STRESS, HEALTH AND COPING AMONG INTERNATIONAL STUDENTS AT THE UNIVERSITY OF MALTA 1

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AT THE UNIVERSITY OF MALTA 1 STRESS, HEALTH AND COPING AMONG INTERNATIONAL STUDENTS AT THE UNIVERSITY OF MALTA Claire Borg and Carmel Cefai Second Monograph in Resilience and Health, Centre for Resilience
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AT THE UNIVERSITY OF MALTA 1 STRESS, HEALTH AND COPING AMONG INTERNATIONAL STUDENTS AT THE UNIVERSITY OF MALTA Claire Borg and Carmel Cefai Second Monograph in Resilience and Health, Centre for Resilience and Socio-Emotional Health, University of Malta, 2014 AT THE UNIVERSITY OF MALTA 2 STRESS, HEALTH AND COPING AMONG INTERNATIONAL STUDENTS AT THE UNIVERSITY OF MALTA Second Monograph in Resilience and Health by the Centre for Resilience and Socio-Emotional Health, University of Malta Published by the Centre for Resilience and Socio-Emotional Health, University of Malta, Malta. First published in 2014 Claire Borg and Carmel Cefai All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the authors or the publisher. ISBN: AT THE UNIVERSITY OF MALTA 3 Resilience and Health Monograph Series Series Editors: Carmel Cefai & Paul Cooper We are pleased to publish the second monograph in the Resilience and Health series by the Centre for Resilience and Socio-Emotional Health at the University of Malta. The series aims to provide an open access platform for the dissemination of knowledge and research in educational resilience and social and emotional health. We plan to have one e-publication per year in such areas as social and emotional development, health, resilience and wellbeing in children and young people, social and emotional learning, mental health in schools and professionals health and wellbeing. The publication of the Resilience and Health Monograph Series is based on the philosophy of the Centre for Resilience and Socio-Emotional Health, which is develop and promote the science and evidence-based practice of social and emotional health and resilience in children and young people. We welcome contributions from colleagues who would like to share their work with others in the field. AT THE UNIVERSITY OF MALTA 4 CONTENTS INTRODUCTION... 7 FINDINGS... 9 Physical Health... 9 Emotional Health Social Health Stress, Health and Coping International Students Issues and Concerns CONCLUSIONS AND RECOMMENDATIONS Health Stress and coping Relationships and academic life Issues and concerns Recommendations CONCLUSION REFERENCES AT THE UNIVERSITY OF MALTA 5 ABOUT THE AUTHORS CLAIRE BORG. Following five years of voluntary work experience with school children, refugees, persons who experienced different types of abuse and domestic violence, and persons with mental health issues, Claire graduated as a B.Psy (Hons.)(Melit.) student in Since then she has been working as a project worker in a residential setting for persons with mental health issues, and currently she is working on an outreach level as a home support worker. Claire is also studying to become a Gestalt Psychotherapist and she is now in her fourth and final year of her studies. CARMEL CEFAI PhD (Lond.) is the Director of the Centre for Resilience and Socio- Emotional Health, and Head of the Department of Psychology, at the University of Malta. He is founding co editor of the International Journal of Emotional Education, Joint Honorary Chair of the European Network for Social and Emotional Competence (ENSEC), and coordinator of various local and international research projects on mental health, wellbeing and resilience in education. He is co-author of Healthy Students Healthy Lives (2009), the first major publication on the health and wellbeing of Maltese university students. ACKNOWLEDGMENTS The authors would like to express their gratitude to all the international students who participated in this study; to Prof Liberato Camilleri (University of Malta) for his help with the statistical analysis; and to Dr Valeria Cavioni (University of Pavia) for the design of the monograph s cover and layout. AT THE UNIVERSITY OF MALTA 6 INTRODUCTION The University of Malta is fast becoming an international community as the number of international students continues to increase from one year to the other. There are currently over 600 full time international students and about 500 exchange and transfer students from 80 countries, registered at the University of Malta. Their length of stay varies from one semester to a full time course programme. Though the majority of undergraduate students stay for one semester or one academic year, the number of full time postgraduate students is increasing with the recent opening of the International Masters Programme at the University of Malta. Over the past years, studying at the University of Malta has been made easier for international students as the University has reviewed its structures to be in line with the Bologna process. With its diverse programmes, expertise and high academic standards, the use of the English as the official language, and free registration for EU nationals, coupled with Malta s rich historical and architectural heritage, temperate climate and the hospitality of the people, the University of Malta provides a very attractive, worthwhile and unique package for international students. Studying abroad however, does present a number of challenges, particularly for first time students studying. While registration in the case of the University of Malta, fees are waved away for EU undergraduate students, while other students benefit from scholarships and other funding schemes, the expenses involved in living and studying abroad, coupled with finding adequate accommodation, is a main issue for many overseas students (Yusliza Mohd & Chelliah, 2010). Another challenge is related to proficiency in the English language, particularly at the academic level, since for many students, English is not the mother language. At more informal levels, such as in social gatherings, Maltese may also be spoken, which may leave the students feeling somewhat excluded. International students may also have to adjust to new ways of learning and assessment, including written examinations in English. This would be over and above the common stresses associated with academic life, which such students share with Maltese peers (Cefai & Camilleri, 2011). Finally, international students would also need to adapt to a new culture, and the process may require considerable time, energy and effort. In many instances, they would also find themselves away from their families and friends and their usual sources of support. Homesickness is in fact one of the most frequently reported concerns of international students (Poyrazli, Thukral, & Duru, 2010; Yusliza Mohd & Chelliah, 2010). AT THE UNIVERSITY OF MALTA 7 This study explores the perceived health and wellbeing of international students at the University of Malta. More specifically it examines the personal and academic concerns and challenges of international students, their perceived stress, health and coping, and whether these vary by gender, language and country of origin, and how they compare with the health of Maltese university students (as reported in Cefai & Camilleri, 2009). All undergraduate foreign students at the University of Malta were approached to complete a questionnaire online. Seventy-six students, mostly exchange and transfer students, completed the questionnaire: 48 females and 28 males, average age years, from 30 different countries, mostly European. The questionnaire was based on the one used by Cefai and Camilleri (2009) in the study with Maltese university students. A section was added, however, on the issues and concerns experienced by international university students such as financial and accommodation issues, language and culture, homesickness and loneliness (Poyrazli, Thukral, & Duru, 2010; Thomson, Rosenthal & Russell, 2006; Yusliza Mohd & Chelliah, 2010). The questionnaire consisted of four sections, namely demographic details including mother language and country of origin, physical health and lifestyle, emotional and social wellbeing, and life and challenges as an international student. Students were asked to answer a number of statements in each section and tick the most suitable response. There were also a small number of qualitative questions. The questionnaire was piloted with a small number of students and some minor modifications were made to the final version. The questionnaire was administered online anonymously. The Chi-Square test and the One-way ANOVA test were used to make inferences through tests of hypothesis; for both tests a 0.05 level of significance was employed. The Chi-Square test was used extensively to determine whether the associations between health-related variables and demographic variables were significant. The One-way ANOVA test was used to compare the mean values of various quantitative dependent variables across the categories of independent explanatory variables, such as age, gender, language and country of origin. The P- value and the Z-score of the percentages of the study were compared with those of the study with Maltese students (Cefai & Camilleri, 2009), making use of z score to p value conversion calculator. AT THE UNIVERSITY OF MALTA 8 FINDINGS Physical Health Figure 1 shows that 89% of undergraduate international students feel healthy, with only 11% feeling quite unhealthy. Overall, more male students feel that they are healthy and more females believe that they are unhealthy, but the P-value is slightly above the 0.05 and thus not significant (Figure 2). These results are quite similar to those of Maltese students (90% healthy, 10% unhealthy), but Figure 3 also shows that international students feel healthier than Maltese students. When asked about psychosomatic symptoms in the past semester, the participants chose tiredness as the symptom which they suffer most from (30%). This is followed by neck and shoulder pain, sleep problems, back pain, sadness, bad temper, anxiety, stomach pain, and dizziness respectively; the least common symptoms were allergy problems, headache and asthma. Tiredness, shoulder pain and back pain may signify the busy yet sedentary life of a university student. When the international and Maltese cohorts are compared, all the results are statistically significant (except for back pain), suggesting that international students reported significantly lower levels of psychosomatic symptoms than Maltese peers (Figure 4). Figure 1. Perceived health of international students AT THE UNIVERSITY OF MALTA 9 Figure 2: Perceived health by gender Figure 3 Perceived health of international and Maltese students AT THE UNIVERSITY OF MALTA 10 Figure 4. Psychosomatic symptoms amongst international and Maltese students Emotional Health Figure 5 shows that the vast majority of the participants are happy as university students, while Figure 6 shows that the majority of the students feel emotionally healthy. This contrasts with the relatively low percentages of those who find it difficult to cope, feel emotionally exhausted and helpless. However, 27% claimed to feel sad quite often, 28% feel bad tempered on a regular basis and 26% suffer from anxiety quite often. 19% of students often feel panicked 16% insecure, 26% too busy to cope and 28% emotionally exhausted. 17% reported feeling quite helpless and 10% said that they often suffer from depression. When compared with Maltese students, international students appear to be more satisfied, happy and confident and less likely to feel exhausted and helpless (Figure 7). AT THE UNIVERSITY OF MALTA 11 Figure 5. Feeling happy as a university student Figure 6. Perceived emotional health AT THE UNIVERSITY OF MALTA 12 Figure 7. Perceived emotional health amongst international and Maltese students Social Health As expected, the communication levels between international students and their significant others such as parents, siblings, friends and partners decreased since they left their home country (Figures 8-11). However, 68% said they still find it easy to speak with their parents about issues that trouble them. As one may also expect, three quarters of the students reported missing their friends and families, one third to a significant degree (Figure 12). Figure 13 shows that the majority of the students do have a number of close friends, and only 11% reported having only one friend or no friends at all. When asked about their personal relationships, 72% reported that they are satisfied with their relationships, but more than one fourth may not be (Figure 14). Figure 15 suggests that the more close friends one has, the happier one is, though the relationship is not significant. Figure 16 shows that while the majority of international friends do not experience loneliness, 23% appear to be lonely, which is considerably lower than the 51.5% rate for Maltese students. AT THE UNIVERSITY OF MALTA 13 Figure 8. Communication with parents: before and after coming to Malta Figure 9. Communication with friends: before and after coming to Malta AT THE UNIVERSITY OF MALTA 14 Figure 10. Communication with siblings: before and after coming to Malta Figure 11. Communication with partners: before and after coming to Malta AT THE UNIVERSITY OF MALTA 15 Missing friends & family back home None at all 1% Extremely 8% A little bit 24% A lot 24% Average 43% Figure 12. Missing friends and family. Figure 13. Number of close friends of international and Maltese students AT THE UNIVERSITY OF MALTA 16 Figure 14. Satisfaction with relationships amongst international and Maltese students Figure 15. Relationship between degree of happiness and number of close friends AT THE UNIVERSITY OF MALTA 17 Figure 16. Feelings of loneliness amongst international and Maltese students. Stress, Health and Coping The majority of undergraduate international students do not feel stressed, but one third feel that life at University is stressful or very stressful, with female students being more stressed. This is significantly lower, however, than the two thirds of Maltese students who feel stressed; the difference is particularly striking in the very stressful category (7% vs 26%) while in all potentially stressful items, local students are more stressed (Figures 17-19). When presented with a list of potential stressors, half of international students said that tests and exams were the most stressful, followed by transport (38%) and too many assignments/projects (30%). This is to be expected since most international students use public transport; in fact in comparison to Maltese students, parking is the least stressful for the former, followed by too many students in one class and writing a dissertation. Most international students do not complete a dissertation as they come here for one or two semesters, and they may be used to large classes in their home university. When perceived stress level was compared to physical ailments, no significant results or particular trends could be noted. This is probably due to the low levels of physical complaints expressed by students, as well as the moderation of stress by AT THE UNIVERSITY OF MALTA 18 other psychosocial variables. On the other hand, however, there was a significant negative relationship between the level of perceived stress and the perception that life was going well (Figure 20). A similar relationship was observed, though the p value was slightly higher than 0.05, between the level of perceived stress and the difficulty to make friends (Figure 21). As one can see from Figure 22 on coping strategies, international students make most use of friendship support, positive thinking better planning and organization and going out to social events. On the other hand, counseling, avoidance praying and studying harder are the least common coping strategies. Maltese students used praying, better planning and organization and studying harder more than international students, while the latter made more use of palliative coping strategies such as eating, drinking, smoking, as well healthier practices like friendship support, positive thinking better planning and organization and going out to social events. Figure 17. Level of perceived stress amongst international and Maltese students AT THE UNIVERSITY OF MALTA 19 Figure 18. Sources of stress amongst international and Maltese students Figure 19. Perceived stress level by gender AT THE UNIVERSITY OF MALTA 20 Figure 20. Perceived stress level and feeling that life is going well Figure 21. Perceived stress level and ease in making friends AT THE UNIVERSITY OF MALTA 21 Watching television Yoga/relaxation Eating Smoking Avoidance/escaping Going out to social events Drinking alcohol Physical exercise Spending less time doing leisure activities Time management Positive thinking Praying Talking to friends Family support Counseling Asking help from lecturers and colleauges Better planning and organization Studying harder Maltese students Foreign students 0% 10% 20% 30% 40% 50% 60% 70% Figure 22. Coping strategies adopted by international and Maltese students International Students Issues and Concerns A number of qualitative questions indicated that a small number of students felt that studying in Malta was quite challenging at first. Leaving family and friends behind did make them feel homesick at times. Some students also found it difficult to deal with certain responsibilities such as finding a place where to live, managing their budget, making friends, coping with language difficulties and with different lecturing methods. Some students also found it difficult to adapt since Maltese students tended to work on their own and not in groups, and thus had difficulty to make friends, to get help with lecture notes and share course materials. Some students experienced a mild culture shock because they felt that the University of Malta operated quite differently than their own university. However, on a general note, students were very glad to be in Malta and did not take long to adjust to a new way of living. Moreover, variables such as financial issues, missing loved ones, making friends or experiencing a different university system, were not significantly related to stress. When asked why they chose to come to study in Malta, the most common reason was the sunshine and the weather, followed by the use of the English AT THE UNIVERSITY OF MALTA 22 language and the good reputation of the University and course content respectively. Historical heritage and culture, the sea, geographical position, proximity or lack of, to their country, and the hospitality of the Maltese people were some of the other reasons mentioned by the participants (Figure 23). A number of students also said that they had friends who were living or had been in Malta and who recommended the country to them. Some students were already living here and/or having partners living in Malta or had been to Malta on holiday before. Finally, a small number of students said that they chose Malta because they were not chosen for another country, because of low tuition fees and because in Malta there is a residence for international students. Figure 23. Reasons for studying in Malta As Figure 24 shows, 91% of international students said that their understanding of the English language is good or very good; however, this dropped to 77% when it came to speaking: 22% said that their speaking is average to bad. Figure 25 illustrates that 40% of international students encountered problems when making friends with Maltese people (not necessarily Maltese students). With AT THE UNIVERSITY OF MALTA 23 regards to relationships with the university community, the great majority of students (78%) reported that their lecturers are helpful and caring, while 83% said that local students are friendly and supportive (Figures 26-27). When asked about the use of and help provided by the various university services, students sought help mainly from the International Office and their respective department Departments, but made less use of student organizati
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