Mental health of international students : prevalence and predictors for mental disorders and symptom severity

1 Zusammenfassung . 3 1 Theoretical background . 5 1.1 General situation of international students . 5 1.1.2 International students in the world: Facts . 5 1.1.3 International students in Germany: Who are they? 6 1.1. 4 Problems and concerns of international students . 7 1.2 Mental disorders . 8 1.2.1 Diagnostic and prevalence of mental disorders . 9 1.2.1.1 Major depressive disorder and other depressive disorders . 9 1.2.1.2 Somatoform Disorder . 11 1.2.1.3 Anxiety disorder . 13 1.2.2 Mental health in international students: What do we know so far? 14 1.3 Potential predictors (risk and protective factors) for mental disorders . 15 1.3.1 Personality traits: Neuroticism and extraversion . 15 1.3.1.1 Theory and description of personality traits: The Five Factor Model (FFM) . 15 1.3.1.2 Personality traits and mental health . 17 1.3.1.3 Personality traits and mental health in international students . 21 1.3.2 Social Support . 21 1.3.2.1 Definition and general concepts . 21 1.3.2.2 Social support and physical and mental health . 23 1.3.2.3 Social support and mental health in international students . 29 1.3.3. Psychosocial stress and traumatic life events . 30 1.3.3.1 Psychosocial stress . 30 1.3.3.1.1 Approaches to the concept of stress . 30 1.3.3.1.2 Measuring stress . 33 1.3.3.1.3 Forms of stress . 34 1.3.3.2 Traumatic life events . 35 1.3.3.3 Stress, Traumatic life events and physical and mental health . 35 1.3.3.4 Stress and traumatic life events and mental health in international students . 39 1.3.4 Resilience . 39 1.3.4.1. Definitions and general concepts . 39 1.3.4.2 Resilience and mental health . 42 1.3.4.3 Resilience and mental health in international students . 43 2 Aims of the study, research questions and hypotheses . 45 3 Methods . 49 3.1 Sample selection . 49 3.2 Survey description . 50 3.3 Contact of participants and data collection . 51 3.4 Demographic description . 52 3.4.1 International students . 52 3.4.1.1 Cross sectional study (T1) . 52 3.4.1.2 Follow-up assessment (T2) . 54 3.4.2 German students . 54 3.4.2.1 Cross sectional study (T1) . 54 3.4.2.2 Follow-up assessment (T2) . 54 3.4.3 Comparison of demographic characteristic between international and German students . 55 3.5 Measurement instruments . 56 3.5. 1 Mental disorders and stress: Patient Health Questionnaire (PHQ) . 56 3.5. 2 Personality dimensions: NEO Five Factor Inventory (NEO-FII-30) . 59 3.5. 3 Social support: Social Support Questionnaire (F-SozU K-14) . 60 3.5. 4 Resilience: The Resilience Scale (RS-11) . 61 3.5. 5 Traumatic life events: Traumatic Life Events Questionnaire (TLEQ). 62 3.5. 6 Positive and negative life experiences: Life Experiences Survey (LES) . 63 3.6 Statistical analysis . 63 4 Results . 71 4.1 Prevalence rates and descriptive results of mental disorders and predictors . 71 4.1.1 Prevalence rates of mental disorders in the total sample at T1 . 71 4.1.1.2 Gender differences . 71 4.1.2 Prevalence rates of mental disorders among international and German students . 72 4.1.2.1 Gender differences . 73 4.1.3 Prevalence rates by nationality in the sample of international students . 75 4.1. 4 Comorbidity of mental disorders . 78 4.1. 5 Mean differences of symptom severity . 79 4.1. 6 Remission rates of mental disorders . 80 4.1. 7 Medication and treatment . 81 4.1. 8 Mean differences of possible predictors of mental disorders . 81 4.2 Factorial validity and measurement invariance of instruments . 83 4.2.1 Testing the factorial validity of measuring instruments . 84 4.2.2 Testing measurement invariance across samples . 86 4.2.3 Latent mean differences . 89 4.3 Predicting diagnoses of mental disorders . 90 4.3.1 Major depressive disorder (MDD) . 91 4.3.2 Other depressive disorder . 94 4.3.3 Somatoform disorder . 97 4.3.4 Anxiety disorder . 102 4.3.5 Predictors of mental disorders in the sample of international students . 105 4.4 Predicting symptom severity . 106 4.4.1 Predicting severity of depressive symptoms . 106 4.4.2 Predicting severity of somatic symptoms . 111 4.4.3 Predicting severity of anxiety symptoms . 116 4.4.4 Predictors of symptom severity in the sample of international students . 119 4.5 Predicting the course of symptom severity . 120 4.5. 1 Predicting the course of depressive symptoms . 121 4.5. 2 Predicting the course of somatic symptoms . 124 4.5. 3 Predicting the course of anxiety symptoms .