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Social support buffering of acculturative stress: a study of mental health symptoms among Korean international students
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International Journal of Intercultural Relations 28 (2004) 399–414 www.elsevier.com/locate/ijintrel
Social support buffering of acculturative stress: a study of mental health symptoms among Korean international students Jee-Sook Lee, Gary F. Koeske, Esther Sales School of Social Work, University of Pittsburgh, 700N. Highland Avenue, 113 Pittsburg, PA 15206, USA
Abstract The relationship between acculturative stress and mental health symptoms and the role of social support as a moderator of this relationship was studied among Korean international students (N=74) living in the Pittsburgh area. Findings included: (1) acculturative stress was strongly correlated with mental health symptoms; (2) social support moderated and buffered the effect of stress on symptoms. Students with high levels of social support were significantly less likely to report symptoms with increasing levels of acculturative stress, compared to students reporting low levels of social support; and (3) the buffering effect of support was mainly or exclusively present when there was a high level of acculturation to American language and interpersonal associations. Granting limitations imposed by the small convenience sample, the study supports the theoretical buffering role for social support in the context of acculturative processes and suggests the need for facilitating the support systems of international students, particularly as they become more acculturated. r 2004 Elsevier Ltd. All rights reserved. Keywords: Acculturative stress; Social support; Mental health; Acculturation; International students
Corresponding author. Tel.: +1-412-361-6120; fax: +1-412-586-9559.
E-mail addresses: [email protected], [email protected] (J.-S. Lee), [email protected] (G.F. Koeske), [email protected] (E. Sales). 0147-1767/$ - see front matter r 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijintrel.2004.08.005
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1. Introduction Since American colleges and universities opened their doors to international students, the number of international students has continued to grow. By the academic year 1997–1998, there were more than 480,000 international students enrolled in various institutions of higher education in the United States. Among these international students, East Asian students have become the largest segment of international students, who have grown from only 290 in 1979 (Klineberg, & Hull, 1979) to 179,256 by 1997–1998 (Digest of Education Statistics, 1999). Research has shown that international students experience more difficulties than their US counterparts (Kaczmarek, Matlock, Merta, Ames, & Ross, 1994; Mallinckrodt & Leong, 1992). Furthermore, studies have indicated that Asian students report more acculturative stress than European students because of a greater cultural gap between the Asian culture and the host culture (Guclu, 1993; Parr, Bradley & Bingi, 1992; Yang & Clum, 1994). Therefore, it is critical to consider their cultural background to understand their adjustment in the United States. While some studies (Mori, 2000; Yang & Clum, 1994) have been conducted on Asian international students’ stress and mental health, little has been done to look at the needs and problems of the Korean international student population. Moreover, recent studies (Bhattacharya, 1998; Chi, Lubben, & Kitano, 1989; Trimble, 1995) have emphasized the importance of subgroup differences among Asian populations. Therefore, the present study is designed to test the relationship between acculturative stress and mental health symptoms and the buffering effect of social support on this relationship in a sample of Korean international students. 1.1. Acculturative stress There have been many studies suggesting that adaptation to the host culture is very difficult and stressful (Choi, 1997; Mori, 2000; Sandhu & Asrabadi, 1994; Yang & Clum, 1994). Stress induced by this adaptive process is referred to as acculturative stress. International students need to adapt to the new culture as well as a new educational and social environment. In a review of over 30 years of research, Church (1982) reported that international students confronted ‘‘language difficulties, financial problems, adjusting to a new educational system, homesickness, adjusting to social customs and norms, and for some students, racial discrimination’’ (p. 544). Similarly, Lin and Yi (1997) indicated the following problems unique to or exacerbated among international students: academic difficulties due to the English language and the different educational system, financial pressures, psychosocial stressors due to unfamiliarity with new customs and social norms, and changes in one’s support system, and intrapersonal and interpersonal problems caused by the process of acculturation and adjustment. In addition, Mori (2000) described five unique sources of stress encountered by international students: linguistic, academic, interpersonal, financial, and intrapersonal problems. In sum, the major problems encountered by international students, identified by various studies, are language barriers to academic performance as well as to daily
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living, difficulties with the new American educational system, social relationships due to different cultures and social norms, their sense of identity, and financial concerns. Financial concerns can be greater for international students because they are not allowed to work outside the university. Thus, they need to find jobs on campus, which are typically in short supply. In addition, they are not qualified for federal financial aid so that many international students accelerate their programs to graduate as soon as possible (Cadieux & Wehrly, 1986). Overall, international students have to overcome these unique problems as well as those typically confronted by indigenous students. There are some studies reporting that stress may be more severe for students from Asian countries than European countries (Guclu, 1993; Yang & Clum, 1994). These studies suggest that if there is more discrepancy between the host culture and the culture of origin, the adjustment is likely to be more stressful. Therefore, it is important to test how acculturative stress especially influences Korean students as the fastest-growing group of Asian international students. As suggested, the level of stress is positively related to a discrepancy between the host culture and the culture of origin. There are other factors that are also related to the level of stress, such as the mode of acculturation, the individual characteristics, and the nature of the host society (Brilliant, 2000). Berry (2003) describes four modes of acculturation, including assimilation, integration, separation, and marginalization. Assimilation implies moving into the host society and giving up cultural identity. Integration implies moving to join the host society but maintaining cultural identity, which is viewed the most desirable strategy in this multicultural society (Berry & Kim, 1988). Separation implies holding onto cultural identity and avoiding the host society. The last dimension is marginalization, which refers to groups (or individuals) having cultural and psychological contact with neither their traditional culture nor the dominant society. Williams and Berry (1991) report integration and assimilation generate lower levels of stress, whereas separation and marginalization generate high levels of stress. They also claim that integration generates the least amount of stress. When going through the acculturation process, individuals face challenges regarding the use of language, perceptual and cognitive style, identity, attitudes, and most importantly, the experience of acculturative stress. Berry (1980) claims that such stress is common and may lead to disruptive behaviors such as drug use as well as homicide, and suicide.
1.2. Acculturative stress and mental health symptoms As many studies have indicated, entering into an unfamiliar environment and adjusting to the new environment requires changes, which can lead to anxiety, confusion, and depression (Choi, 1997; Lin & Yi, 1997). Numerous studies have suggested a moderate relationship between stress and mental health symptoms, depression in particular (e.g., Choi, 1997; Flannery & Wieman, 1989; Oh, Koeske & Sales, 2001; de Snyder, 1987; Yang & Clum, 1994). The loss or attenuation of the
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natural social support system and facing excessive amounts of stress simultaneously are likely to encourage the development of psychological distress. In addition, somatization of stress is an essential factor that needs to be taken into account, along with anxiety, depression, and interpersonal problems, in order to address the mental health symptoms of international students. Many Asian international students tend to develop physical symptoms rather than express their distress as anxiety or depression (Allen & Cole, 1987; Mori, 2000), and they may feel a ‘‘loss of face’’ by seeking therapy or counseling (Allen & Cole, 1987). It is not uncommon to find Asian international students who suffer from respiratory disorders (Allen & Cole, 1987), headaches, low-energy level, gastrointestinal problems (Thomas & Althen, 1989), lack or loss of appetite, sleep difficulties, and fatigue (Lin & Yi, 1997). 1.3. Acculturative stress and social support Mallinckrodt and Leong (1992) stated that ‘‘not only is social support crucial in itself for positive well-being, but social support also provides a powerful coping resource for persons experiencing stressful life changes, including the stress of adjusting to an unfamiliar culture’’ (p. 71). Asian students may be particularly at risk, since they are physically away from their support networks, especially from their close-knit families. Despite the theoretical centrality of social support to the acculturation process and the long track record of research on the direct and buffering effects of social support generally, relatively little has been done on social support in relation to acculturative stress. Yang and Clum (1994) found both depressive symptoms and hopelessness to be related to social support. Mallinckrodt and Leong (1992) studied eight factors of social support among international students and found most of them related to depression, anxiety, and physical health symptoms. Shinn (1994), however, failed to find an expected relationship between the utilization of social support and depression among Korean–American immigrant women in New York. Choi (1997) found four dimensions of availability of social support related to both acculturative (immigrant) stress and depression in a sample of Korean American families. Numerous studies conducted in the last 20 years have found evidence for direct effects of social support on an array of outcomes, including somatic and mental health symptoms (see, e.g., Cohen & Syme, 1985; Payne & Jones, 1987; and Veiel, & Baumann, 1992). These studies have been done in work, school, and general life settings. Several studies have also found a buffering effect of social support, in which the impact of stress on negative outcomes is lessened in the presence of social support. Jou and Fukada (1997), in a recent example, tested the dimensions of needed support, perceived support, and received support and reported a stress buffering effect of perceived and received support on somatic complaints. Other researchers, however, have failed to confirm buffering effects of social support. Since the detection of buffering involves testing for statistical interaction effects, typically in naturalistic (as opposed to experimental) studies, the statistical power available to the researcher is low (McClelland & Judd, 1993). Koeske and Koeske (1991b) and
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Morris, Sherman, and Mansfield (1986) also discuss factors that complicate the testing and detection of stress by support and other interactions. In this study, we tested the buffering effect of social support on the acculturative stress-symptoms relationship in a Korean student sample, using comprehensive measures of each construct. We used the Brief Symptom Inventory (Derogatis & Melisartos, 1983) as the outcome measure to incorporate problems inclusive of depression, anxiety, interpersonal concerns, and somatization. In addition, we explored the role of amount or level of acculturation, respondent gender, age, income, marital status, and length of time residing in the United States. Level of acculturation refers to the extent to which the immigrant or visitor has adopted the values and behaviors of the host culture; it was examined both as a control and moderator variable. The background variables were studied as controls.
2. Method 2.1. Participants and procedures Participants in this study were enrolled in classes at a US university. They were neither permanent residents nor American citizens and held either an F (student) or J (school-related) visa. A total of 74 Korean international students, residing in the area of Pittsburgh, participated in the study. Seventy-two of the participants were enrolled at the city’s two major universities. The participants ranged in age between 19 and 41, with a mean of 30. Eighty percent were studying in masters, doctoral, or post-doctoral programs. Seventy percent (N=52) of the respondents were men. The average length of residence in America was 31 months; 34% had lived in the US for a year or less, two-thirds for 3 years or less. One half of the participants were single, 35 were married, and 2 were divorced or widowed. The questionnaire was distributed in three Korean churches, one Korean Catholic Church, and the English Language Institute in the University of Pittsburgh. Twentynine were collected from three Korean churches; 8 questionnaires were gathered from the Korean Catholic Church, and 8 were collected from the English Language Institute. In addition, 102 questionnaires were mailed out to prospective participants from a list of Korean students studying in the Pittsburgh area. This mailing was done to increase both the size and diversity of the sample. The participants were instructed to disregard the mailed questionnaire if they had previously filled out the survey. Each mailed survey packet contained a cover letter, a questionnaire, and a returned envelope. A week after the mailing, an e-mailed reminder was sent to each potential respondent. One week after the e-mailed reminder, phone calls were made by the first author to encourage the students to participate and return the survey. A total of 29 (28% of the 102 mailed) surveys were completed by the mailed distribution. Since the participants were predominantly post-graduate students in two American universities, the survey was written in English. Nonetheless, a pretest was done on a small number of Korean church members to detect and eliminate any ambiguity or misunderstandings due to language difficulty.
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2.2. Measures 2.2.1. Acculturative stress Acculturative stress was measured with the modified version of the index of life stress (ILS) (Yang & Clum, 1994) and four additional items generated by the researcher. The ILS was developed to incorporate aspects of stress that are unique to Asian international students. The ILS is a 31-item self-report measure assessing five areas of stressors: problems with language, cultural adjustment, academic pressure, financial concerns, and outlook for the future. The response range of the original scale is from never (0) to often (3). The modified version used in this study added a fourth (very often) alternative to increase response variability and rephrased a few items to enhance understanding. Sample items are ‘‘I don’t like the way people treat each other here,’’ ‘‘I worry about my financial situation,’’ and ‘‘I can feel racial discrimination toward me from other students.’’ Yang and Clum (1994) in their study reported a test–retest reliability of .87 and an internal consistency estimate of .86. In the current study, the coefficient alpha reliability was .88, after four items were excluded based on an item analysis. 2.2.2. Psychological distress and symptomotology The brief symptom inventory (BSI) was modified to examine psychological distress of Korean students. Of 49 BSI items that loaded on 9 factors in a principal components analysis (Derogatis & Melisartos, 1983), 3 psychotocism items were excluded because they were presumed to be extreme and potentially distracting for our non-clinical sample. The other dimensions, including hostility, anxiety, depression, paranoid ideation, somatization, obsessive–compulsive, and phobic anxiety was represented by 5 or more items. Respondents rated how much they had been bothered by each symptom over the past 2 months from 0 (not at all) to 4 (extremely). Derogatis and Melisartos (1983) reported the test–retest reliability in the range from a low of .68 for Somatization to a maximum of .91 for Phobic Anxiety. They also reported the alpha coefficients ranged from a low of .71 for Psychoticism to a high of .85 for Depression. In the current study, in which only an overall symptom score was used, the coefficient alpha was .96. Derogatis and Melisartos (1983) also reported evidence for the predictive and construct validity of the BSI. 2.2.3. Social support Perceived social support was measured by a direct measure of practical and emotional support developed by Koeske and Koeske (1989, 1993). A version of this scale has been used extensively in studies of job stress of human service workers, and has also been adapted for use in studies of student stress (Koeske & Koeske, 1991b). Each significant other or potential source of support is rated from 1 (none at all) to 5 (a great amount) on the amount of support they make available to the respondent. Separate ratings are made for practical and emotional types of support, and a ‘‘not applicable’’ response is available in case the listed source is not relevant for the respondent (e.g., the respondent does not have a spouse). In this study, there were 11 listed sources of support, including My Parent, Spouse/Partner, Korean Friends, and
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American Friends. Five of the sources were Korean culture sources, one was an American culture source (American Friends), and the others were indeterminate, but probably mainly American (e.g., My Academic Advisor). The primary social support measure used in the current study was an overall mean rating across practical and emotional support, based on the sources applicable for the respondent. The scale has shown adequate test–retest reliability of .70 over an 8-week interval, and construct validity has been established in previous research, including studies in which buffering interaction effects have been detected (e.g., Koeske & Koeske, 1989). 2.2.4. Level of acculturation An abridged version of the Suinn–Lew Asian Self-Identity Acculturation Scale (SL-ASIA, Suinn, Richard-Figueroa, Lew & Vigil, 1987) was used to measure level of acculturation to the American culture. Respondents rated 15 items by choosing in a range between a separatist Korean alternative (scored 1), a bicultural alternative (scored 3), and an assimilative American response (scored 5). The original scale was modified to fit a Korean sample by changing the term ‘‘Asian’’ to ‘‘Korean.’’ For example, a question asked, ‘‘What language do you prefer?’’ with responses including Korean only; Mostly Korean, some English; Korean and English about equally; Mostly English, some Korean; and only English. Psychometric and item analysis procedures showed that 9 of the items from the set of 15 used had an internal consistency (alpha coefficient) of .76. These items dealt with interpersonal associations and language use and corresponded, with one exception, to an 8-item set that had a reliability of .85 in an earlier study (Oh, Koeske & Sales, 2001). In this previous study, the corresponding acculturation level measure was significantly related to both acculturative stress and depression. 2.2.5. Demographic Information The last part of the questionnaire included reports of age, gender, marital status, length of residency in America, program enrolled in, income (1=less than $10,000 to 6=more than $60,000), and visa status.
3. Results 3.1. Descriptive findings The mean, standard deviation, skewness, kurtosis, and reliability of the critical variables, acculturative stress, social support, acculturation level, and mental health symptoms, are shown in Table 1. Each of these variables had an acceptable alpha reliability and approximately normal distribution, except acculturation level, which was transformed by a reciprocal transformation. The scoring of acculturation level was thereafter inverted to retain the meaning of high scores as reflecting greater acculturation. The mean of .81 for the BSI indicates that on the average the symptoms were reported slightly less than ‘‘a little bit’’ distressing. The most frequently reported symptoms were ‘‘feeling lonely,’’ ‘‘nervousness or shakiness
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Table 1 Summary of mean, SD, skewness, kurtosis, and reliability of construct variables Variables
Mean
SD
Acculturative stress Social support Psychological distress (BSI) Acculturation level
1.57 2.59 0.81 0.35
0.45 0.59 0.58 0.06
Skewness
Kurtosis
0.01 0.39 0.55 0.08
0.64 0.09 0.54 0.48
Reliability 0.88 — 0.96 0.76
Note. The internal consistency model is not appropriate for the social support measure, since there is no expectation that high support from one source will be associated with higher support from another; nonetheless, the coefficients were moderate at .69 for practical support and .74 for emotional support, based on respondents who had all 11 support sources available in their network.
Table 2 Bivariate intercorrelations for study variables Variable 1. Gender (1=female, 2=male) 2. Age 3. Marital status (1=single, 2=married) 4. Log years in US 5. Income 6. BSI symptoms 7. Stress 8. Social support 9. Acculturation level
1 — .21a .10 .08 .19 .05 .00 .04 .07
2
3
4
5
6
7
8
— .47c .36c .06 .23a .06 .02 .03
— .09 .03 .25a .08 .07 .05
— .10 .07 .02 .32b .01
— .12 .13 .17 .05
— .56c .12 .13
— .22 .37c
— .18
Note. N of cases varies from 68 to 74. a po .05. b po .01. c po .001.
inside,’’ and ‘‘feeling blue.’’ The mean acculturative stress score of 1.57 indicated that on the average the stressful feeling occurred between ‘‘hardly ever’’ and ‘‘sometimes.’’ Most stressful were ‘‘It would be the biggest shame for me if I fail in school,’’ ‘‘I have to work much harder than American students,’’ and ‘‘My English embarrasses me when I talk to people.’’ The social support mean of 2.59 suggests a sense of between ‘‘a little’’ and ‘‘A fair amount’’ of available support. The median level of (pre-transformed) acculturation was 2.44, indicating that the respondents fell somewhat more toward Korean than bicultural or American in their associations and preferences, despite residing in the US for an average of over 30 months. 3.2. Bivariate relationship The bivariate relationships for the primary study variables, including the five background variables included as controls, are shown in Table 2. We see that the BSI was highly correlated with acculturative stress (r=.56, po.001), a significantly correlated with being younger (r= .23, po.05) and single (pt. bis. r= .25, po.05).
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Acculturative stress was also related to lower levels of acculturation (r= .37, po.001) and lower support (r= .22, po.05). Social support did not have a significant relationship to the BSI (r= .12), but it was substantially related to having been in the US longer (r=.36, po.001), perhaps due to increases in American-based sources of support. Because age and marital status were significantly related to symptom distress, they will be used as control variables in the test of the direct and buffering effects of social support. 3.3. Test of the buffering role of social support Moderated multiple regression analysis was conducted to test the predicted moderating role of social support. In the hierarchical moderated regression analysis, the control variables of age and marital status were entered first, then the main effects of acculturative stress and social support were entered at step 2, and finally, the interaction product term (stress support) was entered in the third step. Table 3 shows that the main effect of stress was significant (b=.56, po.001), but social support did not have a direct effect on symptoms (b=.01). The stress social support interaction (product) term was statistically significant (b= 1.47, p=.02; rsquared increment=.05), consistent with the buffering hypothesis. The slope Table 3 Coefficients for moderated multiple regression analysis: predicting BSI symptoms in primary and in secondary analysis including acculturation level B Primary analysis Step 1 Age Marital status Step 2 Stress Support Step 3
SEb
.02 .17 .70 .01 .05
Stress support .61 Secondary analysis (including acculturation level)
.02 .15
Beta
.14 .15
R2INC
p
.75 .02 .78
.13 .10 .02
.56 .01
o.001 .93
.25
1.47
.02
Stress support Stress acculturation Support acculturation Step 3
.69 .31 .36
Stress support acculturation
14.96
.14 .10 1.03 .28 1.96 1.82 4.87
.59 .02 .08 1.69 .09 .18 13.71
.06
.12
.31
o.001
.32
o.001
.07
.08
.08
.003
.29 .26
Step 1 Stress Support Acculturation Step 2
PINC
o.001 .83 .45 .02 .87 .84 .003
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Table 4 Social support subgroup coefficients for relationship of stress with BSI symptoms N Social support subgroup Low support 36 High Support 35 Social support by acculturation level subgroup Low support-low acculturation 22 Low support-high acculturation 14 High support-low acculturation 13 High support-high acculturation 21
B
Beta
P
1.11 0.52
.68 .47
o.001 .004
0.87 1.51 0.89 0.31
.61 .81 .68 .30
.003 o.001 .01 .19
Note. Subgroups created by median splits. Smaller n’s in middle groups due to correlation of support with acculturation level (r= .37).
coefficient for the interaction of .61 indicates that the slope of BSI on stress becomes .61 less positive for a one unit increase in social support. A subgroup analysis was conducted dichotomizing the social support scores into low and high levels of support. Table 4 shows that the slope of BSI on stress was over twice as steep (b=1.11 for the low support group, b=.52 for the high support group) when support was low. The significant stress support interaction documents that the slope coefficients were significantly different. Fig. 1 presents the regression lines of BSI on stress for the low and high social support groups, clearly showing, consistent with the buffering hypothesis, that stress has less damaging implications for symptom occurrence when social support is high. We retested the buffering effect for invariance across certain modifications. First, the BSI was log transformed to a skewness of .05, down from .54; the initial BSI distribution was not significantly non-normal but skewness in the .50’s is a moderate departure from normality. Second, although the regression diagnostics were acceptable for the primary analysis, we removed the five most influential cases based on SPSS influence statistics and reanalyzed. Third, we added income, years in the US, gender, and level of acculturation as control variables. The buffering effect was invariant across these analytic modifications, retaining significance at the .05 level or beyond. 3.4. Follow-up analyses Additional analyses were done to assess the generality–specificity of the buffering interaction. Splitting the data by gender revealed that the effect was apparent for both males and females. Examination of the separate dimensions of the BSI showed buffering was most pronounced for depression, anxiety, and paranoid ideation and least pronounced for psychotocism and somatization. The BSI on stress regression line was examined for low and high support, using each source of support separately. The buffering effect appeared most pronounced for support from parents, Korean friends, religious organizations, the academic advisor, school
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0.6 Social Support Group 0.5
High Low
Log of Symptoms
0.4
0.3
0.2
0.1
0.0
-0.1 0.0
0.5
1.0 1.5 2.0 Acculturative Stress
2.5
3.0
Fig. 1. Stress—symptoms regression lines for low and high support levels: Social support buffering.
services (e.g., counseling services), and Korean student organizations. Of these, only the advisor and counseling services are not fully Korean-based support sources. Acculturation level was examined as a possible qualifier of the support buffering effect. Acculturation level was added to the moderated regression analysis. The bottom half of Table 3 shows that the three-way interaction (stress support acculturation) accounted for 8% additional variance and was significant at p=.008. This indicates that the moderating effect of social support was significantly different depending on level of acculturation. Table 4 reports the bivariate regression statistics for the four subgroups resulting from median splits of support and acculturation level. We can see that the non-standardized regression coefficients (and betas) for the low vs. high support conditions were only markedly different (b=1.51 for low support, b=.31 for high support) when acculturation level was high, indicating that the buffering effect is apparent only when acculturation is at a high level. Fig. 2 demonstrates this by presenting the buffering-relevant regression lines for the low and high acculturation conditions separately.
4. Discussion The findings in this study clearly indicated that acculturative stress was a strong predictor of mental health symptoms. Korean international students with high
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Low Level of Acculturation 0.6
Social Support Group 0.5
Log of Symptoms
High
0.4
Low
0.3 0.2 0.1 0.0 -0.1 0.0
0.5
1.0
1.5
2.0
2.5
3.0
Acculturative Stress High Level of Acculturation 0.6
Social Support Group 0.5
High
Log of Symptoms
Low
0.4
0.3
0.2
0.1 0.0 0.0
0.5
1.0
1.5
2.0
2.5
3.0
Acculturative Stress Fig. 2. Stress—symptoms regression lines for low and high support levels: Social support buffering for low and high levels of acculturation.
acculturative stress exhibited high mental health symptoms. In addition, a stress-buffering effect of social support was strongly demonstrated in this study. Korean international students with acculturative stress but with a high level of social support would express lower mental health symptoms than the students with
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low level of social support. The main or direct effect of support on symptoms was not significant. Effective buffering seemed to arise from both Korean and host American sources. An unexpected, but potentially theoretically and practically relevant, qualifier of support buffering was the acculturation level of the student: buffering occurred only when acculturation was at a higher level. Excepting this qualification, buffering was quite general or invariant across a number of factors. We are not aware of a previous demonstration of social support buffering of acculturative stress. Choi (1997) did not report a formal test of buffering, and Mallinckrodt & Leong (1992) studied international graduate students, but used a general life events stress measure. In the latter study, significant stress buffering occurred only for graduate program support, which included apparently non-social elements such as the quality of instruction, facilities, and the curriculum. Family support was not a buffer, but both types of support had significant main effects on symptoms. By this time, there have been enough successful demonstrations of social support buffering of mental and physical health outcomes that the reality of the phenomenon is not in doubt. More research is needed to clarify the conditions under which it is manifested and detectable. The type of stress studied and the way it is measured, as well as the measurement of social support and the negative outcomes examined, are apparent qualifying factors. Characteristics of the sample, research design, and statistical analytic procedures used also effect whether or not buffering will be found. A number of important limitations in the study must be addressed. First, the convenience sample of Korean international students residing in the area of Pittsburgh is probably not representative of all Korean international students in the US Moreover, 80% of the participants in this study were graduate students. There may be differences between the stresses faced by students who are enrolled in different programs, non-degree to post-doctoral program. The small sample size, especially of female students, also limits the ability to generalize these findings. Future research on larger and more representative samples is necessary to establish the generality of the findings for Korean international students, and to extend the findings to other groups of international students. In addition, the original scale of SL-ASIA (Suinn–Lew Asian Self-Identity Acculturation) was developed on the basis of linear and uni-dimensional aspect of acculturation. However, current research has acknowledged that acculturation is multidimensional and orthogonal, and should be measured accordingly. Therefore, further research is required to investigate multidimensional aspects of acculturation. Static correlational studies using self-report measures are always potentially vulnerable to assumptions of causal direction and the possibility of shared method variance. Regarding the former, it may be that pre-existing mental health symptoms caused the student to have greater acculturative stress, rather than the stress-symptom direction of effect we presumed. We are comfortable with our directional assumption, because of the wealth of prior research supporting it, the demonstration of the theoretically meaningful buffering
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interaction, and the use of a symptom measure that focused the respondent on relatively recent feelings. The stress measure, on the other hand, covered the broad, undefined period in which the respondent had been in the United States. Shared method variance may account for part of the high correlation between stress and symptoms, but it cannot explain the buffering interaction or the absence of a bivariate relationship (direct effect) between social support and symptoms. Granting the necessary tentativeness imposed by these limitations, the findings in this study suggest that Korean international students confronting adjustment to the host culture may suffer psychological distress. Successful completion of their academic programs by Korean students, and international students generally, may depend on colleges and universities providing programs that enhance the social support systems of these students. Lin and Yi (1997) suggested programs based on the stage of the adjustment, prearrival adjustment (before arrival), initial adjustment (first 6 months), on-going adjustment (6 months to graduation), and return-home adjustment (upon graduation to first 6 months after returning home). Such specialized programs could help international students be more successful in their academic areas and increase satisfaction with their scholastic stay in the United States. Programs relevant to early stage adjustment might emanate from the student’s country of origin, with later stage adjustment supported by programs in the United States. The current data suggest that program administration at the later stages should not be overlooked.
References Allen, F. C. L., & Cole, J. B. (1987). Foreign student syndrome: fact or fable. Journal of American College Health, 35, 182–186. Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. Padilla (Ed.), Acculturation: theory, models, and findings (pp. 9–25). Boulder, CO: Westview. Berry, J. W. (2003). Conceptual approaches to acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: advances in theory, measurement, and applied research (pp. 17–37). Washington, DC: American Psychological Association. Berry, J. W., & Kim, U. (1988). Acculturation and mental health. In P. Dasen, J. W. Berry, & N. Sartorius (Eds.), Health and cross-cultural psychology (pp. 207–236). Newbury Park, CA: Sage. Bhattacharya, G. (1998). Drug use among Asian–Indian adolescents: identifying protective/risk factors. Adolescence, 33(129), 169–185. Brilliant, J. J. (2000). Issues in counseling immigrant college students. Community College Journal of Research and Practice, 24, 577–586. Cadieux, R. A. J., & Wehrly, B. (1986). Advising and counseling the international student. New Directions for Student Services, 36, 51–63. Chi, I., Lubben, J. E., & Kitano, H. H. L. (1989). Differences in drinking behavior among three Asian–American groups. Journal of Studies on Alcohol, 50(1), 15–23. Choi, G. (1997). Acculturative stress, social support, and depression in Korean–American families. Journal of Family Social Work, 2(1), 81–97. Church, A. T. (1982). Sojourner adjustment. Psychological Bulletin, 91(3), 540–572. Cohen, S., & Syme, S. L. (Eds.) (1985), Social support and health. Orlando FL: Academic Press.
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de Snyder, N. S. V. (1987). Factors associated with acculturative stress and depressive symptomatology among married Mexican immigrant women. Psychology of Women Quarterly, 11, 475–488. Derogatis, L. R., & Melisartos, N. (1983). The brief symptom inventory: an introductory report. Psychological Medicine, 13, 595–605. Digest of Education Statistics. (1999). US Department of Education. Flannery, R. B., & Wieman, D. (1989). Social support, life stress, and psychological distress: an empirical assessment. Journal of Clinical Psychology, 45, 867–872. Guclu, N. (1993). A study to identify and analyze international graduate students’ adjustment problems at the University of Pittsburgh. Unpublished doctoral dissertation, University of Pittsburgh, Pennsylvania. Jou, Y. H., & Fukada, H. (1997). Stress and social support in mental and physical health of Chinese students in Japan. Psychological Reports, 81, 1303–1312. Kaczmarek, P. G., Matlock, G., Merta, R., Ames, M. H., & Ross, M. (1994). An assessment of international college student adjustment. International Journal of the Advancement of Counseling, 17, 241–247. Klineberg, O., & Hull, W. F. (1979). At a foreign university: an international study of adaptation and coping. New York: Praeger. Koeske, G. F., & Koeske, R. D. (1989). Work load and burnout: can social support and perceived accomplishment help. Social Work, 34, 243–248. Koeske, G. F., & Koeske, R. D. (1991b). Student burnout as a mediator of the stress-outcome relationship. Research in Higher Education, 32, 415–431. Koeske, G. F., & Koeske, R. D. (1993). A preliminary test of a stress-strain-outcome model for reconceptualizing the burnout phenomenon. Journal of Social Service Research, 17(3/4), 107–135. Lin, J. G., & Yi, J. K. (1997). Asian international student’s adjustment: issues and program suggestions. College Student Journal, 31(4), 473–479. Mallinckrodt, B., & Leong, F. T. (1992). International graduate students, stress, and social support. Journal of College Student Development, 33, 71–78. McClelland, G. H., & Judd, C. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114(2), 376–390. Mori, S. (2000). Addressing the mental health concerns of international students. Journal of Counseling & Development, 78, 137–144. Morris, J. H., Sherman, J. D., & Mansfield, E. R. (1986). Failures to detect moderating effects with least squares—moderated multiple regression: some reasons and a remedy. Psychological Bulletin, 99(2), 282–288. Oh, Y., Koeske, G. F., & Sales, E. (2001). Acculturation, stress, and depressive symptoms among Korean immigrants in the United States. Journal of Social Psychology, 142(4), 511–526. Parr, G., Bradley, L., & Bingi, R. (1992). Concerns and feelings of international students. Journal of College Student Development, 33, 20–25. Payne, R. L., & Jones, J. G. (1987). Measurement and methodological issues in social support. In S. V. Kasl, & C. L. Cooper (Eds.), Stress and health: issues in research methodology (pp. 167–205). New York: Wiley. Sandhu, D. S., & Asrabadi, B. R. (1994). Development of an acculturative stress scale for international students: preliminary findings. Psychological Reports, 75, 435–448. Shinn, K. R. (1994). Psychosical prediction of depressive symptoms in Korean–American women in New York City. Women and Health, 21(1), 73–82. Suinn, R., Richard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn–Lew Asian Self-Identity Scale: an initial report. Educational and Psychological Measurement, 47, 401–407. Trimble, J. E. (1995). Toward an understanding of ethnicity and ethnic identity, and their relationship with drug use research. In G. J. Botvin, S. Shinke, & M. A. Orlandi (Eds.), Drug abuse and prevention with multiethnic youth (pp. 3–27). Thousand Oaks: Sage Publications. Veiel, H. O. F., & Baumann, U. (Eds.) (1992), The meaning and measurement of social support. New York: Hemisphere Publishing Corporation.
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Williams, C. L., & Berry, J. W. (1991). Primary prevention of acculturative stress among refugee. American Psychologist, 46, 632–641. Yang, B., & Clum, G. A. (1994). Life stress, social support, and problem-solving skills predictive of depressive symptoms, hopelessness, and suicide ideation in an Asian student population: a test of a model. Suicide and Life Threatening Behavior, 24, 127–139.
International Journal of Intercultural Relations 28 (2004) 399–414 www.elsevier.com/locate/ijintrel
Social support buffering of acculturative stress: a study of mental health symptoms among Korean international students Jee-Sook Lee, Gary F. Koeske, Esther Sales School of Social Work, University of Pittsburgh, 700N. Highland Avenue, 113 Pittsburg, PA 15206, USA
Abstract The relationship between acculturative stress and mental health symptoms and the role of social support as a moderator of this relationship was studied among Korean international students (N=74) living in the Pittsburgh area. Findings included: (1) acculturative stress was strongly correlated with mental health symptoms; (2) social support moderated and buffered the effect of stress on symptoms. Students with high levels of social support were significantly less likely to report symptoms with increasing levels of acculturative stress, compared to students reporting low levels of social support; and (3) the buffering effect of support was mainly or exclusively present when there was a high level of acculturation to American language and interpersonal associations. Granting limitations imposed by the small convenience sample, the study supports the theoretical buffering role for social support in the context of acculturative processes and suggests the need for facilitating the support systems of international students, particularly as they become more acculturated. r 2004 Elsevier Ltd. All rights reserved. Keywords: Acculturative stress; Social support; Mental health; Acculturation; International students
Corresponding author. Tel.: +1-412-361-6120; fax: +1-412-586-9559.
E-mail addresses: [email protected], [email protected] (J.-S. Lee), [email protected] (G.F. Koeske), [email protected] (E. Sales). 0147-1767/$ - see front matter r 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijintrel.2004.08.005
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1. Introduction Since American colleges and universities opened their doors to international students, the number of international students has continued to grow. By the academic year 1997–1998, there were more than 480,000 international students enrolled in various institutions of higher education in the United States. Among these international students, East Asian students have become the largest segment of international students, who have grown from only 290 in 1979 (Klineberg, & Hull, 1979) to 179,256 by 1997–1998 (Digest of Education Statistics, 1999). Research has shown that international students experience more difficulties than their US counterparts (Kaczmarek, Matlock, Merta, Ames, & Ross, 1994; Mallinckrodt & Leong, 1992). Furthermore, studies have indicated that Asian students report more acculturative stress than European students because of a greater cultural gap between the Asian culture and the host culture (Guclu, 1993; Parr, Bradley & Bingi, 1992; Yang & Clum, 1994). Therefore, it is critical to consider their cultural background to understand their adjustment in the United States. While some studies (Mori, 2000; Yang & Clum, 1994) have been conducted on Asian international students’ stress and mental health, little has been done to look at the needs and problems of the Korean international student population. Moreover, recent studies (Bhattacharya, 1998; Chi, Lubben, & Kitano, 1989; Trimble, 1995) have emphasized the importance of subgroup differences among Asian populations. Therefore, the present study is designed to test the relationship between acculturative stress and mental health symptoms and the buffering effect of social support on this relationship in a sample of Korean international students. 1.1. Acculturative stress There have been many studies suggesting that adaptation to the host culture is very difficult and stressful (Choi, 1997; Mori, 2000; Sandhu & Asrabadi, 1994; Yang & Clum, 1994). Stress induced by this adaptive process is referred to as acculturative stress. International students need to adapt to the new culture as well as a new educational and social environment. In a review of over 30 years of research, Church (1982) reported that international students confronted ‘‘language difficulties, financial problems, adjusting to a new educational system, homesickness, adjusting to social customs and norms, and for some students, racial discrimination’’ (p. 544). Similarly, Lin and Yi (1997) indicated the following problems unique to or exacerbated among international students: academic difficulties due to the English language and the different educational system, financial pressures, psychosocial stressors due to unfamiliarity with new customs and social norms, and changes in one’s support system, and intrapersonal and interpersonal problems caused by the process of acculturation and adjustment. In addition, Mori (2000) described five unique sources of stress encountered by international students: linguistic, academic, interpersonal, financial, and intrapersonal problems. In sum, the major problems encountered by international students, identified by various studies, are language barriers to academic performance as well as to daily
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living, difficulties with the new American educational system, social relationships due to different cultures and social norms, their sense of identity, and financial concerns. Financial concerns can be greater for international students because they are not allowed to work outside the university. Thus, they need to find jobs on campus, which are typically in short supply. In addition, they are not qualified for federal financial aid so that many international students accelerate their programs to graduate as soon as possible (Cadieux & Wehrly, 1986). Overall, international students have to overcome these unique problems as well as those typically confronted by indigenous students. There are some studies reporting that stress may be more severe for students from Asian countries than European countries (Guclu, 1993; Yang & Clum, 1994). These studies suggest that if there is more discrepancy between the host culture and the culture of origin, the adjustment is likely to be more stressful. Therefore, it is important to test how acculturative stress especially influences Korean students as the fastest-growing group of Asian international students. As suggested, the level of stress is positively related to a discrepancy between the host culture and the culture of origin. There are other factors that are also related to the level of stress, such as the mode of acculturation, the individual characteristics, and the nature of the host society (Brilliant, 2000). Berry (2003) describes four modes of acculturation, including assimilation, integration, separation, and marginalization. Assimilation implies moving into the host society and giving up cultural identity. Integration implies moving to join the host society but maintaining cultural identity, which is viewed the most desirable strategy in this multicultural society (Berry & Kim, 1988). Separation implies holding onto cultural identity and avoiding the host society. The last dimension is marginalization, which refers to groups (or individuals) having cultural and psychological contact with neither their traditional culture nor the dominant society. Williams and Berry (1991) report integration and assimilation generate lower levels of stress, whereas separation and marginalization generate high levels of stress. They also claim that integration generates the least amount of stress. When going through the acculturation process, individuals face challenges regarding the use of language, perceptual and cognitive style, identity, attitudes, and most importantly, the experience of acculturative stress. Berry (1980) claims that such stress is common and may lead to disruptive behaviors such as drug use as well as homicide, and suicide.
1.2. Acculturative stress and mental health symptoms As many studies have indicated, entering into an unfamiliar environment and adjusting to the new environment requires changes, which can lead to anxiety, confusion, and depression (Choi, 1997; Lin & Yi, 1997). Numerous studies have suggested a moderate relationship between stress and mental health symptoms, depression in particular (e.g., Choi, 1997; Flannery & Wieman, 1989; Oh, Koeske & Sales, 2001; de Snyder, 1987; Yang & Clum, 1994). The loss or attenuation of the
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natural social support system and facing excessive amounts of stress simultaneously are likely to encourage the development of psychological distress. In addition, somatization of stress is an essential factor that needs to be taken into account, along with anxiety, depression, and interpersonal problems, in order to address the mental health symptoms of international students. Many Asian international students tend to develop physical symptoms rather than express their distress as anxiety or depression (Allen & Cole, 1987; Mori, 2000), and they may feel a ‘‘loss of face’’ by seeking therapy or counseling (Allen & Cole, 1987). It is not uncommon to find Asian international students who suffer from respiratory disorders (Allen & Cole, 1987), headaches, low-energy level, gastrointestinal problems (Thomas & Althen, 1989), lack or loss of appetite, sleep difficulties, and fatigue (Lin & Yi, 1997). 1.3. Acculturative stress and social support Mallinckrodt and Leong (1992) stated that ‘‘not only is social support crucial in itself for positive well-being, but social support also provides a powerful coping resource for persons experiencing stressful life changes, including the stress of adjusting to an unfamiliar culture’’ (p. 71). Asian students may be particularly at risk, since they are physically away from their support networks, especially from their close-knit families. Despite the theoretical centrality of social support to the acculturation process and the long track record of research on the direct and buffering effects of social support generally, relatively little has been done on social support in relation to acculturative stress. Yang and Clum (1994) found both depressive symptoms and hopelessness to be related to social support. Mallinckrodt and Leong (1992) studied eight factors of social support among international students and found most of them related to depression, anxiety, and physical health symptoms. Shinn (1994), however, failed to find an expected relationship between the utilization of social support and depression among Korean–American immigrant women in New York. Choi (1997) found four dimensions of availability of social support related to both acculturative (immigrant) stress and depression in a sample of Korean American families. Numerous studies conducted in the last 20 years have found evidence for direct effects of social support on an array of outcomes, including somatic and mental health symptoms (see, e.g., Cohen & Syme, 1985; Payne & Jones, 1987; and Veiel, & Baumann, 1992). These studies have been done in work, school, and general life settings. Several studies have also found a buffering effect of social support, in which the impact of stress on negative outcomes is lessened in the presence of social support. Jou and Fukada (1997), in a recent example, tested the dimensions of needed support, perceived support, and received support and reported a stress buffering effect of perceived and received support on somatic complaints. Other researchers, however, have failed to confirm buffering effects of social support. Since the detection of buffering involves testing for statistical interaction effects, typically in naturalistic (as opposed to experimental) studies, the statistical power available to the researcher is low (McClelland & Judd, 1993). Koeske and Koeske (1991b) and
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Morris, Sherman, and Mansfield (1986) also discuss factors that complicate the testing and detection of stress by support and other interactions. In this study, we tested the buffering effect of social support on the acculturative stress-symptoms relationship in a Korean student sample, using comprehensive measures of each construct. We used the Brief Symptom Inventory (Derogatis & Melisartos, 1983) as the outcome measure to incorporate problems inclusive of depression, anxiety, interpersonal concerns, and somatization. In addition, we explored the role of amount or level of acculturation, respondent gender, age, income, marital status, and length of time residing in the United States. Level of acculturation refers to the extent to which the immigrant or visitor has adopted the values and behaviors of the host culture; it was examined both as a control and moderator variable. The background variables were studied as controls.
2. Method 2.1. Participants and procedures Participants in this study were enrolled in classes at a US university. They were neither permanent residents nor American citizens and held either an F (student) or J (school-related) visa. A total of 74 Korean international students, residing in the area of Pittsburgh, participated in the study. Seventy-two of the participants were enrolled at the city’s two major universities. The participants ranged in age between 19 and 41, with a mean of 30. Eighty percent were studying in masters, doctoral, or post-doctoral programs. Seventy percent (N=52) of the respondents were men. The average length of residence in America was 31 months; 34% had lived in the US for a year or less, two-thirds for 3 years or less. One half of the participants were single, 35 were married, and 2 were divorced or widowed. The questionnaire was distributed in three Korean churches, one Korean Catholic Church, and the English Language Institute in the University of Pittsburgh. Twentynine were collected from three Korean churches; 8 questionnaires were gathered from the Korean Catholic Church, and 8 were collected from the English Language Institute. In addition, 102 questionnaires were mailed out to prospective participants from a list of Korean students studying in the Pittsburgh area. This mailing was done to increase both the size and diversity of the sample. The participants were instructed to disregard the mailed questionnaire if they had previously filled out the survey. Each mailed survey packet contained a cover letter, a questionnaire, and a returned envelope. A week after the mailing, an e-mailed reminder was sent to each potential respondent. One week after the e-mailed reminder, phone calls were made by the first author to encourage the students to participate and return the survey. A total of 29 (28% of the 102 mailed) surveys were completed by the mailed distribution. Since the participants were predominantly post-graduate students in two American universities, the survey was written in English. Nonetheless, a pretest was done on a small number of Korean church members to detect and eliminate any ambiguity or misunderstandings due to language difficulty.
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2.2. Measures 2.2.1. Acculturative stress Acculturative stress was measured with the modified version of the index of life stress (ILS) (Yang & Clum, 1994) and four additional items generated by the researcher. The ILS was developed to incorporate aspects of stress that are unique to Asian international students. The ILS is a 31-item self-report measure assessing five areas of stressors: problems with language, cultural adjustment, academic pressure, financial concerns, and outlook for the future. The response range of the original scale is from never (0) to often (3). The modified version used in this study added a fourth (very often) alternative to increase response variability and rephrased a few items to enhance understanding. Sample items are ‘‘I don’t like the way people treat each other here,’’ ‘‘I worry about my financial situation,’’ and ‘‘I can feel racial discrimination toward me from other students.’’ Yang and Clum (1994) in their study reported a test–retest reliability of .87 and an internal consistency estimate of .86. In the current study, the coefficient alpha reliability was .88, after four items were excluded based on an item analysis. 2.2.2. Psychological distress and symptomotology The brief symptom inventory (BSI) was modified to examine psychological distress of Korean students. Of 49 BSI items that loaded on 9 factors in a principal components analysis (Derogatis & Melisartos, 1983), 3 psychotocism items were excluded because they were presumed to be extreme and potentially distracting for our non-clinical sample. The other dimensions, including hostility, anxiety, depression, paranoid ideation, somatization, obsessive–compulsive, and phobic anxiety was represented by 5 or more items. Respondents rated how much they had been bothered by each symptom over the past 2 months from 0 (not at all) to 4 (extremely). Derogatis and Melisartos (1983) reported the test–retest reliability in the range from a low of .68 for Somatization to a maximum of .91 for Phobic Anxiety. They also reported the alpha coefficients ranged from a low of .71 for Psychoticism to a high of .85 for Depression. In the current study, in which only an overall symptom score was used, the coefficient alpha was .96. Derogatis and Melisartos (1983) also reported evidence for the predictive and construct validity of the BSI. 2.2.3. Social support Perceived social support was measured by a direct measure of practical and emotional support developed by Koeske and Koeske (1989, 1993). A version of this scale has been used extensively in studies of job stress of human service workers, and has also been adapted for use in studies of student stress (Koeske & Koeske, 1991b). Each significant other or potential source of support is rated from 1 (none at all) to 5 (a great amount) on the amount of support they make available to the respondent. Separate ratings are made for practical and emotional types of support, and a ‘‘not applicable’’ response is available in case the listed source is not relevant for the respondent (e.g., the respondent does not have a spouse). In this study, there were 11 listed sources of support, including My Parent, Spouse/Partner, Korean Friends, and
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American Friends. Five of the sources were Korean culture sources, one was an American culture source (American Friends), and the others were indeterminate, but probably mainly American (e.g., My Academic Advisor). The primary social support measure used in the current study was an overall mean rating across practical and emotional support, based on the sources applicable for the respondent. The scale has shown adequate test–retest reliability of .70 over an 8-week interval, and construct validity has been established in previous research, including studies in which buffering interaction effects have been detected (e.g., Koeske & Koeske, 1989). 2.2.4. Level of acculturation An abridged version of the Suinn–Lew Asian Self-Identity Acculturation Scale (SL-ASIA, Suinn, Richard-Figueroa, Lew & Vigil, 1987) was used to measure level of acculturation to the American culture. Respondents rated 15 items by choosing in a range between a separatist Korean alternative (scored 1), a bicultural alternative (scored 3), and an assimilative American response (scored 5). The original scale was modified to fit a Korean sample by changing the term ‘‘Asian’’ to ‘‘Korean.’’ For example, a question asked, ‘‘What language do you prefer?’’ with responses including Korean only; Mostly Korean, some English; Korean and English about equally; Mostly English, some Korean; and only English. Psychometric and item analysis procedures showed that 9 of the items from the set of 15 used had an internal consistency (alpha coefficient) of .76. These items dealt with interpersonal associations and language use and corresponded, with one exception, to an 8-item set that had a reliability of .85 in an earlier study (Oh, Koeske & Sales, 2001). In this previous study, the corresponding acculturation level measure was significantly related to both acculturative stress and depression. 2.2.5. Demographic Information The last part of the questionnaire included reports of age, gender, marital status, length of residency in America, program enrolled in, income (1=less than $10,000 to 6=more than $60,000), and visa status.
3. Results 3.1. Descriptive findings The mean, standard deviation, skewness, kurtosis, and reliability of the critical variables, acculturative stress, social support, acculturation level, and mental health symptoms, are shown in Table 1. Each of these variables had an acceptable alpha reliability and approximately normal distribution, except acculturation level, which was transformed by a reciprocal transformation. The scoring of acculturation level was thereafter inverted to retain the meaning of high scores as reflecting greater acculturation. The mean of .81 for the BSI indicates that on the average the symptoms were reported slightly less than ‘‘a little bit’’ distressing. The most frequently reported symptoms were ‘‘feeling lonely,’’ ‘‘nervousness or shakiness
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Table 1 Summary of mean, SD, skewness, kurtosis, and reliability of construct variables Variables
Mean
SD
Acculturative stress Social support Psychological distress (BSI) Acculturation level
1.57 2.59 0.81 0.35
0.45 0.59 0.58 0.06
Skewness
Kurtosis
0.01 0.39 0.55 0.08
0.64 0.09 0.54 0.48
Reliability 0.88 — 0.96 0.76
Note. The internal consistency model is not appropriate for the social support measure, since there is no expectation that high support from one source will be associated with higher support from another; nonetheless, the coefficients were moderate at .69 for practical support and .74 for emotional support, based on respondents who had all 11 support sources available in their network.
Table 2 Bivariate intercorrelations for study variables Variable 1. Gender (1=female, 2=male) 2. Age 3. Marital status (1=single, 2=married) 4. Log years in US 5. Income 6. BSI symptoms 7. Stress 8. Social support 9. Acculturation level
1 — .21a .10 .08 .19 .05 .00 .04 .07
2
3
4
5
6
7
8
— .47c .36c .06 .23a .06 .02 .03
— .09 .03 .25a .08 .07 .05
— .10 .07 .02 .32b .01
— .12 .13 .17 .05
— .56c .12 .13
— .22 .37c
— .18
Note. N of cases varies from 68 to 74. a po .05. b po .01. c po .001.
inside,’’ and ‘‘feeling blue.’’ The mean acculturative stress score of 1.57 indicated that on the average the stressful feeling occurred between ‘‘hardly ever’’ and ‘‘sometimes.’’ Most stressful were ‘‘It would be the biggest shame for me if I fail in school,’’ ‘‘I have to work much harder than American students,’’ and ‘‘My English embarrasses me when I talk to people.’’ The social support mean of 2.59 suggests a sense of between ‘‘a little’’ and ‘‘A fair amount’’ of available support. The median level of (pre-transformed) acculturation was 2.44, indicating that the respondents fell somewhat more toward Korean than bicultural or American in their associations and preferences, despite residing in the US for an average of over 30 months. 3.2. Bivariate relationship The bivariate relationships for the primary study variables, including the five background variables included as controls, are shown in Table 2. We see that the BSI was highly correlated with acculturative stress (r=.56, po.001), a significantly correlated with being younger (r= .23, po.05) and single (pt. bis. r= .25, po.05).
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Acculturative stress was also related to lower levels of acculturation (r= .37, po.001) and lower support (r= .22, po.05). Social support did not have a significant relationship to the BSI (r= .12), but it was substantially related to having been in the US longer (r=.36, po.001), perhaps due to increases in American-based sources of support. Because age and marital status were significantly related to symptom distress, they will be used as control variables in the test of the direct and buffering effects of social support. 3.3. Test of the buffering role of social support Moderated multiple regression analysis was conducted to test the predicted moderating role of social support. In the hierarchical moderated regression analysis, the control variables of age and marital status were entered first, then the main effects of acculturative stress and social support were entered at step 2, and finally, the interaction product term (stress support) was entered in the third step. Table 3 shows that the main effect of stress was significant (b=.56, po.001), but social support did not have a direct effect on symptoms (b=.01). The stress social support interaction (product) term was statistically significant (b= 1.47, p=.02; rsquared increment=.05), consistent with the buffering hypothesis. The slope Table 3 Coefficients for moderated multiple regression analysis: predicting BSI symptoms in primary and in secondary analysis including acculturation level B Primary analysis Step 1 Age Marital status Step 2 Stress Support Step 3
SEb
.02 .17 .70 .01 .05
Stress support .61 Secondary analysis (including acculturation level)
.02 .15
Beta
.14 .15
R2INC
p
.75 .02 .78
.13 .10 .02
.56 .01
o.001 .93
.25
1.47
.02
Stress support Stress acculturation Support acculturation Step 3
.69 .31 .36
Stress support acculturation
14.96
.14 .10 1.03 .28 1.96 1.82 4.87
.59 .02 .08 1.69 .09 .18 13.71
.06
.12
.31
o.001
.32
o.001
.07
.08
.08
.003
.29 .26
Step 1 Stress Support Acculturation Step 2
PINC
o.001 .83 .45 .02 .87 .84 .003
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Table 4 Social support subgroup coefficients for relationship of stress with BSI symptoms N Social support subgroup Low support 36 High Support 35 Social support by acculturation level subgroup Low support-low acculturation 22 Low support-high acculturation 14 High support-low acculturation 13 High support-high acculturation 21
B
Beta
P
1.11 0.52
.68 .47
o.001 .004
0.87 1.51 0.89 0.31
.61 .81 .68 .30
.003 o.001 .01 .19
Note. Subgroups created by median splits. Smaller n’s in middle groups due to correlation of support with acculturation level (r= .37).
coefficient for the interaction of .61 indicates that the slope of BSI on stress becomes .61 less positive for a one unit increase in social support. A subgroup analysis was conducted dichotomizing the social support scores into low and high levels of support. Table 4 shows that the slope of BSI on stress was over twice as steep (b=1.11 for the low support group, b=.52 for the high support group) when support was low. The significant stress support interaction documents that the slope coefficients were significantly different. Fig. 1 presents the regression lines of BSI on stress for the low and high social support groups, clearly showing, consistent with the buffering hypothesis, that stress has less damaging implications for symptom occurrence when social support is high. We retested the buffering effect for invariance across certain modifications. First, the BSI was log transformed to a skewness of .05, down from .54; the initial BSI distribution was not significantly non-normal but skewness in the .50’s is a moderate departure from normality. Second, although the regression diagnostics were acceptable for the primary analysis, we removed the five most influential cases based on SPSS influence statistics and reanalyzed. Third, we added income, years in the US, gender, and level of acculturation as control variables. The buffering effect was invariant across these analytic modifications, retaining significance at the .05 level or beyond. 3.4. Follow-up analyses Additional analyses were done to assess the generality–specificity of the buffering interaction. Splitting the data by gender revealed that the effect was apparent for both males and females. Examination of the separate dimensions of the BSI showed buffering was most pronounced for depression, anxiety, and paranoid ideation and least pronounced for psychotocism and somatization. The BSI on stress regression line was examined for low and high support, using each source of support separately. The buffering effect appeared most pronounced for support from parents, Korean friends, religious organizations, the academic advisor, school
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0.6 Social Support Group 0.5
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Fig. 1. Stress—symptoms regression lines for low and high support levels: Social support buffering.
services (e.g., counseling services), and Korean student organizations. Of these, only the advisor and counseling services are not fully Korean-based support sources. Acculturation level was examined as a possible qualifier of the support buffering effect. Acculturation level was added to the moderated regression analysis. The bottom half of Table 3 shows that the three-way interaction (stress support acculturation) accounted for 8% additional variance and was significant at p=.008. This indicates that the moderating effect of social support was significantly different depending on level of acculturation. Table 4 reports the bivariate regression statistics for the four subgroups resulting from median splits of support and acculturation level. We can see that the non-standardized regression coefficients (and betas) for the low vs. high support conditions were only markedly different (b=1.51 for low support, b=.31 for high support) when acculturation level was high, indicating that the buffering effect is apparent only when acculturation is at a high level. Fig. 2 demonstrates this by presenting the buffering-relevant regression lines for the low and high acculturation conditions separately.
4. Discussion The findings in this study clearly indicated that acculturative stress was a strong predictor of mental health symptoms. Korean international students with high
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Acculturative Stress Fig. 2. Stress—symptoms regression lines for low and high support levels: Social support buffering for low and high levels of acculturation.
acculturative stress exhibited high mental health symptoms. In addition, a stress-buffering effect of social support was strongly demonstrated in this study. Korean international students with acculturative stress but with a high level of social support would express lower mental health symptoms than the students with
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low level of social support. The main or direct effect of support on symptoms was not significant. Effective buffering seemed to arise from both Korean and host American sources. An unexpected, but potentially theoretically and practically relevant, qualifier of support buffering was the acculturation level of the student: buffering occurred only when acculturation was at a higher level. Excepting this qualification, buffering was quite general or invariant across a number of factors. We are not aware of a previous demonstration of social support buffering of acculturative stress. Choi (1997) did not report a formal test of buffering, and Mallinckrodt & Leong (1992) studied international graduate students, but used a general life events stress measure. In the latter study, significant stress buffering occurred only for graduate program support, which included apparently non-social elements such as the quality of instruction, facilities, and the curriculum. Family support was not a buffer, but both types of support had significant main effects on symptoms. By this time, there have been enough successful demonstrations of social support buffering of mental and physical health outcomes that the reality of the phenomenon is not in doubt. More research is needed to clarify the conditions under which it is manifested and detectable. The type of stress studied and the way it is measured, as well as the measurement of social support and the negative outcomes examined, are apparent qualifying factors. Characteristics of the sample, research design, and statistical analytic procedures used also effect whether or not buffering will be found. A number of important limitations in the study must be addressed. First, the convenience sample of Korean international students residing in the area of Pittsburgh is probably not representative of all Korean international students in the US Moreover, 80% of the participants in this study were graduate students. There may be differences between the stresses faced by students who are enrolled in different programs, non-degree to post-doctoral program. The small sample size, especially of female students, also limits the ability to generalize these findings. Future research on larger and more representative samples is necessary to establish the generality of the findings for Korean international students, and to extend the findings to other groups of international students. In addition, the original scale of SL-ASIA (Suinn–Lew Asian Self-Identity Acculturation) was developed on the basis of linear and uni-dimensional aspect of acculturation. However, current research has acknowledged that acculturation is multidimensional and orthogonal, and should be measured accordingly. Therefore, further research is required to investigate multidimensional aspects of acculturation. Static correlational studies using self-report measures are always potentially vulnerable to assumptions of causal direction and the possibility of shared method variance. Regarding the former, it may be that pre-existing mental health symptoms caused the student to have greater acculturative stress, rather than the stress-symptom direction of effect we presumed. We are comfortable with our directional assumption, because of the wealth of prior research supporting it, the demonstration of the theoretically meaningful buffering
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interaction, and the use of a symptom measure that focused the respondent on relatively recent feelings. The stress measure, on the other hand, covered the broad, undefined period in which the respondent had been in the United States. Shared method variance may account for part of the high correlation between stress and symptoms, but it cannot explain the buffering interaction or the absence of a bivariate relationship (direct effect) between social support and symptoms. Granting the necessary tentativeness imposed by these limitations, the findings in this study suggest that Korean international students confronting adjustment to the host culture may suffer psychological distress. Successful completion of their academic programs by Korean students, and international students generally, may depend on colleges and universities providing programs that enhance the social support systems of these students. Lin and Yi (1997) suggested programs based on the stage of the adjustment, prearrival adjustment (before arrival), initial adjustment (first 6 months), on-going adjustment (6 months to graduation), and return-home adjustment (upon graduation to first 6 months after returning home). Such specialized programs could help international students be more successful in their academic areas and increase satisfaction with their scholastic stay in the United States. Programs relevant to early stage adjustment might emanate from the student’s country of origin, with later stage adjustment supported by programs in the United States. The current data suggest that program administration at the later stages should not be overlooked.
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