areas with different racial/national compositions. Secondly, almost half of the responses were not included in the analysis due to invalid data entry. To maintain the anonymity of the survey, it was conducted without school ID entry, but many students solicited this participation opportunity for the monetary incentive. In-person survey might have gathered responses in a better quality, but that was not eligible due to the COVID-19 Pandemic. The responses were reviewed thoroughly to screen meaningless responses, but it may have biased the findings. Lastly, a quantitative study might not have captured this new experience among international students. A qualitative study needs to be conducted to understand the impact of the COVID-19 Pandemic on their mental and physical health.</p> <hd id="AN0176405469-7">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of United States of America and received approval from the Institutional Review Board of Rutgers, the State University of New Jersey.</p> <hd id="AN0176405469-8">Funding</hd> <p>No funding was used to support this research and/or the preparation of the manuscript.</p> <ref id="AN0176405469-9"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Annmarie Watcha-Montes is now at the Center for Traumatic Stress, Resilience & Recovery, Glen Oaks, New York, USA. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Experiences and Impact on Wellness among International Students in the United States during the COVID-19 Pandemic
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ni+Gao%22">Ni Gao</searchLink><br /><searchLink fieldCode="AR" term="%22SunHee+J%2E+Eissenstat%22">SunHee J. Eissenstat</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4317-6984">0000-0002-4317-6984</externalLink>)<br /><searchLink fieldCode="AR" term="%22Annmarie+Wacha-Montes%22">Annmarie Wacha-Montes</searchLink><br /><searchLink fieldCode="AR" term="%22Yushi+Wang%22">Yushi Wang</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(2):361-365.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 5
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Pandemics%22">Pandemics</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Students%22">Foreign Students</searchLink><br /><searchLink fieldCode="DE" term="%22Wellness%22">Wellness</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Experience%22">Student Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22School+Role%22">School Role</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Health%22">Physical Health</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2052077
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Assessing experiences and impact on wellness among international students during the COVID-19 pandemic. Participants: 405 undergraduate and graduate international students from 65 countries studying at a large public university. Methods: An online, voluntary and anonymous survey consisting of 50 quantitative and qualitative questions was conducted through Qualtrics. Descriptive and frequency analyses were used. Results: 27% of the students had concerns about the changes in student visa status that could seriously disrupt their studies in the U.S. 66.2% of them reported a moderate level, 18.8% reported a high level of stress related to the pandemic. Students identified the highest confidence in getting tested for infection but the lowest confidence in getting treatment if infected. They preferred telehealth for mental health services. Conclusions: Universities can best help international students by assisting with student visa and international travel issues, access to treatment for COVID-19 infection and developing telehealth for mental health services.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1419756
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1419756
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  BibEntity:
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      – Type: doi
        Value: 10.1080/07448481.2022.2052077
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 5
        StartPage: 361
    Subjects:
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
        Type: general
      – SubjectFull: Foreign Students
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      – SubjectFull: Wellness
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      – SubjectFull: College Students
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      – SubjectFull: Student Experience
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      – SubjectFull: Health Behavior
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      – SubjectFull: Mental Health
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      – SubjectFull: Physical Health
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      – SubjectFull: Student Attitudes
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    Titles:
      – TitleFull: The Experiences and Impact on Wellness among International Students in the United States during the COVID-19 Pandemic
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            NameFull: Yushi Wang
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              Value: 72
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