Utilization of counseling services: comparing international and U.S. college students.(Research)(Report)

Counseling center utilization patterns during a 2-year period for 218 international and 222 U.S. college students were examined. Significant between-group differences were found with regard to age, academic status, referral source, relationship status, self-reported concerns, counselor diagnosis, disposition, hospitalization rates, prior counseling experience, and use of crisis appointments. Significant within-group differences among international students were also found. Implications for improving programs and clinical services are discussed.

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Over the past 20 years, the number of international students studying in the United States has increased by 62% (Institute of International Education, 2006). Despite a small reduction in numbers following the terrorist attacks on September 11, 2001, as of 2005, there were 565,039 international college students in the United States. As U.S. campuses become more culturally diverse, counseling and other student affairs professionals are challenged with finding ways to identify and intervene with distressed students who may be unfamiliar with U.S. counseling practices or who are reluctant to use counseling services because of the stigma of mental health problems, a preference for using social support systems, a belief that their language proficiency is inadequate, or a cultural mistrust of U.S.-born helpers (Byon, Chan, & Thomas, 1999; Heggins & Jackson, 2003; Mallinckrodt & Leong, 1992; Zhang & Dixon, 2003).

Some of the typical concerns of international students, such as adjustment to a new culture, language barriers, the inextricable link between visa status and student status, social isolation, loneliness, unfamiliarity with U.S. academic expectations and financial concerns, have been well documented (Chen, 1999; Parr, Bradley, & Bingi, 1992; Wilton & Constantine, 2003). Several studies have found that international students hold attitudes toward and preferences about counseling that differ from those of U.S. students. For example, Byon et al. (1999) found that Korean international students expected to terminate counseling quickly if the process was viewed as unpleasant or did not seem immediately helpful. Lippincott and Mierzwa (1995) found that Asian international students were more likely than U.S. students to report that they would seek counseling services when they experienced somatic discomfort. Similarly, another study found that Korean international students expressed their depressive affect through somatic symptoms more than U.S. students did (Yoo & Skovholt, 2001).

The research also suggests that within-group differences among international students exist and need to be taken into account when discussing the needs of these students. Wilton and Constantine (2003) found that Latin American international students reported significantly higher levels of psychological distress than Asian international students did. Greater length of stay in the United States was associated with lower levels of psychological distress among both groups. Higher acculturative distress and intercultural competence concerns predicted higher levels of psychological distress in these students. European international students showed less adaptation strain than Asian international students did (Tomich, McWhirter, & Darcy, 2003). International students who were female and who had previously engaged in counseling had more open attitudes toward seeking counseling (Komiya & Eells, 2001).

Oftentimes, participants in studies about the mental health concerns of international students were recruited from classes or student organizations. Unfortunately, less is known about the international students who actually use counseling services. In their 2004 study, Nilsson, Berkel, Flores, and Lucas sought to understand the 1-year counseling center utilization rates and presenting concerns of international students in order to identify relevant topics for outreaching programming. However, any recommendations stemming from their data are hampered by a small sample size (n = 41), a nonrepresentative sample, and a high dropout rate (31%). Using a much larger sample (n = 562) over a 6-year period, Yi, Lin, and Kishimoto (2003) examined subgroup differences among international students relating to demographic factors, reasons for seeking counseling, referral sources, and self-reported concerns. Academics, anxiety, and depression were major concerns for international students. Undergraduates worried more about their grades than graduate students did, whereas graduate students were more likely to report relationship problems with a romantic partner. The results also revealed that gender, age, and grade point average (GPA) were related to reasons for seeking counseling.

Yoon and Portman (2004) identified several problematic patterns in research related to international students. First, there is a tendency to overgeneralize research findings to all international students and to underemphasize within-group differences. A second concern is that previous studies have focused mainly on relationships between personal factors (i.e., age, gender, social contact, English proficiency) and dependent variables (i.e., adjustment), largely ignoring environmental factors that may be important. For example, Mallinckrodt and Leong (1992) found that quality relationships with faculty, faculty interest in students' professional development, and quality instruction (as perceived by students) can help protect against the development of depression in international students experiencing stress. Furthermore, Yoon and Portman asserted that the existing research relies too heavily on convenience sampling, such as survey or analog, and on nonclinical samples when the research questions deal with counseling issues.