在臺之國際學生於新冠肺炎大流行期間的心理健康與相關因素

Abstract

背景 COVID-19 大流行對全球心理健康產生了負面影響，原因包括了它可能對身體健康造成影響，遏制病毒傳播的措施會對日常生活造成干擾，以及流行本身的社會經濟效果。 學者已經在不同人群中研究了大流行對心理健康的影響，但在國際學生中的研究相對較少，然而，國際學生同時面臨著COVID-19與文化適應的壓力。 目標 本研究旨在探究 COVID-19 大流行期間臺灣國際學生各種心理健康後果的發生率和潛在影響因素。 方法 本研究使用橫斷面的線上匿名調查，調查時間為 2022 年 7 月至 2023 年 4 月，調查內容包括人口學變項、大學相關變項、社會經濟變項、COVID-19 相關變項，和移民相關變項。 心理健康方面則使用世界衛生組織幸福指數(WHO-5)來測量心理健康，使用病人健康問卷-2 (PHQ-2) 測量可能的憂鬱症，使用廣泛性焦慮障礙量表-2 (GAD-2) 測量可能的焦慮症，以及感知壓力量表-4 (PSS-4)測量感知壓力。COVID-19 壓力量表、國際學生文化適應壓力量表 (ASSIS)、與感知社會支持多維量表 (MSPSS)的修改版則分別用於測量 COVID-19相關壓力、文化適應壓力，與社會支持。 最後，調查也包括與心理健康資源需求相關的問題，並使用開放性問題來了解導致壓力的其他因素，以及機構的心理健康支持服務可以如何改善。 T檢驗和變異數分析用於比較組間的心理健康評分。 採用卡方檢定比較心理健康不良（WHO-5總分<13）、可能憂鬱（PHQ-2總分≥3）、可能焦慮（GAD-2總分≥3）和高感知壓力（PSS-4 總分≥16）的組間差異。 我們使用線性回歸研究 WHO-5 和 PSS-4 之相關因素，以及使用羅吉斯回歸來研究心理健康不佳、可能憂鬱和焦慮，以及高感知壓力的風險因素。 結果 在427 名國際學生的樣本中，心理健康狀況不佳 (44.28%)、可能憂鬱 (24.59%) 和焦慮 (37.70%)，以及高感知壓力 (80.09%) 的情形相當常見。COVID-19 壓力與感知壓力呈正相關（校正後的勝算比 [aOR] = 1.02）。COVID-19 壓力大的人患憂鬱症（aOR = 1.36）和焦慮症（aOR = 2.06）的風險也較高。高文化適應壓力是心理健康不佳（aOR = 3.34）和可能出現憂鬱症（aOR = 2.96）和焦慮症（aOR = 3.08）的危險因素。 社會支持與良好的心理健康（調整後的 Beta [aB] = 0.20）和感知壓力（aB = 0.20）呈正相關，而與心理健康狀況不佳（aOR = 0.92）、可能憂鬱（aOR = 0.95）和可能焦慮（aOR = 0.96）呈現負相關。 大約 30% 的國際學生不知道他們可以獲得任何心理健康服務。 學生們還回覆說需要增加獲得心理健康服務的機會（特別是面對面的諮詢）、心理健康促進活動（例如瑜伽和冥想），以及校外心理健康治療的補助。 結論 本研究表明，文化適應壓力和低社會支持是疫情期間國際學生心理健康狀況不佳的重要危險因素。 大學應該了解這一群體的心理健康狀況和需求，並為他們提供信息和語言友好服務，以改善心理健康。

Background The COVID-19 pandemic had an adverse effect on global mental health because of its physical health implications, the disruptions on daily life in an effort to curb its spread, and the socioeconomic consequences. The pandemic’s effect on mental health was researched in various populations, but less so in international students, a group that faced stress associated with both the COVID-19 and acculturation. Objectives This study aimed to investigate the prevalence of various mental health outcomes and potential contributing factors among international students in Taiwan during the COVID-19 pandemic. Methods This study utilized a cross-sectional, online, anonymous survey conducted in English from July 2022 – April 2023. Survey questions included demographic variables, university-related variables, socioeconomic variables, COVID-19 related variables, and migration-related variables. Mental health outcomes were measured using the World Health Organization Well-Being Index (WHO-5) for mental wellbeing, the Patient Health Questionnaire-2 (PHQ-2) for possible depression, the Generalized Anxiety Disorder Scale-2 (GAD-2) for possible anxiety, and the Perceived Stress Scale-4 (PSS-4) for perceived stress. The modified versions of the COVID-19 Stressor Scale, the Acculturative Stress Scale for International Students (ASSIS), and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to measure COVID-19 stress, acculturative stress, and social support, respectively. Finally, questions related to mental health resource need and open-ended questions about other factors contributing to stress and how institutional mental health support could be improved were included. T test and ANOVA were used to compare the means of the mental health scores across groups. Chi-square test was used to compare the prevalence of poor mental health (WHO-5 total score < 13), possible depression (PHQ-2 total score ≥ 3), possible anxiety (GAD-2 total score ≥ 3), and high perceived stress (PSS-4 total score ≥ 16) across groups. Linear regression was used to study factors associated with the WHO-5 and PSS-4. Logistic regression was used to study factors associated with the risk of poor mental health, possible depression and anxiety, and high perceived stress. Results There were relatively high levels of poor mental health (44.28%), possible depression (24.59%) and anxiety (37.70%), and perceived stress (80.09%) in our sample of 427 international students in Taiwan. COVID-19 stress was positively correlated with perceived stress (adjusted odds ratio [aOR] = 1.02). Those with high COVID-19 stress were also at a higher risk of possible depression (adjusted odds ratio [aOR] = 1.36) and anxiety (adjusted odds ratio [aOR] = 2.06). High acculturative stress was associated with poor mental health (aOR = 3.34) and possible depression (aOR = 2.96) and anxiety (aOR = 3.08). Social support was positively correlated with good mental health (adjusted Beta [aB] = 0.20) and perceived stress (aB = 0.20) while negatively associated with poor mental wellbeing (aOR = 0.92) or possible depression (aOR = 0.95) and anxiety (aOR = 0.96). Approximately 30% of international students did not know about any mental health services available to them. The students also reported needs for increased access to mental health services (specifically face-to-face counseling), mental health promoting activities (e.g., yoga and meditation), and reimbursements for mental health treatments off-campus. Conclusion This study showed that acculturative stress and low social support were important risk factors of poor mental health in international students during the pandemic. The universities should become aware of the mental health situation and need in this group and provide them with information and access to language-friendly services to improve mental wellbeing.