International students (ISs) in higher education face significant mental health challenges as they navigate the academic and social life in a new country. Research suggests that a huge proportion of ISs’ experience mental health concerns, specifically depression and anxiety. For example, a recent large-scale survey found that approximately 27% of international college students were screened for major depression and 20% for generalized anxiety (Zhou & Sun, 2021). Some studies even report higher prevalence rates in certain subgroups; a survey of Chinese IS at Yale University found that 45% reported depressive symptoms and 29% reported anxiety, far exceeding the prevalence rate for their domestic counterparts (Han et al. 3). However, the mental health struggles for ISs are not reflections of their deficiencies, rather the results of a complicated matrix of stressors and factors, which make ISs more susceptible to poor mental health. 

Existing Models 

While there is no model that specifically explains the mental health risk factors for ISs, there are two representative frameworks for understanding immigrants’ mental health struggles in the sociology field. However, both of them overlook important aspects of ISs’ experience in U.S. universities.

Classical Assimilation Theory

One long-standing framework for understanding the difficulties of immigrants is the classical assimilation theory. This theory suggests that as immigrants spend more time in their host country, they gradually assimilate—mastering the local language and adopting the local lifestyle—until they are nearly fully integrated (Feldmeyer). Using this framework, IS’s mental health struggle can be explained by lack of integration, which causes feelings of isolation and exclusion. 

Empirical studies support pieces of this narrative. Low English proficiency has been found to correlate with higher depression and anxiety among ISs, presumably because language barriers impede social integration and academic success, leading to isolation and stress (Sümer et al. 433-435; Andrade 143-146). Similarly, difficulties in navigating unfamiliar customs or campus life (“culture shock”) can exacerbate psychological strain for newcomers. Risk factors under this model include limited language skills, lack of local social skills, and inadequate use of support resources (Mori 139-141). 

However, classical assimilation theory only portraits part of the nuance of ISs’ sociocultural experience. While adapting to the host culture is crucial for ISs’ mental health, connections with co-nationals, fellow ISs, and ISs’ heritage cultures are also important. Research on ISs indicated that identification as international student alleviates international students’ psychological distress, potentially due to perceived social support (Parlak et al. 4-6), while Chavajay et al. (671-675) also found that ISs perceive greater social support from fellow ISs than from the U.S. students and professors. Treating ISs’ mental health struggles as a mere result of lack of assimilation could promote self-blaming, causing distress and stigma.

Porte’s theory

The second narrative emphasizes structural and social issues, arguing that even when immigrants assimilate, they may still face negative experiences—sometimes even worse than those who have not assimilated (Portes 209-222). As immigrants get increasingly familiar with the host country’s culture, they might begin to understand discriminatory behavior for characteristics they used to attribute to their own deficiencies (e.g. lacking language proficiency).

Additionally, immigrants may notice social exclusion even with better knowledge and attempts to assimilate. Despite acknowledging the structural obstacles faced by the IS population, this perspective still overlooks cultural differences between immigrants’ cultural heritage and the host culture, stressors specific to immigrants, and obstacles for host-country residents to connect with immigrants. 

Methodology

To make sense of the complex matrix of risk factors affecting ISs’ mental health, this paper takes a sociological approach and organizes the stressors into four categories. I propose the 4-Source Stress Model (4SS model), an integrative model that groups ISs’ stressors into four domains based on their sources: Host Country, Home Country, Peers, and Internalized Stigma. The categorization was backed by existing researches and personal interview data from ISs at Hamilton College.

Participants

I interviewed five international students. three were from China, one was from Thailand, and one were from Ghana. Two were women, and three were men. Two were first-year students, two were sophomores, and one was a junior. Each interview lasted from 25 to 40 minutes and was divided into four procedures. 

Interview Procedure

First, I briefly introduced the purpose of my research without mentioning the 43SSM Model. After obtaining informed consents, I administered the PHQ-9 depression screening survey. I explained the meaning of the survey results and informed anyone with a score of 10 or above (which may suggest moderate depression) about resources at the Hamilton Counseling Center. Third, I asked interviewees to talk freely about anything they felt had impacted their mental health. I followed up with clarifying questions based on their responses. Finally, I asked more targeted questions based on the 4SS model to see how well it reflected their personal experiences. Revisions on the model were made based on interview results and participants’ feedback.

 
Model Proposed

ISs’ mental health stressors and causes of mental health struggles operate at multiple levels and interact with each other. Since no current theories cover the whole picture, a holistic and unified approach to understand ISs’ mental health struggles is needed. 4SS model categorizes stress factors into four domains based on their sources: Host Country, Home Country, Peers, and Internalized.

Host Country

Host Country stressors are the pressures and challenges that originate from the environment of the country and institution where the student is studying. These include experiences of prejudice or discrimination from members of the host society, legal and institutional barriers, and general cultural dissonance and exclusion encountered abroad. 
Perceived discrimination has been consistently associated with higher depression and stress levels. A study of visible-minority immigrant men in Canada by Montazer (225-234) found positive correlation between years of stays and depression, meaning the longer immigrants stay, the more depressed they become. Resonating with Portes’s theory (209-222), they found that the correlation can be largely explained by increases in perceived discrimination and resultant anger. While that study focused on adult immigrants, its findings likely extend to student populations who are mostly members of visible minorities. 

Discrimination can be overt, like racial slurs or exclusive laws, but in recent decades discrimination is experienced in more subtle ways, such as microaggressions and small comments or actions. Subtle or not, discrimination harms ISs’ mental health, and even makes ISs’ feel excluded and incapable. Maleku et al. (2424-2430) found that during COVID-19 pandemic, ISs’ perceived every-day discrimination was correlated with severe depression, while anxiety and loneliness significantly mediated the relationships. This finding resonates with my interviewees. One student shared an experience in Dance Club where her partner suddenly stopped and asked, “Where are you from?” and added, “I’m asking because you have an accent,” without any further explanation. She felt confused, humiliated, and distracted for the rest of practice, processing what just happened in her head. Experiences of discrimination could also lead to fear and anxiety in everyday life. Another student mentioned that although he had not faced discrimination directly, he was “conscious of its presence.” To avoid possible racism, he always tells Uber drivers that he was from New York instead of his real hometown, Shanghai.

Legal and institutional factors in the host country also fall under this category. International students often face restrictive visa regulations (e.g., limits on work and scholarship opportunities, uncertainty in immigration policies) that domestic students do not. Furthermore, fear of losing one’s legal status is a unique stress carried by ISs. Lynch et al. (3458-3462) found that visa-related anxiety was one of the strongest predictors of trauma exposure responses in ISs during the COVID-19 pandemic. Students also reported high levels of anxiety specifically related to their eligibility to stay in the U.S.  
More recently, the recent Trump administration appears to be targeting ISs as well as undocumented immigrants. ISs with past criminal records, drug-related issues, or involvement in political activities such as pro-Palestine protests were targeted for visa cancellation. However, the details of these deportation cases were not transparent, and some of the cancellations of legal status seemed to be unfair or unclear. Brutal arrests like the case for Rümeysa Öztürk, a Tufts student who wrote an essay criticizing U.S. support for Israel (McCormack), casts a shadow of fear and uncertainty on all ISs. One student said she experienced high levels of anxiety in April 2025, when many cases of F-1 Visa cancellations were made public. She said “In the first two weeks of April, the news was overwhelming. I couldn’t sleep and eat well, I thought life was hopeless, my future choices were limited, while I could do nothing about it. My visa might be cancelled if I had an overspeed ticket? It felt like Trump wanted immigrants to be perfect, but that’s impossible. I am not perfect. For the next four years, I will be worried and scared all the time. I thought it would be very painful.” 

Home Country

Home country stressors refer to the pressures that stem from the student’s country of origin. These can include high expectations from family members, financial burdens due to economic circumstances back home, cultural obligations, and value conflicts between home and host country. 

One common theme that emerged in the interviews was the pressure to meet parents’ high academic expectations. Many international students feel a strong sense of obligation to fulfill their families’ expectations back home. For many, studying abroad represents a major financial investment by their parents, which often translates into intense pressure to repay that sacrifice. This pressure was especially salient for Chinese students. All of the Chinese international students I spoke with reported feeling great academic stress, and many described having controlling parents who are obsessed with grades and interfere with students’ academic choices. 

One student shared that his parents rarely called just to check in and chat; instead, their calls always revolved around his academic performance. They would ask questions like, “Are you still getting all A’s?” or “Have your transfer results come out? Regardless, you still need to get straight A’s.” In highly competitive academic environments, this kind of parental pressure becomes an additional burden for ISs.

Another student spoke about being forced into a major she did not want. She had long dreamed of becoming a therapist and was deeply passionate about psychology, but her parents pushed her to study data science, believing it had better career prospects. She described the experience as “depressing.” Not only was she denied the chance to pursue a path she felt deeply connected to, but she also struggled in a field she had no passion for—and her parents dismissed those struggles. Ironically, it was only after they became concerned about the rise of AI replacing data analysts that they finally allowed her to switch to psychology.

Economic pressure is another home-derived stressor. Often, international students come from countries with lower per-capita incomes and must pay for expensive tuition and high living costs in the host country. This financial strain can cause significant worry. Guo et al. (10-16) found that international students experienced the same level of economic stress in general, but experienced significantly increased stress during an economic downturn compared to American students, ISs’ anxiety towards economic failures. ISs might not only feel guilt at the amount of money their family is spending on them, or fear that failure would mean a wasted investment, but also refrain from certain social activities that they have enough money to do in their home-country—such as joining outings, going to concerts, or travels—which increases isolation. 

 

One student in the interview brought up being asked for money every month by friends in his home country. Coming from a lower-income family from a developing country, his friends and acquaintances back home were living in extreme difficult conditions. People use excuses like "my mom is in hospital, and we don’t have a lot on us, we’d really appreciate if you send some help, " "I'm going to school, could you help out a little bit," or "I am applying for some award, and I need money to ask people vote for me, can you give me some money?” While some requests were sincere and reasonable, he feels that some people were “scamming” for his money. However, regardless of the intention, he is pressured to help those people out because “Sometimes when you feel like ‘I cannot send it’, then they think I actually have the money, but just don’t want to. So, you have this pressure that they would think of you as a bad person.”

Peers

Peer-related stressors are the pressures arising from fellow international students. This category covers social stress and competition that occur in the student community context. 

Fear of being judged by peers is a very strong risk factor for ISs’ mental health, especially for those from collective cultures. Lee et al. (458-462) conducted an experiment with 180 Asian international students and found that students were significantly more hesitant to disclose personal problems in a group counseling scenario if a member from their own country was part of the group. Similarly, Ma et al. (3-7) investigated the concept of “face concerns” (concerns for maintaining a positive social image) among Chinese international students. They found that higher concern for maintaining positive social image was associated with higher depression and anxiety, partly because it increased stigma and negatively impacted help-seeking intention. The result from my interviews is consistent with those studies—only students from East Asia reported feeling pressured in the presence of other ISs during classes, group discussions, and social interactions. However, this pressure naturally faded as the interviewees grew and adapted to the foreign college environment. Two students reported comparing themselves with other ISs in terms of language proficiency, number of American friends, and academic performance during the first two months of college, while another student said it took them two years to stop caring about those things.

That said, peers do not act as a complete stressor for ISs’ mental health struggle. They play a more complex role. Peers can be a source of support, but at the same time also a source of stress when they amplify anticipatory stress or promote negative social comparison (Grace, 28-35).

Internalized

Internalized stressors are the pressures that the student imposes on themselves. These pressures are often results of internalized stigma or expectation from the other three domains, including self-blame, internalized discrimination, perfectionism, etc. While internalized stigma is related to stressors from other domains, it is very important to distinguish between stressful experience from others and pressures applied by the IS themselves. Cultural-sensitive treatments usually distinguish between actual pressures caused by cultural factors and internalized stigma. For example, unlike typical Cognitive Behavioral Therapy (CBT), the culturally adapted CBT group therapy appearing in Graham-LoPresti et al. does not challenge perceived discrimination as irrational thoughts—since they can reflect real experiences—but instead focuses on restructuring the internalized negative self-beliefs developed from those experiences. For example, rather than questioning whether the discrimination was real, the therapist validated the experience and helped the client challenge what it made her believe about herself (e.g., “I am not intelligent”). Such cultural-sensitive approaches show why distinguishing internalized pressures from direct stressors from the external world is crucial in understanding ISs’ mental health struggle.

One form of internalized stress comes from the stigma of having mental health problems and help-seeking. An international student who repeatedly hears that seeking help for mental health struggle is shameful may internalize that belief, so even if no peers or family are currently pressuring them, their own mind enforces the stigma “I shouldn’t see a counselor because that means I’m weak.” This internalized stigma has been shown to be a significant barrier to help-seeking, which also contributes to emotional distress (Ma et al. 3-7). 

Another form of internalized stress is internalized racism or discrimination. For instance, one student in the interview, who was a native English speaker, was asked to repeat himself several times when he first arrived at the U.S. because he had an accent. He ended up learning the “white people’s accent” and adapting the way he talked. Although he did not think changing his accent was humiliating in any way, he did confess that the experience made him feel inferior, because he was speaking in “an accent that no one understood”.
Perceived language discrimination can leave long-term impacts. For instance, Ma et al.’s study also looked at the different effects of perceived language discrimination and perceived language proficiency. They found that while perceived English language discrimination (e.g., being treated negatively due to one’s accent or mistakes) was directly associated with increased depression and anxiety, perceived English proficiency was not significantly associated with mental health problems, indicating that perceived discrimination, which creates internalized stigma, is more important to mental health struggles than actual language proficiency.  

Internalized cultural values can also generate stress. Self-imposed academic pressure (i.e. high internalized expectation) was a typical internalized stressor. Many international students are high achievers by the very fact of studying abroad; they often set exceedingly high standards for themselves. While this perfectionism might be partly influenced by external expectations and the pressure of their immigration status, it often becomes a deeply internalized trait. All interviewees expressed strong concern about their GPA and coursework—one even reported that academic pressure was currently her only source of stress: “But all the things I said were in the past. For now, academic pressure is my only stressor. If I didn’t have academic pressure, I would be so happy.” When asked whether her stress differed from that of domestic students, she replied:

“I think so. Leave the fact that international students face more pressure when it comes to jobs and graduate school aside, international students tend to hold higher standards than Americans. Maybe this is because the environment they grew up in—you know, East Asian cultures care more about grades. Also, going to college in the U.S. is much more granted for American students. Many of them just casually attend a school that’s in their state or decide based on a scholarship they got. But for international students, we pay so much, travel so far, and leave our hometowns for at least four years—the cost itself carries a lot of weight. You have to perform well to justify.”

Conclusion

This paper proposed 4SS model as an integrative sociological model for understanding the complex mental health stressors experienced by ISs, categorizing them into four domains based on their sources. Unlike classical assimilation theory or structural exclusion frameworks, which separately focus on integration issues or structural barriers, 4SS model emphasizes the multifaceted nature of ISs mental health stressors and acknowledged the interactions between them. Host country stressors include discrimination, exclusion, and institutional pressures such as visa uncertainty; home country stressors involve high parental expectations, parental controls, and economic burdens; peer-related stressors encompass fear of negative social evaluation and unhealthy competition; and internalized stress represents self-directed pressures, including internalized stigma, discrimination, and cultural expectations. 4SS model not only unifies previously fragmented research, but also provides a systematic approach for understanding and exploring ISs’ mental health risk factors for future researchers.

Future research could take a closer look at how effective different coping strategies used by ISs are in managing their mental health challenges. It is worth noting that the narratives from all interviewees seemed generally positive. Despite having a difficult time adjusting upon arrival and experiencing ongoing social exclusion in various aspects, all the interviewees mentioned they felt significantly better now and had successfully adapted. However, their coping methods differed greatly. For example, in terms of socialization, some ended up with exclusively American friends, others chose to socialize only with fellow ISs, and still others partially assimilated but avoided certain scenarios without making further efforts. Although all these approaches appeared helpful in reducing ISs’ mental health stressors, examining their long-term effectiveness and the different outcomes they lead to would be valuable areas for future research.