How Do Chinese International Students View Seeking Mental Health Services?

Research Highlighted:

Chen, H., Akpanudo, U., & Hasler, E. (2020). How Do Chinese International Students View Seeking Mental Health Services? Journal of International Students, 10(2), 286-305. doi:

Lillian Huan Chen, University of North Texas

The COVID-19 global pandemic has taken an emotional and physical toll on individuals cross countries, and many university international students have been facing the challenges of uncertainties in their academic degree plan, living arrangements in between semesters, lack of social interaction due to quarantine, and unexpected financial adjustment. Prior to the current stressors, international students encounter various cultural barriers that are often overlooked, such as language barriers, identity conflicts, and unfamiliar cultural norms (Jibreel, 2015), which all can impact their mental wellness. While international students may be aware of their anxiety level, they tend to focus more on pressing concerns like academic performances. Though mental health plays an important role in students’ self-identity, there seems to be a disconnect between feeling it and attending to it. Unfortunately, such disconnect extends to the international student affairs units where many schools do not prioritize addressing the mental health concerns and meeting the mental health needs of international students (Qu, 2018). Therefore, this article aims to understand specifically the Chinese international students’ attitude toward seeking mental health services and intends to advocate for these students to higher education practitioners. The article proposes the following research questions: 

1. To what extent does gender and length of stay in the United States influence the attitudes toward seeking mental health services among Chinese students?

2. To what extent does gender and awareness of on-campus counseling services influence the attitudes toward seeking mental health services among Chinese students?


The researchers used convenience sampling and were able to obtain responses of 113 Chinese international students from two southeastern universities in the United States. Attitude Toward Seeking Professional Psychological Help Scale – Short Form (ATSPPH-SF) was utilized as the assessment to collect students’ responses, and a total of 110 valid responses were included for data analysis. Of the participants, 57 were males and 53 were females. 34 participants reported to be in the U.S. for less than one year; 57 participants stayed between one to two years, and 19 residing in the U.S. for more than 3 years. The ATSPPH-SF is a widely used instrument for assessing attitudes toward seeking mental health treatment (Elhai, Schweinle, & Anderson, 2008). The ATSPPH-SF comprises 10 items on a four-point Likert scale (0 = “Disagree”, 1= “Partly Disagree”, 2 = “Partly Agree”, 3 = “Agree”) of which five are reverse scored (Picco et al., 2016). Scores on the scale range from 0 to 30, with higher scores indicating a more favorable attitude toward seeking mental health services (Elhai et al., 2008).


There was no statistical significance found on the interaction between gender and the length of stay in the U.S. for Chinese international students’ attitudes toward seeking mental health services. Neither the main effect of gender nor length of stay yielded statistical significance. However, there was a general pattern in both genders that as students’ length of stay increased a more positive attitude was presented. In addition, the standard deviation for the total mean score for both genders decreased when a longer length of stay was reported, which possibly indicates that students who have spent a longer time in the U.S. resulted in a more unified and positive attitude toward mental health. 

Among the 110 responses, 88 reported their acknowledgment of counseling center on campus, and within those 88 responses, a statistical significance was found on the interaction between male and female students’ attitudes toward seeking professional mental health services and their awareness of a counseling center on campus. There was a significant difference in attitude among gender for students who were not aware of the on-campus counseling center. Among those who are unaware of the availability of on-campus counseling services, male students have attitudes that are significantly less positive toward seeking mental health services than do female students. 


The findings of this study are particularly relevant as these add to the literature regarding the influence that gender, cultural adjustment, and knowledge of on-campus opportunities to receive mental health services may have on mental health help-seeking among international students. Baer (2017) reported that though universities have interventions in place for students who need academic support, typically a narrower range of interventions exists for students with difficulty adjusting to campus life and feeling safe on campus. Academic performances and integrity remained the priority of higher education’s concerns. However, universities are aware of the emotional needs of their international students by placing providing resources on cultural differences between China and the United States, as well as hiring Chinese-speaking international student services staff/counselor following after the academic requirements. Several recommendations were presented in the implications of this article. 

By attending to the emotional needs international students have for their continuous growth in academic settings, universities ought to consider offering mental health care-related events to raise students’ awareness of the importance of mental health. Institutions might also provide opportunities for students to feel personally cared for by recommending support groups or individual counseling therapeutic relationships. As international students are already conceiving of themselves as the minority population on campus, they may have been underrepresented in the campus climate, and the responsibility falls on the international student affairs office to advocate for those students as well as implementing effective interventions. 


Baer, J. (2017). Fall 2017 International Student Enrollment Hot Topics Survey. Retrieved from

Elhai, J. D., Schweinle, W., & Anderson, S. M. (2008). Reliability and validity of the attitudes toward seeking professional psychological help scale-short form. Psychiatry Research, 159(3), 320-329.

Jibreel, Z. (2015). Cultural identity and the challenges international students encounter (master’s thesis). Retrived from

Picco, L., Abdin, E., Chong, S. A., Pang, S., Shafie, S., Chua, B. Y., … & Subramaniam, M. (2016). Attitudes toward seeking professional psychological help: Factor structure and socio-demographic predictors. Frontiers in psychology, 7.

Qu, H. (2018). International student engagement in American higher education: Perspectives of international students toward services provided by the Office of International Services. [Dissertation] ProQuest LLC.

Authors’ Bio:

Huan (Lillian) Chen is a doctoral student focusing her studies in Counselor Education at the University of North Texas. Her clinical experiences in counseling include play therapy, filial therapy, young adult counseling, and multicultural counseling. She has strong research interests in the effectiveness of Child-Parent Relationship Therapy (CPRT) among families cross culture, Chinese speaking population’s perspective on counseling, and training and supervising counselors-in-training. She hopes to continue her pursuit in advocating for multicultural competency and the development of mental health awareness in Chinese-speaking cultures. She can be contacted:,

Dr. Usenime Akpanudo is an Associate Professor of Educational Leadership and Director of Research Initiatives at the CannonClary College of Education, Harding University in Searcy, Arkansas. His research interests include schools as organizations, the intersection of schools and culture, and social vulnerability. Contact:

Erin Hasler graduated from Harding University receiving a B.S. in Psychology, an M.S. and an Ed.S. in Clinical Mental Health Counselling. During her time in graduate school, she developed an interest in research and data analysis, using those skills in her work as a graduate assistant for Harding’s Educational Leadership department. Erin currently works in education in the state of Maine. Contact:

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