Challenges of living abroad can lead to psychological issues

Sandy Zhang became extremely lonely during the second half of her freshman year in college. Her weight slipped from 48 to 35 kilograms within a year, and she lost interest in talking with friends.

“You realize that you are in a foreign country. Your classmates come from a different cultural background, and your friends are on the other side of the planet,” the graduate at Michigan State University in the United States said.

Zhang is a prime example of the many Chinese international students in the United States who have suffered from psychological issues due to the challenges that come with studying abroad.

But she pulled herself up from the depths of despair by meeting new people and talking to family members at home through social media.

However, some others have not been so lucky.

Liu Weiwei, a 20-year-old studying psychology and German at the University of California in Santa Clara, was found dead in her dormitory on Feb 12 last year. Police said her death appeared to be a case of suicide.

Although police did not comment on the cause of Liu’s death, speculation arose that she succumbed to depression.

A note she left on her Sina Weibo account said, “The world is beautiful, but I am a coward who cannot tolerate such a heavy burden, so I choose to escape.”

In October last year, Tang Xiaolin, a promising PhD candidate in space physics at the University of Utah, killed herself by jumping off the Golden Gate Bridge in San Francisco.

According to media outlets such as The China Press and US News Express, Tang, 30, was under tremendous academic pressure before her death.

Completion of her academic program and graduation had been delayed, and a friend said she had expressed a desire to kill herself at the Golden Gate Bridge.

From 2012 to last year, US media reported at least 17 cases involving Chinese international students who killed themselves, including Tian Miaoxiu of Cornell University, Rong Xin from the University of Michigan, Li Yangkai of Johns Hopkins University and Liu Yang of the University of California, Los Angeles.

Multiple factors

According to the Institute of International Education, China is the leading country for international students studying in the US. There were 1,078,822 such students studying at US universities and colleges in the 2016-17 academic year, and 33 percent of them came from China.

Along with the growth in Chinese studying in the US, concerns have increased about their mental health.

According to a survey on mental health among Chinese international students at Yale University, 45 percent of them had symptoms of depression.

Xuesong Han, director of health policy and healthcare delivery research at the American Cancer Society and an author of the Yale report, said it is difficult to identify Chinese students who have depression.

“They look cheerful and happy, but they feel depressed and unhappy,” Han said.

“Some students may go to counseling centers at their colleges, but they feel that this is not useful.”

Justin Chen, a psychiatrist at Massachusetts General Hospital who specializes in cross-cultural psychological issues, said both depression and anxiety are very common among Chinese international students.

They are often stressed by factors that do not affect domestic students, such as language anxiety, concerns about their immigration status, post-graduation planning, lack of social support, homesickness, food differences and racism, Chen said.

“The data that do exist suggest that Chinese international students face high levels of depression and anxiety symptoms,” said Chen, who heads the Center for Cross-Cultural Student Emotional Wellness at Massachusetts General Hospital. The center was formed to address a lack of research in this area.

Doctor Cirecie A. West-Olatunji of Xavier University of Louisiana, a co-author of a review on the mental health situation of Chinese international students in the US, warned that high-profile suicides do not mean Chinese students overseas are more liable to self-harm.

“It’s not that Chinese international students experience these emotional and psychological problems more perhaps than US-born students, or compared to other international students,” West-Olatunji said. “It’s that some of the experiences of transitioning to the US come with unexpected challenges and problems.”

She said many Chinese students might have expectations about studying abroad that are different from real-life experiences. For example, some might expect more friendship with their US peers, but feel disappointed when they do not integrate on campus to the extent they had expected.

“As much as students might prepare with their English-language studies and other work, we know that the real experience of being here is much more challenging than they often imagine before they arrive,” West-Olatunji said.

Zhang, the Michigan State University graduate, experienced this challenge firsthand. She said it is hard for international students to become close with their US peers at first due to cultural differences. She got along with her three US roommates, but they did not immediately become close friends, she said.

“It’s not that they are not nice to you. It’s just that we all have different lifestyles,” Zhang said. “You have to adjust and overcome these challenges on your own.”

Some US colleges and universities do not have counselors who can speak Chinese or who have lived in China. As a result, Chinese students feel that their counselors cannot understand their anxieties.

A student from China at Boston University, who gave her name only as Catherine, said: “The counselors did not understand why I was afraid that my boyfriend considered me to be crazy and that I should go to a psychiatric hospital. They told me they did not consider I was crazy and it was ‘very normal’ for people to have mental health concerns. But this did not end my anxiety.”

More US colleges and universities are increasingly considering the needs of their diverse student populations.

Nicole Green, executive director of counseling and psychological services at the University of California in Los Angeles, said the school has one clinician who speaks Mandarin, four who speak Spanish, two who speak Korean, and one who speaks Vietnamese.

She said international students are more liable to discuss any mental health problems with their doctors first.

“They might think they are not sleeping or eating, and that something is wrong with them physically,” Green said.

“Many times they will discuss their problems with their doctors, and the doctors have to be well trained to respond and ask the right questions so that they can refer them for mental health treatment.”

Cultural stigma

Ellen Yang, a graduate from the University of California in San Diego, said she suffered from insomnia after working on a class project at 3 am during finals week. She remembered feeling very anxious, she was trembling and could not sleep.

She said it took her six months to completely recover from insomnia. She tried telling her parents and friends about her concerns, but most of her friends dismissed these as minor problems.

“It was as if it was raining, but the rain was only pouring down on me,” said Yang, who did not seek psychological help at the time because she was afraid she might have mental health problems.

Steven Sust, a Bay area child and adolescent psychiatrist and clinical instructor at Stanford University’s Department of Psychiatry and Behavioral Sciences in the School of Medicine, said, “It’s sort of like if you have ever been in a stressful situation, and you don’t think there’s anybody who understands you.”

Sust said it’s unsurprisingly difficult for Chinese international students to reach out for help because of the language barrier and cultural differences.

There is also a stigma related to mental health issues in Chinese culture that makes it more difficult.

“Culturally, there’s not as much support for mental health awareness and treatment in the Chinese culture,” said Sust.

Preventive measures

In addition to help from professionals, many experts agree that students need to discuss such issues more frequently among themselves.

Green said, “It’s one thing for the universities to do something, it’s another thing for students to discuss mental health issues with their friends.”

She said reducing the stigma also helps to increase early awareness and detection of mental health problems. Changes in another person’s appetite, energy or mood can be noticeable, which might indicate signs of depression or even suicide.

West-Olatunji suggested putting together orientation packages for students before they arrive in the US to enable them to have realistic expectations of studying abroad.

She also suggested that students form a network, either on social media or offline, which would provide a support system as they move to study in the US.

Sust urged that more international students support each other and share the common experience of navigating a different society or language.  He suggested students actively look out for one another, and those with emotional concerns should reach out and confide in a supportive person they trust. This could be someone who you have a close relationship with or may have even shared a similar experience, Sust said.

If things don’t work out, they should go talk to a chaplain/clergy, physician, counselor, coach, or any school staff to help find additional resources on or off campus.

“The important thing is for everybody to realize there’s a lot of help and support available. It’s also an important first step for people to open up and talk about the situation with the other people who they can trust to compassionately listen without judgment and search for available resources together,” Sust said.

Cui Naiwen in New York contributed to this story.

Names of some student interviewees have been changed to protect their identities.