Cited by 0International Student and Expatriate ChallengesStudent Stress and CopingMental Health Treatment and Access

The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index; none of the 47 sources its claims cite is checked for support yet.

The role of social support in the effectiveness of counseling for international students

Open access

Abstract

Previous studies on college counseling have shown that international student clients experience higher psychological distress and benefit less from individual psychotherapy in a university counseling center (UCC) setting compared to domestic student clients. International students face many challenges during adjustment to a foreign country, and social support plays a crucial role during this process and in their psychological well-being. This study aimed to compare the levels of pre-treatment symptoms and treatment outcomes between international and domestic student clients, and examine how perceived social support was related to these differences. The study used data collected from the Center for Collegiate Mental Health (CCMH), including 4876 clients treated by 1679 therapists in 98 UCCs, of which 2438 were international student clients from 142 countries. Multivariate general linear models were constructed to explore our research questions. International student clients reported lower perceived social network support and higher family support, and higher depression, academic distress and anger/frustration at pre-treatment than domestic student clients, but there were limited differences in treatment outcomes. Both perceived social network support and family support were predictive of pre-treatment symptoms, and family support was shown to be positively related to better treatment outcomes in patients with depression, anxiety and academic distress. Implications for clinical practice and future research are discussed.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This study compared international and domestic student clients in university counseling centers and examined perceived family and social-network support as predictors of pre-treatment symptoms and treatment outcomes. International clients reported lower social-network support and higher family support, showed some higher pre-treatment symptoms, and had largely comparable treatment outcomes, with family support predicting better improvement in depression, anxiety, and academic distress.

Key findings

  • The analyzed sample included 4,876 clients (2,438 international students from 142 countries) seen by 1,679 therapists in 98 UCCs; international clients reported lower perceived social-network support (M = 3.45 vs. 3.68) and higher perceived family support (M = 3.42 vs. 3.26) than domestic clients.
  • At pre-treatment, international clients had higher depression (b = 0.11, p < 0.001) and anger/frustration (b = 0.12, p < 0.001); the univariate results showed no significant differences in anxiety, social anxiety, academic distress, eating concerns, or alcohol use.
  • Family support was negatively related to all CCAPS-34 subscales except alcohol use; social-network support was negatively related to depression, anxiety, social anxiety, academic distress, and anger/frustration, but not eating concerns or alcohol use. The negative relationship between social-network support and depression, anxiety, and social anxiety was stronger when family support was higher.
  • For treatment outcomes, international and domestic clients differed only on anger/frustration improvement (b = 0.05, p = 0.001), with international clients showing less reduction; higher family support predicted more improvement in depression (b = −0.03), anxiety (b = −0.02), and academic distress (b = −0.04). Social-network support did not significantly predict overall treatment outcome (p = 0.010 against the p = 0.003 threshold).

Methods

  • Used Center for Collegiate Mental Health (CCMH) data from 2017–2019 and 2021–2023, excluding 2019–2020 and 2020–2021 because of COVID-19. Eligible clients had at least one psychotherapy session, a first course of treatment with at least two individual sessions or clinical intake, completed SDS, and at least two CCAPS-34 records.
  • International clients were exact-matched to domestic clients on race, gender, academic status, and same UCC using MatchIt; final matched sample was 4,876. Measures included SDS single items for perceived family and social-network support (1–5 Likert) and the CCAPS-34 seven subscales; outcomes were residualized change scores.
  • Analyses used multivariate GLMs followed by univariate GLMs, with a Bonferroni-corrected significance threshold of p = 0.003 (0.05/16). Aim 2 models included number of attended sessions and a treatment-center fixed effect as covariates; therapist effects were not estimated.

Limitations

  • Stated: only pre- and post-treatment time points were examined; social support was measured only at pre-treatment with one item per source; Likert items were treated as continuous; some clients continued after the last recorded outcome measurement, so session counts were imperfect; therapist effects were not examined because most therapists had only one client in the matched dataset; international students are not a monolith, and future work should consider country/region of origin, acculturation level, and native language.
  • Stated: effect sizes were minimal, so the implications should be considered with caution.
  • Evident: the abstract and discussion describe higher academic distress at intake for international clients, while the univariate results report no significant difference on academic distress; this inconsistency is visible in the text.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/28324765.2026.2653852

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

33 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Figures

Figure 1. Interaction effects between perceived social network support and family support on depression, anxiety, and social anxiety. Note: Each plot represents estimates from the statistical model while holding all other variables constant at the mean.
Figure 1. Interaction effects between perceived social network support and family support on depression, anxiety, and social anxiety. Note: Each plot represents estimates from the statistical model while holding all other variables constant at the mean.CC BY · PubMed Central

Verification

Claims the paper makes

56 Own result · 14 Own method · 13 No full text of the sources · 12 Sources not found · 11 Own interpretation · 7 Not checked yet · 4 No basis given · 1 Check pending

Verify all 2 references — free account
  • It may state two separate claims as one. 19
  • Probably not a substantial claim. 19
32 of 32
  • The paper relies on this without support.

    International students often encounter difficulties in providing meaningful social support when acclimating to the collegiate environment, which can engender experiences of loneliness and social isolation, contributing to adverse psychological outcomes.

    “international students often encounter difficulties in providing meaningful social support when acclimating to the collegiate environment, which can engender experiences of loneliness and social isolation, contributing to adverse psychological outcomes.”
  • The paper relies on this without support.

    Family support has varying levels of importance to international student clients and can have a profound impact on psychological adjustment.

    “family support has varying levels of importance to international student clients and can have a profound impact on psychological adjustment.”
  • The paper relies on this without support.

    Cultural variations inform the prevalence of mental health distress, susceptibility to different stressors, expression of distress, help-seeking, and treatment response among international student clients.

    “These cultural variations inform the prevalence of mental health distress, susceptibility to different stressors, expression of distress, help-seeking, and treatment response among international student clients.”
3 of 3

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(1, 4871) = 17.08reported p = .023 · recomputed p < .001

    “F(1, 4871) = 17.08, p = .023”

  • Consistentt(4874) = 3.6reported p < .001 · recomputed p < .001

    “t(4874) = 3.60, p < .001”

  • ConsistentF(1, 4873) = 50.99reported p < .001 · recomputed p < .001

    “F(1, 4873) = 50.99, p < .001”

  • ConsistentF(1, 4873) = 20.63reported p < .001 · recomputed p < .001

    “F(1, 4873) = 20.63, p < .001”

  • ConsistentF(7, 4862) = 13.07reported p < .001 · recomputed p < .001

    “F(7, 4862) = 13.07, p < .001”

  • ConsistentF(7, 4862) = 53.15reported p < .001 · recomputed p < .001

    “F(7, 4862) = 53.15, p < .001”

  • ConsistentF(7, 4862) = 52.44reported p < .001 · recomputed p < .001

    “F(7, 4862) = 52.44, p < .001”

  • ConsistentF(1, 4871) = 26.92reported p < .001 · recomputed p < .001

    “F(1, 4871) = 26.92, p < .001”

  • ConsistentF(1, 4871) = 33.81reported p < .001 · recomputed p < .001

    “F(1, 4871) = 33.81, p < .001”

  • ConsistentF(1, 4871) = 302.19reported p < .001 · recomputed p < .001

    “F(1, 4871) = 302.19, p < .001”

  • ConsistentF(1, 4871) = 55.72reported p < .001 · recomputed p < .001

    “F(1, 4871) = 55.72, p < .001”

  • ConsistentF(1, 4871) = 182.45reported p < .001 · recomputed p < .001

    “F(1, 4871) = 182.45, p < .001”

  • ConsistentF(1, 4871) = 122.13reported p < .001 · recomputed p < .001

    “F(1, 4871) = 122.13, p < .001”

  • ConsistentF(1, 4871) = 105reported p < .001 · recomputed p < .001

    “F(1, 4871) = 105.00, p < .001”

  • ConsistentF(1, 4871) = 5.97reported p = .015 · recomputed p = .015

    “F(1, 4871) = 5.97, p = .015”

  • ConsistentF(1, 4871) = 311.03reported p < .001 · recomputed p < .001

    “F(1, 4871) = 311.03, p < .001”

  • ConsistentF(1, 4871) = 69.18reported p < .001 · recomputed p < .001

    “F(1, 4871) = 69.18, p < .001”

  • ConsistentF(1, 4871) = 177.76reported p < .001 · recomputed p < .001

    “F(1, 4871) = 177.76, p < .001”

  • ConsistentF(1, 4871) = 101.93reported p < .001 · recomputed p < .001

    “F(1, 4871) = 101.93, p < .001”

  • ConsistentF(1, 4871) = 58.09reported p < .001 · recomputed p < .001

    “F(1, 4871) = 58.09, p < .001”

  • ConsistentF(1, 4871) = 6.27reported p = .012 · recomputed p = .012

    “F(1, 4871) = 6.27, p = .012”

  • ConsistentF(1, 4871) = 0.002reported p = .965 · recomputed p = .964

    “F(1, 4871) = 0.002, p = .965”

  • ConsistentF(7, 4862) = 8.18reported p < .001 · recomputed p < .001

    “F(7, 4862) = 8.18, p < .001”

  • ConsistentF(1, 4871) = 20.1reported p < .001 · recomputed p < .001

    “F(1, 4871) = 20.10, p < .001”

  • ConsistentF(1, 4871) = 10.6reported p = .001 · recomputed p = .001

    “F(1, 4871) = 10.60, p = .001”

  • ConsistentF(1, 4871) = 50.1reported p < .001 · recomputed p < .001

    “F(1, 4871) = 50.10, p < .001”

  • ConsistentF(7, 4764) = 3.75reported p < .001 · recomputed p < .001

    “F(7, 4764) = 3.75, p < .001”

  • ConsistentF(7, 4764) = 3.65reported p < .001 · recomputed p < .001

    “F(7, 4764) = 3.65, p < .001”

  • ConsistentF(7, 4764) = 2.63reported p = .01 · recomputed p = .010

    “F(7, 4764) = 2.63, p = .010”

  • ConsistentF(1, 4775) = 10.75reported p = .001 · recomputed p = .001

    “F(1,4775) = 10.75, p = .001”

  • ConsistentF(1, 4775) = 16.36reported p < .001 · recomputed p < .001

    “F(1,4775) = 16.36, p < .001”

  • ConsistentF(1, 4775) = 10.7reported p = .001 · recomputed p = .001

    “F(1,4775) = 10.70, p = .001”

  • ConsistentF(1, 4775) = 18.56reported p < .001 · recomputed p < .001

    “F(1,4775) = 18.56, p < .001”

33 of 33

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 39 references

Research works printed but not linked: 4

  1. Baba, Y., & Hosoda, M. (2014). Home away home: Better understanding of the role of social support in predicting cross-cultural adjustment among international students. College Student Journal, 1, 1–15.
  2. 10.1055/a-1686-4682 · DOI
  3. Hwang, B., Bennett, R., & Beauchemin, J. (2014). International students' utilization of counseling services. College Student Journal, 48(3), 347–354.
  4. Trifonovitch, G. J. (1977). Culture learning/culture teaching. Educational Perspectives, 16(4), 18–22.

Cited by

Still being checked.

Metadata

Authors
Tan, H., Castonguay, L. G., Janis, R. A., Hayes, J. A., Magruder, S. A. N., Chun-Kennedy, C. L., & Scofield, B. E.
Affiliations
Pennsylvania State University (US)
Corresponding author
Tan, Hongjun
Venue
Cogent Mental Health
Published
2026-04-07
Volume
5
Issue
1
Pages
2653852-2653852
ISSN
2832-4765 (ISSN-L)
OpenAlex
W7151245652
Cited by
0
References
39
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • Cogent Mental Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Communication › International Student and Expatriate Challenges
  • Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords
international students, social support, university counseling services, college counseling, family support, psychological distress, depression, academic distress, anxiety, cross-cultural adaptation (acculturation), treatment outcomes, domestic students

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Statistics and arithmetic are recomputed, not judged.

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