Promoting International Students' Mental Health Unmet Needs: An Integrative Review

Background: There are increasing concerns about the mental health needs of international students. Previous studies report that international students experience additional challenges and higher levels of stress compared to domestic students. This integrative review aimed to identify perceived stressors, coping strategies and factors that contributed to accessing mental health services of international students. Methods: A systematic search was performed between January 2010 and December 2023 using PubMed, CINAHL, ProQuest, the Cochrane Library, Scopus and PsycINFO databases. A manual search was also performed that included reference lists of included articles; data was extracted and reviewed by three reviewers. A total of 21 studies were included in this review with a total of 4442 international students recruited, with ages between 17 to 43 years. Nineteen studies reported international students' gender, there were more females (n = 2205) than males (n = 1022). Ethnicity was reported in 18 studies. They included Asia, Europe, Latin America, North America, South America, Africa, the Middle East and Pacific Islands. This review adopted Whittemore and Knafl's fi ve-stage approach, with specific steps for problem identification, literature search, data evaluation, data analysis, and presentation. Results: The Health Belief Model was used to explain relationships among independent and dependent variables and guide the fi ndings of this review. Three identified progressive themes emerged including Theme 1: understanding cultural variations with perceived stress; Theme 2: coping strategies in dealing with stress and challenges in the new environment; and Theme 3: perceived threats and stress affecting how international students perceived barriers and benefits to access counselling support services and mental health services. This integrative review presents an overview of mental health needs and factors contributing to the mental health and well-being of international students via the inclusion of studies with different designs, providing an in-depth understanding of the study phenomenon. The fi ndings of this review may help university health providers, mental health professionals, academic institutions and policymakers better understand the multifaceted needs of international students. Conclusion: This review demonstrates the importance of increased cross-cultural interactions between international students and domestic student counterparts to enhance belongingness and connection to host countries. This may facilitate adaptation to new living and learning environments. It is crucial academic institutions offer programs that can be effectively implemented and sustained to meet the unmet mental health needs of international students. University orientation programs, student counselling and health services may integrate cultural events, social support groups, leadership programs and resilience models of acculturation to promote mental health and well-being among international students. While these studies show promising results, there is a need for further robust evaluative studies to develop culturally sensitive mental health promotion programs for international students.