.2 .. .1: .,:*:.-.;.;‘ NW" ““3 v Ti“: w .8 “i. | 7.. .«Qvlu-m -N. .. Vow; To. «no nwm , Y r...- -h- a v 52.... >3; a.- L. :1 "QT—'12:; : u-ws y... g‘ ng‘ -nw’~ mun -1: - »- ~ A u-dm » “V ,,..~ A»: m«—’ $6.55 9‘2" ‘ 3 J ‘ iiiéfiig‘i'i' t. fidifiififi' ° v Lo . .o «. .Ar 22%" : 1 : 91:1.“ paw-v 3‘: ~m‘ mam lllllllllllllllllllllllllllllllllllllllllllillllllllllllllllll 31293 02058 6495 :7\ “l ‘1‘, {n‘ ”“1 "1. This is to certify that the dissertation entitled THE ROLE OF HARDINESS AND.*‘PERCEPTIONS OF SOCIAL SUPPORT IN THE EARLY COLLEGE ADJUSTMENT OF INTERNATIONAL STUDENTS presented by S . A11 Mirzadeh has been accepted towards fulfillment of the requirements for Ph.D. Counseling Psychology degree in Major professor Date August 30, 1999 MSU i: an Affirmatiw Action/Equal Opportunity Institution 0- 12771 LIBRARY Michigan State Unlverslty PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECAUED with earlier due date if requested. DATE DUE DATE DUE DATE DUE NOV] 7 2001 (MM 2 @805 111701 APR ”‘3 “o 9033 m g 5 2004 ___17_g_§ 11/00 chIRC/DmoDmpfiS—p.“ THE ROLE OF HARDINESS AND PERCEPTIONS OF SOCIAL SUPPORT IN THE EARLY COLLEGE ADJUSTMENT OF INTERNATIONAL STUDENTS By S. Ali Mirzadeh Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Educational Psychology, and Special ‘ Education 1999 ABSTRACT THE ROLE OF HARDINESS AND PERCEPTIONS OF SOCIAL SUPPORT IN THE EARLY COLLEGE ADJUSTMENT OF INTERNATIONAL STUDENTS By S. Ali Mirzadeh Change is a constant, though often gradual, characteristic of most environments. Environmental change is often precipitated by relational factors such as divorce, deaths in the family, or incarceration; by social factors such as crime, riots, and revolutions; by economical factors such as recessions and unemployment, and by natural factors such as earthquakes and floods. It can also be produced by experimental manipulations. Occasionally, however, significant and rapid change is induced through the insertion of an organism into a new environment. International students are an example of a naturally occurring population that experiences a high degree of environmental change in just such a manner. Change in life circumstances has been demonstrated to elicit a stress reaction in some individuals. Research in the past twenty years has consistently demonstrated a link between exposure to stress and the development of a variety of physical and psychological symptoms. This association, though significant, is not universal. The generally cited correlation index is of the order of 0.30. In the past two decades, the roles of a range of individual differences that purportedly influence the stress-illness link have been examined. Hardiness and perceptions of social support have emerged in the literature as two such factors. According to the literature, the prevalence of physical and psychological symptoms among international students is similar to the reported rates of these symptoms among other stress-exposed groups. This implies that although a portion of the international student population exhibits vulnerability to the development of stress related symptoms, another segment remains relatively symptom free. As well as provide descriptive data on the health status of new international students enrolled in a large mid-Westem university, this study examined the roles of hardiness and perceptions of social support in the adjustment of this population to environmental change. This dissertation is dedicated to all Iranian students who left our home country in pursuit of knowledge in the years between 1975 and 1979. As we each stepped onto the plane at Mehrabad, little did we know there was no coming back. ACKNOWLEDGEMENTS Those who complete the requirements of a doctoral degree discover, both directly and vicariously, that the role of the advisor is the single most influential determinant of outcome. In my own case, I was blessed with an advisor who personifies the often discussed but far less oflen observed personal qualities of genuineness, warmth, and unconditional positive regard. Professor Robbie Steward, by her own human-centered example, exposes the fallacy of a task- centered approach to life. This dissertation is yet more evidence in support of the belief that no work is produced by a single author. The original idea of this project was conceived and developed with the generous and expert guidance of professor Frederick G. Lopez. During the latter stages of the project my work was immeasurably facilitated by Professor Kenneth G. Rice’s willingness to remedy the considerable deficits in my statistical skills. Throughout the project, I was helped, assisted, encouraged, advised, inspired, stimulated, and ,most essentially, prodded by my wife Susan Doyle-Mirzadeh. From permitting me to express (and thus think through) half- baked ideas, to most ably helping me in the coding, data entry, and data analytical stages she graciously conspired with me in my delusion that things were always under control. In her willingness to proof-read the various drafts of the manuscript she exhibited the same zeal and commitment to the plight of the distressed that are the hallmarks of her work with the severely mentally ill. Finally, I wish to express my sincere gratitude to the psychology staff at Wright-Patterson Medical Center and in particular Lt. Col. (Dr) Ken Dobbins for graciously providing me with time and support during my clinical residency year. TABLE OF CONTENTS LIST OF TABLES CHAPTER 1 Introduction Problem Statement CHAPTER 2 Review of the Literature . The Health Status of International Students . The Relationship Between Stress and Health . The Role of Hardiness in the Stress-Illness Link . The Role of Social Support in the Stress-Illness Link. The Combined Roles of Hardiness and Social Support in the Stress-Illness ink Questions under Investigation. Hypotheses CHAPTER 3 Methodology . Participants Procedures Instruments Stress . Hardiness . Social Support. Adjustment . Data Analytic Procedures CHAPTER 4 Format. Data Entry Issues Sample Description Sample Representativeness . Variables Used 1n the Present Analyses Internal Consistency of the Instruments Used. . Comparisons of the Scores Obtained by Participants in the Present Study with those Reported in Other Studies . Frequency and Intensity of Symptoms, Syndromes, and Critical Items . . Descriptive Analysis of the Index of Life Stress vii \ju—I 18 21 23 26 28 28 30 3O 31 32 32 33 34 35 36 38 39 39 47 48 51 52 52 57 Descriptive Analysis of the Index of Social Support . . 59 Inferential Statistics and Hypothesis Testing . . . 61 Hypothesis 1 . . . . . . 61 Hypothesis 2 . . . . . . 68 Hypothesis 3 . . . . . . 73 Hypothesis 4 . . 79 The Effects of the Three Components of Hardiness upon Adjustment . 82 Roles of Demographic Factors in the Adjustment of International Students. . . . 98 CHAPTER 5 Discussion . . . 100 The Health Status of International Students . . 103 Significant Sources of Stress and Social Support. . 104 The Role of Hardiness in the Adjustment of New International Students. . 105 The Role of Social Support 1n the Adjustment of New International Students. . 109 The Roles of Native Language and Geographical Region 110 Strengths and Limitations . 1]] Implications for Future Research and Practice. . 113 APPENDICES Appendix A (Initial Contact Letter) . . . . 118 Appendix B (Informed Consent Form) . . . 120 Appendix C (Sign-up Form). . . 122 Appendix D (Demographic lnforrnation) . . . 123 Appendix E (SUNYA-PSC). . . . . 125 Appendix F (SCL-90-R) . . . . . 126 Appendix G (188) . . . . . . 128 Appendix H (ILS) . . . . . . 130 Appendix I (PVS- II). . . . . 132 Appendix J (Demographic Information 11) . . . 134 BIBLIOGRAPHY . . . . . . . 135 viii LIST OF TABLES Table 1. Sample Demographic Information. 2. Sample Social Network Information 3. Sample Education Related Information 4. Descriptive Statistics for All Variables 5.1. Correlations Among Variables Used in the Analyses 5.2. Correlations Among the Three Components of Hardiness 6. The Reliability Coefficients (Cronbach Alpha) of the Instruments . 7. [LS and 188 Scores: Present Study Vs. Other Studies. 8. SUNYA-PSC Scores: Present Study Vs. Other Studies 9. Descriptive Statistics and Paired Sample T-Tests for the Depression, Anxiety, and Somatization Scales of the SCL-90-R 10. T-Scores on the Depression Scale of the SCL-90-R 11. T-Scores on the Anxiety Scale of the SCL-90-R 12. T-Scores on the Somatization Scale of the SCL-90-R . 13. Frequency of Critical Items 14. Frequently and Intensely Experienced Psychosomatic Symptoms 15. Salient Sources of Life Stress 15.1 Frequency of Occurrence of Items Comprising the [LS . 16. Salient Sources of Social Support. 16.1 Frequency of Occurrence of Items Comprising the 188 ix page 41 44 46 49 50 51 51 52 52 53 54 54 55 56 57 58 58 59 60 17.1 The Amount of Variation in BDEPR Explained by Equation 1 17.2 The Evaluation of Coefficients Associated with the Predictor Variables 18.1 The Amount of Variation in BANX Explained by Equation 2 18.2 The Evaluation of the Coefficients Associated with the Predictor Variables 19.1 The Amount of Variation in PSCPST Explained by Equation 3 . 19.2 The Evaluation of the Coefficients Associated with the Predictor Variables 20.1 The Amount of Variation in BSOM Explained by Equation 4 . 20.2 The Evaluation of Coefficients Associated with Predictor Variables 21.1 The Amount of Variation in BDEPR Explained by Equation 5 . 21.2 The Evaluation of Coefficients Associated with Predictor Variables 22.1 The Amount of Variation in BANX Explained by Equation 6 . 22.2 The Evaluation of Coefficients Associated with Predictor Variables 23.1 The Amount of Variation in PSCPST Explained by Equation 7 23.2 The Evaluation of Coeflicients Associated with Predictor Variables 24.1 The Amount of Variation in BSOM Explained by Equation 8 . 24.2 The Evaluation of Coefficients Associated with Predictor Variables 25.1 The Results of the Levene’s Test 25.2 The Results of the ANCOVA 26.1 The Results of the Levene’s Test 62 62 63 63 64 65 66 66 68 69 7O 70 71 71 72 72 74 74 75 26.2 The Results of the ANCOVA . . . . . 75 26.3 The Results of the Independent samples T-Test comparing the means of BDEPR across NATLAN G1 . . . . . 75 27.1 The Results of the Levene’s Test . . . . 76 27.2 The Results of the ANCOVA . . . . . 76 28.1 The Results of the Levene’s Test . . . . 76 28.2 The Results of the ANCOVA . . . . . 76 28.3 The Results of the Independent samples T-Test comparing the means of BANX across NATLANGI . . . . . . 77 29.1 The Results of the Levene’s Test . . . . 77 29.2 The Results of the ANCOVA . . . . . 77 30.1 The Results of the Levene’s Test . . . . 77 30.2 The Results of the ANCOVA . . . . . 77 31.1 The Results of the Levene’s Test . . . . 78 31.2 The Results of the ANCOVA . . . . . 78 32.1 The Results of the Levene’s Test . . . . 78 32.2 The Results of the ANCOVA . . . . . 78 32.3 The Results of the Independent samples T-Test comparing the means of BANX across NATLANGI . . . . . . 79 33.1 The Results of the Levene’s Test . . . . 80 33.2 The Results of the ANCOVA . . . . . 80 33.3 The Results of the Independent samples T-Test comparing the means of BDEPR across ZREGION . . . . . . 81 34.1 The Results of the Levene’s Test . . . . 81 34.2 The Results of the ANCOVA . . . . . 81 35.1 The Results of the Levene’s Test . . . . 81 35.2 The Results of the ANCOVA . . . . . 81 36.1 The Results of the Levene’s Test . . . . 82 36.2 The Results of the ANCOVA . . . . . 82 37.1 The Results of the Levene’s Test . . . . 83 37.2 The Results of the ANCOVA . . . . . 83 38.1 The Results of the Levene’s Test . . . . 84 38.2 The Results of the ANCOVA . . . . . 84 39.1 The Results of the Levene’s Test . . . . 84 39.2 The Results of the ANCOVA . . . . . 84 40.1 The Results of the Levene’s Test . . . . 84 40.2 The Results of the ANCOVA . . . . . 85 41.1 The Results of the Levene’s Test . . . . 86 41.2 The Results of the ANCOVA . . . . . 86 41.3 T-Test for Independent samples: Mean Depression Scores of the High Commitment Vs. The Low Commitment Groups . . . 86 42.1 The Results of the Levene’s Test . . . . 86 42.2 The Results of the ANCOVA . . . . . 86 42.3 T-Test for Independent samples: Mean Anxiety Scores of the High Commitment Vs. The Low Commitment Groups . . . 87 43.1 The Results of the Levene’s Test . . . . 87 43.2 The Results of the ANCOVA . . . . . 87 xii 43.3 T-Test for Independent samples: Mean Psychosomatic Symptoms Scores of the High Commitment Vs. The Low Commitment Groups . 88 44.1 The Results of the Levene’s Test . . . . 88 44.2 The Results of the AN COVA . . . . . 88 44.3 T-Test for Independent samples: Mean Somatization Scores of the High Commitment Vs. The Low Commitment Groups . . 88 45.1 The Amount of Variation in BDEPR Explained by Equation 25 89 45.2 The Evaluation of Coefficients Associated with Predictor Variables 90 46.1 The Amount of Variation in BANX Explained by Equation 26. 91 46.2 The Evaluation of Coefficients Associated with Predictor Variables 91 47.1 The Amount of Variation in PSCPST Explained by Equation 27 92 47.2 The Evaluation of Coefficients Associated with Predictor Variables 92 48.1 The Amount of Variation in BSOM Explained by Equation 28 . 93 48.2 The Evaluation of Coefficients Associated with Predictor Variables 93 49.1 The Results of the Levene’s Test . . . . . 94 49.2 The Results of the ANCOVA . . . . . 95 50.1 The Results of the Levene’s Test . . . . 95 50.2 The Results of the ANCOVA . . . . . 95 51.1 The Results of the Levene’s Test . . . . 95 51.2 The Results of the ANCOVA . . . . . 95 51.3 T-Test for Independent samples: Mean Psychosomatic Symptoms Scores of the High Control Vs. The Low Control Groups . . 96 51.4 The Amount of Variation in PCSPST Explained by Equation 3 1a 96 xiii 51.5 The Evaluation of Coefficients Associated with Predictor Variables 97 52.1 The Results of the Levene’s Test . . . . . 98 52.2 The Results of the ANCOVA . . . . . 98 53.1 The Results of the Levene’s Test . . . . 99 53.2 The Results of the ANCOVA . . . . . 99 53.3 T-Test for Independent Samples: Mean Psychosomatic Symptoms Scores of the With Acquaintance in the Lansing/East Lansing area Vs. No Acquaintance in the Lansing/East Lansing area Participants . 99 CHAPTER 1 INTRODUCTION Change in one or more areas of a person's life has been cited as a major source of stress (Brett, 1980; Brown & McGill, 1989; Hinkle, 1974; Holmes & Rahe, 1967; Miller & Sollie, 1985; Rahe & Arthur, 1978; Zeiss, 1980). Life change has been defined as "any noticeable alteration in one's living circumstances that requires re- adjustment” (Weiten & Lloyd, 1994, p. 73). Empirical work in this area has consistently shown that people are more likely to exhibit physical and psychological problems concurrent with and/or subsequent to a major life change (Dohrenwend & Dohrenwend, 1974). Soon after the initial demonstrations of the relationship between stress and illness, empirical attention was focused upon explaining the repeated observation that many individuals maintain good health even when subjected to prolonged exposure to stress (Adler & Matthews, 1994; Hinkle, 1974; Holohan & Moos, 1985). Accordingly, investigators have sought to study individual differences that might explain why some people are more vulnerable to the deleterious effects of stress than others (e. g., Cohen & Edwards, 1989; Contrada, Leventhal, & O’Leary, 1991; Holroyd & Coyne, 1987; Suls & Rittenhouse, 1987). In the late seventies, Suzanne Kobasa observing the small but significant correlation between stress and illness, began to conceptualize and investigate personality factors that according to a set of theoretical reasons, she believed, explained some of the variation in the stress-illness relationship. Kobasa’s work was grounded in at least two theoretical domains. First, her conceptualization tendencies were based upon her own and her graduate school advisor, Salvatore Maddi’s allegiance to an existential theory of personality (Kobasa & Maddi, 1977). A basic tenet of existential personality theory is that the development of a healthy personality is a function of the capacity to stand on one’s own convictions (May, 1969c, p.243). Furthermore, according to this theory, an individual’s ability to mobilize his or her resources in order to achieve personally meaningful goals (a concept known as “will” or “intentionality”) is also an important factor in the development of a healthy personality (May, 193971967a). Second, Kobasa’s work was influenced by Richard Lazarus’ (1966) formulation of stress as a reaction mediated by an individual’s appraisal of environmental change. More specifically, Lazarus conceived of the stress reaction, a term first coined by Henry Selye in 1956, as a physiological response to the perception of a threat to one’s well-being. Whether or not an event was perceived as threatening was based upon personal belief systems (Lazarus, 1966). Lazarus’ work was partially based upon Magda Amold’s (1945) theory which suggested that organisms instinctively and rapidly appraise their environments “as a fundamental act of perception, producing tendencies to act” (cited in Fiske & Taylor, 1991, p. 436). In a refinement of Amold’s work, Lazarus (1966) introduced the concepts of primary appraisal, evaluation of the relevance of a stimulus, and secondary appraisal, evaluation of available coping resources. In line with these theoretical underpinnings, Kobasa (1979) predicted that psychologically “hardy” individuals would be less vulnerable to the harmful effects of stress. Principle component anaylses conducted subsequent to a series of studies in which she compared personality characteristics of hardy individuals with those exhibiting vulnerability to stress, revealed a set of three personality factors which together explained a significant portion of the variation in the adjustment of her sample to stress. She, therefore, defined hardiness in terms of these three personality characteristics which she labeled as commitment, challenge, and control. Commitment is defined as the “tendency to involve oneself in (rather than experience alienation from) whatever one is doing or encounters” (Kobasa, Maddi, & kahn, 1982, p. 169). Challenge is defined as a “belief that change rather than stability is normal in life and that the anticipation of changes are interesting incentives to growth rather than threats to security” (Kobasa et al., 1982, pp. 169-170). Control is defined as a “tendency to feel and act as if one is influential (rather than helpless) in the face of the varied contingencies of life” (Kobasa et al., 1982, p. 169). Maddi and Kobasa (1984) have suggested that hardiness is an acquired personality characteristic, and as such is subject to change. Although the current empirical status of hardiness will be reviewed elsewhere in this manuscript, it is appropriate to state here that since its introduction the hardiness construct has received a considerable amount of empirical attention. Kobasa’s own initial work demonstrated the influential role of hardiness in the stress-illness link (Kobasa, Maddi, & Courington, 1981; Kobasa, Maddi, & Kahn, 1982;1(obasa, Maddi, & Puccetti, 1982b; Kobasa & Puccetti, 1983). In a review of the literature, Funk (1992) found that the role of hardiness had been studied in such diverse areas as cardiovascular reactivity, development of depressive symptoms, burnout, and the levels of immunoglobulin-A in the breast milk of nursing mothers; and among such populations as nurses, teachers, single parents, attorneys, and bankers. Although the bulk of empirical findings have been consistent with Kobasa’s own discoveries, in recent years several conceptual and methodological criticisms have been leveled against this line of research (Benishek, 1994; Funk & Houston, 1987; Hull, Van Treuren, & Vrrnelli, 1987). These criticisms will be reviewed in chapter 2. A parallel line of research has examined the role of social support as a mitigating factor in the experiencing of harmful effects of stress (Anotonsovsky, 1979; Cassel, 1976; Gentry & Kobasa, 1984; Johnson & Sarason, 1979; Leavy, 1983; Rabkin & Streuning, 1976). The possible role of social support in psychological health was first discussed within the sociological literature (Mechanic, 1974). Early empirical work in this area consisted mainly of studying the role of social support as a mitigating factor against stress-related physical and psychological disorders (e. g., Cassel, 1976; Cobb, 1976; Dean & Lin, 1977). The definition of social support has been the subject of some disagreement (Gentry & Kobasa, 1984). House (1984), for example, conceived of social support as a “flow of one or more of four things between people” (cited from Gentry & Kobasa, 1984, p. 93). These consisted of emotional support (e. g. expressions of affection, interest, and concern), appraisal support (e. g. helping people think through their problems and generate solutions), informational support (e. g. offer advice and new c0ping strategies), and instrumental support (e. g. offering a place to stay, lending money, etc). Recent studies, however, have tended to operationalize social support in terms of the individual’s perceptions of the availability and utility of such support (Cohen & Hoberman, 1983; Gore, 1978). With some exceptions (e. g. Kobasa & Puccetti, 1983) the main weight of empirical evidence supports the view that absence of social support is associated with increased psychological distress. Less certain, however, is the buffering properties of social support against the adverse effects of stress (Leavy, 1983). Although research with populations such as those reported by Funk (1992) is of general interest to counseling psychologists, research concerning the adjustment of college students is of particular interest because a) counseling psychologists routinely help normal functioning individuals who are experiencing mild, moderate, or severe distress in response to life change; b) this line of research places emphasis upon person- environment interactions, rather than the exclusive focus on either the person or the environment; and c) counseling psychologists are often involved in helping relationships with both domestic and international students who have, in pursuit of educational goals, geographically relocated. As well as representing a large source of firnds for various institutions of higher education in Europe and the United States (Annual Report of the Office for International Students and Scholars, 1996), international students, by and large, represent the intellectual and social elite of their countries and frequently return to positions of authority and influence (Hull, 1978). In terms of size, international students continue to evolve into a significant segment of the US. college student population. Torrey (1970) reported that whereas in 1930 the number of international students in the US. was less than 10,000, by the end of the war this number had already climbed to about 20,000, and it exceeded 100,000 in 1968, representing students from over 150 countries. More recent data indicates that over 416,000 international students were enrolled in U. S. colleges and universities in 1991 (U .8. Dept. of Education, 1993 as reported in Yang & Clum, 1995). Furthermore, 11% of all master’s degrees and 23.4% of all the doctoral degrees awarded by US. colleges and universities are earned by international graduate students (US. Dept. of Education, 1993 as reported in Yang & Clum, 1995). Studies addressing the overall health status and the prevalence of stress related symptoms among international students have been rare and flawed. The meager available data have been equivocal: studies have variably described this population as one particularly vulnerable to the development of a range of physical and psychological symptoms (e.g., Sam & Eide, 1991; Fumham & Trezise, 1983), or alternatively as a resilient population, which in many ways, may be better adjusted than its domestic cohort (e.g., Parr, Bradley, & Bingi, 1992; Allen & Cole, 1987). Studies, however, have not attempted to explain this variation. Indeed the present author was unable to locate an article which gave a systematic review of the available literature. Few studies have focused on the adjustment characteristics of international students in the early stages of their sojourn. This is of particular interest in this study since the stressors associated with this early stage are almost exclusively due to environmental changes, whereas stressors present during later stages may be due to such factors as pressures to conform or perform, conflicts, frustration, etc. Finally, no studies have attempted to explain the variation in international student health by investigating personality factors. Emblem Statement The constant increase in the size of the international student population and the paucity of empirical data regarding the health status of this population in their new environment have created a need for a more systematic investigation of this area. There is also a need to examine, in this population, the role of factors that have been demonstrated to influence the stress-illness association in domestic samples. Given the current state of uncertainty about the role of individual differences in the association between stress and illness, there is a need for the kind of data that might allow for added conceptual and empirical clarity. The present study will address some of the gaps in the literature concerning the adjustment of international students by examining the role of factors, such as hardiness and perceptions of social support. Specifically, the primary objectives of this study are to: a) assess the adjustment of new international students in terms of their physical and psychological health; b) examine the role of hardiness in the adjustment of new international students; c) examine the role of perceptions of social support in the adjustment of new international students; (1) examine the combined effects of hardiness and stress in the adjustment of new international students; e) examine the combined effects of perceptions of social support and stress in the adjustment of new international students; and f) assess the possible of effects of such demographic factors as language and ethnicity upon the adjustment of new international students to their new environments. Should the results of this study reveal high prevalence of physical and psychological distress among new international students, and should the results of this study support the view that individual differences explain a significant amount of the variation in the health status of this population, research can then turn to the creation of empirically based programs designed to facilitate the adjustment of new international students. In case, however, that the results of this study reveal low prevalence of physical and psychological distress among this population, firture research can focus on comparing the characteristics of this apparently stress-resistant population with other stress—exposed groups who have traditionally not fared as well. Finally, should the results of this study reveal high prevalence of physical and psychological distress among this population, and should the results of this study indicate an insignificant role to hardiness and perceptions of social support, research can then turn to the examination of the role of other variables, such as neuroticism, self-esteem, or openness to experience, in the stress-illness link of this population. CHAPTER 11 REVIEW OF THE LITERATURE The Hg_al_th Status 21' International Students Travel to intellectually dominant countries by scholars and students has been a constant feature of scholarly life since the time of the Greeks (Pruitt, 1978). Indeed, as Wehrly (1988) points out such universities as Paris and Salerno have been enrolling international students since the 12"‘ century. The United States has received and hosted students from other countries since 1784 (Hendricks & Skinner, 1977). According to Marion (1986), the appeal of the US. as a popular educational destination is based upon a) the advanced state of science and technology; b) English as the language of instnrction; c) the generally high quality of instruction; and (1) social and political stability. “fith a few notable exceptions, the subject of the health and adjustment of intemational students began to draw empirical attention in the early sixties. At the 1961 meeting of the American College Health Association, Lyle Ward described his observation of a set of physical and psychological symptoms prevalent among international students. These symptoms included somatic complaints, adoption of a passive and withdrawn attitude, and a marked reluctance to communicate. In more severe cases, according to Ward, the symptoms mentioned above were accompanied by a general disheveled appearance along with a restriction of physical movements. Although these observations are consistent with signs and symptoms of clinical depression, Ward applied the label of Foreign Student Syndrome to this cluster of symptoms. Ward’s observations were preceded by Lysgaard’s (1955) U-curve hypothesis. Though not exclusively intended for the international student population, the U-curve hypothesis suggests that the process of adjustment of a sojourner to his or her new environment is described, graphically, by a curve resembling the letter U: a sojoumer’s initial experiences in his or her new environment are often pleasant and exciting. This state of affairs, however, begins to deteriorate as the sojourner encounters difficulties arising out of his or her unique situation. Finally, as the sojourner expands his or her repertoire of adaptive skills, his or her adjustment along with his or her sense of well- being improves. In a continuation of Lysgaard’s work, Oberg (1960) proposed the term “culture shock” to describe a series of four stages that, according to his observations, people abroad experienced. Oberg suggested that the initial period of a sojoumer’s experience, the “Honeymoon” stage was characterized by a sense of excitement and hopeful anticipation. This short lived state of affairs is followed by a period of “crisis” when the realities and nuances of the new environment lose their sense of wonder and are instead, are perceived by the sojourner as hurdles with which the sojourner must grapple and, in order to adjust, overcome. Oberg offers a list of these hurdles, or potential sources of stress: racial discrimination, language difficulties, housing difficulties, separation reactions, financial problems, dietary differences, and loneliness. During the third, or the “Recovery” stage, the sojourner’s initial affective reactions begin to give way to a sense of purposefirl mobilization of psychological and physical resources. Finally, Oberg suggests that a sojoumer’s recovery from culture 10 shock is concluded during the “Adjustment” stage. In a review of empirical literature on the viability of the U-Curve hypothesis Church (1982), concluded that the evidence for the U-Curve hypothesis was “weak, inconclusive, and overgeneralized” (Church, 1982, p. 571). More recently, Nash (1991) has suggested that the failure to find empirical support for the U-Curve is more due to the methodological flaws in the studies than the validity of the U-Curve concept. The main thrust of Nash’s criticism is directed towards sampling procedures employed by the early studies. First, Nash suggests that the U-Curve was intended to describe neither the experiences of tourists (since, for obvious reasons, this group is never obliged to adjust to the demands of the new environment), nor those who terminate their stay prematurely. Second, Nash claims that the cross-sectional designs used by the earlier investigators simply do not yield the kind of data necessary for the accurate description of the course of individual sojoumer’s experience in his or her new environment. This criticism was echoed by Zheng and Berry (1991), who also proposed that longitudinal data, collected through more sensitive instruments, were necessary for the definitive testing of the U-Curve hypothesis. In his own study of the U-Curve hypothesis, Nash (1991) employed a longitudinal design to investigate the course of adjustment of a group of American college students enrolled in a “well-established Junior-Year—Abroad program” (Nash, 1991, p.284). His control group consisted of a group of students enrolled in the same university, but who were not making the trip abroad. Nash’s findings did not support the U-Curve hypothesis: there were no significant differences between the 11 psychological well-being of the students studying abroad and those studying at home. In his discussion of the results, Nash questions the representativeness of his sample in that their stay abroad was firlly coordinated and organized by the staff of the Junior- Year-Abroad program to such a degree that the students were either not obliged to adjust and adapt to their new environment, or any adjustments were greatly facilitated. In line with Ward’s observation and description of the Foreign Student Syndrome, Ray (1966), presented data suggesting that the hospital admission rates among the international students enrolled at a major mid-Westem university were significantly higher than those of the domestic students. She also presented data indicating that her figures were in line with those reported fi'om other universities including those in the United Kingdom. Nearly two decades later, Gunn (1985) described the effects of education abroad on international student health as so grave as to be worthy of immediate attention and intervention by the World Health Organization. Largely as a response to Gunn’s claims, Allen and Cole (1987) reviewed the medical charts of a group of international students enrolled in Australian universities and compared them to those of a group of Australian students enrolled in the same universities. Their results did not yield any significant differences in the severity or nature of health complaints between the two groups. In fact, interestingly, this study yielded a borderline significant indication that the international students may enjoy better health than their domestic cohort. Among the most serious limitations of this study was its use of charts as a source of data: it is possible that, due to cultural factors, the international student group was more reluctant to seek health care than its 12 domestic cohort (F umahm & Trezise, 1983). Furthermore, the group of international students used in this study consisted mainly of students from Singapore, Malaysia, and Hong Kong; countries which, by virtue of their historical ties to the British Commonwealth, share a number of cultural and linguistic characteristics with Australia. The role of cultural differences in the adjustment of international students was hypothesized, though not investigated, by Akka (1967). He predicted that higher levels of cultural discrepancy between that of the international student and that of the host nation would be associated with higher levels of pathology among this population. As examples of areas of cultural discrepancy, Akka cited difliculties in communication arising from both language skills and norms of interpersonal interaction, family ties, academic problems, social behavior, and religion. The bulk of the empirical evidence has been supportive of Akka’s prediction (e. g., DeArmond, 1983; Domingues, 1970; Miller & Harwell, 1983; Zurin & Rubin, 1967; and Sam & Eide, 1991, Klineburg & Hull, 1979; Wehrly, 1986). Specifically, in a survey of the health complaints of international students enrolled at 27 large universities across the US, Brislin (1981), found that students from European countries, and students with better language skills reported fewer health concerns as compared with students from Third World countries, and students with poorer language skills. In a review of the literature, Church (1982) found that nationality and prior travel experience were important variables in predicting the adjustment of international students. Some research, however, has failed to reveal any such relationship (e. g. Fumham and Trezise, 1983). Though the results of Fumham and 13 Trezise’s study did indicate a significantly higher level of psychological disturbance among international students as compared to domestic students, the within group analysis of the international student data according to nationality, did not indicate any significant differences. In a study of the mental health of international students enrolled in Taiwanese universities, Ko (1979) administered a questionnaire designed to measure such variables as suspiciousness, hypochondriacal tendencies, asocial tendencies, self- esteem, feelings of inferiority, anxiety, obsessive-compulsive tendencies, psychosexual inhibition, hostility, ego-strength, dependent tendencies, and life satisfaction. Ko compared the results obtained from his sample with that of its domestic cohort. His results indicated significantly higher levels of suspiciousness, feelings of inferiority, obsessive-compulsive tendencies, psychosexual inhibition, and significantly lower levels of satisfaction with life among the male international students. Among the female international students, Ko’s results indicated only significantly elevated rates of suspiciousness, obsessive-compulsive tendencies, and dependent tendencies. It is important to note that Ko obtained these results even though his sample of international students, while from abroad, consisted of ethnic Chinese students sharing much cultural and linguistic characteristics with their host country. An obvious limitation of Ko’s study was its failure to assess the pre-departure levels of these characteristics among his sample. Ko’s findings were replicated in a study by Oei and Notowidjojo (1990). They compared the effects of life change in the adjustment of international students enrolled 14 in an Australian university with that of a group of Australian students. Their results indicated that international students with lengths of stay greater than one year were significantly more likely to experience clinical depression as compared to either the domestic students or newly arrived students. This finding, though cross-sectional in nature, can be construed as supportive of Lysgaard’s U-curve hypothesis. Miller and Harwell (1983), conducted a survey of the health problems of international students enrolled at a small mid-Western university. The results of this study indicated that fatigue, homesickness, headaches, colds, and insomnia were the most common health problems among the sample. This study did not employ a control group of domestic students, nor did the investigators compare their results with the prevalence rates of these complaints on the campus as a whole and so no conclusions regarding the significance of the findings can be drawn. Other authors have conducted similar, though more internally valid studies. Ebbin and Blankenship (1986) for example, reviewed and compared the medical records of both international and domestic students enrolled at a major urban university located in western United States between 1980 and 1983; a time span during which this university, reportedly, had the highest rate of enrollment of international students among US. colleges and universities. As well as reporting the top 27 presenting problems of international students (the top five being common cold, pharyngitis, acne, sprain/strain, and patient education, respectively), this study found that the prevalence of such potentially stress related disorders as chest pain, cough, gastritis, back pain, anxiety and depression (e. g., Dohrenwend & Dohrenwend, 1974) was significantly 15 greater among international students as compared to their domestic cohort. The latter . finding was fiirther supported when these investigators conducted a survey of 476 college health center directors (Ebbin & Blankenship, 1988). A response rate of 38% to the survey, from institutions with an average enrollment of 11,120 and a minimum international student enrollment of 200 yielded results that were generally in line with these authors’ earlier findings from their 1986 study: whereas the prevalence of such potentially stress-related disorders as anxiety, gastritis, headache, constipation, insomnia, depression, chest pain, abdominal pain, and peptic ulcers was found to be significantly higher among the international students; the prevalence of other stress- related disorders such as hypertension, low back pain, amenorrhea, and neurodermatitis was found to be lower among the international students enrolled in the surveyed institutions as compared to their domestic cohort. A prevalent methodological issue in this literature is that most investigators fail to assess the international students’ pre-departure or its immediate post-arrival health. Observing this problem, Sam and Bide (1991) conducted a survey designed to assess the mental health of international students taking into account their pre-departure symptoms. The participants in this study consisted of all international students enrolled at a Norwegian university. In addition to a demographic questionnaire, the survey package consisted of a an inventory of adjustment and health derived fi'om Goldberg’s (1972) General Health Questionnaire and Derogatis’ (1973) Symptom Check List. A return rate of 67%, yielded 400 completed packages fi'om a wide range of students including 118 females, 190 males, and 50 nationalities. Results of this study included 16 the following. First, a t-test of the means of the students’ self evaluation of their current and prior health indicated a significant deterioration of this group’s sense of well-being. More specifically, analysis of responses to the inventory revealed significant change in Zlof the 32 items. There were significant increases in the levels of nervousness, chest pains, suspiciousness, guilt, loneliness, sadness, worry, anhedonia, heart palpitations, insomnia, feelings of worthlessness, and fatigue; as well as poorer appetite. Second, it was found that four factors, paranoia, anxiety, depression, and somatic complaints, accounted for more than 45% of the variance. All four syndromes exhibited significant elevations in their pre and post-arrival levels. Finally, their results indicated that higher levels of mental health were found among the Scandinavian and North American students, whereas being single or married but living away from spouse, being younger, being female, being an undergraduate, being Asian, and being Arabic speaking were all found to be associated with deterioration of mental health. Overall, research on the health status of international students tends to suffer from the following limitations. First, the lack of control groups in these studies severely limits the range of conclusions that could drawn. Second, a large number of these studies suffer from sampling problems that severely limit the generalizability of their results. These include narrow range of nationalities represented; the presence of high levels of similarities between the host culture and the cultural characteristics of the sample; and the problems that often plague survey data e. g. volunteer bias. Third, with the exception of the Sam and Bide (1991) study, most studies designed to assess the health status of international students fail to take into account pre-anival l7 symptoms. The Reggignship Begun Stress and Health The nature of the relationship between mind and body has been of interest to philosophers since antiquity (Contrada, Leventhal, & O’Leary, 1991). Accounts of charismatic individuals (e.g. Indian fakirs, faith healers, shamans, voodoo practitioners) capable of influencing physiological functioning through psychological manipulations are widely available. Walter Cannon (cited in Dohemewend & Dohrenwend, 1984, p. 2) was among the first scientists to undertake a systematic investigation of the effects of psychological stress upon physiological functioning. He suggested that vital bodily organs would be irreparably damaged if the autonomic nervous system was maintained in a highly aroused state through prolonged psychological stress. Hans Selye’s (193 6) introduction of the general adaptation syndrome allowed for more clarity in Cannon’s assertions by suggesting that prolonged exposure to stress leads, inevitably, to the exhaustion of physical and psychological defensive resources. This exhaustion leaves the organism vulnerable to a variety of physical and psychological disorders, and in severe cases it can be fatal. It is firrther suggested that although the experiencing of sudden and severe stressors that result in fatality are nowadays relatively rare, certain characteristics of modern life do lead to a sustained state of autonomic arousal characteristic of a mild stress reaction. This type of a mild stress reaction has been associated with poor academic performance (Lloyd, Alexander, Rice, & Greenfield, 1980); insomnia (Hartmann, 1985); nightmares (Cernovslry, 1989); sexual difficulties (Malatesta & Adams, 1984); drug abuse 18 (krueger, 1981); and anxiety and depression (Weiten, 1988). Holmes and Rahe (1967) were among the first investigators to cite changes in life circumstances as sources of this kind of mild stress reaction. More recently, researchers have been successfirl in inducing an array of illnesses in laboratory animals through exposing them to severe stress. Sklar and Anisman (1979) for example, found that mice that were administered electric shock, afler having had cancerous cells surgically planted into them, were more likely to grow tumors more rapidly and die as compared to those animals with cancerous cells that were not administered electric shock. Studies with humans have, for obvious reasons, been of a quasi-experimental nature. Although these designs lack the degree of internal validity necessary for strong causal statements, they do, nevertheless, allow the investigator to make causal claims of a somewhat weaker kind. Kasl and Cobb (1970) for example, studied a group of workers beginning two months before their jobs were to be terminated and for two years subsequent to loss of employment. Their design included a control group consisting of men in similar occupations who did not lose their jobs. For the group of workers who lost their jobs, the results indicated elevated blood pressure both with anticipation of job loss and afler termination of employment. No such rise in blood pressure was found in the control group. The inclusion of a control group adds to the internal validity of this study. Interestingly, however, the authors do not account for those workers who lost their jobs but did not experience a rise in blood pressure. Jemmott and Magloire (1988), examined the efi‘ects of academic stress upon 19 salivary concentrations of Immunoglobulin A (IgA) among 15 healthy undergraduates 5 days before, during, and 14 days after their final exams (IgA is an immune system protein responsible for the protection of mucus membranes fiom pathogens). Their results supported the hypothesis that academic stress can temporarily suppress immune system activity through reducing the concentrations of IgA in the saliva. A strength of this study was its collection of data regarding the levels of subjects’ social support. These data were used to account for within sample differences in the concentrations of IgA. Other studies have established a link between chronic stress and onset of such diseases as the common cold (Totman, Kiff, Reed, & Craig, 1980), vaginal infections (Williams & Deffenbacher, 1983), cardiovascular disease (Rosengren, Tibblin, & Wilhelrnsen 1991); infectious disease (Stone, Reed, & Neale, 1987); and pregnancy complications (Pagel, Smilkstein, Regen, & Montano, 1990). Studies have also established an association between chronic exposure to stress and psychological symptoms. In a widely cited study, Seligrnan (1974) initially exposed a group of dogs to inescapable electric shock. He subsequently found that these dogs were less likely to learn to escape the electric shock in situations from which escape was possible. He cited this kind of “learned helplessness” as a possible antecedent of depression. More recently, Bodnar and Kielcot-Glaser (1994), using a longitudinal design, discovered significantly higher prevalence of depression among caregivers of persons with Alzheimer's disease as compared to a control group. Although the existence of a stress-illness link has been consistent and significant, it has rarely been found to be greater than .30 (Holohan & Moos, 1985). 20 The usual range of correlations has been reported as between 0.20 and 0.40 with a standard deviation that is about eight times the mean (Rabkin & Struening, 1976a, 1976b). This finding has provided the impetus for researchers to explain these within group variations through the investigations of personality factors. The Role of Harding; in the Stress-Illness Link The role of hardiness as a mitigating factor in the stress-illness link was first studied by Suzanne Kobasa in the course of her doctoral dissertation research (Kobasa, 1979). In this seminal work, Kobasa predicted that individuals high in commitment, challenge, and perceived control would be less vulnerable to the deleterious effects of life change. Her results significantly supported this prediction. An immediate criticism of Kobasa’s findings was that data from her first study did not include information regarding individual levels of hardiness prior to exposure to stress. This was deemed important because in order to demonstrate that hardiness acted as a buffer against the adverse effects of stress, it was essential to show that symptomatic individuals were low in hardiness prior to exposure to stress. Kobasa acknowledged the need for a prospective study to determine the directionality of her findings. She and her colleagues published this prospective study in 1982 (Kobasa, Maddi, & Kahn, 1982). Their results confirmed that hardiness acted prospectively as a buffer against the harmfirl effects of stress. (Kobasa et al., 1982, p. 174) Since Kobasa's introduction of hardiness, other researchers have studied its role in the stress-illness link of other populations. Rhodewalt and Zone (1989) for example, 21 conducted a survey study of adult women to examine whether psychological hardiness acted as a buffer against stressful life change. Their results indicated a significant difference between hardy and nonhardy subjects' appraisal of their life events as either negative or positive. Hardy and nonhardy women also differed in their reports of the average amount of adjustment required for each event. Although Rhodewalt and Zone discovered an interaction between hardiness and appraisal of undesirable life events in the prediction of depression and illness, this interaction was found to be much stronger for nonhardy women than it was for hardy women. On the basis of this finding Rhodewalt and Zone suggested that appraisal processes are perhaps a major determinant of most hardiness effects reported in the literature. Accordingly, other researchers have examined the role of variables such as neuroticism (Bensihek, 1993) or maladjustment (Bernard and Belinsky, 1993) as possible confounds in this line of research. In their review of the literature, Bernard and Belinsky (1993 ), reported that the dimensionality of the hardiness construct has been questioned along with the methods used in its measurement. Specifically, with regards to the dimensionality criticism, they found that contrary to Kobasa’s claims, the three components of hardiness appeared to possess differential effects upon the stress-illness link. Furthermore, with regards to the measurement criticism, Bernard and Belinsky found a general consensus in the literature to the effect that measuring the converse of a variable, as most hardiness instruments did, was not a satisfactory way of measuring that variable (It was claimed, for example, that the presence of alienation was perhaps not quite the same thing as the 22 absence of commitment and so on). Criticism has also been directed at the statistical procedures employed in the analyses of hardiness data (Benishek, 1993). It has been reported, for example, that in many hardiness studies, analyses of variance (ANOVA) have been carried out using continuous data. Finally, there has been a criticism of hardiness samples with respect to their generalizability characteristics (Funk, 1992). Although it would be a gross distortion to suggest that the role of hardiness as a factor in the stress-illness link has been rejected, it would be equally inaccurate to state that its role has been fully understood. Further research in this area is needed. The Role of Soeial Suemrt in the Stress-Illneee link The study of the role of social support as a means of ofi'setting stress induced psychological and psychosomatic disorders dates back to at least the seventies. As Heller and Monahan (1977; reported in Leavy, 1983) noted "in general, the evidence is sparse concerning the ability of supportive social structure to moderate the impact of stressful life events ..... how support operates, or how its beneficial effects can be optimized is a matter for firture research" (p. 3). A large number of studies in this area have been done in the twenty years since Heller and Monahan’s observation. One of the early problems of this line of research was the conceptualization of social support. Various definitions have been offered. House (1981) for example, defined social support in terms of emotional support, consisting of the exchange of affection, admiration, and affirmation; appraisal support, consisting of listening to people and helping them in the assessment of their problems and the evaluation of 23 options; informational support, consisting of guidance and direction in the solution of practical matters; and instrumental support, consisting of, for example, lending money or providing transportation to one in need of such services. Other researchers have conceptualized social support in terms of an individual‘s perceptions regarding its availability, utility, and meaning (e. g., Yang & Clum, 1995). Gore (1978) used a longitudinal design to study the efi‘ects of social support in moderating the health consequences of unemployment. Her sample consisted of 54 rural and 46 urban married blue collar men with an average age of 49. Gore also used a matched control group consisting of 74 men who were employed in similar occupations that did not lose their jobs. In this study, social support was operationalized in terms of a) subject’s perception of his wife, fiiends, and relatives as supportive or unsupportive; b) fi'equency of activity outside the home with the same individuals; and c) subject's perceived opportunity for engaging in social activities which are satisfying and which allow him to talk about his problems. Her results indicated a significant difference between the depression, self-blame, and illness symptoms of the tenninees according to their levels of measured social support. Data obtained fiom the control group, however, was highly suspect and therefore not analyzed, since the subjects in this group reported a significant amount of health related concerns. As Gore notes, these subjects were apparently motivated by the prospects of being visited by a registered nurse on a regular basis. Cohen and Hoberman (1983) studied the combined and separate roles of positive life events and social support in the development of psychological and 24 physical symptoms of stress due to life change. Their subjects consisted of a group of college students enrolled at a large university. The instruments were administered during several class periods and student attendance influenced the number of subjects completing each instrument. In this study, social support was defined as perceived availability of support and as perceived support received during the past month. Results indicated the following: a) perceived availability of social support provided some protection fiom the adverse effects of high levels of stress; and b) increases in the perceived availability of support were associated with decreases in depressive symptoms but not with decreases in physical symptoms. Yang and Clum (1994) studied the combined and separate roles of life stress, social support and problem solving skills as predictors of depression, hopelessness, and suicidal ideations among a group of international students from Asia enrolled in a US. university. In this study, social support was operationalized in terms of scores on the UCLA Loneliness Scale (Russell, Peplau, & Ferguson, 1978 as reported in Yang & Clum, 1994). This instrument measures perceived social support and degree of social integration. Yang and Clum hypothesized that levels of life stress, problem-solving deficits, and social support would both independently and interactively predict depressive symptoms, hopelessness, and suicide ideation. Results of this study affirmed both the separate and combined utility of social support, problem-solving deficits, and life stress in the prediction of depression, hopelessness, and suicidal ideation. In a review of forty-six studies investigating the role of social support in the 25 stress-illness link, Leavy (1983) concluded that ”regardless of research methods, one finding is consistently reported: the absence of social support is associated with increased psychological distress" (p. 15). Leavy, however, found that his literature review did not allow him to make a similarly conclusive assertion regarding the bufi’ering effects of social support against the adverse effects of life stress. Kobasa and Puccetti (1983), for example, found that for male business executives perceptions of support from their boss did produce a buffering effect, whereas perceptions of support from their family did not produce such an effect. Indeed Kobasa and Puccetti found that family-rooted support was associated with greater number of symptoms in subjects low in hardiness. Although the literature on the role of social support is equivocal, no researcher has argued for the wholesale dismissal of its role. Instead there seems to be a need for refinements in both conceptual and methodological approaches. Leavy identified some possible reasons for the inconsistent findings including the use of inappropriate or insensitive instruments, inappropriate statistical procedures, problems with how social support is operationalized, and variations in sample characteristics. Th om ined Roles f Hardiness and Social Su in he Stress-nines Link As early as 1983, Kobasa and Mark Puccetti were investigating the combined roles of hardiness and social support in the stress-illness link. In this relation, they also studied the roles of various types of social support (e. g. support received at home vs. support received at work). They hypothesized that a) high levels of hardiness along with high levels of access to social resources will predict better health status in male 26 executives experiencing high levels of stress; and b) higher levels of hardiness along with low levels of social resources will be correlated with better health status as compared with lower levels of hardiness and higher levels of social resources. The subjects in this study consisted of 240 middle and upper level business executives. The results were mixed. First, although hardiness combined with social support received at work served as a buffer against the adverse effects of stress, the interaction of low levels of hardiness and social support received at home led to adverse health consequences. Second, social support received from the family functioned as a resistance resource only among hardy participants. Subjects who were high in hardiness but low in family social support showed significantly lower illness scores than executives who were low in hardiness but high in family social support. This study is subject to some of the same criticisms as were leveled against Kobasa's earlier work. Kobasa (1979) had suggested that the three components of hardiness (commitment, challenge, and control) are so highly interrelated that a composite score can be used to represent all three components. This suggestion has been contradicted in several studies. Ganellen and Blaney (1984), for example found that the three components of hardiness were differentially related to social support. Specifically, they found strong correlations between the commitment and challenge dimensions of hardiness and social support, but they failed to find such a correlation for the control component. With respect to the roles of hardiness and social support, this study revealed that although life stress, social support, and hardiness were all directly related 27 to depression, social support was not found to buffer the effects of life stress. Mummies This study is designed to address the following questions: a) In terms of physical and psychological health, how do international students adjust to their new environment; b) does hardiness play a role in the adjustment of new international students; c) do perceptions of social support play a role in the adjustment of new international students; d) does the interaction of perceptions of social support and stress play a role in the adjustment of new international students; e) does the interaction of hardiness and stress play a role in the adjustment of new international students; 1) is there a relationship between immediate post-arrival health and the 12- week post-arrival health of international students; g) are there any demographic characteristics that help predict the adjustment of new international students; and h) are there any differential effects due to the three components of hardiness. Me To address the above questions, the present study is designed to test the following hypotheses: A The hardiness level of new international students will significantly moderate the relationship between stress and adjustment. Specifically, among new international students with higher levels of hardiness, stress will be unrelated to adjustment; whereas among new international students with lower levels of hardiness, stress will be significantly related in a negative direction with adjustment. 28 B. New international students’ perceptions of social support will significantly moderate the relationship between stress and adjustment. Specifically, among new international students with more positive perceptions of social support, stress will be unrelated to adjustment, whereas among new international students with less positive perceptions of social support, stress will be significantly related in a negative direction with adjustment. C. The adjustment of new international students will be significantly negatively correlated with the level of discrepancy between U. 8. culture and the new international students’ native culture. Specifically, the mean of the adjustment scores of the new international students for whom English is the native language will be significantly lower than the mean of the adjustment scores of the new international students for whom English is not the native language. D. The adjustment of new international students will be significantly negatively correlated with the level of discrepancy between US. culture and the new international students’ native culture. Specifically, the mean of the adjustment scores of the new European (or from European extraction) international students will be significantly lower than the mean of the adjustment scores of the new non-European (or from non-European extraction) international students. 29 CHAPTER II I METHODOLOGY Participants The sample for this study consisted of a group of new international students. For the purposes of this study “new international student” was defined as: a) born outside of the US; b) Fall 1997 enrollment at Michigan State University (MSU) represented the first and only enrollment at a US. college or university; c) arrived in the US. on or after August 1, 1997; (1) other than the present stay, has not resided continuously in the US. for more than a month in the last 10 years; and e) has never resided in the US. for more than 2 months. A power analysis (Cohen, 1977), using an alpha level of.05, R2 of .2, power of .8, and with 7 predictor variables ( base-line depression, base-line anxiety, base-line psychosomatic symptoms, base-line somatization, hardiness, social support, and stress), yielded a required sample size of 102. In order to compensate for the effects of attrition in our sample, and in order to enhance the randomness of the sample all “new” international students were contacted and solicited to participate. The pool of potential participants for this study was identified through cooperation with the university’s office of the Registrar. This office generated a list of 412 names and addresses of first-time-enrolled international students. In order to preserve the privacy of the new international students, stamped envelopes containing a cover letter (see appendix A), a sign-up sheet (see appendix C), and the initial survey package along with a stamped return envelope were submitted to the Registrar’s office, 30 The cover letter described the purpose of the study and extended an invitation to those interested in participation, to complete and return the sign-up sheet. The registrar’s office affixed the address labels and mailed the envelopes. Of the 412 mailed packages, 9 were returned by the post office as undeliverable. Of the remaining 403 presumably delivered packages, 218 were returned (54% response rate). Of this number 92 were deemed unusable for the following reasons: 71 were excluded because the respondent did not meet all participation requirements; 14 were excluded because the respondent had not completed the survey package; and 7 were excluded because the respondent had not completed the sign-up sheet and thus could not be contacted for the final data collection session. Of the remaining 126 respondents, who had satisfied all the inclusion requirements of the study, 102 (81% response rate) completed the final survey package and thus formed the final sample of this study. medium: The initial survey package consisted of the following: an informed consent form, the first demographics questionnaire (see appendix D), and two instruments measuring the physical and psychological health of the participants (see appendices E and F). The measurement of these variables in the first two weeks after arrival allows for the assessment of the effects of the predictor variables in this study while controlling for baseline levels of symptoms. The design of this study required that the initial survey package be completed on or before 30 September, 1997. The second survey package consisted of a second demographics questionnaire 31 (see appendix J), the two instruments measuring the physical and psychological health of the participants, the hardiness instrument (see appendix 1), the measure of stress (see appendix H), and the measure of social support (see appendix G). In order to minimize fatigue effects, four versions of this package were produced. The packages differed only in the order in which the instruments appeared. These packages were administered in person on three evenings in mid-November, 1997. Lamar: The present study included one measure of stress (The Index of Life Stress); one measure of hardiness (the Personal Views Survey-II); one measure of social support (The Index of Social Support); and two measures of adjustment (the SUNYA- Psychosomatic Symptoms Checklist and the Symptoms Check List-90-R); a demographic questionnaire designed to elicit data on such variables as might covary with the outcome measures, or alternatively exert a confounding effect upon the results of the study. Examples include nationality, race/ethnicity, age, gender, housing situation, major, relatives within 200 miles, relatives living in the U. S., native language, and TOEFL scores. An important variable obtained from the demographic questionnaire is “relatedness.” This variable is a composite of items 9 and 10 of the questionnaire (see appendix D). geese. The Index of Life Stress (ILS; Yang & Clum, 1995) consists of 31 statements which measures six areas of stress relevant to the international student population: language difficulty ,cultural adjustment, perceived ethnic/racial discrimination, academic concem, financial concern, and outlook for the future. 32 Subjects rate each statement fi'om never (0) to often (3) according to how often the individual "feels the way described in each statement.” Item ratings are summed to produce a total stress score, with higher scores reflecting higher levels of stress. Sample items include: “My financial situation makes my life very hard,” “My English embarrasses me when I talk to people,” and “People treat me badly just because I am a foreigner.” The test-retest reliability of this instrument over a 1-month interval was .87 (n=20); the internal consistency estimate was .86 (n=101); and the concurrent validity, measured by the correlation between the ILS and the Life Events Survey Scale (Sarason, Johnson, & Siegel, 1978 as reported in Yang & Clum, 1995), was r(100)=- .46, p<.0001. Hardiness. The Personal Views Survey 11 (PVS II; Hardiness Institute, 1995) consists of 50 statements which assess the commitment, control, and challenge components of hardiness. Each statement is answered using a 4-point Likert scale (0 = Not at all true; 3 = Completely true). Higher scores indicate greater degree of each component. In contrast to the Revised Hardiness Scale, the PVS contains both positive and negative indicators of hardiness. Composite scores are calculated by combining the three component scores. The internal consistency for the composite score range from 0.87 (Wiebe, Williams, & Smith, 1991) to 0.90 (Hardiness Institute, 1985). The internal consistency reliability for commitment, control, and challenge are .72, .62, and .70, respectively (Wiebe et al., 1991). Similar values are reported by the Hardiness Institute (1985). 33 Test-retest reliabilities of the PVS over time periods of two weeks or more have been reported to be in the .60's (Hardiness Institute, 1984). Social Suppgrt. The Index of Social Support (ISS; Yang & Clum, 1995) is a 40-statement scale based on the international students' special social contact patterns. It assesses the personal meaning of social support, the level of trust and satisfaction toward the support, and the availability of support when it is needed in relation to immediate family, extended family, old fiiends in the home country, new fiiends in the US, churches, school organizations, the international student center on campus, and community activities. Subjects rate each statement from never (0) to often (3) according to how often the individual "feels the way described in each statement" (Yang and Clum, 1995). Item ratings are summed to produce a total score and higher scores correspond to higher levels of social support. Sample items include: “I have contact with my old fiiends in my home country,” “I trust the international student center on campus,” “The international student center on campus means a lot to me,” “I participate in community activities here,” “My new fiiends in the USA. are available when I need them,” “I trust my church.” The test-retest reliability of this instrument over a l-month interval was .81 (n=20); the internal consistency estimate was .81 (n=100); and the concurrent validity, measured by the correlation between the ISS and the UCLA Loneliness Scale (Russell, Peplau, and Ferguson, 1978 as reported in Yang and Clum, 1995) was r(100)= -.39, p<.0001 (Yang and Clum, 1995). 34 Adjustment. The Symptom Check List-90-Revised (SCL-90-R; Derogatis, 1990), is a widely used 90-item Likert-type self-report symptom inventory designed to reflect the psychological symptom patterns of community, medical, and psychiatric respondents. Each item is rated on a five-point scale of distress (0-4) ranging from “Not at All” to “extremely.” The SCL-90-R is scored and interpreted in terms of the following nine primary symptom dimensions: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. For the purposes of this study, only the three symptom dimensions of Depression Anxiety, and Somatization will be used. Sample items for the Depression scale include: “Loss of sexual pleasure or Interest,” and “Thoughts of ending your life.” Sample items for the Anxiety scale include: “Nervousness or shakiness inside,” and “Feeling tense or keyed up.” And sample items for the Somatization scale include: “Headaches,” and “A lump in your throat.” The internal consistencies for the Depression, Anxiety, and Somatization scales have been reported as .90, .87, .82 respectively (Derogatis, Rickels, & Rock, 1976). The combined test-retest reliabilities of these scales have been reported as .78 and .80 respectively (Derogatis, Rickels, & Rock, 1976). The concurrent validity of the SCL- 90-R was established by calculating correlations between its nine primary symptom dimensions and the similar scales on the MMPI. The correlation coefficients between SCL-90-R’s Depression scale and MMPI’s Wiggins Depression, and Tryon Depression scales has been reported as .75 and .68, respectively. The correlation coefficient 35 between SCL-90-R’s Anxiety scale and MMPI’s Tryon Anxiety scale has been reported as .57. The correlation coefficients between SCL-90-R’s Somatization scale and MMPI’s Hypochondriasis and Tryon’s Body Symptom scales has been reported as .57, .66 (Derogatis, Rickels, & Rock, 1976). The SUNYA-Psychosomatic Symptoms Checklist-Revised is a self-report scale which contains 17 common psychosomatic complaints. Subjects are asked to rate. each item on fi'equency and intensity of occurrence, using a five-point scale. The PSC yields a composite score, derived by summing the cross-product of each item’s fiequency by intensity. Sample items include: “Headaches”, “Backaches”, and “Sore throat.” Test-retest reliability for the PSC has been reported as generally high across 1- week, 4-week, and 8-week intervals. These were .88, .84, and .80, respectively (Attanasio, Andrasik, Blanchard, & Arena, 1984). D n i r ur ' 1. Descriptive statistics (i.e., mean, stande deviation, skewness, and range) were carried out on all the predictor and outcome measures and also on data obtained through the demographics questionnaire (i.e., age, nationality, major, gender, housing situation, relatives within 200 miles, relatives living in the US, native language, and TOEFL scores). 2. Cronbach's alpha, a measure of internal consistency reliability, were computed for the appropriate measures used in this study. 3. The strength of the relationships between various dependent and independent variables were evaluated through the generation of a correlation matrix. 36 Additionally, this analysis yielded preliminary information regarding confounds and covariates. Chi-square analyses were used to assess mean differences with categorical data. A set of full-model regression analyses were performed in order to obtain estimates of the influence of each predictor variable (pre-test symptoms, stress, hardiness, and social support) and their interactions upon the outcome variable (Post-test symptoms). Other regression (F -test) analyses, as well as post-hoc analyses were carried out in order to investigate the roles of such variables as race, language, nationality, and relatedness. The prediction of adjustment by the interaction between life stress and social support and the interaction between life stress and hardiness were tested by hierarchical regression analysis. 37 Fermet CHAPTER IV RESULTS The results chapter is divided into the following sections: 1. 2. Data Entry Issues a. Sample Description. b. Sample Representativeness. a. Description of the Variables Used in the Analyses. b. Internal Consistencies of the Instruments. c. Comparison of Scores Obtained in the Present Study with Those Reported in Other Studies. a. Frequency and Intensity of Symptoms, Syndromes. l. Psychological Symptoms and Syndromes 2. Psychosomatic Symptoms a. Descriptive Analysis of the ILS b. Descriptive Analysis of the ISS. a. Inferential Statistics and Hypothesis Testing 1. Hypothesis 1 2. Hypothesis 2 3. Hypothesis 3 4. Hypothesis 4 b. The Individual Effects of the Three Components of Hardiness. 1. Challenge 2. Commitment 3. Control a. Role of Demographic Factors 38 W The data was first examined for missing values, outliers, and accuracy of data entry. Eight data entry errors were detected and rectified. The number of missing values for a scale item ranged fi'om 1 to 6. With regards to the demographic information, missing values were found for Relatives in the United States (n=2), Relatives in Lansing/East Lansing (n=2), Distance of Relatives from Lansing/East Lansing (n=3), Closeness to Relatives (n=2), Friends/Acquaintances in Lansing/East Lansing (n=2), Mother’s Education (n=2), Father’s Education (n=4), Parents Educated in the United States (n=1), and Significant Incidents While in the United States (n=8). Semele Deseription Table 1 contains descriptive demographic characteristics of the sample which consisted of 48% males (n=49), and 52% females (n=53). They ranged in age from 17 to 41 years with an average age of 24.43 years. The sample included students of 34 nationalities with students from China forming the largest group (n=21; 20.6%), followed by students from Thailand (n=11; 10.8%). When participants were assigned to geographical regions according to their country/culture of origin the Far East was the largest group (n=54; 52%), followed by the Middle East (n=16; 15%) and Western Europe (n=12; 12%). For the purposes of hypothesis D, the regions were then collapsed into European (n=17; 17%) and Non-European (n=85; 83%). The resultant variable was labeled “Zregion.” On the race/ethnicity dimension, the majority of the participants identified themselves as Asian (n=68; 67%), followed by White (n=26; 26%), and Black (n=3; 3%). The majority of the participants described their marital 39 status as single (n=71; 70%), followed by married or engaged but currently not residing with their spouse (n=20; 20%). 4O Table 1. Sample Demographic Information. (Numbers in parentheses reflect the appropriate MSU population data) [ Variable Sex Males Females Age 17 years or less 18-20 years 21 -23 years 24-26 years 27-29 years 30-32 years 33-35 years 36-38 years 39-41 years 42 years or more Nationality China Thailand Malaysia South Korea Taiwan Pakistan India Germany Turkey Philippines Indonesia Belgium France Lebanon Sri-Lanka Russia Australia Romania Japan United Kingdom Yugoslavia Chile Kenya Brazil Netherlands Peru Hong Kong Nigeria Sweden Haiti Colombia Egypt 41 111 49(1607) 53(1057) 15 31 30 O-‘O-hm 21(269) 1 1(74) 7(83) 6(550) 6(293) 5 4(176) 3 3 3 3(54) (197) (54) u—I—du—I—d—dl—d—nl—Iu—I—I—II—Ir—l—NNNNNNN I'/-l 48(60) 52(40) 14.7 30.4 29.4 14.7 4.9 3.9 2100) 11(2.8) 7(3.1) 6(21) 6(11) 5 4(6.6) 3 3 3 3(2) (7.4) u—nu—o—n—u—n—u—a—ac—n—Ir—n—1—I—INNNNNNN Table l (cont’d). Region Jordan Tanzania Far East (Japan, S.Korea, Taiwan, Thailand, China, Philippines, Hong Kong, Malaysia) Middle East (Pakistan, India, Sri-Lanka, Indonesia) Near East (Lebanon, Turkey, Egypt, Jordan) Africa (Kenya, Nigeria, Tanzania) Eastern Europe (Yugoslavia, Russia, Romania) Western Europe (UK, Belgium, Germany, France, Netherlands, Australia, Sweden) South America (Chile, Brazil, Peru, Haiti, Colombia) Zregion (European Vs. Non-European) European Non-European Language Arabic Chinese Dutch English Filipino French German Hindi Indonesian Japanese Korean Portugese Romanian Russian Serbian Sinhalese Spanish Swahili Swedish Thai Turkish Urdu 42 54 16 12 17 A mw———w——NN—O\~umwhwmwuh 53 15 12 17 83 3.9 33.3 2.9 4.9 2.9 3.9 2.9 4.9 2.9 5.9 1.0 2.0 1.0 1.0 2.9 1.0 1.0 10.8 2.9 4.9 Table 1 (cont’d). Race Asian 68 Black 3 White 26 Hispanic Pacific Islander Mixed Race Other Cunt—ow Marital Status Married/engaged spouse with me Married/engaged spouse not with me Single Living with Boyfriend/Girlfriend Separated Divorced Widowed --O ONONQNQ Table 2 contains information regarding the social network characteristics of the participants. It is evident that the sample consisted mostly of individuals with no established social network upon anival. Of the 102 participants only 33% (n=34) had relatives in the United States, of whom only 21% (n=7) resided in the Lansing/East Lansing area. Of these participants, 71% (n=24) indicated that they felt close or very close to these relatives. Overall, just under half (n=47; 46%) had fiiends or acquaintance in the Lansing/East Lansing area upon arrival. The majority (47%) of the participants resided on campus in residence halls and 75% (n=76) described their new accommodation as different or very different from their accommodations in their home countries. 43 66.7 2.9 25.5 2.9 6.9 19.6 69.6 ONON Table 2. Sample Social Network Information [ Variable # | 7. ] Relatives in the United States Yes 34 33 No 66 65 Missing 2 2 Do you have relatives in the Lansing/East Lansing area Yes 7 21 No 27 79 How close do you feel to your relatives in the US Very Close 16 47 Close 8 24 Not Close 10 29 Did you have friends or acquaintances in Lansing/East Lansing area No 53 52 Yes 47 46 Missing 2 2 Accommodation Type Live on campus in a residence hall 48 47 Live on campus in the university apartments 39 38 Live in a fraternity or sorority 0 0 Live off-campus in an apt or house 10 10 Live off-campus with parents or relatives 5 5 Live in a cooperative house 0 0 Accommodation Similarity Very similar 1 1 similar 25 25 Different 31 30 Very Different 45 44 Table 3 contains the education related variables of the sample which consisted mostly (n= 75; 74%) of graduate students. The largest group (n=28; 28%) was pursuing degrees in the College of Business followed by the College of Engineering (n=19; 19%). Although only 5 members (n=5; 4.9%) of the sample identified themselves as native English speakers, the sample as a whole tended to be relatively proficient in their English language skills as illustrated by a mean score of 605 in the TOEFL (mode: 630; median: 610). The usual required score for the purposes of 44 admission to a US. college or university is 550. The participants also tended to be the children of well-educated parents with roughly 46% of their mothers and 61% of their fathers holding at least a bachelor’s degree. Only 9 (8%) of their parents were educated in the United States. 45 Table 3. Sample Education Related Information rVarlable I # I v. | Educational Level Graduate 75 73.5 Undergraduate 27 26.5 TOEFL scores 490-532 4 3.9 533-575 20 19.6 576-618 24 23.5 619-661 27 26.5 662-704 8 7.8 Mean: 605.52; Mode: 639; Median: 610 SD: 41.88 Major College of Business 28(448) 28(17) College of Engineering 19(430) 19(16) College of Natural sciences 18(408) 18(15) College of Agriculture 8(27 2) 8(10) College of Communication Arts & Science 7(242) 7(9) College of Education 6(136) 6(5) College of Arts & Letters 5(280) 5(1 1) ELC 4 4 College of Social Sciences 2(170) 2(6) College of Human Ecology 2(65) 2(2) Undecided 1 1 Missing 2 2 Mother’s Educational Level Less than HS 16 15.7 HS 30 29.4 Some College 6 5.9 Bachelor’s Degree 40 39.2 Graduate, Professional Degree 7 6.9 Deceased l 10 Missing 2 2.0 Father’s Educational Level Less than HS 6 5.9 HS 21 20.6 Some College 5 4.9 Bachelor’s Degree 45 44.1 Graduate, Professional Degree 18 17.6 Deceased 3 2.9 Missing 4 3.9 Parents Educated in the US Yes 9 9 No 92 91 46 Sample Represeneetivengs The representativeness of the sample used in this study was evaluated by comparing the demographic characteristics of the sample with that of the international student population at MSU. Values in parentheses in tables 1, 2, and 3 indicate the demographic characteristics of the international students enrolled at MSU. These data were collected in a descriptive study carried out by the MSU Oflice of International Students and Scholars (MSU-OISS) between September 20, 1996 and October 30, 1996, approximately one year prior to the collection of data for the present study. With regards to the sex of the participants, the international students enrolled at MSU consist mostly (60%) of males, while the participants in this study were more equally divided with a slightly higher number of females. Students fi'om South Korea form the largest single group of international students enrolled at MSU while students from China formed the largest group in the present study. The top five nationalities represented in this study, however, include five of the top eight nationalities represented at MSU as a whole. Finally, the distribution of majors in our sample closely resembles that of MSU as a whole. 47 Varial s in heP n An Table 4 contains the full name, abbreviated name, mean, standard deviation, skewness, and range for each of the variables used in the present analyses. The distribution of all variables was fairly normal. With the exception of hardiness and its three components (i.e. challenge, commitment, and control), the distribution of all other variables was characterized by some positive skewness. The negative skewness characterizing the distribution of hardiness and its components is indicative of a generally hardy sample. Furthermore, on certain variables, such as depression, anxiety, or psychosomatic symptoms, the positive skewness of self-reported symptoms is typical of most non-clinical samples and indicates that the majority of the sample reported fewer, and less severe psychological and/or physical symptoms. Tables 5.1 and 5.2 are correlation matrices composed of the Pearson correlation coefficients of the strength of the relationships between the various variables used in the present analyses. Although there are a fairly large number of significant correlations between the various variables used in this study, no correlation coeflicient is of a magnitude large enough to raise multicollinearity concerns. Indeed, as Tabachnik and F idell (1989) have noted multicollinearity becomes a problem when bivariate correlations are equal to or greater than .90. 48 Table 4. Descriptive Statistics for All Variables. [ Variable Name benviation [ M J so ] Sir. | Range Depression at Time A ADEPR 14.81 1 1.51 1.47 0-58 Anxiety at Time A AANX 4.70 5.24 1.68 0-25 Psychosomatic Symptoms at Time A PSCPRE 16.36 17.23 2.22 0-98 Somatization at Time A ASOM 4.77 4.88 1.88 0-26 Depression at Time B BDEPR 14.59 12.00 1.28 0-54 Anxiety at TimeB BANX 4.17 5.12 2.07 0-25 Psychosomatic Symptoms at Time B PSCPST 16.57 15.77 1.54 0-73 Somatization at Time B BSOM 4.68 4.75 1.51 0-22 Hardiness Score HARDINES 89.44 12.76 -().46 55-111 Index of Life Stress STRESS 32.97 13.23 0.26 1-72 Index of Social Support SUPPORT 74.70 16.01 0.36 31-1 18 Components of Hardiness Commitment ACOMM 31 .77 5.70 -.35 18-41 Challenge ACHAL 25 .79 4.92 -.74 10-36 Control ACONT 31 .57 5.36 -.84 9-4 49 ~ teen... 3. 5.- wmr act son.. 2.- 8. wot 2... 9895”: ~ :97 :34. samm. 1.3.. aamm. 3:. seem. seen. :94. $0.5de fl sawmr sstr ssmmr 8.6m... that 3.3.- sst... asbmr maid a Each. same. :3. :3. same. :8. :8. 20de g sewn. same. :34. the. same. sewn. 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