在臺國際學生知覺微歧視、跨文化適應壓力以及憂鬱之相關研究

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(1)國立臺灣師範大學教育心理與輔導學系碩士論文. 指導教授：田秀蘭博士. 在臺國際學生知覺微歧視、跨文化適應壓力以及憂鬱之相關研究. 研究生：李欣怡撰. 中華民國一百零四年六月.

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(3) 國立臺灣師範大學教育心理與輔導學系碩士論文. 指導教授：田秀蘭博士. 在臺國際學生知覺微歧視、跨文化適應壓力以及憂鬱之相關研究. 研究生：李欣怡撰. 中華民國一百零四年六月.

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(5) THE RELATIONSHIPS AMONG PERCEIVED MICROAGGRESSIONS, ACCULTURATIVE STRESS, AND DEPRESSION IN A MULTI-ETHNIC SAMPLE OF INTERNATIONAL STUDENTS IN TAIWAN. A Thesis Submitted to The Faculty of Graduate School National Taiwan Normal University. In Partial Fulfillment Of the Requirements for the Degree of Master of Education. By Hsin-Yi Lee Dr. Hsiu-Lan Tien, Thesis Advisor. June, 2015.

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(7) Acknowledgement 首先，我要誠摯地感謝田秀蘭老師接受我為指導學生，並且在這一年之間持續地鼓勵及協助我完成了這份論文。也謝謝郭崇信老師和喬虹老師兩位口試委員的厚愛，崇信老師於百忙之中抽空與我討論論文，提供非常多的建議；喬虹老師則是與我延續了在密蘇里大學同為指導教授的緣分，撥冗北上參加我的論文口試，真的是萬分感謝。另外，我要特別感謝維素老師，在我讀研究所的期間無論是專業領域的教導以及日常生活的關心問候，每次都讓我感激在心，期望自己將來能成為像老師一樣對案主溫暖且嚴以律己的助人工作者。感謝我的母親，黃淑昭女士，在我六年前突然冒出一句「我以後想成為諮商師」時，二話不說就支持我的決定直到今天，謝謝您讓我沒有後顧之憂的完成碩士學位，並且實現我出國深造一年的夢想。另外，也要感謝我的父親，李德源先生對我從小到大的栽培，雖然現在的您無法閱讀這段文字，但我相信這份感謝是可以傳達進您心裡的。感謝我在研究所的同學盈伶和宣融，從我們在密蘇里大學讀書時就約定了回國後要在一年內寫完論文然後一起畢業，以及之後持續一年的論文互助會。在師大就讀期間能夠結識這兩位知己真是我最大的福氣。 I sincerely appreciate Todd Morman for helping edit my thesis, and, Lynn Chiu, for discussing on microaggressions with me and supporting me as a thesis/dissertationwriting group member. Also, many thanks to Ted and Marianne Dyson, who have shown great interests in my research and had a lot of confidence in me. Last but not least, I must acknowledge the support, love, and encouragement I have received from Scott Dyson. I cannot thank you enough for helping me throughout the tumultuous thesis process and life crises. You are the best friend and husband I could ever ask for.. i.

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(9) 在臺國際學生知覺微歧視、跨文化適應壓力以及憂鬱之相關研究中文摘要本研究目的在探討不同人口學變項之國際學生在知覺微歧視和跨文化適應壓力之差異情形，以及知覺微歧視、跨文化適應與憂鬱之相關情形。研究採用問卷調查法，針對全台各區的大專院校國際學生，進行「種族微歧視量表（Racial Microaggression Scale）」、「國際學生跨文化適應壓力量表（ Acculturative Stress Scale for International Students）」、「流行病學研究中心憂鬱量表修訂版（The Center for Epidemiological Studies Depression Scale–Revised）」與基本資料問卷的施測。填答有效問卷的研究餐與者共 213 人，其中男性 92 人，女性 121 人，平均年齡為 23.7 歲。問卷調查所得資料以描述統計、單因子變異數分析、相關分析與逐步迴歸分析。所得研究結果為：女性、高加索白人／歐洲人、有穩定關係與修讀正式學位之國際學生於知覺微歧視的得分顯著較高；亞洲人、旅外華僑與修讀正式學位之國際學生於跨文化適應壓力的得分則顯著較高。另外，國際學生之知覺微歧視、跨文化適應壓力與憂鬱之間具有顯著正相關，且知覺微歧視及跨文化適應壓力可聯合解釋在臺國際學生憂鬱的總變異量的 31%。整體而言，本研究以多元文化觀點，探究不同族群的國際學生在微歧視和跨文化適應壓力表現上的差異性，以及微歧視和心理健康的關聯性。最後，本研究根據上述結果，建議未來研究可檢驗在臺國際學生的知覺微歧視種類別、修正微歧視的定義以適用於各種文化脈絡、探討台灣人對國際學生之觀感，以及研究國際學生於跨文化適應歷程中的正向因素（例如：因應策略）。. 關鍵字：在臺國際學生、知覺微歧視、跨文化適應壓力、憂鬱. iii.

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(11) Abstract The purpose of this study was to explore differences between microaggressions and acculturative stress of international students with different demographic backgrounds, and relations between their perceived microaggressions, acculturative stress and depression. A total of 213 international students (male = 92, female = 121; average age = 23.7) across Taiwan participated in the study through paper-and-pencil and online surveys. Participants completed the Racial Microaggression Scale (RMAS), Acculturative Stress Scale for International Students (ASSIS), The Center for Epidemiological Studies Depression Scale–Revised (CESD-R), and a demographic questionnaire measuring the study variables. Data was analyzed by descriptive statistics, one-way analysis of variance, correlation, and stepwise regression. In. terms. of. demographics,. the. findings. indicated. that. male. Whites/Caucasians/Europeans students who were in relationship and who studied in degree programs reported higher levels of microaggressions. In addition, Asians, overseas Chinese, and students who studied in degree programs indicated higher amounts of acculturative stress. For all groups there was a positively significant correlation between perceived microaggressions, acculturative stress and depression, and 31% of variance of depression was explained by acculturative stress and perceived microaggressions. In general, this study provided a multicultural perspective on ethnicity as a factor for microaggressions and acculturative stress, and on the link between microaggressions and mental health among international students in Taiwan. Due to the current findings, future research is encouraged to examine specific microaggression issues among international students in Taiwan, adjust the definition of microaggressions for applying to more cultural backgrounds, attitude of Taiwanese society toward international students, and positive factors, such as coping strategies, relating to acculturating process among this group.. v.

(12) Keywords:. perceived. microaggressions,. international students in Taiwan.. vi. acculturative. stress,. depression,.

(13) Table of Contents Acknowledgement.......................................................................................................... i Chinese Abstract........................................................................................................... iii Abstract ..........................................................................................................................v Table of Contents ........................................................................................................ vii List of Tables ................................................................................................................ ix List of Figures .............................................................................................................. xi Chapter 1: Introduction ..................................................................................................1 1.1 Background of the Study .....................................................................................1 1.2 Statement of the Problem ....................................................................................7 1.3 Research Purpose ................................................................................................9 1.4 Research Questions .............................................................................................9 1.5 Definitions .........................................................................................................10 1.6 Hypotheses ........................................................................................................ 11 Chapter 2: Literature Review .......................................................................................15 2.1 Perceived Microaggressions ..............................................................................15 2.2 Acculturative Stress ...........................................................................................20 2.3 Depression .........................................................................................................28 Chapter 3: Method........................................................................................................35 3.1 Participants ........................................................................................................35 3.2 Procedure ...........................................................................................................38 3.3 Instruments ........................................................................................................40 3.4 Data Analysis .....................................................................................................47 Chapter 4: Results ........................................................................................................49. vii.

(14) 4.1 Descriptive Statistics .........................................................................................49 4.2 Examination of Hypothesis 1 ............................................................................50 4.3 Examination of Hypothesis 2 ............................................................................58 4.4 Examination of Hypothesis 3 and 4 ..................................................................63 4.5 Examination of Open-ended Question ..............................................................67 Chapter 5: Discussion ..................................................................................................71 5.1 Descriptive Result on Depression .....................................................................71 5.2 Demographics Variations among Microaggression ...........................................71 5.3 Demographics Variations among Acculturative Stress......................................77 5.4 Correlation and Multiple Regression ................................................................81 5.5 Implications .......................................................................................................83 5.6 Limitations.........................................................................................................86 Reference......................................................................................................................89 Appendix ....................................................................................................................105 Appendic A: Research Invitation .......................................................................105 Appendix B: Informed Consent Statement ...........................................................107 Appendix C: Debriefing form ...............................................................................109 Appendix D: Racial Microaggressions Scale, Revised ......................................... 110 Appendix E: The Center for Epidemiological Studies Depression Scale, Revise 113 Appendix F: Demographic Questionnaire ............................................................. 114 Appendix G: Permission to Use the RMAS .......................................................... 116 Appendix H: Permission to Use CESD-R ............................................................. 117. viii.

(15) List of Tables Table 1. Demographics of research participants ............................................................. 36 Table 2. Descriptive Statistics for All Scales .................................................................. 49 Table 3. ANOVA/t-test of Microaggression among Demographic Variables ................. 55 Table 4. T-test of Microaggression subscales among Gender ........................................ 55 Table 5. ANOVA of Microaggression subscales among Nationality.............................. 56 Table 6. ANOVA of Microaggression subscales among Ethnicity ................................. 56 Table 7. T-test of Microaggression subscales among Marital Status .............................. 56 Table 8. T-test of Microaggression subscales among Study Program ............................ 57 Table 9. Correlations among Age, Length of Residence (months), Mandarin Proficiency, Microaggressions, and acculturative stress ....................................................... 57 Table 10. Intercorrelations of Racial Microaggressions Scale Subscales ...................... 57 Table 11. ANOVA/t-test of Acculturative Stress among Demographic Variables .......... 61 Table 12. ANOVA of Acculturative Stress subscales among Nationality ...................... 62 Table 13. ANOVA of Acculturative Stress subscales among Ethnicity .......................... 62 Table 14. T-test of Acculturative Stress subscales among Study Program ..................... 63 Table 15. Correlations among Microaggression, Acculturative Stress, and Depression 65 Table 16. ANOVA of Depression among Ethnicities...................................................... 66 Table 17. Multiple Linear Regression for Prediction of Depression .............................. 66. ix.

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(17) List of Figures Figure 1. The Hypothetical Model of This Study ........................................................... 14 Figure 2. Acculturation Strategies .................................................................................. 23. xi.

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(19) Chapter 1: Introduction 1.1 Background of the Study Since 1980s, international students have played an essential role in the phenomenon of internationalization of higher education (Arthur, 2004; Chen, 2011). In order to hone national competitiveness and attract talented people worldwide, more and more countries have created an international student-friendly learning environment by providing international courses (Chang, 2007). Since 2004, school assessments conducted by the Ministry of Education in Taiwan have included measurements of the level of internationalization. The Ministry of Education has implemented projects, such as Aiming for the Top University, Elite Research Center Development Plan, and The Taiwan Fellowships & Scholarships (TAFS, 2012) program, in order to encourage universities to enroll international students (Huang, 2008). As a result, the number of international students has increased from 27023 to 92685 people over 10 years, including students from degree programs, non-degree Mandarin Language Enrichment Programs (LEP), and exchange students (Department of Statistics, Ministry of Education, 2015). As the number of international students in Taiwan has grown rapidly, the issue of those students’ life circumstance in Taiwan has become increasingly important (Huang, 2008). To effectively help them adjust to a new culture, helping professionals must first understand what problems they, as a group, encounter before we can begin to enhance cross-cultural sensitivity. Otherwise, any program or policy could simply waste time and resources, or even aggravate problems. Therefore, this study undertakes a quantitative assessment of international students’ mental health status and the potential difficulties they might experience in Taiwan, in order to advise the public on how best to serve the international student population. 1.1.1 Concept of international students 1.

(20) As a multicultural perspective, international students from diverse ethnicities were all included in this study. However, the group overseas Chinese students needs to be clarified. Based on regulations, overseas Chinese students are defined as those who are identified as Chinese, were born overseas and resided there until the present time, or have stayed out of Taiwan for more than six consecutive years and have a permanent or longterm residence certificate (Regulations Regarding Study and Counseling Assistance for Overseas Chinese Students in Taiwan, 2014). Despite the Taiwanese government sometimes classifying overseas Chinese as international students (Number of Colleges Overseas Students Studying, 2014) and sometimes not (TAFS, 2012; International Students Undertaking Studies in Taiwan, 2014) this research includes them for the following reasons: First, from the perspective of acculturation, there is considerable evidence suggesting that overseas Chinese people encounter some multicultural difficulties when they come to Taiwan for study. For example, Chiang (2003) and Hung (2009) found that due to differences in economic status and the educational system between their home country and Taiwan, overseas Chinese students, despite having a similar cultural and linguistic background, often have great difficulty maintaining their schoolwork, and must also take several part-time jobs in order to survive in Taiwan. Meanwhile, unfair discrimination, lack of social support, and language barriers such as unable to recognize Taiwanese accents and deficiency in expressing themselves in classes, are also common barriers for these international students when adapting to Taiwanese culture. Because these barriers are also found among other international students (Huang, 2008; Shih, 2006), it can then be concluded that overseas Chinese students encounter a process of acculturation similar to that of other international students. Second, when it comes to cultural-identity, whether overseas Chinese people share. 2.

(21) the same ethnicity as Taiwanese people or not is controversial. For example, Li (2008) pointed out that for some Malaysian- and Indonesian-Chinese students, they actually identify themselves as Chinese. They also accept the concept of belonging to the same ethnicity as Taiwanese people. However, legally, they identify themselves as citizens of Malaysia/Indonesia, and they do not feel that coming to Taiwan is returning to their country of origin. Instead, they often perceive their residence in Taiwan as going to an alien place, culturally dissimilar to their homeland. Therefore, despite how government policy labels them, Malaysian-Chinese students would rather be considered as international students (Chen, 2006). To conclude, because of the reasons mentioned above, this research adopts a broader concept of international students. In this study, international students are defined as foreigners who currently take courses with/without a degree program, or who learns Mandarin in college as a student in Taiwan. In addition, they should meet the following requirements: (a) people who were not born in Taiwan and resided outside Taiwan for the majority of their childhood, or have stayed overseas for more than six consecutive years and have a permanent or long-term residence certification in the country they live in; and (b) people who have foreign nationality. This includes students who have foreign nationality and who possess an overseas Chinese student status. 1.1.2 Cultural problems among international students In the process of adapting to a new culture, international students face unique issues that differ from domestic students, and acculturative stress is one of the most common problems they face. Acculturative stress refers to a certain category of stress, in which the stressors are identified as resulting from the experience of change and adaptation to a foreign culture, as well as encountering unfamiliar social norms and mores (Berry, 2005; Church, 1982; Lin & Yi, 1997; Smart & Smart, 1995). In order to be conceptualized as. 3.

(22) acculturative stress, the stressor needs to be perceived as a problem caused by intercultural contact that cannot be dealt with easily or by simply assimilating to them (Berry, 2005). The symptoms resulting from acculturative stress can be broad and may include physical, psychological and social aspects. For international students in Taiwan, the sources of acculturative stress often include perceived discrimination, lack of social support, language difficulties, difficulties in adjusting to new food or weather, academic pressure, and homesickness (Chiang, 2003; Hsu, 2007; Huang, 2008; Shih, 2006). Also, moving to a new culture can lead to numerous challenges for international students and has potentially negative effects on their mental health (Mallinckrodt & Leong, 1992; Sandhu, 1994; Sodowsky & Lai, 1997). Recently, studies have indicated that acculturative stress is positively associated with depression and mental distress among international students in the United States (U.S.; Wei, Heppner & Mallen, 2007). In Taiwan, those international students who reported having higher levels of acculturative stress often feel vulnerable and isolated (Huang, 2008). Previous studies of international students in Taiwan have focused almost exclusively on the relationship between personal factors and dependent variables such as financial problems, cultural adjustment, or social networks (Chang, 2008b; Hsu, 2007; Huang, 2008; Shih, 2006; Wang, 2011). Examples of these demographic variables include age, gender, social contact, geographical home region, length of residence time, language proficiency, etc. However, exclusive emphasis on demographic variables without consideration of environmental factors can lead to attributing adjustment difficulties or problems of the international students solely to the individual without adequately acknowledging the role of environment in the students' problems (Yoon & Portman, 2004). Moreover, as Fouad (1991) stated, environmental factors can be more predictive of international students' successful adjustment than individual factors. Scholars need to. 4.

(23) balance between exploring personal factors and environmental factors rather than assigning all problems to international students, in essence blaming the victims. Thus, except for focusing on international students’ acculturative stress and depression level, as outcome variables, this study also assesses their perceived microaggressions, as predictor variables, to obtain a broader perspective of how these students adapt to the host culture. Perceived discrimination is reported to be one of the most common stressors in international students’ acculturation processes (Sandhu & Asrabadi, 1994). Harrell (2000) argued that experiences of racism are a unique source of chronic stress for ethnic minorities distinct from other general life stressors. Because this common stressor is related to host culture members’ attitudes and behaviors toward the students, it can directly influence international students’ relationships and communications with domestic people (Jung, Hecht & Wadsworth, 2007). Several studies have found a positive association between experiences of perceived discrimination and depression among international students (Dion, Dion & Pak, 1992; Wei, Ku, Russel, Mallinckrodt & Liao 2008). Despite the importance of the topic, few studies in Taiwan focus on perceived discrimination among international students. There are several qualitative studies that interview international students and found that some students have received racial discrimination and prejudice from Taiwanese people (Shih, 2006; Tsao, 2013). Huang (2008) assessed international students’ level of acculturative stress, which includes perceived discrimination and perceived hatred. She then interviewed some students and found out that even though White students tended to be treated better than non-White students, both groups reported experiencing unfair discrimination. Also, in Lan’s study (2011) on White immigrants in Taiwan, several Whites reported experiencing a unique form of racism, which is called positive racism in the study. For example, they are often. 5.

(24) viewed as only an English speaker and other traits are usually ignored from Taiwanese people. However, those studies paid little attention to the frequency of discrimination encountered by international students and whether the discrimination harmed those students. Instead, most studies concluded that Taiwanese people are in general friendly to foreigners despite the fact that some of them mentioned the existence of racial discrimination in Taiwan. While measures of acculturative stress often include items for perceived discrimination (Sandhu & Asrabadi, 1994; Ying, 2005), what exact types of discrimination are being perceived is important for making personal and policy changes to decrease the stress of international students. If scholars are finding that Taiwanese people are being friendly, while at the same time finding that international students are perceiving discrimination and prejudice, then the discrimination is likely not blatant, and may even stem from well-intentioned (friendly) offenses. In fact, this is well in line with modern assessments of racism. Prejudice, stereotypes, and discrimination are more likely to be subtle rather than blatant (Boysen, 2012). Research has also indicated that overt, traditional types of racism (i.e., overt acts, such as racial segregation and physical violence towards certain races) have been widely recognized as inappropriate. However, the notion of racial bias continues to exist and has transformed into less blatant form than in the past (Constantine, 2007; Dovidio & Gaertner, 2000; Pearson, Dovidio & Gaertner, 2009). The term microaggressions refer to one of the common forms of these subtle acts of discrimination that can be characterized as “verbal, nonverbal, and environmental slights or insults, whether intentional or unintentional, that send denigrating or negative messages to target people simply based on their marginalized group identity” (Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007). These exchanges are usually viewed as harmless and innocuous, but. 6.

(25) it is found that microaggressions may have potentially negative impacts on an individual’s psychological and physical health. (Nadal, Davidoff, Davis, & Wong, 2014; Sue, Capodilupo, & Holder, 2008; Sue et al., 2007). In fact, Sue (2003) believe, that “this contemporary form of racism is many times over more problematic, damaging, and injurious to persons of color than overt racist acts” (p. 48). Despite the relatively short period of time that international students spend in the host country, when compared to domestic residents, this population is not excluded from microaggressions. Literature has addressed several themes of microaggressions that international students commonly experience from native people. For example, Kim and Kim (2010) pointed out that, in the U.S., international students whose first language is different from the host culture may suffer from being perceived as unintelligent or uneducated. Also, students from South-East Asian countries reported being negatively associated as caretakers or immigrant workers in Taiwan (Chen, 2012; Shih, 2006). These examples support the notion that microaggression exists in Taiwan, but no study has examined whether it is microaggressions specifically that are significant contributors to the acculturative stress or depression of international students in Taiwan. Therefore, this study attempts to assess the frequency and the potential impact of perceived microaggressions among this population.. 1.2 Statement of the Problem Studies show that depression has been one of the top presenting concerns among international students who seek help from university counseling centers (Nilsson, Berkel, Flores, & Lucas, 2004; Yi, Lin, & Yuko, 2003). For Taiwanese international students, acculturative stress and perceived discrimination could be two factors related to depression. There are numerous studies in the U.S. focusing on international students’. 7.

(26) mental health, but the issue is rather neglected in Taiwan. Therefore, it is worth investigating whether depression is also a significant concern among international students in Taiwan. There is a positive relation between acculturative stress and depression level (Constantine, Okazaki, & Utsey, 2004; Lee, Koeske & Sales, 2004; Ying & Han, 2006; Wei et al, 2007), but there is no research conducted in Taiwan that examines the relation between these two variables. Studying in Taiwan has many distinct differences from studying at other international institutions, and thus clarifying this issue is warranted. As for discrimination, studies have indicated that international students in Taiwan received discrimination and prejudice (Chen, 2011; Huang, 2008; Shih, 2006). Still, when considering interpersonal interactions in Taiwan, most studies tend to overlook the issue, and, instead, conclude that Taiwanese people are friendly to foreigners or at least their intention is good (e.g., Han, 2009; Huang, 2008; Shih, 2006). While Taiwanese may in fact endeavor to be welcoming to foreigners, because microaggressions can (and often are) unintentional (Sue et al., 2007), it is possible that well-intentioned friendliness may actually be perceived as subtle attacks on the foreigner. This is an important distinction as of yet unexplored. Another issue found in the existing literature is that whether different ethnic groups perceive microaggressions and acculturative stress differently. The majority of research on international students in the U.S. specifically studied people of color (POC). The reason for this is that POC are considered minorities, tend to receive discrimination or racism from Whites, and therefore require more attention on how these behaviors impact their psychological well-being (Harrell, 2000). However, in Taiwan, Han people and other Asians are the majority, and Caucasians are considered a minority in terms of population. Compoared to students in Western countries, are the acculturating processes and. 8.

(27) interpersonal experiences different for Asian and non-Asian international students in Taiwan?. 1.3 Research Purpose The purpose of this study was to assess acculturative stress and perceived microaggression among international students in Taiwan, and how those two variables relate to their level of depression. Explicitly, the purposes were: (1) To investigate risk factors of acculturative stress and microaggressions among international students in Taiwan. (2) To investigate how outcome variables, such as depression and acculturative stress, and how predictor variable, such as perceived microaggressions, relate to each other among international students’ during the acculturation process. (3) To enhance the understanding of international students, and to facilitate the awareness of counselors or other helping professionals when handling cultural adjustment issues among international students in Taiwan.. 1.4 Research Questions This study addressed three research questions as follows: (1) Do significant differences exist among international students with different demographic backgrounds (genders, nationalities, ethnicities, ages, length of residence, marital status, native languages, programs of study, and Mandarin proficiency) and on the dependent variables of perceived microaggressions and levels of acculturative stress? (2) Does a relationship exist among microaggressions, acculturative stress, and depression in international students in Taiwan? (3) Can the microaggression and acculturative stress levels of international students in Taiwan predict their depression level? 9.

(28) 1.5 Definitions (1) In this study, international students are defined as foreigners who currently take courses with/without a degree program, or who learns Mandarin in college as a student in Taiwan. In addition, they should meet the following requirements: (a) people who were not born in Taiwan and resided outside Taiwan for the majority of their childhood, or have stayed overseas for more than six consecutive years and have a permanent or long-term residence certification in the country they live in. (b) people who have foreign nationality. This includes those who have a foreign nationality and who possess an overseas Chinese student status. (2) Microaggression refer to one of the common forms of these subtle acts of discrimination that can be characterized as “verbal, nonverbal, and environmental slights or insults, whether intentional or unintentional, that send denigrating or negative messages to target people simply based on their marginalized group identity” (Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007). This study focuses on racial/ethnic microaggression, which refers to brief, everyday exchanges that send denigrating messages to people because they belong to a certain racial or ethnic minority group (Sue et al., 2007). In this study, microaggression was measured by a revision of the Racial Microaggressions Scale (RMAS; Torres-Harding, Andrade Jr, & Romero Diaz, 2012). Its subscales include foreigner/not belonging, criminality, sexualization, low-achieving/undesirable culture, and invisibility. Higher scores implies greater levels of microaggression. (3) Acculturative stress refers to a certain category of stress, in which the stressors are identified as resulting from the process of adapting to a new culture (Berry,. 10.

(29) 1984). In order to be conceptualized as acculturative stress, the stressor needs to be perceived as a problem that are encountered during cultural adjustment process and that cannot be dealt with easily or quickly by simply assimilating (Berry, 2005). In this study, acculturative stress was measured by Acculturative Stress Scale for International Students (ASSIS; Sandhu & Asrabadi, 1994). Its subscales include perceived discrimination, homesickness, perceived hate, fear, stress due to change/culture shock, guilt, and miscellaneous. Higher scores implies greater levels of acculturative stress. (4) Depression refers to depressed mood and depressive syndromes that represent the common experience of the majority of international students’ general emotional disturbance (or lack thereof) in the process of adapting to a new culture. In this study, depression was measured by the revision of Center for Epidemiological Studies Depression Scale–Revised (CESD–R; Eaton, Smith, Ybarra, Muntaner, & Tien, 2004). Higher scores imply greater levels of depressive symptomology. A score above 16 indicates potential risk of clinical depression.. 1.6 Hypotheses Based on the first research question advanced, the hypotheses were addressed as follows: Hypothesis 1. A significant difference exists between international students’ demographic variables (genders, nationalities, ethnicities, ages, length of residence, marital status, native languages, programs of study, and Mandarin proficiency) and the dependent variable of perceived microaggressions among international students in Taiwan. The following will be tested in regard to this hypothesis: Hypothesis 1a: A significant difference will be found between international students’. 11.

(30) gender and perceived microaggressions. Hypothesis 1b: A significant difference will be found between international students’ nationality and perceived microaggressions. Hypothesis 1c: A significant difference will be found between international students’ ethnicity and perceived microaggressions. Hypothesis 1d: A significant difference will be found between international students’ age and perceived microaggressions. Hypothesis 1e: A significant difference will be found between international students’ length of residence (months) in Taiwan and perceived microaggressions. Hypothesis 1f: A significant difference will be found between international students’ marital status and perceived microaggressions. Hypothesis 1g: A significant difference will be found between international students’ native language and perceived microaggressions. Hypothesis 1h: A significant difference will be found between international students’ program of study in Taiwan and perceived microaggressions. Hypothesis 1i: A significant difference will be found between international students’ Mandarin proficiency and perceived microaggressions. Hypothesis 2. A significant difference exists between international students’ demographic variables (genders, nationalities, ethnicities, ages, length of residence, marital status, native languages, programs of study, and Mandarin proficiency) and the dependent variable of acculturative stress among international students in Taiwan. The following will be tested in regard to this hypothesis: Hypothesis 2a: A significant difference will be found between international students’ gender and acculturative stress. Hypothesis 2b: A significant difference will be found between international students’. 12.

(31) nationality and acculturative stress. Hypothesis 2c: A significant difference will be found between international students’ ethnicity and acculturative stress. Hypothesis 2d: A significant difference will be found between international students’ age and acculturative stress. Hypothesis 2e: A significant difference will be found between international students’ length of residence (months) in Taiwan and acculturative stress. Hypothesis 2f: A significant difference will be found between international students’ marital status and acculturative stress. Hypothesis 2g: A significant difference will be found between international students’ native language and acculturative stress. Hypothesis 2h: A significant difference will be found between international students’ program of study in Taiwan and acculturative stress. Hypothesis 2g: A significant difference will be found between international students’ Mandarin proficiency and acculturative stress. Based on the second research question advanced, the hypothesis is addressed as follows: Hypothesis 3. A positively significant relationship exists between the levels of perceived microaggressions, acculturative stress, and depression among international students in Taiwan. Based on the third research question advanced, the hypothesis is addressed as follows: Hypothesis 4. Perceived microaggressions and acculturative stress positively predicts depression among international students in Taiwan.. 13.

(32) To sum up, the hypothetical model proposed in this study is shown in Figure 1.. Figure 1. The Hypothetical Model of This Study.. 14.

(33) Chapter 2: Literature Review 2.1 Perceived Microaggressions 2.1.1 Definition and forms of Microaggression Over the past few decades, schools in Taiwan have become increasingly racially and ethnically diverse due to the nation’s policy of attracting talented people from around the world, and to the expanding number of cross-nation marriages and second-generation immigrant students (Huang, 2008; Lin, 2011). However, many studies have reported that these minority students often perceive discrimination or racism in educational environments as well as daily life. For example, Tsai and Huang (2004) interviewed presidents, teachers, and administrators at universities who have frequent contacted with second-generation immigrant students, and concluded that these students often encountered interpersonal difficulties at school, such as being teased because of their accent, being racially discriminated against and negatively labeled, and feelings of inferiority. In addition, Shih (2006) reported that some Taiwanese teachers assume all White people are people from the U.S., which causes Russian students to feel uncomfortable; Mongolian students also reported being upset by stereotypes of Mongolians riding horses all the time, which negatively affects their psychological adjustment in Taiwan. There is little research that specifically focuses on international students’ experiences of being discriminated since they are viewed as temporary residents who will leave this country when they graduate from school or finish their language training program. Furthermore, it is generally considered the responsibility of international students to adapt to the host culture as soon as possible (Fe, 2013). However, research has pointed out that exclusive emphasis on demographic variables without consideration of environmental factors, such as perceived prejudice and discrimination, can lead to 15.

(34) attributing all problems to international students, without acknowledging the role of environment in the students' problems (Fouad, 1991; Yoon & Portman, 2004). Literature has also suggested that acculturation-related studies need independent assessment of perceived discrimination (Krieger, Smith, Naishadham, Hartman, & Barbeau, 2005; Rudmin, 2009). Therefore, this study attempts to provide a broader perspective, as to how international students perceive a subtle form of discrimination from the host culture and how it relates to international students’ mental health. Nowadays, the prejudice, stereotypes, and discrimination that students encounter are more likely to be subtle rather than blatant (Boysen, 2012). Research has also indicated that overt, traditional types of racism (i.e., overt acts, such as racial segregation and physical violence towards certain races) have been widely recognized as inappropriate. However, the notion of racial bias continues to exist and has been transformed into a less blatant forms than in the past (Constantine, 2007; Dovidio & Gaertner, 2000; Pearson, Dovidio & Gaertner, 2009). This subtle form of racism is known as aversive racism. Aversive racism refers to underlying, unintentional, negative racial feelings, usually held by individuals who perceive themselves as egalitarian and non-prejudiced (Gaertner, Kawakami, & Hodson, 2002). For example, individuals who believe they are friendly to minorities may subconsciously avoid walking past Thai people or become fearful when they see Black people on the street. Also, racial and ethnic minority students report that they frequently face subtle insults that are offensive but often unintentional (Bourke, 2010; Boysen, 2012). A common form of aversive racism is addressed as racial microaggressions by psychological and sociological scholars, and their existence had been documented in college campuses (Sol´orzano, Ceja, and Yosso 2000; Sue, Lin, Torino, Capodilupo, & Rivera, 2009). Microaggressions are defined as “verbal, nonverbal, and environmental. 16.

(35) slights or insults, whether intentional or unintentional, that send denigrating or negative messages to target people simply based on their marginalized group identity,” (Sue et al., 2007). Interpersonal exchanges involving microaggressions are mostly delivered by wellintended individuals who believe their actions are innocent (Sue, 2010). These daily events may seem harmless on the surface, but scholars have suggested that microaggressions, like other forms of racism, may be particularly harmful because they are unique, chronic stressors that cause physical and psychological dysfunctions among minority groups (Nadal, Davidoff, Davis, & Wong, 2014; Sue, Capodilupo, & Holder, 2008; Sue et al., 2007). There are three forms of microaggressions introduced by Sue et al. (2007): microassaults, microinsults, and microinvalidations. Microassaults most closely represent traditional forms of prejudice, referring to biased attitudes, beliefs, or behaviors, often consciously, towards marginalized groups. Microinsults, on the other hand, are characterized by communications that convey rudeness and disrespect which demean a person’s ethnic identity. Finally, Microinvalidations are defined as exclusion, denial, or the undermining of thoughts, feelings, or experiences of minorities. Research has shown various circumstances international students encounter fit these categories of microaggressions. For example, common classroom microassaults include verbal derogation such as using the word gay to mean bad, calling Black students monkey or teasing about their color skin. Some international students have also experienced being cursed by pedestrians. As for microinsults, students make assumptions about what are appropriate jobs for women, characterize all immigrants as illegal, and address foreign cultures as abnormal. Examples of microinvalidations include denying the existence of racism and sexism, treating minorities like foreigners, and thoughts of color blindness (Boysen & Vogel, 2009; Shih, 2006).. 17.

(36) Another study of immigrant women in Taiwan also listed their experiences in family daily interaction based on those three categories (Fan & Ni, 2013). For example, microassaults was manifested in an environmental level, which Taiwanese society negatively labeled the husband of an immigrant woman. The husband then internalized the stereotype and expressed his anger toward the immigrant wife, regarding her as a burden to him. Second, microinsults happened when the immigrant spouses were referred to as problem-makers, as lazy and slow learners of Mandarin, and were deemed to be the cause of the children’s language delays. Third, microinvalidations appeared in the form of invalidating the native languages of those immigrant women. Their deficiency in Mandarin skills was regarded by the families as a personality flaw. Even though any marginalized group may become victims of microaggressions, in this study the researcher will mostly focus on racial/ethnic microaggressions that international students perceive from Taiwanese people in daily life. There are reasons for choosing this approach. First, race/ethnicity is one of salient identities that defines international students, and differentiates them from local students (Gargano, 2009). Second, research has found that a great amount of problems that international students encountered are caused by neo-racism, a new form of racism (Lee & Rice, 2007). This type of racism, referring to discrimination based on emphasizing cultural and racial differences, is generally a form of microaggression (Lee & Rice, 2007; Sue, 2010). Third, examining the racial/ethnic issue in Taiwan, as an Asian country, may bring a new perspective as most of the research on this subject was done in Western countries. In the U.S., for example, when addressing racial microggression, the reference is always White people discriminating against people of color. Researchers even define racial microaggressions as subtle insults toward people of color (Solorzano, Ceja, & Yosso, 2000; Sue et al., 2007; Sue, 2010). However, if the original meaning of microaggression. 18.

(37) is examined, the concept is basically about the conflict between a dominant group and a minority group, and doesn’t necessarily refer to specific races. As for the situation in the U.S., the culturally dominant race is White while Asians, African American, Latino/a people, etc., are the minorities. However, in Taiwan, Han people dominate society, while Caucasians are minorities in terms of population and political power. Therefore, it is worth examining the degree to which the phenomenon of racial microaggressions in Taiwan differs from Western countries. 2.1.2 Microaggressions among international students General themes of microaggressions that international students receive have been identified in the literature. Assumptions of inferiority is one of the most common issues. For international students whose first language is different from the host culture, there appears to be an ascription of unintelligent or uneducated from others based on unique accents and language deficiency (Kim & Kim, 2010). For example, Shih (2006) noted that due to the lack of fluent Chinese capacity, international students tend to be silent in class, which makes Taiwanese students or professors often overlook their opinions. In addition, South-East students in Taiwan have reported being perceived as coming from an inferior country and therefore being treated poorly (Chen, 2012). Assumption of homogeneity is another common form of microaggression toward international students. It is characterized as diminishing the traits of the home culture that international student comes from, and subjecting them to the racial categorizations of stereotypes that the dominant culture holds (Kim & Kim, 2010; Lee & Rice, 2007). For example, research has indicated that international students may feel uncomfortable being treated especially well by teachers in the classroom due to the assumption they are incapable. Also, students from South-East Asian countries have reported being negatively associated as caretakers or immigrant workers in Taiwan (Chen, 2012; Shih, 2006).. 19.

(38) International students also receive microinvalidations, such as feeling excluded from both classroom and social activities. Numerous studies have indicated that international students often have experiences of feeling like a perpetual outsiders, never being able to join dominant-culture groups and organizations, and being negatively labeled as foreign/different or socially maladjusted, and dealing with social avoidance (Shih, 2006; Spencer-Rodgers, 2001). In Huang’s study (2008), international students reported that, due to their appearance as White, they are always treated as a foreigner or outsider no matter how long they stay in Taiwan, which sometimes makes them feel uncomfortable. They have also experienced being ignored, instead of receiving an apology, when Taiwanese people step on their foot. Previous study has suggested that future research should explore the ways in which different ethnic groups experience racial microaggressions, and also examine emotional effects of microaggressions on these groups (Wong, Derthick, David, Saw, & Okazaki, 2014). In addition, not only did the concept of microaggression originate from the U.S., but also the majority of the related research was done there. There are several exceptions but those studies are still done in Western countries such as United Kingdom and Portugal (Burdsey, 2011; De Oliveira Braga Lopez, 2011, as cited in Wong et al, 2014). Thus, this study was designed to assess racial microaggression experiences among various ethnic groups of international students in Taiwan, which provides a multicultural perspective of how the construct works in a non-western society. Furthermore, this study examined the relationship between microaggression and depression, and the correlation between microaggression and acculturative stress in order to explore the potential effects of microaggression on individuals’ mental health.. 2.2 Acculturative Stress 2.2.1 Acculturation. 20.

(39) There are two fundamental concepts of acculturation. The first was addressed by anthropologists Redfield, Linton, & Herskovits (1936) as follows: Acculturation comprehends those phenomena which result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original culture patterns of either or both groups (p. 149-150). While acculturation was originally defined as a group-level phenomena, later Graves (1967) introduced a second concept of “psychological acculturation,” which is recognized as an individual-level phenomenon. At this level, acculturation refers to changes in an individual who participates in a contact situation with a dominant group while being influenced both by the external culture and by the changing culture of the minority group the individual belongs to. The first concept focuses on the interaction between two cultures of people, and the mutuality of changes happening in either or both groups. The second concept points out that acculturation involves the power structure within society, which refers to a minority group, recognized as the culture of origin, interacting with a dominant group, recognized as the host culture. Usually, individuals who deal with acculturation are those from the non-dominant cultural group (Berry, 1997; Berry, Kim, Minde, & Mok, 1987). There are two terms which are similar to acculturation and need clarification: adaptation and cultural adjustment. Adaptation is defined as the changes that take place in an individual or group in response to external demands (Berry, 2005). It also refers to the outcome of acculturation, including psychological adaptation (individual’s overall emotional and physical well-being) and sociocultural adaptation (how well an individual manages daily life in the new cultural context) (Berry, 2005). As for cultural adjustment, Kagan and Cohen (1990) pointed out that there is no clear. 21.

(40) distinction between this concept and acculturation. In addition, according to literature reviews, cultural adjustment is often found to be a substitute for acculturation (Arthur, 2004; Li, 2011). On the other hand, acculturation can also be viewed as a factor of the cultural adjustment process but there it still lacks clarification (Yeh, 2003). Therefore, in this study, cultural adjustment and acculturation are regarded as the same concept and are used interchangeably. In this study, acculturation was viewed as a process. Research from this perspective usually considers a broad context and focuses on possible environmental and individual variables that may affect the outcomes on individuals experiencing a new culture (Kim & Abreu, 2001 as cited in Wang & Mallinckrodt, 2006). For example, studies revealed that language proficiency may be an important indicator of acculturation level (Mouw & Xie, 1999). Moreover, a qualitative study of international students in Taiwan concluded that social support, both from their home country and the host culture, is an important factor of cultural adjustment (Tsao, 2013). How individuals engage the acculturation process varies. To elaborate, Berry (1997) addresses the concept of acculturation strategies, and identified two major issues of how to acculturate: (1) cultural maintenance, a relative preference for maintaining one’s heritage culture and identity; and (2) contact/participation, a relative preference for having contact with and participating in the larger society along with other ethno-cultural groups. From the perspective of non-dominant groups, these two issues can be considered simultaneously and generally positive or negative orientations to these issues intersect to define four acculturation strategies (see Figure 2): (1) Assimilation, referring to individuals not wishing to maintain their cultural identity and become absorbed into the dominant society (2) Separation, referring to individuals emphasizing on holding on to their original. 22.

(41) culture, and at the same time avoiding involvement with other cultural groups. (3) Integration, referring to which there is some degree of cultural integrity maintained, and at the same time seeking to participate as an integral part of the larger social network, integration is the option. (4) Marginalization, referring to which there is little possibility or interest in heritage cultural maintenance (often for reasons of enforced cultural loss) and little interest in having relations with others (often for reasons of exclusion or discrimination). In short, when facing conflicts of cultural values during the acculturation process, individuals must choose between maintaining and letting go of their original culture, or to choose different attitudes and behaviors to interact with the host culture (Berry, 2005).. Figure 2. Acculturation Strategies. Adapted from “Immigration, Acculturation, and Adaptation,” by J. W. Berry, 1997, Applied psychology, 46, p. 10. To sum up, acculturation is the dual process of cultural and psychological change that takes place as a result of contact between two or more cultural groups and their individual members. (Berry, 2005). In this study, one of the focuses is the stress generated during the acculturation process, and how it relates to individual’s mental health and negative attitudes from the dominant group. 23.

(42) 2.2.2 Definition of acculturative stress There have been many studies suggesting that adapting to a new culture can be difficult and stressful (Mori, 2000; Sandhu & Asrabadi, 1994; Ying & Han, 2006). Generally, stress is considered to be a set of a specific demands. Whether a particular demand produces stress depends on the individual's perception of the demand. If the individual does not have the physical, mental or emotional resources to meet the demand, the demand is perceived as a potential stressor. In this case, stress is seen as the result of an imbalance between demands from environment, and the adaptive capacities of the individual's mind and body (Fontana, 1989 as cited in Abouserie, 1996). All college and graduate students need to adjust to new educational and social environments. However, besides the developmental issues that most students may have to face, international students encounter added stressors during culture adjustment. Previous studies have also found that the majority of students who have studied abroad report the experiences to be stressful in some domains, such as schoolwork, communication, social relationships, financial difficulties, future plans, etc. (Ginter & Glauser, 1997; Mallinckrodt & Leong, 1992; Misra, Crist, & Burant, 2003; Mori, 2000; Tsao, 2013). Therefore, the concept of acculturative stress is introduced as a broader idea of stress and adaption based on how individuals encounter and deal with acculturative problems over time. Generally, acculturative stress refers to a certain category of stress, in which the stressors are identified as resulting from the process of adapting to a new culture (Berry, 1984). In order to be conceptualized as acculturative stress, the stressor needs to be perceived as a problem that are encountered during cultural adjustment process and that cannot be dealt with easily or quickly by simply assimilating (Berry, 2005). Symptoms of acculturative stress can include anxiety, feelings of alienation, or depression. 24.

(43) (Berry, 2005). Research has indicated that international students experience higher acculturative stress level than immigrants and ethnic groups do. This may be related to the temporary nature of their contact with their host society, the lack of a full-scale social network, their relatively young age, or to their student status (Berry et al., 1987). In Taiwan, even though international students’ frequency of acculturative stress was reported to be rather low, studies have pointed out some factors which make international students feel especially stressed and even distressed (Huang, 2008). Those stressors will be explained in section 2.2.3. 2.2.3 Common Acculturative Stressors With regard to the process of acculturative stress, Berry et al. (1987) specifies three stages: acculturation experience, stressors, and acculturative stress. First, acculturation occurs in a particular situation, varying in degrees, in which individuals participate and experience when moving to a new culture. Second, stressors, defined by Thoits (1995) as environmental, social, or internal demands that cause an individual to adjust his or her behavior, may result from the experience of acculturation; for some people, almost all factors induced from acculturation can be seen as stressful, while for others, these may be seen as opportunities to enhance their life experiences. Last, varying levels of acculturative stress may become manifest as a result of acculturation experience and stressors. International students need to adapt to their new culture as well as a new educational and social environment, which can be stressful to them. Brink and Saunders (1976, as cited by Ryan and Twibell, 2000), proposed five categories of stressors which require individuals to readjust themselves while adapting to new surroundings. The categories include: communication, mechanical/environmental differences, isolation, customs, and. 25.

(44) attitudes/beliefs. A further review of sojourner adjustment studies by Church (1982) spanning from the 1940s to the 1970s, indicated that international students encountered "language difficulties, financial problems, adjusting to a new educational system, homesickness, adjusting to social customs and norms, and for some students, racial discrimination" (p. 544). Similarly, Misra, Crist, & Burant (2003) reported four indicators that highly predicted life stress among international students: stress from adapting to a new culture and accompanying cultural adjustment, such as food, holidays, and social values; interpersonal stress; and academic concerns. In sum, the major stressors international students encountered can be effectively categorized as language barriers to daily living, conflicts of cultural values and social norms, homesickness, and perceived discrimination/racism from domestic people (Sandhu & Asrabadi, 1994). Overall, international students have to overcome these unique problems as well as those typically confronted by indigenous students. These domains of stressors were included in the Acculturative Stress Scale for International Students (ASSIS) used in this study. 2.2.4 Acculturative stress and microaggressions There is no research that specifically addresses the relationship between microaggressions and acculturative stress. However, discrimination, as a boarder concept that includes microaggression, is often conceptualized as a unique stressor for ethnic groups. Research has documented that experiences of racial and gender discrimination are associated with stress that may negatively influence mental health for recipients (Williams, Neighbors, & Jackson, 2003). Studies also indicated that experiences of racism and perceived discrimination are a unique source of chronic stress for international students distinct from other general life stressors. (Wei et al., 2008; Harrell, 2000). Furthermore, research has determined that discrimination is one of the stressors. 26.

(45) encountered by individuals during the acculturating process. In the studies of sojourners and immigrants, perceived discrimination has been commonly referred to as a negative component of acculturation (Berry, 2005; Malcarne, Chavira, Fernandez, & Liu, 2006), and as the most influential predictor of psychological stress and poor psychological adaptation (Jasinskaja- Lahti, Liebkind, & Perhoniemi, 2006; Rudmin 2009; Zlobina, Basabe, Paez, & Furnham, 2006). In Sandhu and Asrabadi’s (1994) instrument development study of an acculturative stress inventory, among various types of acculturative stresses that the researchers identified (i.e., perceived discrimination, homesickness, fear, guilt, and perceived hatred), perceived discrimination was the most common and concerning stressor for international students during their acculturation processes. Several studies imply a link between microaggression and acculturative stress. For example, Sue (2012) pointed out that microaggressions fulfill the criteria of being stressors. To be more specific, he introduced microaggressive stressors as race, gender, or sexual-orientation related events that threaten an individual’s biological, cognitive, emotional, psychological, or social well-being. Furthermore, Kim and Kim (2010) indicated that international students, especially those whose first language is not English, often experience microaggressions in classrooms, such as having professors and peers dismiss those students’ comments or questions, implying that they are unintelligent. These subtle but hurtful messages make the students feel a great amount of pressure to make impressive achievement at school in order to challenge the view of the host society. In addition, international students often reported being isolated from local peers both inside and outside the classrooms, conveying the hidden message that those students do not belong. Such sense of isolation refers to a social factor and a category of acculturative stressors that may hinder acculturation for those students (Brink and Saunders, 1976 as. 27.

(46) cited by Ryan and Twibell, 2000; Kim & Kim, 2010). Thus, these examples of microaggressions can be seen as acculturative stressors which those students encountered during cultural adjustment. To sum up, it appears that microaggressions, as a subtle form of discrimination, can be viewed as a type of acculturative stressor that occurs during an individual’s acculturating process. Therefore, this study assesses the correlation between these two variables in addition to the relation between these two variables and depression.. 2.3 Depression 2.3.1 Definition and features Depression is a significant mental disorder worldwide. The World Health Organization (WHO) reported that depression affects 350 million people across the world, and on average about 1 in 20 people reported having an episode of depression in the previous year. Depression is also the leading cause of disability worldwide in terms of total years lost due to disability (Marcus, Yasamy, Van Ommeren, Chisholm, & Saxena, 2012). The definition of depression varies based on different theories. Nurcombe (1994) indicated that the term depression can be interpreted in several ways, including a momentary affect, a prevailing mood, a complex of conscious and unconscious ideas and feelings, a syndrome dominated by depressive mood, a disorder, or a hypothetical disease. Also, Petersen, Compas, Brooks-Gunn, Stemmler, Ey, & Grant (1993) categorize the assessment of depression into three approaches: (1) Depressed mood: Periods of sadness or unhappy mood which are commonly experienced by individuals in their life, and may occur in various situations, such as loss of significant others or failure on an important task. Depressive mood is typically measured by self-report instruments, either through measures. 28.

(47) especially concerned with mood (e.g., Petersen, Schulenberg, Abramowitz, Offer, & Jarcho, 1984) or through items included in checklists of depressive symptoms (e.g., Radloff, 1977), based on an individual's perceived emotional status. (2) Depressive syndromes: A series of psychological complaints that include symptoms relating to anxiety and depression, such as loneliness, fears of doing bad things, the need to be perfect, feeling unloved, a sense of worthlessness, nervousness, guilt, self-consciousness, suspiciousness, sadness and/or worries (Achenbach, 1991a, 1991b, 1991c as cited in Petersen et al., 1993). (3) Clinical Depression: The most widely used definition of clinical depression, referred to as Major Depressive Disorder (MDD) by the American Psychological Association (APA), is a mental disorder with identifiable symptoms that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning for an individual. To meet the criteria of MDD, five or more symptoms (and at least one of depressed mood and loss of interest or pleasure) needs to be experienced by an individual in the same 2-week period: (a) Depressed mood; (b) Loss of interest or pleasure; (c) Change in weight or appetite; (d) Insomnia or hypersomnia; (e) Psychomotor retardation or agitation; (f) Loss of energy or fatigue; (g) Worthlessness or guilt; (h) Impaired concentration or indecisiveness; and (i) Thoughts of death or suicidal ideation or attempt (American Psychiatric Association, 2013, p.94-95). Numerous research has pointed out that depressive mood, syndromes, and disorders often co-occur with other symptoms and disorders, and suicide is one of the most frequently mentioned (Petersen et al., 1993). Depressed mood has been reported as a strong predictor of suicidal ideation (Harrington, 2001; Kandel, Raveis, & Davies, 1991),. 29.

(48) and a high proportion of suicide attempters are found to be depressed (Rotheram-Borus & Troutman, 1988; Spirito, Overholser, Ashworth, Morgan, & Benedict-Drew, 1989). Studies also found an increased rates of completed suicide in depressed adolescents, and that mood disorder such as MDD is one of the risk factors for completed suicide after an attempt (Harrell, 2000; Rao, Weissman, Martin, and Hammond, 1993). In addition, depressed mood, drug use, and suicidal ideation are strongly related (J. Block & Gjerde, 1990; Kandel et al., 1991). Moreover, depression is also frequently related with eating disorders (Attie, BrooksGunn, & Petersen, 1990; Katon, Kleinman, & Rosen, 1982; Rivinus et al., 1984). It is one of the main factors for individuals who have experienced deliberate self-harm to repeat the behavior (Harrington, Kerfoot, Dyer, E., McNiven, F., Gill, J., Harrington, V., & Byford, S. (1998). In addition, based on a follow-up study for averagely 15.6 years in the U.S., depressed mood is highly correlated with health behaviors associated with the development of diabetes among men and women aged 25–74 years (Carnethon, Kinder, Fair, Stafford, & Fortmann, 2003). To sum up, depressive mood, syndromes, and disorders are related to a broad spectrum of other disorders and problems for both the clinical population and the general public, and thus need to be considered when evaluating an individual’s mental health. In this study, depression refers to depressed mood and depressive syndromes that represent the common experience of the majority of international students’ general emotional disturbance (or lack thereof) in the process of adapting to a new culture. 2.3.2 Depression among international students Research has indicated that the experience of adapting to a new culture can have potentially detrimental psychological and emotional impacts on these students (Constantine, Okazaki, & Utsey, 2004; Sandhu, 1994; Wei et al, 2007). For example,. 30.

(49) international students may experience psychological and interpersonal dysfunctions, such as communication barriers, maladjustment to weather or food, fear, academic stress, social withdrawal, ethnic discrimination, anger, and sadness (Chen 2011; Huang, 2008; Shih, 2006). It is commonly suggested that sojourners tend to feel depressed in their new country, and many international students are reported to have feelings of depression, often described as down, depressed, and sad (Brown & Holloway, 2008). As various studies have indicated, adjusting to an unfamiliar environment requires personal, social, and environmental changes, which can lead to anxiety, confusion, and depression for an individual (Choi, 1997; Lin & Yi, 1997; Sandhu, 1994). Research also points out that during this period of adjustment, international students may experience isolation, loneliness, and hopelessness, and these symptoms may be the manifestation of depression (Mori, 2000; Sümer, Poyrzli, & Grahame, 2008). Studies show that depression has been one of the top concerns among international students who seek help from university counseling centers (Nilsson, Berkel, Flores, & Lucas, 2004; Yi, Lin, & Yuko, 2003). Wei et al. (2007) also reported that about 30% of Asian international students’ in the U.S. scores are above the cutoff point as an indicator for potential clinical depression. However, there is no research conducted in Taiwan that directly measures international students’ depression levels. Therefore, this study seeks to fill this current gap in the literature. 2.3.3 Depression and microaggressions Many scholars have noted that racism and racial/ethnic discrimination is related to the poor mental health of minorities (Buser, 2009; Cortina, & Kubiak, 2006; Santana, Almeida‐Filho, Roberts, & Cooper, 2007; Williams & Williams-Morris, 2000). Evidence also suggests that microaggressive stressors can be implicated in the manifestation of. 31.

(50) mental illness such as depression and anxiety (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Sue, 2012; Torres, Driscoll, & Burrow, 2010). For example, in Sue, Nadal, Capodilupo, Lin, Torino, and Rivera’ study (2008), participants reported feelings of anger, frustration, doubt, guilt, or sadness when they experienced microaggressions. Also, Sue (2012) lists psychological symptoms reported by the recipients of microaggressions, such as fatigue, hopelessness, and withdrawal from social activities, all which are found to be correlated with depression. Furthermore, even though there is no obvious evidence, various studies in Taiwan indicated the potential relation between microaggression and depression. For example, Fan and Ni (2013) indicated that immigrant women who experienced racial microaggression reported negative emotional responses, such as isolation and passiveness which are factors of depression. Similarly, Wu (2013) indicated that perceived discrimination is predictive of greater depression symptoms among immigrant Women. As for the international student population, studies found that perceived discrimination, which includes instances of microaggression, to be a contributing factor to depression level. These studies then suggest that international students’ experience of discrimination may be a factor of their depression levels (Jung, Hecht, & Wadsworth. 2007; Noh and Kaspar’s 2003, Wei et al, 2008). Moreover, research shows that microaggressions may be linked to a negative impact on an individual's ability to cognitively process information, which is a depressive symptom (Boysen, 2012; Salvatore, & Shelton, 2007). A qualitative study in Taiwan also implied that microassaults, such as being verbally insulted because of an international students’ skin color, may lead to increased mental distress and perceived hostility in a school environment (Shih, 2006). Therefore, it was predicted that there would be a positive relation between perceived microaggressions and depressive symptoms for international students in Taiwan in the. 32.

(51) present study. 2.3.4 Depression and acculturative stress Research has indicated that entering into a new culture and adjusting to the unfamiliar environment can have potentially detrimental effects on people's mental health, including anxiety, confusion, and depression (Berry, 1997; Lin & Yi, 1997; Mallinckrodt & Leong, 1992; Sandhu, 1994). Similarly, Berry (1988, as cited in Berry, 1997), addressed that when changes in a multicultural context exceeds an individual’s capacity to cope, psychological disturbance occurs and may lead to clinical depression and anxiety. In addition, numerous studies have suggested that a higher acculturative stress level is predictive of greater mental health symptoms, depression in particular, among international students (Constantine et al., 2004; Lee, Koeske & Sales, 2004; Ying & Han, 2006; Wei et al., 2007). For international students in Taiwan, Lee (2000) found a negative relationship between life stress level and psychological adjustment symptoms, including depression, anxiety, anger, sleep deprivation, etc. For other cross-cultural groups, research also shows a. positive. relationship. between. acculturative. stress. level. and. depressive. symptoms/mental health, and a negative relationship between life stress level and general mental health, among immigrant women (Chang, 2008a; Fang, 2011; Jiang, 2006). However, no study has explicitly stated the specific relationship between acculturative stress and depression for international students in Taiwan. Therefore, this study aims to explore how the process of acculturation relates to mental health issue of international students in Taiwan.. 33.

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