International Journal of Nursing Science

p-ISSN: 2167-7441    e-ISSN: 2167-745X

2021;  11(1): 1-7


Received: Dec. 22, 2020; Accepted: Jan. 15, 2021; Published: Jan. 30, 2021


Social Support, Psychological Adjustment, and Acculturative Stress among International Students in Baguio City of the Philippines

Blesslove Nimako Pinamang1, Ohene Bobie-Nimako2, Williams Kwasi Peprah3, Simon Akwasi Osei1, Fiskvik Boahemaa Antwi1, Nana Owusu Nimako4, Elvis Agyenim-Boateng1

1Saint Louis University, Philippines

2St. Barnabas Hospital, USA

3Valley View University, Ghana

4University of Vermont, USA

Correspondence to: Blesslove Nimako Pinamang, Saint Louis University, Philippines.


Copyright © 2021 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).


International students' cross-cultural living though exciting, can be challenging as they experience stress due to the continual changes and adaptation difficulties in host countries. During the acculturation process, these students' stress subjects them to poor mental health and well- being. Initial evidence suggests a link between social support, psychological adjustment, and acculturative stress experienced by students. This study examined the extent of social support, psychological adjustment, acculturative stress among international students and their relationship. This descriptive- correlational study utilized 125 international students in Baguio City, Philippines, using a convenience sampling method, and researchers contacted students to answer an online distributed self-constructed questionnaire. The questionnaires had a Cronbach alpha of 0.78 for social support, 0.86 for psychological adjustment, and acculturative stress as 0.82. Data were analyzed descriptively using parametric inferential statistics by relying on regression analysis in SPSS and central tendency. The study revealed that international students experience very high acculturative stress. International students also reported low social support and a very high psychological adjustment. The study revealed a moderately negative significant relationship between psychological adjustment and acculturative stress. The study also revealed that there is a highly negative significant relationship between social support and acculturative stress. Results of this study imply that students with low social support often encounter high acculturative stress. In the present study, international students reported a very high psychological adjustment, although they have high acculturative stress.The study recommends that international students engage in more innovative programs and activities to maintain their psychological adjustments. Social support network systems should also be strengthened in both host and home countries to reduce acculturative stress. Future research studies should investigate social support sources and other factors contributing to high acculturative stress among international students.

Keywords: Social Support, Psychological Adjustment, Acculturative Stress, and International Students

Cite this paper: Blesslove Nimako Pinamang, Ohene Bobie-Nimako, Williams Kwasi Peprah, Simon Akwasi Osei, Fiskvik Boahemaa Antwi, Nana Owusu Nimako, Elvis Agyenim-Boateng, Social Support, Psychological Adjustment, and Acculturative Stress among International Students in Baguio City of the Philippines, International Journal of Nursing Science, Vol. 11 No. 1, 2021, pp. 1-7. doi: 10.5923/j.nursing.20211101.01.

1. Introduction

Globally, international education is becoming a vital part of higher education as students strive to fulfill personal, familial, and career goals in other countries. According to Peprah (2018), due to quality education, students pursue foreign education and look for programs and courses that do not exist in their universities or home country. However, Ra and Trusty (2017) posit that acculturation problems accompany this transit, and cross-cultural living becomes a critical challenge that international students face in host countries. This acculturative stress occurs as a result of the numerous and constant adaptation to a variety of continual changes (Lee, Nezu & Nezu, 2018), adjusting to a different culture, the physical and social environment, achieving proficiency in a new language, academic demands, climate, food, social norms, among others and the need to overcome feelings of isolation and acculturative stress (Li & Li, 2017).
According to data from the UNESCO Institute of Statistics, global international student mobility increased from 2 million to 4.8 million between 2000 and 2016 (UNESCO, 2018). In the Philippines, higher education internationalization has recently developed rapidly, making the country one of the world's leading study destinations, attracting many students abroad (Dotong, & Laguador, 2015; Peprah, Balila, Mbokani, Evinta & Riziki, 2019). According to Take and Shoraku (2018) and Olson and Banjong (2016), the number of international students studying abroad doubles year after year.
International students leave their home country to move to another to learn as foreign people (Abdullah, Aziz & Ibrahim, 2014; Nguyen, Le & Meirmanov, 2019). According to the Organization for Economic Co-operation and Development (OECD, 2016), the number of international has increased by 50% globally from 2005 to 2016, and they estimated the number to be around five million international students. In Southeastern Asia, like the Philippines, according to the report by the Bureau of Immigration (2018) total of 18,713 Special Study Permit (SSP) for primary and secondary school, short courses, non-degree, international students, undergraduate students, and 14,848 transfers and extensions for undergraduate and postgraduate courses have been provided in 2017 alone which comprise of 65 different countries.
While most international students adapt reasonably well to the host culture and academic institutions demands, many are likely to experience acculturative stress, racism, and reduced access to their usual support system (Thomas & Sumathi, 2016; Qi, Wang, Pincus & Wu, 2018; Nasirudeen & Josephine, 2019). Studies have reported that these changes and differences may affect such students' mental health, resulting in depression, anxiety, and other psychological problems (Sullivan & Kashubeck-West, 2015; Liu, Y., Chen, Li, Yu, Wang & Yan, 2016; Gebregergis, 2018). The World Health Organization (WHO, 2014) defines mental health as a state of well-being in which each person understands his or her potential, can cope with everyday life pressures, work productively and fruitfully, and contribute to society.
According to Sullivan and Kashubeck-West (2015), acculturative stress is a reduction in the mental health and well-being of ethnic minorities that occurs during the process of adaptation to a new culture. Studies show that international students experience more mental health problems such as depression and anxiety than local students, and globally, a more significant number of international students report high levels of acculturative stress-related psychological problems (Marino, Montalbo & Bugtong, 2017; Gebregergis, 2018; Nasirudeen & Josephine, 2019).
A study by Bai (2016) measured levels of acculturative stress among international students in a midsize U. S. Midwestern University and investigated the predictors of acculturative stress. In a descriptive correlational study, 186 students participated through an online survey, and results indicated that international students demonstrated high levels of acculturative stress, which affected not only their mental health but also their academic performance. The predictor of acculturative stress in this study found social support as it was the only significant predictor.
Gebregergis (2018) in Wuhan, China, explored the significant causes of acculturative stress and their relations to socio-demographic factors and depression among international students using a correlational descriptive study design. Utilizing the Acculturative Stress for International Students Scale and a Center for Epidemiological Studies Depression Scale, 506 international students participated in the study. This study delineated that culture shock, discrimination, prejudice, and homesickness were the leading factors of acculturative stress among the students. Participants' marital status, age, Chinese language proficiency, educational level, friendship with local students, prior travel experience, and financial support source were also significant to their acculturative stress scores.
Lee et al. (2018) explored the perceived cultural stress among 107 foreign Korean American students and their connection to social problem solving and depressive symptoms. A descriptive correlational study revealed a high level of acculturative stress, and hierarchical regression analysis showed that acculturative stress significantly predicted depressive symptoms among respondents. Sources of acculturative stress identified in this study included financial challenges, educational stressors, cultural distance, and religion. This study concluded that international students experience high-stress levels in their host countries, which influences their physical, emotional, and psychological health, resulting in the exhibition of behaviors such as alienation, heightened psychosomatic symptoms, anxiety, marginalization, depression, and identity confusion.
In the Philippines, research works on International students' mental health problems such as acculturative stress and psychological adjustments are significantly limited (Marino et al., 2017). A literature search suggests no published studies on acculturative stress among international students in the Philippines. This study has identified a paucity in the literature that examines the overall acculturative stress perceived by international students in the Philippines and its relationship to other variables.
The second literature gap involves social support, which mitigates acculturative stress and psychological adjustment, resulting in acculturation. A few scholars have particularly extensively investigated the relation between acculturative stress, social support, and psychological adjustment (Mesidor & Sly, 2016; Panchang, Dowdy, Kimbro & Gorman, 2016; Ladum & Burkholder, 2019). Although there is a substantial body of indication on the association between social support and psychological adjustment in international students' acculturative process in other settings, there is no relationship between these phenomena among international students in the Philippines. Hence, the second gap of the study.
The purpose of this research is to fill in the gap of understanding acculturative stress among international students in the Philippines and its relationship with social support and psychological adjustments. This study will provide the first in-depth analysis of acculturative stress experiences among international students in the Philippines. The results of this study will offer a framework to develop internationalization policy, intercultural educational programs and implement resource programs, foster strengthened social support network systems in both home and host countries, allow university counseling centers to tailor care to improve mental health and enhance adaptation outcomes. The study answers the following research questions:
1. What is the level of international students'?
a. acculturative stress
b. Social Support
c. Psychological Adjustment
2. Is there a significant relationship between?
a. Psychological adjustment and acculturative stress?
b. Social support and acculturative stress?
Null Hypotheses
1. There will be no significant relationship between:
c. Psychological adjustment and acculturative stress.
d. Social support and acculturative stress.

2. Literature Review

Berry (2017) and Mesidor and Sly (2016) indicated that individuals who go through acculturation should have intercultural interaction with other individuals and undergo four stages of the process of acculturation, including assimilation, marginalization, separation, and integration. According to Lashari, Kaur, and Awang-Hashim (2018) and Pogrebtsova, Craig, Chris, O'shea, and González‐Morales (2018), stressful acculturation experiences can contribute to stress-related development, i.e., positive life changes such as improving personal strength, discovering new life opportunities, developing meaningful relationships, and enhancing spiritual growth and life satisfaction.
On the other hand, individuals may encounter stress labeled as "acculturative stress" and defined by Berry (2017) as a dual cultural and psychological change mechanism that results from the interaction between two or more cultural groups and their members. Cura and Işık (2016) also elucidate it as a type of stress caused by adaptation or acculturation due to a change in the cultural environment in which a person has to make several personal, social, and environmental changes.
Acculturative stress may result in international students' experience of psychological health problems (Li & Li, 2017), cultural identity confusion, strained interpersonal relationship, feeling of isolation, low self-esteem, greater risk of poor academic performance, low quality of life and satisfaction (Lowinger, He, Lin, & Chang, 2014). Most frequently documented acculturative stressors encountered as challenging as international students attempt to adjust to the host culture include homesickness, discrimination, and prejudice, isolation or alienation, loss of social support, among others (Thomas & Sumathi, 2018).
At the individual level, acculturation is the dual cycle of socio-cultural and psychological transition about the host and heritage culture arising from contact with people from different cultures, according to (Jackson, Ray & Bybell, 2019). Lashari et al. (2018) posit that individuals need to use positive coping mechanisms to deal with acculturation stress and its accompanying stressors.
As one of the effects of acculturation, psychological adaptation demonstrates the psychological changes that international students undergo during the acculturation process (Jackson et al., 2019). Psychological adjustment is a central result of acculturation, which refers to feelings of well-being and life satisfaction in adjustment to the host culture, and the vital acculturative condition is social support, as identified in a previous study (Nailevna, 2017). Psychological acculturation change links to the affective dimension of acculturating to a new cultural setting and involves depression, anxiety, self-esteem, and life satisfaction (Ward & Geeraert, 2016).
Nailevna (2017) examined the acculturation and psychological adjustment of international students in the Elabuga Institute of Kazan Federal University. Among 180 international students using the Acculturative Stress Scale for International Students (ASSIS) and psychological adjustment scale, results indicated that participants experienced moderate to high levels of acculturative stress, which significantly impacted their psychological well-being; low reported levels of psychological adjustment.
In the works of literature, the level of acculturative stress and psychological adjustment depends on personal characteristics (e.g., age, gender, personality), social variables (education status, course of study, the continent of origin, marital status, sources of financial support, coping styles) and situational contexts such as social support, stressful situations (Akhtar & Kröner-Herwig, 2015). According to Ozer (2015), an internal locus of control, humor, and relationship satisfaction mitigate the stressors encountered as an international student.
Social support is the most frequently studied social factor in international student-focused research and one of the reported predictors of psychological adaptation outcomes, including acculturative stress (Bierwiaczonek & Waldzus, 2016). In terms of Berry's 1997 acculturation framework, as cited in a study by Ladum and Burkholder (2019), Social support can buffer the extent to which the cultural distance characterizing acculturation experiences is assessed as stressful in the acculturation process earlier, thereby reducing the immediate effects of stress and improving the long-term outcomes of adaptation.
Forbush and Foucault-Welles (2016) defines social support as providing both psychological and tangible resources to satisfy an individual's need for concern, approval, belonging, and security. According to Hamamura and Laird (2014), it can be challenging to develop new social support systems in the host country for international students who risk social isolation that impairs their psychological well-being. Rui and Wang (2015) posit that having broader social support networks, such as those developed through social networking sites, has been linked to better adaptation among international students and an essential factor during the cross-cultural transition and intercultural education.
Studies by Rui and Wang (2015) and Van Gorp, Boroş, Bracke, and Stevens (2017) show that social support is a positive coping mechanism for dealing with stress and adjusting psychologically by enhancing functioning and acts as a buffer against adverse outcomes. Unfortunately, international students with the highest cultural distance rates and thus most need social support struggle to receive adequate social support, thus depriving them of a valuable social tool for managing stressors (Mesidor & Sly, 2016).
Van Gorp et al. (2017) identified two types of social support; objective social support, which is measured by self-reports of either the actual social support provided or the size of the social network of the person, and subjective social support, which is generally measured as either perceived social support or a sense of social inclusion or connectedness. Unlike the objective assessment of the actual support received by others, subjectively assessed social support probes the individual recipient's expectations and interpretations (Bender, Van Osch, Sleegers & Ye, 2019).
Lashari et al. (2018) identified social support sources to include host social networks, academic peer groups, student support services, university support, close family and friend relationships, informal interactions with faculty, and personal tutorials. According to Van Gorp et al. (2017) and Lashari et al. (2018), these sources provide an individual with the means to deal with stress and tension originating from new cultures. For instance, behaviors such as active listening, demonstrating empathy, and warmth support an individual's well-being and facilitates the academic, behavioral, and emotional changes of international students (Pang, 2018).
In an empirical study, Thomas and Sumathi (2016) examined acculturative stress and social support among 100 international students in India. Using a purposive sampling technique, researchers collected data through an online survey using a questionnaire. Results showed that social support from family, friends, and significant others had a significant relationship with acculturative stress. Researchers concluded that social support benefits international students in reducing tension and stress.
Another study by Sullivan and Kashubeck-West (2015), which examined the relationship between acculturation modes, social support, and acculturative stress among 104 graduate and undergraduate international students in a medium-sized public university in The Midwestern United States, found that international students encountered lower rates of acculturative stress with strong social support and an integrated approach to acculturation. Researchers concluded that social support is an essential factor in cross-cultural living and improves the psychological well- being of international students.
In the United States, Korean students with higher social support levels were substantially less likely to experience physical and psychological symptoms with higher stress rates than students with lower social support levels, as found by Ra, 2016. In another study, social support buffered the adverse effects of acculturative stress on depression among Chinese students in the United States (Du, Li, Lin & Tam, 2015).
Social support appears to be becoming more valuable during adversity. Given the multitude of challenges facing international students, it is crucial to see whether there is a similar difference in the relationship between social support and positive and negative psychological adjustment and acculturative stress (Bender et al., 2019).

3. Methodology

This study adopted a descriptive-correlational design to study acculturative stress, social support, and psychological adjustment among international students in Baguio City of the Philippines. The study utilized parametric inferential statistics by relying on regression analysis in SPSS and central tendency for the descriptive results. The study used 125 international students who were conveniently sampled and contacted with online distributed self-constructed questionnaires for them to answer. Based on the Cronbach alpha, the instrument validity showed social support as 0.78, psychological adjustment of 0.86, and acculturative stress as it was 0.82.
Figure 1. Conceptual Framework
The items in the questionnaire were assessed using a Likert-type4-point scale, based on the recommendation of Vagias (2006) Likert scale, which ranged from Strongly Agree-4, Agree-3, Disagree-2, and Strongly Disagree-1. Cohen (1998) used absolute correlation values in evaluating the strength of the relationship, where r=.10 to .29 means weak, r=.30 to .49 means moderate, and r=.50 to 1.0, meaning high; were used. In the distribution, the study observed all ethical principles considerations.
Table 1. Scoring System table for Acculturative Stress, Social Support, and Psychological Adjustment

4. Results and Discussions

The respondents' demography was made of females 76(60.8%), males 49(39.2%). Also, 52% were graduate students, and 48% were undergraduates' students. It had African 54(43.20%), Asians excluding Filipinos 44(35.20%), North Americans 20(16%), South Americans 2 (1.6%), Europeans 2(1.6%), and others 3(2.4%).
The research questions looked at the level, and extent of the acculturative stress, social support, and psychological adjustments amount to international students. The study revealed that acculturative stress is very high (M=3.830, SD = .1892), social support is low (M=2.094, SD = .2377) and the psychological adjustment is also very high (M=3.331, SD = .1354) as shown in table 2.
Table 2. Descriptive Statistics (N=125)
These results imply that international students in Baguio city admit to very high acculturative stress and reported low social support. However, they have a very high psychological adjustment. This finding is supported by Bai (2016), Gebregergis (2018), and Lee et al. (2018), as discussed in the literature of this study.
Also, the study investigated the relationship between acculturative stress, social support, and psychological adjustment. The study resulted in a moderately negative significant relationship between psychological adjustment and acculturative stress (r=-.380, p= .023), as shown in table 3. This study revealed that, as international students increase their psychological adjustment, they lessen their acculturative stress moderately. This result implies that international students apply other psychological approaches to manage their acculturative stress as they reported high psychological adjustments. Results of this study support a study by Nailevna (2017), which examined acculturation and psychological adjustment of international students in Elabuga Institute of Kazan Federal University, where the participants experienced moderate to high levels of acculturative stress, which had a significant impact on their psychological well-being as they reported low levels of psychological well- being.
Table 3
Furthermore, when it comes to the social support associated with psychological adjustment, the study revealed a highly negative significant relationship between social support and acculturative stress (r = -.607, p= .003) shown in table 3 above. The meaning of this result is that as social support increases, the acculturative stress of the international students in Baguio City highly decreases. The international students rely highly on social support to adjust. Studies by Rui and Wang (2015) and Van Gorp et al. (2017) showed that social support is a positive coping mechanism for dealing with stress and adjusting psychologically by enhancing functioning and acts as a buffer against adverse outcomes; support this result. Social support also hurts acculturative stress on depression among Chinese students in the United States (Du et al., 2015). The study has rejected the null hypotheses in a nutshell, stating that there is no significant relationship between social support, psychological adjustment, and acculturative stress.

5. Conclusions and Recommendations

The study sought to investigate the extent and relationship between social support, psychological adjustment, and acculturative stress among international students in Baguio City, Philippines. The results revealed very high acculturative stress and psychological adjustment, and low social support to aid the adjustment. Also, there were moderately negative significant relationships between psychological adjustment and acculturative stress and a highly negative significant relationship between social support and acculturative stress. The study recommends that international students engage in activities to improve their social support and find other psychological adjustment mechanisms to manage acculturative stress. Future research studies can investigate the sources of social support and other factors contributing to the high level of acculturative stress among international students.


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