Muhammad Zahid abbas 梁雪梅 劉可智

1 Introduction

International students got to know well about China for education purposes in the last decade.According to U.S.NEWS ＆ World Reports，China has become the third most popular destination for international students after UK and USA.According to records of MOE of China，it had 265，090 international students in 2010 from Europe，America，Africa，Oceania and Asia［1］.Living in a host country becomes challenging due to cultural differences and language barriers.The stress experienced by the international students from the differences between their native culture and the dominant host culture is commonly referred to as“acculturative stress”［2］.This cultural transition leads to acculturative stress and adaptation difficulties accompanied by psychological disorientation.Adapting to new environments may be stressful for international students who experience accumulated pressure to adjust to a new language，cultural values，as well as to social norms.The pressure may put a significant demand on the individual，increasing their feelings of stress or fear［3］.Yang［4］described the psychological problems due to internal and external factors effecting the international students.When acculturative stress accumulates or fails to find a way to be released，it may exert an adverse effect on one＇s psychological well － being［5］，These psychological or mental health problems may include depression，anxiety and perceived stress.Depression is often listed as one of the top presenting symptoms of psychological problems that international students may have when they experience a high level of acculturative stress［6］.Adjusting to life in college can bestressful for anystudent but for international students，this stress is often multiplied［7］.In the host country international students meet a lot of stressful situations such as language barriers，academic demands，homesickness，lack of social support［8］.High acculturative stress often leads to more difficulty in adapting socioculturally［9］It is very important to analyze the levels of acculturative stress，adaptation difficulties and mental health problems among international students so that the cultural transition process can be understood and facilitated.A lot of research has been done in western countries to evaluate the prevalence and causes of acculturation stress，mental health issues and maladjustment among international students.The purposes of all these research and studies were to understand the problems of international students in the host country from all aspects，to facilitate the acculturation process and to help the international students to adjust to the host culture successfully.In China this kind of research is at its beginning phase as China has become known to international students for just a decade.The main purpose of this study was to evaluate and understand acculturation stress，mental health issues and adjustment problems among international students studying in China.Other purposes were to study physical，social and psychological interaction of international students to the host culture.

2 Methods

2.1 Subjects This was a cross sectional self administered questionnaire survey.This study was done on international medical students studying in Luzhou medical college，Sichuan province China.General demographic details e.g.Age，Gender，Country and Grade were obtained in the first part of the questionnaire.

2.2 Measurements Acculturative stress:acculturation stress was measured using Acculturative Stress Scale for International students(ASSIS)by［10］.It is a 36 items scale in which responses are assessed in a Likert scale ranging from 1(strongly disagree)to 5(strongly agree).The total score for this scale ranges from 36 to 180 with higher score indicating higher acculturative stress levels.

Mental health problems:To evaluate the mental health status a new version of Depression，Anxiety，Stress Scale－21(DASS－21)was used.This scale contains 21 items.There are 7 items for each subscale e.g.depression，anxiety and stress respectively.

Socio－cultural adjustment:To evaluate the social and cultural adjustment a standard scale known as Revised Socio Cultural Adjustment Scale(SCAS－R)by Wilson＆ Ward was used.This revised scale consists of total 21 items.The higher score shows the higher levels of adjustment difficulties.

2.3 Analysis All the data was computed and analyzed using SPSS(version 16.0).Further analysis was done by using descriptive statistics and t－ test.

3 Results

3.1 General demographic information 150 questionnaires were distributed，out of which 100 questionnaires were collected back successfully.General demographic information were collected in the first part of the questionnaire.The age of the students ranged from 17 years to 25 years.Mean age was 21.5 years with(SD=1.957).Out of total 100 students 68 were males and 32 were females.All the students were studying in different school years.21 students were in 1styear，8 students in 2ndyear，19 students in 3rdyear，20 students in 4thyear and 32 students in 5thyear.All the students were undergraduate medical students.Most of the students were from Asia and others were from Nigeria，Ghana，Somalia，Canada and America.

3.2 Acculturative Stress Scale for International students(ASSIS):The range of scores for this sample ranges from 42 to 145 with mean of 97.41(SD=22.08).The prevalence of acculturation stress among international students in this study is 32 percent.It means out of 100 students 32 percent of students are facing acculturation stress.There might be some important stressors in host culture which can induce higher levels of acculturation stress.The important stressors evaluated in this study were homesickness，food problems，student＇s problems at campus，cultural differences and lack of understanding each other＇s cultural and religious values.The results of ASSIS are given in the table 1 below.

Table 1 The results of ASSIS

3.3 Depression，Anxiety，Stress Scale －21(DASS－21) Depression:An evaluation of depression was done for all students from 1styear to 5thyear.Results given in the following table were obtained.28.6 percent students in 1styear，12.5 percent students in 2ndyear，5 percent students in 3rdyear， 40 percent students in 4thyear and 31.2 percent students in 5thyear were depressend.

Anxiety:The percentage of students with perceived anxiety was calculated.52.3 percent students in 1styear，37.5 percent students in 2ndyear，12.1 percent students in 3rdyear，30 percent students in 4thyear and 28.1 percent students in 5thyear were with anxiety.Length of stay was slightly influencing the presence of anxiety，showing higher anxiety in 1styear students and then decrease in the prevalence of anxiety with increase in time of stay in China.

Stress:The prevalence of perceived stress was also evaluated.The results are given in the following table 2.9.6 percent students in 1styear，37.5 percent students in 2ndyear，10.6 percent students in 3rdyear，25 percent students in 4thyear and 25 percent students in 5thyear were with stress.Prevalence of stress was lowest in 1styear students and was highest in 2nd year students.

Table 2 The evaluation of depression，anxiety，and stress of all students from 1styear to 5thyear(%)

3.5 Socio － cultural adjustment Scale(SCAS):An analysis of subscales of SCAS－R is given in the following table 3.

Table 3 The result of subscales of SCAS－R

Results of this study show that international students are experiencing a lot of difficulty in learning Chinese language.Language is the most important factor(mean=2.41).

4 Discussion

In this study，the prevalence of acculturation stress among international students is 32 percent.And the homesickness was the top stressor for international students，whereas failure of adjustment to new foods was the second most important stressor.This result is the same as Bebe＇s study which BeBe［1］also describes language，food and cultural differences as highly disturbing problems for international students in China.According to Sandhu ＆ Asrabadi［10］，stressors related with daily living，academics，language，and culture can be categorized under acculturation stress due to changed environment whereas stressors associated with interpersonal relations with local people may be described as perceived discrimination.Living in an entirely new culture can lead to culture shock or acculturation stress.Furthermore，stressors about family and loneliness can be defined by homesickness.These stressors are commonly experienced by international students and can affect their academics and satisfaction in living and studying in host country.Cultural differences and poor understanding of host culture values was also a factor leading to acculturation stress.Homesickness，food problems and cultural differences are the top factors which are playing the key role in the acculturation stress among international students in host culture.

International students were also experiencing the stress，depression and anxiety.In this study，an evaluation of stress，anxiety，and depression was done for all students from 1st year to 5thyear.And the anxiety was higher in 1st year students which could be aassociated with the length of stay in the host culture.Accul-turation stress or acculturation shock can lead to poor performance and psychological problems in international students.Acculturation shock often leads to mental health problems like depression，anxiety and stress.Depression and anxiety have strong association with culture shock.Failure of adjustment to new culture also leads to depression and anxiety.

Results of this study show that international students are experiencing a lot of difficulty in learning Chinese language.Language is the most important factor(mean=2.41)which leads to successful socio －cultural adjustment if it is learned and understood.Failure or difficulty in learning and understanding of language of host culture leads to great levels of adjustment problems.International students are also facing difficulties in maintaining their hobbies and personal interests in the host community.It is also difficult for them to involve with in the community socially and psychologically as well as challenging to interact with Chinese people because of cultural barriers and poor understanding of each other＇s emotions.Students face moderate levels of difficulties in adjusting to new learning style and education system.It has also found that length of stay was slightly facilitating the adaptation but it has no significant effect on socio－cultural adjustment.It was different from other studies which stated that the longer individuals reside in the foreign country，the better the adjustment process to the new environment will be.For instance，Wilton and Constantine［11］found that greater length of stay in the U.S.was associated with lower levels of psychological distress among Asian and Latin American international college students.It was also difficult for students to maintain their hobbies and interests in the host society.International students were also facing lack of social support and social interaction with the host community.It is also found that length of stay has its effect on the process of adaptation.A student with increased length of stay has more successful adaptation in host society but this study does not support this effect at significant levels.

As now China is going to be a popular destination for international students so there is a need to do research in this area.University authorities should appoint experts in this field，in order to understand the social，psychological and academic problems of international students.This not only would improve academic performance of international students but also help to attract more students to Chinese universities.

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