Virtual Design Team

The majority of studies were conducted in the US followed by Australia, and the UK. The findings of the existing literature were grouped into eight categories: 1) Acculturative stress in the West; 2) Psychological adaptation arising from study abroad; 3) Sociocultural adaptation of international students; 4) Social support in an intercultural context; 5) Academic stress hidden in a different culture; 6) English proficiency as pertinent to psychological health; 7) Access to psychological counselling/TCM service; and 8) Cultural beliefs in relation to diet and weather.

3.3.1 Acculturative stress in the West

The reviewed studies showed that the most frequently-reported variables were acculturation level and acculturative stressor, with acculturation identified as the key variable (Smith & Khawaja, 2011). The majority of the key concepts regarding acculturative studies were derived from acculturation models (Arends-Tóth & van de Vijver 2006; Berry 1997; Berry, Phinney, Sam, & Vedder, 2006; Bourhis, Moise, Perreault, & Senecal, 1997; Navas, García, Sánchez, Rojas, Pumares, & Fernández, 2005; Piontkowski, Rohmann & Florack, 2002; Safdar, Lay, & Struthers, 2003; Van Oudenhoven, Ward, & Masgoret, 2006). In spite of the plethora of research on acculturation about migrants or immigrants, there was a shortage of research concerning international students. Among the various models on acculturation models, only a multidimensional individual difference acculturation (MIDA) model has been tested with the sample of international students using a longitudinal research design (Rasmi, Safdar, & Lewis, 2009; Smith & Khawaja, 2011).

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Acculturation is broadly defined as “cultural socialization to the mainstream society” (Kim & Omizo, 2006, p.143) in contrast with the notion of ‘enculturation’ which is termed as “cultural socialization to the culture of origin” (Kim & Omizo, 2006). Berry (1997) proposed an acculturation model based on the framework stress and coping model (Lazarus & Folkman, 1984 a, b).

An individual’s attitudes toward cultural change and cultural continuity were categorised into four orientations: integration, assimilation, separation, and marginalisation (Berry, 1997), which were integrated into the bi-dimensional, fourfold model of acculturation (Berry, 1997; Smith & Khawaja, 2011).

Berry’s Acculturation Model

Integration occurs when immigrants accept both home culture and host cultures; assimilation involves the yielding of their native culture to adopt the host culture; if home culture and host culture are both rejected, marginalisation occurs; separation occurs when immigrants desire to maintain traditions and refuse to have contact with

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the host society. Noteworthy, ‘integration’ is deemed to be in line with reduced acculturative stress and greater subjective well-being (Scottham & Dias, 2010; Ward & Geeraert, 2016), beneficial to positive emotions and psychological well-being, such as higher self-esteem, lower depression (Chen, Hwang, Tai, & Chien, 2013; Hui, Chen, Leung & Berry, 2015; Schwartz, Unger, Zamboanga, & Szapocznik, 2010). Berry’s (1997) acculturation framework provided a valuable insight into the complex acculturation process. The four categories of attitudes were individually appraised, through the exploration of acculturative stress and coping framework, different factors affecting the adaptation of acculturation are identified.

Nonetheless, the acculturation model developed by Berry (1997, 2005) has been criticized for its arbitrary cutting point between accept or reject host/ home culture which may lead to difficulty in making comparisons across studies with different samples (Rudmin, 2009; Rudmin, 2003). As an approach of acculturation, how many people will reject home culture and host culture simultaneously is questionable, thus the validity of marginalisation has been questioned (Del Pilar & Udasco, 2004; Schwartz & Zamboanga, 2008).

Focusing on migrant and refugee populations alone, the unilinear model of Berry (1997) was widely criticised for its false premise that change in cultural adaptation and identity occurs on a single linear continuum, that is, as one adapts to the host culture, an inevitable weakening of ties to one’s culture of origin follows (Kim & Omizo, 2006; Kumar & Nevid, 2010; Miller, 2007, 2010; Yoon, Lee & Goh, 2008). That is to say, the more acculturated an individual was to the host culture, the more

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likely this individual agreed with the host culture’s values and behaviours, thereby leading to a reduced identification with his original culture.

In response to the criticism, Berry (e.g. Berry, 2005) re-defined acculturation as “the dual process of cultural and psychological change that takes place as a result of contact between two or more cultural groups and their individual members” (Berry, 2005, p. 698). It was posited that the process of acculturation and enculturation could happen simultaneously. Changes were deemed to be taking place on a micro level of individuals (psychological acculturation) as well as on a macro level of group cultural acculturation (Berry, 2005; Smith & Khawaja, 2011) with both home and host culture. Such a bilinear model of acculturation consistently outperformed the unilinear model (Miller, 2007) in culturally relevant behaviours related to cultural adjustment (Kang, 2006).

On the basis of Berry’s (1997; 2005) model, Ward, Bochner, and Furnham (2005) integrated cultural learning and social identification perspectives, adding new dimensions to the model of stress and coping in their new model of acculturation study. Noteworthy, Ward (2001) and his associates (Ward & Kennedy, 1996) distinguished between psychological adaptation and sociocultural adaptation. Psychological adaptation is understood within a stress and coping model, involving feelings of well-being, self-esteem, or satisfaction with transitions, though it is usually measured through depression and other negative emotions (Ward, 2001; Ward & Rana - Deuba, 1999); while sociocultural adaptation is understood within the social/cultural learning and social identification theory (Smith & Khawaja, 2011), concerning how an

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individual is managing daily tasks in the new society. The two concepts are inter- related conceptually and empirically (Brisset, Safdar, Lewis, & Sabatier, 2010).

With 85 male and 81 female Iranian participants including a number of postgraduates (MA and PhD) in Canada, Safdar, Lay, and Struthers (2003) developed a MIDA model, and used the hassles i.e. a composite of psychological well-being, perceived social support, and cultural competence, as a predictor of psychological and sociocultural adaptation. To probe the Iranian immigrants’ acculturation experience in Canada, the researchers concentrated on three composite predictor variables in the model: 1) psychosocial adjustment including psychological well-being, bicultural competence, and perceived out-group social support; 2) connectedness to family and culture, such as family allocentrism, ethnic identity and perceived in-group support; and 3) the experience of acculturation-specific and non-specific daily hassles (Safdar & Struthers, 2003). The predictor variables such as psychosocial adjustment, hassles, and assimilation/separation were found to be crucial for predicting the psychological and sociocultural adaptation, and for promoting a more comprehensive understanding of the complexities of the experience in the acculturation as well.

On the basis of longitudinal data, Rasmi, Safdar and Lewis (2009) explored the international students’ intercultural adaptation in Canada and tested the MIDA model on those students. Their study was designed to test whether or not psychosocial resources and difficulties at Time 1 (T1) would predict health status and sociocultural adaptation at Time 2 (T2). It was found that psychosocial resources at T1 would predict psychophysical distress and academic hassles (i.e. difficulties such as understanding lectures, taking notes, or asking questions) at T1, and they would

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predict psychophysical distress at T2. Those international students reporting more academic hassles at T1 would perceive more psychophysical distress at T2 than those reporting fewer academic hassles.

Studies from Australia (e.g. Zheng, Sang, & Wang, 2004) brought to light a new perspective through its exploration of the cross-cultural adaptation and well-being of Chinese international students. Their study claimed that strong identification with either the host or home culture would enhance the students’ subjective well-being, including their satisfaction with life and positive affect.

Their findings were echoed in the study of Wei and colleagues (Wei, Liao et al. 2012), who conducted an online survey of 188 Chinese international students, and explored the interaction of forbearance coping, heritage culture identification and acculturative stress and their effect on psychological distress. Via a hierarchical regression model, they found a significant predictive effect of the three way interaction on psychological distress. Specifically, those who reported a lower level of identification with their heritage culture tend to report experiencing a higher acculturative stress, and the active use of forbearance coping strategy was positively related with psychological distress. However, the use of forbearance coping was not significantly associated with psychological distress when acculturative stress was lower. More importantly, “for those with a stronger cultural heritage identification, the use of forbearance coping was not significantly associated with psychological distress regardless of whether acculturative stress was high or low” (p.97). Seemingly, cultural variables such as forbearance, perfectionism (a cultural value to honour their family through academic

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achievement), and emotional self-control may be used to explore potential moderators to increase international students’ health and well-being when studying abroad.

As becomes clear, the acculturation models aforementioned provided a range of key concepts and predictor variables for further acculturative stress studies in an intercultural context. Acculturative stress and cultural adjustment difficulties prove to be complex and challenging issues, which is worthy of an in-depth study.

3.3.2 Psychological adaptation arising from study abroad

In the literature reviewed, more than a dozen studies examined psychological adaptation in relation to the health and well-being of Chinese international students. Among them, eight studies (Dao, Lee, & Chang, 2007; Han, Han, Luo, Jacobs, & Jean-Baptiste, 2013; Spencer-Oatey & Xiong, 2006; Wei, Heppner, Mallen, Ku, Liao, & Wu, 2007; Ying & Han, 2006, 2008; Ying, Lee, & Tsai, 2007a) have explored depression of Chinese international students. Studies worldwide have identified international students as a high-vulnerability group for suffering poor psychological well-being given the massive challenges in the adaptation they encounter (Mori, 2000).

Through online surveys of 189 Chinese international students, Wei, Heppner, Mallen, Ku, Liao, and Wu (2007) explored whether there is a moderating effect of maladaptive perfectionism on the relationship between acculturative stress and psychological well-being, especially depression. Facing a culturally distant new environment, communicating with a second language, and new cultural values and norms, Chinese international students tend to struggle in maintaining the high standard academic practice that they used to in their home culture. These students tend to see

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these challenges as personal failure, which exacerbated impact of acculturative stress on depression in a negative way and increased their vulnerability to depression (p.391). They suggested that acculturative stress, maladaptive perfectionism, and length of time stayed in the US had a three-way interaction to have a significant predictive effect on depression.

Their findings lent support to the Ying, Lee, and Tsai’s (2007b) study, which showed that acculturative stress was correlated with depression of Taiwanese international students. Specifically, Ying et al. (2007) discovered a mediating effect of sense of coherence on the association between parent/peer attachment and depressive symptoms. The sense of coherence served as a partial mediator and moderator of the effect of university challenges on depressive symptoms. In a study of Taiwanese international students in the US, Dao, Lee, and Chang’s (2007) study found that less- acculturated Taiwanese students were more likely to be at risk of depressive feelings. In a similar vein, Wang and Mallinckrodt’s (2006) study revealed that acculturation to the host culture was negatively related to anxiety.

To investigate the emotional health and well-being of postgraduate students from mainland China (n = 400) at Hong Kong, Pan (2008) focused on a resilience model of acculturation. With a cross-sectional research design, she employed a range of measurements including 1) Stress Appraisal Measure; 2) Chinese Personal Meaning

Profile; 3) Acculturative Hassles Scale for Chinese Students (AHSCS)；and 4)

Chinese Making Sense of Adversity Scale (CMSAS) in her study. Hierarchical

regression analyses showed that positive predictors included positive sense-making coping and meaning in life on Chinese international students’ emotional health and

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well-being; whereas for negative emotions, the significant predictors included acculturative hassles of academic work, cultural difference, and negative coping styles.

With regard to the depression and anxiety symptoms prevalence in the sample of Chinese international students, Yale University (Han et al, 2013) conducted an anonymous on-line questionnaire with 130 Chinese international students. Forty-five percent of the participants reported depression symptoms. For the anxiety symptoms, twenty-nine participants reported experiencing anxiety in the past month. Several factors were identified for the Chinese international students’ depression and anxiety prevalence in the prestigious US universities, including a low level of self-rated health status and a poor relationship with one’s academic supervisors. The depressive illness increased sharply in China since the early 1980s when the “Open-Door Policy” was implemented in China. Worthy of note, it is almost the same time when “One Child Policy” officially implemented. Growing up as the only child in the family, this generation of Chinese international students are called “little emperors”, who are the centre or the focus in the whole family, not only in the nuclear family but also in the extended family. They have been growing up “over-protected” and as the “little emperors” of the family, this may lead to their vulnerability to loneliness and independent life.

With 508 Chinese international students in the US, Zhang and Goodson (2011 b) examined mechanisms through which psychosocial adjustment was influenced by acculturation of Chinese international students in the US, utilising a bilinear acculturation model. Results from regression analyses on the web-based survey showed the importance of social connectedness with US locals having a mediating

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effect on the association between acculturative stress and psychosocial health (i.e., depression), that is to say acculturative stress has an impact on psychological health partially through their social connectedness. Social connectedness with Americans has a moderating effect on the association between adherences to the home culture and psychological health (e.g. depression). The finding highlighted the importance of social support and social connectedness in maintaining the health and well-being of international students and reducing negative emotions as well as acquiring sociocultural communication skills. Through the moderation model, this study’s innovative finding is the positive and protective role of adherence to home culture, especially for the group of Chinese international students who have limited interaction with Americans. Another significant contribution of this study is that international students who simultaneously detached the home culture of Chinese and host culture of US reported the highest level of depression. This has not been reported in the previous literature (Cemalcilar, Falbo, 2008; Wang & Mallinckrodt, 2006). This lends support to Berry’s model of acculturation on the “marginalization” attitudes of rejecting both the host and native cultures in the new environment, which has been associated with most difficulty in the acculturation (Birma & Simon, 2014; Ward, Bochner, & Furnham, 2005). It was believed that these differences could not be captured with a unilinear model (Berry, 1997). Their findings indicated that “social connectedness with Americans holds potential as an important factor in the psychosocial adjustment of Chinese international students and deserves further careful study” (Zhang & Goodson, 2011 a, p. 614).

Different voices were also raised regarding the psychological distress of Chinese international students especially during their initial cultural transition to the US. The

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findings from Spencer-Oatey and Xiong (2006) appeared to challenge Berry’s (1997) model by underscoring the importance of pre-arrival personality and dispositional coping variables in predicting acculturative stress. Some Chinese international students may not experience severe psychological distress before their arrival in the US. Spencer-Oatey and Xiong (2006) reported an empirical study with Chinese international students participating in a UK university foundation course. Findings from interview-based qualitative data showed that the majority of students experienced few psychological or sociocultural adjustment difficulties, and that the valuables of age and lengths of stay in the UK were significantly correlated with Chinese international students’ adaptation.

These studies suggested that study abroad tends to heighten the risk of depression and increase the likelihood of poor psychological adaptation of Chinese international students (Han, Han, Luo, Jacobs & Jean-Baptiste, 2013; Zhang & Goodson, 2011a). However, the findings from the study of Wang, Heppner, Fu, Zhao, Li and Chuang (2012) generated from four groups of Chinese international students indicated that the psychological adaptation of Chinese international students was not uniform, but diverse across individuals. With respect to psychological adaptation, it is interesting to notice the contradiction between Spencer - Oatey, et al.’s (2006) findings and that of Han et al. (2013) in Yale, which found a high prevalence rate (45%) of depression among Chinese international students. Viewed thus, it seems that whether Chinese international students run into psychological adaptation difficulty during their study abroad remains an unanswered question.

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As becomes clear, the acculturation models aforementioned provide a range of key concepts and predictor variables for further acculturative stress studies in an intercultural context. Yet these models tend to focus on social-psychological processes (e.g. adaptation and adjustment) for research and training purposes. They need to be treated with caution as they may not fully capture the complexities of the mobility experiences of international students. Acculturative stress and cultural adjustment difficulties prove to be complex and challenging issues, which is worthy of an in- depth study.

3.3.3 Sociocultural adjustment of international students

Sociocultural adjustment is conceptualized as the “ability to fit in and to negotiate interactive aspects of the new culture” (Searle & Ward, 1990, p.450). Wang and Mallinckcrodt (2006, p.431) suggested that good sociocultural adjustment is related with a close contact with host nationals, involvement in extracurricular activities, good language skills, and less perceived discrimination and longer periods of stay. It was associated with social learning, the behavioural and cognitive response, especially performing effectively during the intercultural transition (Ward & Greeraert, 2016).

According to Demes and Geeraert (2014), sociocultural adjustment involved 1) Climate (temperature, rainfall, humidity); 2) Natural environment (plants and animals, pollution, scenery); 3) Social environment (size of the community, pace of life, noise); 4) Living (hygiene, sleeping practices, how safe you feel); 5) Practicalities (getting around, using public transport, shopping); 6) Food and eating (what food is eaten, how food is eaten, time of meals); 7) Family life (how close family members are, how much time family spend together); 8) Social norms (how to behave in public, style of clothes, what people think is funny); 9) Values and beliefs (what people think about

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religion and politics, what people think is right or wrong); 10) People (how friendly people are, how stressed or relaxed people are, attitudes toward foreigners); 11) Friends (making friends, amount of social interaction, what people do to have fun and relax); and 12) Language (learning the language, understanding people, making yourself understood).

With a photo-voice research project in Belgium, Wang and Hannes (2014) invited international students to capture the challenges related to their intercultural adjustment. They probed the sociocultural adjustment of Asian international students in the Western culture. It was found that contact with local communities facilitated the international students to understand the lifestyle, religious beliefs, values and customs of the host society. Friendship with host nationals tends to reduce feelings of homesickness and loneliness, thus enhancing life satisfaction.

International students’ sociocultural experience and feeling of loneliness have been qualitatively investigated in Australia (Sawir, Marginson, Deumert, Nyland & Ramia; 2008). In their study with 200 international students in Australia, over a hundred and thirty of participants reported experiencing loneliness or isolation in Australia, especially at the initial stage of transition. During their study abroad, international students need to seek and build a new social support network. However, developing friendship with the local students proved to be difficult mainly due to three reasons: the limited English language proficiency, and the reluctance to form new deep level and meaningful friendships with international students or local Australian students (Hendrickson, Rosen, & Aune, 2011, p.283). It seems that the forming of the friendships depends on factors of personality, such as attachment style, being