1. Introduction

In the age of globalization, high education institutions around the world are attracting international students, who are the main keys in areas like cultural economics communications. According to the Open Doors Report, from 2013 to 2014, there were 886,052 international students in the USA (Institute of International Education, IIE) [1]. Not only that, but international students also play a significant role in the economy. From 2013 to 2014, they accounted for more than $27 billion in the national economy. However, their mental health is easily overlooked. Stress brought by academic career and cultural differences. Moreover, social and financial pressures are incredibly damaging mental health of a large number of international students. For example, depression caused by language barriers, problem-solving problems, and lack of communication and social relationships is quite particular in East Asian students [2]. It is acknowledged on a global scale that disorders related to mental health are becoming more prevalent in all facets of general healthcare. Therefore, aiming to provide convenience to international students at the level of society and individuals, experts in multiple fields have investigated a lot. This article is going to identify research and current literature about international students’ mental health and analysis the possible reasons behind it. Then, we will point out the gap in an attempt to improve future mental health care of international students.

2. Methods

This literature review is under a structured search method. Both qualitative and quantitative studies (including full-text, peer-reviewed, and scholarly journal articles) are included in this article. They are all from reference sources Web of Knowledge and Google Scholar. The search terms initially are mental health, international students, and higher education, then are expanded to health care, social pressure, and cultural difference to identify reasons for unhealthy mental states. Meanwhile, the discussion subjects are limited to the American-European institute and their overseas students from East Asia. Researchers found that the similarity between host culture and original culture brought less stress to students [3]. Moreover, the ideological gap between educational institutions and international students varies geographically.

3. Literature Review

3.1. Discrimination as a Culture Shock

Discrimination is a major issue faced by international students in many countries. As mentioned above, discrimination is another form of culture shock [4]. International students may face discrimination based on their nationality. Discrimination may significantly impact international students’ mental health, causing stress, anxiety, and depression. According to research, lack of social support has been linked to lower academic performance and detrimental psychological experiences like stress and depression [5]. Depending on their country of origin, race, ethnicity, and whether they are from a community-based or individualistic culture, international students adjust differently to their new environment [6]. Experiences of discrimination may be an additional barrier for some students to overcome. International students from different countries may react differently to the culture of the host country. While some students adjust to the culture of their host country very well, others may experience negative feelings and alienation. Students from more collectivist cultures may feel less integrated than students from more individualistic cultures if they study in western countries [7]. Some university students are generally brought up in a culture where black people are the norm, and when they arrive in a predominantly white society, race can become a very prominent problems. As an example, for Kenyan Nigerian and Ghanaian university students, some of the salient cultural value conflicts are related to the different worldviews and values of white American university students [8]. In the lives of international students in Kenya, Nigeria and Ghana, their values revolve around group survival, communalism, and collective responsibility. Due to American emphasis on individualism, including being self-sufficient and independent, they might have trouble relating to white American students [7]. Constantine et al. [8] suggested that they can be subjected to name slander by white Americans. Some blacks point out that white teaching assistants call them stupid niggers in class. In addition, some Americans think Africans are less intelligent than they are. As a result, these students’ feelings of isolation can be particularly pronounced in an individualistic environment. Moreover, They are more likely to connect with other foreign students than with the local population if they feel prejudiced [9]. Despite the University’s attempts to reduce racial discrimination, researchers have not found a significant reduction [10]. Scholars have suggested that when racial discrimination is combined with homesickness, it can cause university students may experience feeling alone and anxious [11]. Homesickness among university students has been discussed as a by-product of cultural shock [10]. Homesickness among international students depends on the student’s country of origin in the same way that international students are discriminated against. The greater the difference between one’s culture and that of the host country, the more likely homesickness will arise [12]. It can induce feelings of anxiety and depression. Such thoughts and emotions can affect an individual’s behaviour and physical and mental health. Scholars have shown that the level of discrimination perceived by students’ level of homesickness [10]. This suggests that students who experience discrimination are more likely to feel homesick. The study also discovered that younger pupils reported greater degrees of feeling homesick while older pupils reported greater degrees of discrimination [10]. Scholars have interpreted this to mean that older students are better able to judge discrimination than younger students and that older student resilience to homesickness is higher. In addition to the non-white American students mentioned above, immigrant and international students also experience discrimination. These two groups experience or feel discrimination even more than non-white American students. Ying et al. [13] have found that because they speak less English than European international students, international students from Asia, Africa, and South America experience more discrimination than those from Europe.

3.2. Differences in Education Systems

Chinese students encounter some frustrations when they first come to study in other countries, and these frustrations can cause a lot of psychological stress to learners. For example, there are differences regarding teaching styles. Many Chinese universities teach in the traditional educational way, where teachers spend a lot of time talking, and the talk comes from one or two textbooks [14]. In contrast, in UK universities, teachers will only extract from a few books the important points that will be covered in class, and if students want to study the point in-depth, students have to find the relevant book if they are interested in module topics themselves [14]. Gu and Maley conducted a survey and found that nearly a third of students said they felt that the UK education system was not systematic and that assessment criteria were unclear [15]. Moreover, they felt that teachers did not care whether students could understand the subject matter or not. Finally, students felt that a lot of time was spent on classroom discussions in the UK education classroom, while students felt that classroom discussions were a waste of time [15]. Wu believed this is because Chinese people’s long experience of education has taught them that it is not good to question and challenge their teachers [14]. More importantly, Chinese education assumes that teachers need to provide students with the right answers, so students do not realise the need to question lecturers and the content of textbooks. They see uselessness in discussing their opinions with others and critiquing others’ ideas [14]. McMahon’s research used interviews with mainland Chinese students attending university in the UK [16]. His research compares students’ study life in China and the UK. For example, students can continue to interact with their teachers outside of class in China, but students in the UK do not have as close a relationship with their teachers as they do in China. McMahon also suggests that students pass the exam by repeating the correct answers given by the teacher in China, whereas in the UK, students complete their assignments by discussing them with classmates in class [16]. Furthermore, it is hard for Chinese students to be aware of critical thinking and get used to the UK education system [16]. To conclude, differences in the teaching and learning process affect the academic performance of international students. Moreover, international students often represent the most educated segment of their home society, and their families may expect students to achieve unrealistically high levels of achievement [4]. As a result, students’ psychological well-being is affected by the immense pressure on them, which may eventually lead to academic failure or dropping out of school. Mori points out that these students who are reported to have high expectations by their families may have a deep sense of loss and sadness when faced with reality [4]. When encountering a completely different education system, they can develop an inferiority complex if they have achieved very high levels of success in their own country.

3.3. Limitation of Job Opportunities

Besides educational background and cultural differences impact characteristics, foreign young adults are facing some other pressure brought by a rigid frame of local society, like limited job opportunities. Many of them expect to obtain a long-term legal identity and earn a living in more developed countries like the US and European countries. The data showed an increasing number of international students participating the Optional Practical Training (OPT) in the U.S. There were 24,857 international students engaged in OPT, while in 2013–2014, there were 105,997 [1]. However, the regulation and control of employment for these young adults are strict. In the United States, before employers hire an international student, they need to consider tons of express terms relating to aspects like working time limit, visa classification and authorization of host institution [17]. Even worse, in developed countries, the argument rises gradually, which points out that foreign nationals take away job opportunities from locals [17]. Such disputes increase the difficulty of international students joining an unfamiliar society. In addition, there is a cultural barrier and resource shortage when international students try to transform into foreign workers. Language barriers, immigration concerns, and cultural differences resulted in their discomfort. The stereotyping against them will remain straight after their graduation [18].

3.4. Mental Health

Anxiety is often observed among international students. Lucas suggested that humans frequently experience anxiety, which appears to be related to feelings of fear in general [19]. Although Gullahorn and Gullahorn’s U-Curve model was outdated, the model does effectively represent the anxiety many researchers link to the once-dubbed “culture shock” process of adjusting to a new culture [20]. Hartwell et al. suggested that Individual and group identity are fundamental components of food behaviour, which is ingrained in cultural processes and practise [21]. Food customs strengthen identity, which is beneficial to psychological health [21]. According to Verbeke and López, foods have emotional connotations and can represent “home,” happy memories of holidays, or nostalgia for the past [22]. The emotional turmoil that comes with leaving familiar surroundings is added to this.

All these stressors contribute to cognitive fatigue, including cultural confusion and disorientation and difficulty concentrating, and psychological symptoms, including feelings of isolation, sadness, loss, homesickness, resentment, and frustration [4]. Furthermore, researchers show that the risk of mental illness for internationals is much higher than for their local peers. Even worse, international students, who are with less social support, are more sensitive to stress and have higher levels of distress [6]. Having identified some main reasons for international students’ pressure and their vulnerability, the method of psychological adjustment should be found. Some researchers have suggested several keys to the solution. Zhang and Goodson pointed out that international students interacting more with local people and adhering to the host culture have a more substantial adaptive capability [23]. Such interaction covers the shortage of social support, cultural difference and even language skills, improving students ‘confidence and feeling of mastery. However, it is the result of students’ strong sense of autonomy and independence. And researchers discovered that the subjective consciousness is free from social support.).

4. Implications

Internationalization is important to institutions of higher education, so people may be aware of the importance of solving the challenges of international students. In the first part of the literature review, discrimination against international students is discussed. In order to create an equal environment, institutions need to bear some responsibility for international students’ satisfaction [24]. Lee and Rice suggested that members of the educational community become aware of discrimination, they may need to develop intellectual settings that support international understanding and learning, and their responsibility to reject the maintenance of national stereotypes [24]. To ensure that administrators and faculty are aware of their duty to create a secure and welcoming environment for international students, policies regarding teaching and working with international students be clearly stated [24].

Then the difference in the educational system may also affect international students’ mental health. However, there are solutions for both schools and teachers. As mentioned in Ramachandran [25], international students require assistance in adjusting to other cultures, customs, and daily life. Individual health can be significantly improved by having social confidence and forging an identity in the host country, which can also lead to better interactions with others and integration in social networks [25]. Turner and Robson, however, contend that instruction in social and cultural factors competency does not ensure students’ achievement in academia [26]. It is impossible to manage cultural issues solely through classroom lectures or handing out pamphlets [26]. We must acknowledge that it is very difficult to integrate into a new educational system, but teachers and schools who can constantly help international students in their daily lives, for example, by encouraging them to counter the views of others in the classroom and by guiding international schools in their own ability to search for relevant literature. According to Orpen [27], it’s important to get students involved in activities that will increase their awareness of other cultures and help them learn how to adapt to them. It is Programs that highlight the potential cultural differences that international students may encounter should be organized by qualified staff who are familiar with cultural issues [25].

As mentioned above, these difficulties may influence international students’ mental health. However, effective methods can be used for international students to adjust successfully. In order to prevent crippling anxiety and frustration from impairing their daily functioning and academic work, international students may need to develop a variety of stress-management techniques [4]. Recognizing and modifying unfounded assumptions about themselves and others can be a valuable component of cognitive self-care because the discrepancy between their high expectations for their lives in another country and reality seems to be one of the main sources of their stress [4]. It is possible to introduce and practise meditation, imagery, and breathing techniques. Mori suggested that reminding the students of the value of fitting in enough physical self-care, such as therapeutic massage, exercise, and healthy eating habits, into their hectic schedules may also be helpful [4]. However, some scholars doubt the effectiveness of counseling. According to Alavi et al., international students don’t want to go to counsellors and counselling centres [28]. The reason may be relevant to different cultures. International students come from a variety of nations and cultural backgrounds, and they view counselling differently [28]. Some college students might undervalue the importance of seeking professional assistance to treat their mental illnesses. They also emphasize the informational gaps experienced by international students, who may not be aware that the university has a counselling centre [28]. As a result, at the start of the study, schools might need to send out information about counselling. Additionally, foreign students are unsure of counsellors’ confidentiality, and believe that their issues may not be kept private [28]. It recommends schools should have specific rules and punishments if counselors share their clients’ information. Moreover, when schools hire counselor, they should carefully check their professional qualifications.

Besides, beginning to develop cultural competence and accepting acculturation before their departure from home is neglected. Colleges and universities should encourage international students to participate in cross-cultural events. Continuity of encouragement should be considered, which should be enough time for foreigners to build a connection with the host country. Academic institutes can provide enriched opportunities for internationals to make new friends, practice their language skills, and range themselves in the new environment. The idea has partially been put into practice, like a welcoming week for new students, in order to get familiar with local communities. However, events focused on international students are limited in number and variety. Therefore, future event designers could pay attention to cultural assistance and the unique challenges of the internationals.

From the perspective of society and government, effort should be paid when international students integrate into the community. Since this topic covers various disputes about social stabilities, citizens’ welfare, and national economic development, we only discussed the possible solution focusing on easing the burden of international students. In specific, to cope with the challenge of employment for them, there are plenty of ways. The government could lower the cost and difficulty of work visa applications. And providing an all-sided counseling and training system for these young adults. Practitioners should be as experienced as possible, providing students with in-depth suggestions and information (e.g., local regulation of employment and difference in cultural values) [29]. Communication among the population is also necessary, which provides effective guidance and hopeful conviction.

5. Conclusion

In this article, several stressors for international students are analysed. There is a mainstream of viewpoints accepted by the public. The findings from the studies point out that challenges for international students are caused by the cultural, social, and educational gap between the host country and their homeland. The effect of these challenges is serious (e.g., anxiety, depression, and homelessness). As the population has increased recently, supporting them in this area should be emphasised. Some researchers suggested that in-campus services provided by universities staffs could benefit them. Meanwhile, government and social organizations can make efforts to provide assistance and guidance to internationals.

Although much research has indicated the principle and inner reasons for unstable living quality, the ideas are not put into effective practice. This might be influenced by external factors and the government’s considerations. Therefore, research on how to design practical systems to reduce the challenges for students is required. The outcome of future progress is long-lasting and meaningful, promoting communication among new generations across the world in the framework of advantageous international student service.