Topic: Impact of Migration on Mental Health of International Students across the UK

Topic: Impact of Migration on Mental Health of International Students across the UK

Dissertation 2023

Declaration

I declare that this piece of work is completely and solely performed by me, and this assignment is my own original work and that I have read and understood the regulations in the student handbook concerning plagiarism. All resources that are used in this study have been properly cited and acknowledged furthermore I have adhered to the university guidelines, and I totally understand that any breach in academic integrity or non-ethical conduct in the completion of my dissertation may result in disciplinary action and can affect my degree.

Acknowledgement

I would like to express my heartfelt gratitude to my supervisor Katie Taenas who supported me and guided me with her valuable feedback that how can I improve this piece of work. Here I would like to thank to our coordinator Elisabetta Corvo and academic writer Bojan for their guidance furthermore I want to praise and appreciate the faculty members and staff especially our librarians Michelle and Katie and to our student support staff Brendan and Ianthe and the wellbeing team and Mrs Lin Irwin it was not possible without their efforts and motivation and most importantly to my parents it was their consistent efforts that I get the motivation which helped me to complete my work on time. Moreover, I would like to thank the university of Christ church for their amazing research facilities, their library resources and conductive academic environment that help me in completion of my research.

Abstract

The purpose of this study was to evaluate the impact of migration on mental health of international students. The focus of this study is on students migrating to UK for higher education. A total number of 15 articles were included in the review between 2014 -2023. Four major databases Google Scholar, Cochrane Library and PubMed and web of science were searched for relevant studies. Qualitative and Quantitative studies were included in this review. The study of this review demonstrated the presence of depression, stress and anxiety among migrants students studying in the UK. Stress was found to be the most common mental health issues faced by international students in the UK, followed by anxiety and depression. The review also highlighted some major sources of stress faced by international students which include financial stress, language, stress, academic stress, social isolation and discrimination. This review will illustrate about the findings that the international students do suffer from mental health furthermore it will summarize key findings and will emphasize on the implications and will contribute the understanding of the challenges faced by international students.

Keywords: migration, mental health, international students, stress, depression, anxiety, UK.

Table of Contents

TOC o "1-3" h z u Introduction PAGEREF _Toc146148353 h 7Background Literature Study PAGEREF _Toc146148354 h 8Migration PAGEREF _Toc146148355 h 9Economic Migration PAGEREF _Toc146148356 h 10Educational Migration PAGEREF _Toc146148357 h 10Migration and Health PAGEREF _Toc146148358 h 11International Students PAGEREF _Toc146148359 h 12Mental Health PAGEREF _Toc146148360 h 13Mental Health Problems Faced by international students PAGEREF _Toc146148361 h 14Factors Helping Protect Poor Mental Health Outcome for international students PAGEREF _Toc146148362 h 16Resilience for international students PAGEREF _Toc146148363 h 16Religious Faith for international students PAGEREF _Toc146148364 h 17Social Support for international students PAGEREF _Toc146148365 h 17Impact of Migration on Well-being and Mental Health of International Students PAGEREF _Toc146148366 h 18Migration and Challenges for International Students PAGEREF _Toc146148367 h Interventions and Policies to Reduce Problems of Mental Health PAGEREF _Toc146148368 h 19Extensive Orientation Programs PAGEREF _Toc146148369 h 20Supportive Community Building PAGEREF _Toc146148370 h 20Training programs and workshops PAGEREF _Toc146148371 h 20Community Organizations and Their Collaboration PAGEREF _Toc146148372 h 20Gap in the Literature PAGEREF _Toc146148373 h 21Research Questions, Aims and Objectives of the Study PAGEREF _Toc146148374 h Research QuestionsResearch AimsResearch Objectives PAGEREF _Toc146148377 h .Methodology, Methods and Data Analysis PAGEREF _Toc146148378 h 22Research Design PAGEREF _Toc146148379 h 22Keywords Strategy PAGEREF _Toc146148380 h 23Databases PAGEREF _Toc146148381 h 23Inclusion and Exclusion PAGEREF _Toc146148382 h 24Data Collection PAGEREF _Toc146148383 h 24Data Analysis PAGEREF _Toc146148384 h 25Quality Appraisal PAGEREF _Toc146148385 h 25Themes PAGEREF _Toc146148386 h 27Ethical Implications PAGEREF _Toc146148387 h 29Results PAGEREF _Toc146148388 h 30Mental Health Issues PAGEREF _Toc146148390 h 31Data Synthesis PAGEREF _Toc146148391 h 33Description of Findings PAGEREF _Toc146148392 h 41Migration and Mental Health Among International Students PAGEREF _Toc146148393 h 41Stress, Depression and Anxiety PAGEREF _Toc146148394 h 41Discussion and Analysis PAGEREF _Toc146148395 h 51Key Findings and Themes PAGEREF _Toc146148396 h 51Themes One: Stress Among International Students PAGEREF _Toc146148397 h 51Theme Two: Depression among International Students PAGEREF _Toc146148398 h 53Theme Three: Anxiety among International Students PAGEREF _Toc146148399 h 54Conclusion PAGEREF _Toc146148400 h 56Study Limitations PAGEREF _Toc146148401 h 57Implications PAGEREF _Toc146148402 h 59.References PAGEREF _Toc146148403 h 62

List of Tables

TOC h z c "Table" Table 1: Table of data synthesis PAGEREF _Toc146198380 h 40

IntroductionIn recent decades, the increasing globalization of education has led to surge in the number of international students pursuing higher education in the United Kingdom. While this trend offers numerous benefits in terms of cultural exchange and diversity, it also brings forth a critical concern for the mental health of these international students. This study seeks to delve into multifaceted relationship between migration and mental health, with a specific focus on the experience of international students within UK. Through an exploration of the challenges they face, the support system available, potential interventions, this research aims to contribute valuable insights to the intersection of migration studies and mental health discourse.

Compared to home students, international students are experiencing more obstacles to maintain their mental health condition. They are more prone to sadness, stress, and anxiety (Brunsting et al., 2018). The migration of international students is intricately linked with global migration on various level one of the reasons is it reflects the broader trend of increasing global mobility, where students pursue educational opportunity beyond their home country.

During 2020, there were around 4.4 million international students, accounting for 10% of all tertiary students. The ratio of receiving countries were united states (22%), UK (13%), and Australia (10%). Though the destinations of international students have expanded during the past decades, the main countries of origin are China (22%) and India (10%) (OECD, 2022).

The reason for this study is important for diversity and globalization, wellbeing of a vulnerable population, Academic success and retention, policy development, social integration, cultural competence in education, global reputation of educational institutions and for long term impact on individuals(berry, J. W. (2005) it is essential to understand the impact on scientific knowledge for migration and mental health of international students in UK for the identification of patterns and trend and for the cultural specificity moreover the study influences policies at institutional and government levels. It provides the basis for creating policies that prioritize mental health support for international students in the UK. (Misra, R., Crist, M., & Burant, C. J.(2003).

Figure SEQ Figure * ARABIC 1: Migrants across the world (International Organization for Migration, 2022).Background Literature StudyThe literature on migration and mental health among international students in the UK highlights the complex interplay of various factors influencing their psychological wellbeing. Numerous studies have underscored the significance of acculturation stress as a primary contributor to mental health challenges (Berry,2005). As individuals navigate a new cultural context, the process of adapting to unfamiliar norms and values can lead to heightened stress levels and psychological strain (Ward, Bochner, &Furnham2011). Social support emerges as crucial mitigating factor in this context. Albeit the potential challenges, international students often rely on social networks for coping mechanisms (Wei, Liao, Ku & Shaffer,2010). The role of academic stressors cannot be understated, with academic pressures contributing to heightened stress and anxiety levels (Misra & Castillo, 2004).

Moreover, studies such as b ying, Lee and Tsai (2000) emphasize the importance of cultural identity in influencing mental health outcomes among international students. The preservation of adaptation of ones cultural identity may act as a protective factor or a source of stress, depending on the individuals approach. Notably, the available support systems, including counselling services and cultural adaptation programs, play a pivotal role in shaping the mental health trajectories of international students (Smith & Khawaja, 2011). However, the efficacy of these interventions may vary, necessitating a nuanced examination of their impact on diverse student populations.

As this dissertation aims to contribute the existing knowledge base, it will delve into these aspects, examining the nuanced relationships between migration, cultural adaptation, academic pressures, social support and the mental health of international students in the UK. Though a comprehensive review of the literature, this research seeks to offer a deeper understanding of the challenges and potential interventions in this critical intersection of migration studies and mental health discourse.

MigrationMigration, the movement of individuals or groups from one place to another, is a multifaceted phenomenon with significant social, economic and cultural implications. According to Lynette Nazareth she said, moving is a challenge and in that space very often they dont say goodbye (@whiteswan foundation. Org). Ever since human emerged, they have always moved around migrating from one place to other for several reasons (Mendenhall and Holmes, 2021). In an era of globalization and rapid urbanization, it is inevitable that people would migrate within the country and across national boundaries (Mendenhall and Holmes 2021). Some of the reasons for primary comprise of political, economic and educational reasons. Moreover, the mental health implications of migration are a growing area of research. Individuals undergoing migration may face acculturation stress, identity, challenges and social isolation impacting their psychological wellbeing. Understanding this dynamic is crucial for developing supportive policies and interventions for migrant populations.

Types of migration:

Migration can be categorized into various types based on different criteria some of the types are internal migration, international migration, voluntary and forced migration, seasonal migration chain migration, step migration, return migration, circular migration, transnational migration, labor migration, family reunification and student migration. These types of migration highlight the circumstances that are the reasons for the people to move from their origin and destination regions.

Economic MigrationEconomic migration, driven primarily by the pursuit of better economic opportunities plays a central role in shaping global demographic and labour markets. Understanding the dynamic of economic migration is crucial for policy makers, researchers and societies to create informed policies that address both the opportunities and challenges associated with this form of migration Stark, & Bloom, D. E (1985). Economic migration refers to the movement of individuals or groups across geographic borders or within a country with the primary goal of improving their economic prospects. The causes for economic migration can be employment opportunities, wage disparities, quality of life, economic inequality, globalization, political stability, government policies.

the decision regarding whether and where to migrate are associated with the presence of income and utility differences among places. However, these models have been criticised for not explaining why people do not migrate irrespective of sever income differences (Hagen-Zanker, 2008; Brown and Neuberger, 2014). Skeldon (2021) conducted an empirical analysis on drivers or causes of migration and it was found that economic and sociocultural factors outnumbered other factors. Worsening financial circumstances often persuade individuals to migrate to other countries (Kunuroglu et al., 2017). Short-term and medium-term variations and variations in economic situations such as gross domestic product (GDP) and the business cycle of country are major drivers for migration (Beine et al., 2018).

Educational MigrationEducational migration refers to the movement of individuals across geographic boundaries or within a country for the primary purpose of pursuing academic opportunities. This type of migration is characterized by the individuals seeking educational experiences at various levels from primary, secondary and tertiary or higher education. Motivations for educational migration can include access to quality education, specialized academic programs, cultural exposure, language acquisition and the pursuit of academic or career goals. International students often engage in educational migration, contributing to the globalization of education and fostering cross cultural exchanges. Understanding educational migration involves examining the push and pull factors that influence individuals decision to pursue educational opportunities abroad, as well as the impact of this migration on both the sending and receiving societies. Findlay, A. M., King, R., Smith, f. m., Geddes, A., & skeldon, R (2012). People migrate for education for various reasons some reasons that are quality of education, specialized programs, cultural exposure, language acquisition and career opportunities. For data statistics the reliable sources are organization for economic cooperation and development (OECD), UNESCO institute for statistics, world bank and national statistical offices for educational migration.

Migration and HealthWhile searching for dissertation I have gown through a webinar for migration and mental health which was published by an international health authority (WHO Regional office for Europe) so in that webinar there were different speakers who spoke about myths and reality of migrants. Guglielmo shining said about migrants that they come from middle income countries to high income countries in search of better opportunities. He further said that migrants are vulnerable and create public health threat if they are traumatized, they traumatized us. In that same webinar another speaker Essam Daoud talked about gender base approach to mental health and about depression in men that they dont talk about it, and he further talked about the mentality and cultural background especially Syria, Iraq, Greece, and Europe. Moreover, another speaker Fahmy said that in any community even before emergency mild, moderate or severe the percentage of severe cases is 3 to 4 and mild cases is 15 to 20 % wide range of mental health conditions like depression. In short, the summary was not all migrants would have mental health needs, but some do have it. (Who.int/Europe, 2011).

Health issues related to migration are a longstanding issue. However, most of the authors acquired proof that migrants are more healthy than non-migrants, supporting the healthy migrant hypothesis (Lassetter and Callister, 2008; Norredam, 2015). There is also a selection prejudice in migration as people who migrate willingly have healthy lives and lower ratios of chronic disorders (Franzini and Fernandez-Esquer, 2004). Evidence also exists that individuals encounter poor health after migrating voluntarily. One justification for this is the acculturation hypothesis that states that the migrants from cultures having protective health practices often face deteriorating health outcomes (Franzini and Fernandez-Esquer, 2004; Lassetter and Callister, 2008). Migrants often take exhausting and long journeys with lack of access to food, water, and sanitation, which increase the risk of communicable disease especially measles, and food or waterborne diseases. They might also be at risk of burns, accidental injuries, and hypothermia (World Health Organization, 2022).

International StudentsInternational students are people leaving their countries of origin and arrive in another country for study (OECD, 2022). During 2020, around 4.4 million students got enrolled in the OECD countries and more than 1.4 million in European OECD country (OECD). In the similar year, around one in every five (22%) students in the OECD countries studied in the UK, followed by UK and Australia. Irrespective of a minor Decline in domination of these destinations, around 45% of the international studies in 2020 were studying in the above-mentioned top three English speaking countries (OECD, 2022). The major recipient countries in Europe are France and Germany, hosting around 14% of migrant students to OECD and 45% of those studying in a European OECD country. From the topic seven destinations, Canada has witnessed a rise in its popularity among students. In 2020, around 7% of the migrant students were studying in Canada.

Figure SEQ Figure * ARABIC 2: International students in OECD countries (OECD, 2022).Mental Health

Mental health refers to a state of wellbeing that involves emotional, psychological and social aspects. It encompasses an individuals ability to cope with stress, maintain positive relationships, work productively and make informed decisions. Good mental health is not just the absence of mental disorders but also the presence of positive qualities such as resilience, self-esteem and emotional balance American psychiatric Association (2013). Mental health problems can arise from combination of biological, physical and environmental factors.

This section explains the mental health illnesses faced by people migrating to other countries. This study on mental health and issues faced by children and adolescents migrating to different countries. The studies included in this section would help set the background for discussing mental health issues among migrations and how it affects their social, physical and emotional states.

In case of migrants, there are confirmed reports that their mental health remains poor. Darrelle et al., (2021) studied students aged 11,13, and 15 from 29 countries and found that first- and second-generation migrants have greater levels of life disappointment than their local peers, and this relationship varied across schools and countries. They also studied and found the position of social capital as being a moderating factor in the connection among migration and mental condition of adolescents (Darrelle et al., 2021).

Associated to their local peers, migrant children and teenagers are at bigger risk for mental health difficulties. This was found in the study of Gutmann et al., (2019) who compared children and adolescents of Turkish migration environment with their local Austrian peers and found noticeable differences in psychological states of the two groups. It was concluded that migration-associated stress factors are accountable for these variations. This research was significant because it highlighted the differences in psychological issues faced by children and adolescent with and without a migration background. Therefore, it can be assumed that migrated-related stress factors might be accountable for these differences (Gutmann et al., 2019).

Gao et al., (2015) argued that the mental health issues rise with age, with a minor peak among years 6 to 10, and a major peak among year 12 to 16. These frequencies in age are not directly linked with a particular mental issue. Externalizing and internalizing issues and behavioral difficulties are more seen in adolescents as compared to young children (Janssen, et al., 2004). Major depression is more repeatedly seen in adolescents than in children (Kessler, et al., 2001). Cadenas et al., (2022) studied around 501 immigrant students, with 114 with temporary immigration types and found that temporary immigration status was linked to lower positive mental health, and higher anxiety. These studies demonstrated that mental health disorders increase with age so it can be assumed that when an adolescent reach the adult phase, they would be more likely to have mental issues.

Transnational cross-sectional research made across six nations by Gatt et al., (2020) explored wellbeing and mental well-being behaviors in migrant and non-migrant adolescents. This research used a survey design with a convenience sample of 194 ten to seventeen-year-old migrants and non-migrants and was conducted across Australia, New Zealand, UK, China, South Africa, and Canada. This sample comprise of internal as well as external immigrants for the purpose of comparison. Immigrants stated a higher number of traumatic experiences in the past year than the non-migrant population (Gatt et al., 2020).

The research by Gao et al., (2015) explored the health status of a group of 1,466 children of immigrant workforce in Beijing, China. The students belonged to both public and private area school locations. Their research found that generally, immigrant children stated more internalizing and externalizing mental health challenges and decrease life satisfaction than native peers.

Migration has demonstrated to have harmful impacts on health of immigrant students (Cemalcilar & Falbo, 2008). Irrespective of a huge number of international student admissions, studies on migration of international students, mobility and their mental condition are limited (Skromanis, et al., 2018). Gan and Forbes-Mewett (2019) looked at the issues faced by immigrant students during replacement and adjustment. They interviewed international Singaporean university students in Melbourne, Australia, aged between 20 and 25 years and found that immigrant students often require to adapt to an unacquainted setting whereas at the same time dealing with their education without support from their family. Intercultural adjustment is traumatic for these students, consequently adding to higher risk of a susceptible mental and emotional state. This research also emphasized the high incidence of unawareness among students on the concept of mental health and available services.

Mental Health Problems Faced by international students.

This section explains the mental health illnesses faced by people migrating to other countries. This study includes studies on mental health issues faced by university students migrating to different countries. The studies included in this section would help set the background for discussing mental health issues among migrations and how it affects their social, physical and emotional states.

In case of international students, there are confirmed reports that their mental health remains poor. Darelle et al., (2021) Associated to their local peers, university students are at bigger risk for mental health difficulties.

Major depression is more repeatedly seen in adolescents than in children (Kessler, et al., 2001). Cadenas et al., (2022) studied around 501 international students, with 114 with temporary migration types and found that temporary migration status was linked to lower positive mental health, and higher anxiety. These studies demonstrated that mental health disorders increase with age so it can be assumed that when an adolescent reach the adult phase, they would be more likely to have mental issues.

Transnational cross-sectional research made across six nations by Gatt et al., (2020) explored wellbeing and mental well-being behaviours in migrant and non-migrant students. This research used a survey design with a convenience sample of 194 ten to seventeen-year-old migrants and non-migrants and was conducted across Australia, New Zealand, UK, China, South Africa, and Canada (Gatt et al., 2020).

Migration has demonstrated to have harmful impacts on health of international students (Cemalcilar & Falbo, 2008). Irrespective of a huge number of international student admissions, studies on migration of international students, mobility and their mental condition are limited (Skromanis, et al., 2018). Gan and Forbes-Mewett (2019) looked at the issues faced by international students during replacement and adjustment. They interviewed international Singaporean university students in Melbourne, Australia, aged between 20 and 25 years and found that international students often require to adapt to an unacquainted setting whereas at the same time dealing with their education without support from their family. Intercultural adjustment is traumatic for these students, consequently adding to higher risk of a susceptible mental and emotional state. This research also emphasized the high incidence of unawareness among students on the concept of mental health and available services.

Conditions that cause mental health issues

There are some people who are happy, and some are sad so it depends on their mood and personality and that make them depressed, or anxious (Allan V. Horwitz) Mental health can arise due to many factors that include biological, social, environmental factors. Some of the common cause that can lead to mental health issues can be brain chemistry, traumatic life events, substance abuse, family environment, social isolation, grief and loss, childhood experience, financial hardship, environmental factors, lack of access of healthcare. One of the causes is inequality that leads to mental health issue.

Inequality of international students

The inequalities that are experienced by international students living in the UK are multifaceted and can be observed in different aspects for instance economic inequalities for international students in that case they often face higher tuition fees compared to home students, contributing to financial strain.(Altbach, p. G.,& Knight, J. (2007).another example is social inequalities which is the result for social isolation due to culture or language barriers (Ward, C., Masgoret, A. M.(2004)furthermore there are mental health and legal inequalities so the international students often experience high level stress, depression and anxiety due to academic as well as cultural challenges.( Mori, S.(2000) and as far as legal inequalities is concerned so the variation in policies and visa regulation create uncertainties and challenges for international students. (Findlay, A. M., & Li, F. l. n. (1996).

Factors Helping Protect Poor Mental Health Outcome for international students.

There are many factors that promote the wellbeing and help to overcome poor mental health issues those factors are social networking, cultural sensitivity, access to healthcare, mental health awareness campaigns, training for education, counselling therapies. Religious faith, resilience and social support so here I would discuss few of them.

Resilience for international students

Resilience is explained as an active progression for adaptation, that outcomes in good consequences regardless of having faced adversity (Rutter, 2013). In other descriptions, resilience is considered as an innate trait or the result of defeating adversity (Fritz et al., 2018). Though international students are at a higher risk for growing mental disorders. Resilience, which is explained as the capability of an individual to adjust to and retrieve from traumatic and disturbing experiences, is highlighted as a potential protective factor (Siriwardhana et al., 2014). Despite getting exposed to traumatic experiences, not all international students demonstrate mental health issues, hence presenting resilience (Cicchetti, 2010; Masten, 2011). Till today, not much is acknowledged about mental health strength in migrant population, particularly in those who migrated from Middle East to European countries (Schlechter et al., 2021).

Religious Faith for international students

Another protecting factors for international students might be their religious faith as identified by different studies (Elsass and Phuntsok, 2009; Leaman and Gee, 2012; Reed et al., 2012). One qualitative research has found that spirituality has appeared continually as a basis of spiritual resilience (McGraw, 2016). In one qualitative study including 27 mothers from Syrian refugee camps in Syria and Turkey explained a positive impact of Islam on their mental health (El-Khani et al., 2017). According to these participants, it was their faith which helped them in accepting the situation, removed control and responsibility from them and their faith in Allah was a source of hope for them (El-Khani et al., 2017). Furthermore, praying is also considered as a coping strategy for international students in different studies (Ai et al., 2005; Schweitzer et al., 2007).

Social Support for international students

According to Lazarus and Folkman (1984) social support is explained as the interactions which occur in social relationships, especially the way they are evaluated by the person as to their supportiveness. Studies have proved that social assistance could decrease mental depression and anxiety (Constantine et al., 2005) and certainly add towards academic accomplishment in international students (DeBerard et al., 2004). In research conducted on international students in Denmark, mental health issues reduced with time with the increase in social support (Montgomery, 2010). Consequently, providing active support or allowing international students to develop social links would in theory help decrease emotional distress. However, more research is needed to appreciate the benefits of psychological distress (Schlechter et al., 2021).

The combination of resilience, faith and social support forms a holistic approach to promote the health of international students in the UK. By enhancing these protective factors, educational institution can contribute in an environment that encourages the wellbeing of diverse student population.

Impact of Migration and Mental Health on International StudentsMigration can significantly impact the well-being and mental health of international students (Raghuram and Sondhi, 2022). The whole process of changing the country for the purpose of education and settling into an unfamiliar place or environment can be stressful and challenging for students. According to Humphrey and Forbes-Mewett (2021. Initially, the adjustment process to the new social, academic, and cultural environment can lead to feelings of loneliness, isolation, and homesickness (Humphrey and Forbes-Mewett, 2021). The experience of international students is often linked to the disconnection from their friends, family, and home country. Furthermore, Cheng (2021) stated that the loss of familiar social connections and support networks could result in isolation feelings that can cause challenges and issues for students who do not have strong support in another country.

Gan and Forbes-Mewett (2019) investigated the evidence and informed that academic issues or academic challenges, for instance, the pressure of performing better in studies, can also impact international students mental health. Moreover, Ploner and Nada (2020) mentioned that differences in the educational system and language barriers could make it challenging and difficult for students to meet the expectations of academic requirements. Gan and Forbes-Mewett (2019) added that international students often feel stressed and anxious due to their coursework load and change in educational criteria in their host country. Academic underperformance and fear of failure can also impact the mental health of international students severely.

According to Riao and Piguet (2016), another challenge that is one of the main challenges international students face after leaving their home country is financial concerns. This issue mainly contributes to the mental health of the students to meet the financial requirements. It is noted that different students rely on part-time jobs, scholarships, and family support in terms of financial support to fulfill their educational as well as basic needs (Ploner and Nada, 2020). Usually, in host countries, financial, educational, and living expenses are different from the expenses of the home country. This causes tension in the mind of international students, and the pressure of educational and financial needs impact their mental health and well-being. Consequently, Gan and Forbes-Mewett (2019) mentioned that there are limited opportunities for jobs, strict work permit policies, and high fees and tuition can make it a major challenge for international students to meet their financial requirements. This financial stress and challenge can put an additional burden on their mental health, which can lead to increased depression and anxiety levels (Ploner and Nada, 2020).

Humphrey and Forbes-Mewett (2021) mentioned and elaborated that another main challenge faced by international students is racism and discrimination, which impact their mental health negatively. These racism and discrimination experiences can contribute to the feeling of low self-esteem and exclusion. In the long-term impact, the psychological health of the students in the host country (Cheng, 2021; Gan and Forbes-Mewett, 2019).

Ploner and Nada (2020) instigated and explained that access to the services of mental health is another important challenge for international students, which impacts their mental health. It is explained by Riao and Piguet (2016) that lack of awareness and language barriers regarding the services for mental health is other reasons why international students dont get proper services. However, the access to the international student after the migration is lower compared to the national student due to lack of awareness.

Interventions and Policies to Reduce Problems of Mental HealthThere are different interventions and policies for international students to deal with their mental health issues. Riao and Piguet (2016) investigated the evidence and informed that educational institutes are also implementing various policies to deal with international students well-being. Institutes and policymakers aim to create an inclusive and supportive environment for the student who leaves their home country to get better educational facilities in the host country. Some main interventions and policies are:

Extensive Orientation ProgramsThere are comprehensive orientation programs introduced by institutes tailored specifically for international students. Such programs provide support for students and provide necessary information related to services, coping strategies, and cultural adaptation (Riao and Piguet, 2016). The institutions will equip international students with the necessary skills and knowledge it can help to reduce the stress and anxiety linked with their migration process (Cheng, 2021).

Supportive Community BuildingEstablishing mentorship programs and international student associations can stand in the supportive community. These supportive programs and communities provide opportunities for international students to connect with colleagues, peers, and the local community who share different challenges and experiences. Cao (2021) stated that mentors can offer support, guidance, and practical advice to help international student steer their changed environment effectively. Humphrey and Forbes-Mewett (2021) added that building a sense of belonging and community can significantly impact which contributes to the well-being of international students.

Training programs and workshopsThe institutes can offer and organize workshops and programs of training which can focus on topics regarding stress management and how to deal with depression, mental health awareness, and coping skills (Gan and Forbes-Mewett, 2019). These workshops and programs can offer practical strategies to deal with such situations and stress management contributing positively to their mental health. Educational institutes also provide necessary resources and tools to cope with the issues that can improve their overall mental health conditions (Riao and Piguet, 2016).

Community Organizations and Their CollaborationThe institutes often collaborate with professionals in mental health to increase support for international students (Cheng, 2021). Different support systems are prepared by institutes, such as language classes, cultural events, and opportunities like community engagement to help international students learn about the cultural norms and social requirements of the host country. Choudaha (2017) explained that mental health professionals and collaborating with them could also play the main role in specialized support systems.

The importance of mental health awareness, barriers, and lacking are discussed and analysed in this literature review. Literature also highlights the challenges an international student face after migration, and strategies of how to cope with such challenges are also mentioned. It is analysed by comparing different research that students, after the migration process, faced various challenges that can lead to depression, anxiety, and stress. However, it is identified that orientation programs, training, and workshops can help students to reduce their mental health issues caused by changes in environment, culture, and country.

While these strategies have positive impact in various contexts, the success of their implementation can vary. Continuous assessment, feedback from students and flexibility in adapting strategies to evolving needs are key factors in ensuring sustained improvement in mental health outcomes for international students in the UK.

Gap in the Literature

Regardless of several research on immigration and mental health, there is still a lack of studies on mental health of migrant students, irrespective of their increased incidence in learning institutes globally. In the year 2019-2020, the UK had about 556,625 international students (UK Council for International Students Affairs, 2020). The literature on identifying and addressing mental health issues of international students is limited and less clear. Thus, this review aimed to fill this gap in the literature and study the effect of migration on mental health of transnational students.

Research Questions, Aims and Objectives of the Study

Research Questions

What is the impact of migration on mental health of international students studying in the UK?

Research Aims

The overreaching aim of this study is to evaluate the impact of migration on mental-health and well-being of international students in UK and responses to it.

Research Objectives

To evaluate the impact of migration on the mental health and well-being of international students?

To highlight some of the challenges faced by international students when migrating to the UK for higher education.

To assess, address and evaluate the policies and interventions available to educational institutes to reduce mental health problems.

To pursuit these objectives the research combines the methods drawn upon qualitative, quantitative, surveys, interview, existing literature.

Methodology, Methods and Data Analysis

In this chapter, the research methodology applied to this study is discussed in detail. This chapter also discusses the research designed being applied to achieve the study objectives. Research strategy and the steps involved in it are also highlighted in this chapter.

Research Design

The research design adopted in this study is literature review. Literature review helps in establishing a reliable evidence base for the research topic. Literature review is explained as a scientific process which is governed by a set of explicit and demanding rules towards demonstrating comprehensiveness, transparency, immunity from bias and accountability of method and execution (Gough et al., 2018). Healthcare decision makers are often looking for the best evidence to inform decisions and they have come to depend on literature review (Gough et al., 2018). Well-conducted literature review recognizes, choose, evaluate, and integrate important research and help make clear what is known and not known (Higgins and Thomas, 2019). Narrative review was not used because they are unsystematic and of less value (Tod, 2019). Literature review was used because literature reviews need to be reinforced by an organized approach else there is a risk of being overly biased (Booth et al., 2016). Using qualitative, quantitative studies, this study aims to collect 15-30 studies on mental health and its impact on international students in UK migrating from different countries.

Keywords Strategy

A keyword search strategy was used in this review. The researcher looked at the databases with the help of different index terms such as migration and mental health. Databases were explored utilizing a blend of terms such as International students mental health and international students in UK and mental health. Other search terms included were mental health, depression, stress, anxiety, psychological distress, AND international students. Boolean operators AND OR were also used to expand and combine the search terms. For example, for international students, keywords such as overseas students OR foreign students OR study abroad OR student sojourner were used. To look for studies on UK, search terms such as UK OR United Kingdom OR Great Britain OR Brit were used.

Databases

Data bases are the collection of information that can be accessed, managed and updated. They are important in order to restore, retrieve, and generate information. Some types of databases are relationship databases, graph database, document database, key value store, time series database, block chain database, cloud database, object database. The selection of database totally relies on the nature of the data and the scale of the application and the specific use case.

One of the major phases in conducting a systematic review is identifying all the relevant literature through databases and removing the duplicates simultaneously recorded by other databases (Qi et al., 2013). However, searching different databases is a time-consuming and laborious process. In this research, four major databases including Google Scholar, Cochrane Library and PubMed and Web of Science were used. Authors have argued that searching only a single database is sufficient as looking for other databases has no effect on the outcome (Rice et al., 2016). This is the reason for selecting more than two databases in this research (Bramer, Giustini and Kramer, 2016). Along with the above-mentioned databases, grey literature was also used in this research. This research highlights the importance of considering grey literature to fill gaps in knowledge and avoid publication bias, ensuring a deeper understanding of the study (Moher et al., 2015).

Inclusion and ExclusionSystematic literature search could result in hundreds of records. Sustained attention to detail is a pre-requisite for recognizing relevant research(Higgins & Green, 2011). Clear, explicit, and well-constructed inclusion and exclusion criteria help in decision making consistency. (Khan, K. S., Ter Riet, G., Popay, J., Nixon, J., Kleijnen, J. (2001) Inclusion/exclusion criteria helps in ensuring the transparency of the review where unambiguous criteria reduce subjectivity in the search and literature selection process (Booth et al., 2016).

Inclusion criteria

The inclusion criteria for this research are studies published during the past 10 years from 2014 to 2023 as the recent data is considered reliable and relevant. This time frame is regarded to have the most up-to-date and accurate information. This review only includes papers for which the complete text is publicly accessible. Age restriction was one of the factors that are 18 and above were considered because this research specifically focused on students that are enrolled in the university. The studies which are published in English language were included in the review. Only studies available full text was included in this review. The studies which addressed the impact of migration on mental health of students migrating to the UK were included in this review because of the policy implications that change according to the latest development Moreover, qualitative, quantitative, and systematic reviews were included in this review.

Exclusion criteria

The articles which were published before 2014 were excluded from this review because the researcher aimed to include studies published in the last 10 years. The articles that were available in other languages such as Chinese or French were excluded from the review because not everyone understand it.

Data Collection

In this research, secondary data collection was implemented. Secondary research involves collecting and analysing data that that has previously been compiled and which already exists. This type of research methodology can be a very useful tool for finding insights, patterns, and trends in data without having to conduct primary research. The first step in the secondary research methodology involves defining the objective or goal of the research. This helps in identifying the kind of data that is relevant and the sources that will be used. Moreover, it helps to determine the kind of useful information to collect and the best places to look for it. In this step, also decide the research questions for the study (Mohajan, 2018). Once the research objective has been defined, the next step is to identify the sources of data. Sources could be data from published research articles and books, government reports, market research reports, and online databases.

Data AnalysisData analysis for research involves processing and interpreted the data that has been collected. In this research the articles that were selected are mixed that are qualitative, quantitative and systemic review. For analysing the qualitative data collected in this research, thematic analysis was applied. The articles were grouped based on the themes identified from them.

Quality Appraisal

The quality of articles included in this review was considered to be of higher quality. For evaluating the quality of studies, CASP tool was used to demonstrate the robustness of the papers and evaluate them for risk of bias. The Critical Appraisal Skills Programme (CASP) tool is the most commonly applied tool for evaluating quality of qualitative evidence. The tool is also suitable for novice researchers, however there is limited guidance available on its application (Long et al., 2020). The main risk of bias related with the studies was the limitation of sample size, emphasize on a sample from a single country (UK) and lack of generalization of results. For instance, Hosseinpur et al. (2023) and Cogan et al., (2023) had smaller sample sizes included in their research and thus their results cannot be generalized.

ThemesThree major themes were noted during the review of selected studies.

Theme Sub-themes Hosseinpur et al., (2023), Cogan et al., (2023) Magnusdottir & Thornicroft, (2022) and Holliman et al., (2022) Saravanan and Subhashini (2021) Ejim, et al., (2021 (Chen & Li, 2020) (Bennouna, et al., 2019) Albarhi & Smith, (2018) and Cheng et al., (2018) Ecochard & Fotheringham, (2017) Adeoye and Evans, (2015)

Akanwa, (2015) Li, et al., (2014), (Lillyman & Bennette, (2014)

Stress Suicidal thoughts

Inadequate finances

Acculturative stress X

x

x x

x x

x

x X x

Depression Lack of finances

Academic stress

Social isolation

X

x X

X

Anxiety Acculturation

Language limitation x

x Ethical ImplicationsResearch in migration and mental health like in different fields require ethical consideration. In any research the ethical implication plays an important role and the considerations for ethical approval are informed consent, respect of autonomy, to make sure privacy and confidentiality, vulnerable population, their cultural competency, the risk related to mental health, community engagement, ethical review, their long term and long lasting impact as well as data sharing and collaboration with the partners is required.

The ethical considerations related to conducting systematic reviews in research are not discussed explicitly (Zawacki-Richter et al., 2019, pp.4154). However, ethical issues related with what and how the reviews are produced and used have serious implications. It is thus important for systematic reviewers to involve in a range of ethical issues related to conflicts of interest and issues of voice and representation (Zawacki-Richter et al., 2019, pp.4154). As systematic reviewers do not involve collection of personal or sensitive information from participants, there is no need to seek an institutional ethics approach before conducting the review.

One of the ethical issues related with this research is publication bias. Publication bias arise when studies are published or not based on their outcomes. However, research suggests that published work is considered as more positively significant than unpublished research (Dwan et al., 2013). Publication bias often results in overestimation and is a threat to validity of review and makes available evidence unreliable (Dwan et al., 2013). Therefore, in this research, only published articles were included to reduce publication bias. All the unpublished articles were excluded from the review. In this research, grey literature was also included to reduce the risk of publication bias and search bias. Policy makers healthcare providers and the public rely on the research that has been published to make right decisions.

Systematic reviews should also consider other form of biases such as database bias, citation bias, country bias, and multiple publication bias. The researcher in this study also considered the quality and relevance of the evidence reported in the selected articles regarding the presence of mental health problems among international students (OToole, 2011).

Results

This chapter is based on presenting the results of this systematic review. A total of 15 articles were included in the review after applying the inclusion criteria and evaluating their suitability in achieving the research aims and objectives. Out of 15 articles included in this research, most of them were published between 2021-2023 and 2014-2015 because of the latest development and policies as every year there are amendments made. The graph below shows the number of articles published in each year. Two articles were published each year from 2023 to 2021 and 2018. Only a single article was published in 2020, 2019 and 2017. No articles were published in 2016. Moreover, two articles were published in each year including 2014 and 2015 that can be seen in the given figure 6.

Figure SEQ Figure * ARABIC 3: Number of articles published in each year.Mental Health IssuesThe mental health issue is also known as mental health disorders that involves psychological and emotional challenges that affect ideas and thoughts and the behaviour and overall wellbeing. These vary in many aspects some of the issues are depression, anxiety disorders, bipolar disorder, schizophrenia, post traumatic disorder.

The figure below shows the mental health issues highlighted in the selected studies. This figure 7 shows three different colour coding that is blue indicates for stress grey colour talks about anxiety and orange colour shows depression. All these colour coding illustrates the percentage of mental illness. Stress was highlighted in 10 articles out of 15 articles. Depression was highlighted in five articles and anxiety was mentioned in four articles. Therefore, stress was considered as the most common mental health issue found among international students in the UK. Literature has also supported that there is a rise in prevalence of stress and anxiety among university students (Beiter et al., 2015; Xiao et al., 2017). Higher levels of stress in this population group have been related with other mental health issues. Some major stressors experienced by university students are health issues, academic difficulties, financial issues, environmental issues, and interpersonal relationship problems (Wang et al., 2023). From these sources, academic and financial issues are considered as the primary sources of stress. Most of the studies selected in this review mentioned stress as experienced by international students who migrate to UK for higher education (Kamardeen and Sunindijo, 2018).

Figure SEQ Figure * ARABIC 4: Mental health issues found in articlesData Synthesis

l

Table SEQ Table * ARABIC 1: Table of data synthesisDescription of FindingsIn this section, the researcher has analysed the found literature to gain novel insights by concentrating on the individual papers. The discussion is centered on the aim of the article, mental health issues emphasized, methodology implemented, findings and the limitations of the study. Moreover researcher has tried to address students that are originally from different background that come to study specifically in uk.

Migration and Mental Health Among International StudentsStress, Depression and AnxietyEjim et al. (2021) in their study tried to determine the incidence of depression, anxiety, and stress (DAS) among post-graduate students across the UK. The research sought to determine in these students the linked individual features and different life and academic issues that lead to DAS and suicidal thinking. Besides, management approaches applied by the affected students were also explored. The shift to postgrad levels could give rise to mental problems because of a confusing structure of the learning course and inaccessibility of opportunities for social networking (McPherson, et al., 2017). Moreover, compared to local students, international students find it difficult to adapt due to being in a new culture (Jackson, et al., 2019).

The authors used a quantitative (cross-sectional) approach to conduct this research. Sample was drawn using purposive sampling technique. The authors observed that postgraduates with a migration status had greater rates of DAS and suicidal thoughts than the UK population.Prevalence of DAS was found to be 43% while and 12% of the respondents experienced suicidal thoughts. The authors also found that there are significant challenges associated with DAS that mostly pertained to migration to a new country. In this regard, issues such as homesickness, problems locating a community with collective cultural/spiritual values and shift of climate were present. Other challenges faced by migrating students include relationship problems, insufficient finances, complexity carrying out household chores, and apparent inadequate support from university staff.Their study however had some limitations that impact the generalizability of its findings. This was due to the fact that the study was conducted on postgraduate students studying in a same English university. Moreover, self-reporting mechanism was used to ascertain prevalence of depression that could bear implications for research outcomes.

Hosseinpur et al. (2023) also conducted a similar study on immigrant students studying in a UK university to ascertain the prevalence of depression among them. Another intention of their study was to reveal the predictors of depression in these students. For this, the authors relied on use of quantitative approach that was carried out as descriptive cross-sectional study. The sample comprised of 153 students registered in MSc in public health and community health-being which was drawn using convenience sampling technique. They found that the incidence of depression among immigrant postgraduates in the UK was 34.6%. A connection was found between depressive indicators and numerous socio-demographic features including ethnicity, supply of funding, and housing status in the UK. Authors found a considerable correlation between depression and all typical difficulties faced by immigrant students except housing. Their study had several limitations. The study was performed on students from only one university. Sample diversity was limited, comprising mostly of South Asian and African students. Sampling method (convenience sampling) could hinder the replicability of findings. To measure depression, self-reporting method was used instead of clinical screening and the role of aspects including family background and individual history of the illness were largely ignored.

The third study on this topic was performed by Adeoye-Agboola & Evans CITATION Ade n l 1033 (2015). This small-scale study had the objective to evaluate the presence of anxiety and its perceived relationship with academic accomplishment in international postgraduate students at the University of Bedfordshire, UK. The authors adopted quantitative approach to inquiry and a cross-sectional questionnaire survey was done. Sample was drawn using non-randomized purposive sampling. The findings of the study revealed that migration induces anxiety among international university students that is also substantially linked with academic performance. Workload, option of coping with stress, future options, and change in educational system are the general sorts of anxiety that affected the students giving substantial association when cross-tabulated with gender and/ ethnicity. The study has several limitations. The data gathered could not be generalizable as a true expressive of British international university students as all participants belonged to same university. Moreover, the study could not determine that anxiety is the only expressive behaviour or feature which could cause poor academic success among these students. Limitation could also happen due to the method of gathering reactions from the respondents at a single point time (cross sectional studies) which might give rise to bias.

Saravanan & Subhashini CITATION Sar n l 1033 (2021) carried out a systematic literature review on the incidence of depression and the linked factors among immigrant university students in the UK. They made use of numerous online databases to recognize research articles associated with the incidence of depression among immigrant students. Studies issued from January 2010 and April 2020 were considered. The final sample comprised of ten articles to be added in the review process considering the selection criteria. They established that the incidence of depression was higher among immigrant students, ranging from 22.6% to 45.3%, contrasted to domestic students and the general population. Moreover, the prevalence of depression in males was found lower, ranging from 34.2% to 46.5%, but higher in females, ranging from 33.2% to 54.1%. The researchers also concluded an exhaustive list of predicting factors such as culture shock, loneliness, English proficiency, academic stress, burnout, distress, acculturative stress, and lack of social connection that contributed to depression in international students. This study has limitations regarding databases used for searching articles. Only those studies were included that were issued from January 2010 and April 2020. The sample size selected was also very limited.

Figure SEQ Figure * ARABIC 5: Depression and its associated factors CITATION Sar l 1033 (Saravanan & Subhashini, 2021)A fifth study in this series was made by Albarhi & Smith CITATION Alb18 n l 1033 (2018) who undertook an analysis of the earlier studies regarding stress and health of immigrant students in English-speaking countries including the UK. Their review aimed to report the main causes of stress faced by immigrant students, the function of specific variations, the narrative of their stress degrees and health over time, and gaps in the present literature. To conduct their study, the researchers looked for suitable studies using two electronic databases which include Psych Info and PubMed. Only articles that were in English and were peer-reviewed were searched for using eight search terms. The final sample comprised of thirty-eight studies that were parted into themes and sub-themes such as mental health issues comprising stress, depression and wellbeing, sources of stress, and individual differences. The findings of the review highlight some major stressors for immigrant students in English speaking countries including UK that contribute to stress among migrant students. Among these are acculture stress, language expertise issues, apparent discrimination, isolation, and learning stress. The results also highlighted some of the specific variances among these students that can play a significant part in controlling stress and well-being such as age, gender, ethnicity, level of social support, coping strategy used and personality traits. Hence, the study was an important one but there are limitations regarding methodology in this study. The present study used literature review to understand mental well-being of international students however, there is a requirement to use a mixed methods and longitudinal research design for understanding the experience of international students better. Then there are limitations regarding generalizability of findings as most studies focused on Asian students especially Chinese students in these countries of which UK was one.

The study by Magnusdottir & Thornicroft CITATION Mag22 n l 1033 (2022) evaluated the psychological condition of Chinese migrant undergraduates in the UK. In view of authors, the quantity of students who arrive from China at universities in the UK exceeds any other nationality. A major growth has been seen especially during the past years as could be seen infigure 5. Moreover, it is challenging to verify from existing literature whether Chinese immigrant students in the UK encounter increased risk of mental distress, as claimed by studies on other countries. Therefore, to ascertain this, the researchers in this study employed literature review method to understand about the psychological health experiences of Chinese immigrant students in the UK. Only literature published between 2009 2019 was deemed suitable for this study. The study, however, like other studies in the past, also could not establish anything satisfactory about the psychological status of Chinese students enrolled in UK universities. The effectiveness of the study was further impacted by the limitations of the study. A quantitative approach could have proved useful over a literature review. Moreover, the studies included only had information about students from the PRC. This research is also limited in a way that only a single Chinese database was used by the researcher, Chinese Web of Knowledge (CKKI). Additionally, being a non-native Chinese speaker, the author might have ignored key search terms which might have produced more outcome. The study concluded by stating that there are obvious gaps in knowledge on psychological health of Chinese undergraduates across the UK.

Figure SEQ Figure * ARABIC 6: International Chinese Students in HE in the UK CITATION Mag22 l 1033 (Magnusdottir & Thornicroft, 2022)Chen & Li (2020) in their research conducted a systematic literature to establish the mental health condition of international students studying in different countries including the UK. They concluded that during regular situations and particularly during the pandemic, immigrant students are susceptible to various mental health issues such as depression. The authors request universities to take the plan to reach out to immigrant students and fulfill their needs in an ethnically sensitive way. However, the results of the research are limited by the research design of the study. The study included retrospection of studies pertaining to only five major host countries: the US, the UK, Australia, Germany, and France. Hence this study was not a representative of global international student body.

In a similar attempt, Li et al. CITATION LiJ14 n l 1033 (2014) organized a systemic review on East Asian immigrant students and their psychological well-being. They reviewed 18 quantitative articles issued in peer-reviewed journals. The time period for inclusion of studies was from 2000 to 2011. All these studies were conducted in English-speaking countries of which the UK was prominent. They found that studies on mental wellbeing of East Asian immigrant students are thoroughly related with certain variables of which depression, acculturative stress, number of days in the host country, English proficiency, and attitudes toward seeking help were prominent. It was found that depression was the most common variable (33.3%), followed by acculturation (27.8%). They concluded that most of the students from Asia undergo stress during the acculturation process and acculturative stress and language proficiency in turn results in depression among these students. There are several limitations existing in this study. One limitation was that this review was restricted to five databases of ESCO. As an outcome, other databases were missing from the literature. The study was also restricted to studies which were issued in English language from 2000 to 2011. Lastly, the respondent recruited were not completed comprised of East Asian students.

In research by Holliman et al. CITATION Hol22 n l 1033 (2022), the aim was to evaluate the mental health of Chinese immigrant students at UK universities and to examine the relationship between social support, adaptability, and psychological well-being among these students. The authors state that despite the knowledge that entry in a university signify a period of substantial change for students, no study to date has examined these relations among international students. The study made use of the quantitative inquiry mode to accomplish its goals. The sample comprised of 325 Chinese students enrolled in UK universities. The authors concluded their study with the finding that lack of support to international students from their host country leads to psychological issues such as stress as it hinders with their adaptability. The research has suggestions for teachers and universities to support the transition of immigrant students to university and enhance their experience using social support that moderates the link between adaptability and mental health.

The study of Akanwa CITATION Aka15 n l 1033 (2015) tried to study the problems encountered by transnational students in western nations such as US, UK and Australia. To achieve their aim, they conducted a literature review. The themes observed in this research are past viewpoints on international students, social variances, language problems, resources at university and their impact on learning of students and the impact of social adjustment and connection building on educational performance of the students. They found that immigrant students in the UK face many problems such as cultural differences, language problems, adjustment issues, medical troubles, academic challenges, housing problems, lack of support services, and financial complexity. This often leads to development of stress in these students.

In continuation of efforts for assessing the impacts of migration on students migrated to UK, Ecochard & Fotheringham CITATION Eco17 n l 1033 (2017) tried to research the unique encounters experienced by immigrant students in their shift to higher education. The authors believe that although the view of transition in the perspective of higher education is better explained as a procedure of transformation and adaptation to the higher educational culture, international shifts by immigrant students demonstrate additional and explicit challenges. They conducted a literature review of past studies to evaluate the challenges faced by migrant students in the UK higher education. Their literature review recognised three major challenges or obstacles pertaining to the adjustment process underwent by these international students: language expertise, academic opportunities, and socio-cultural incorporation. The authors assert that cultural dissonance causes acculturation stress among these students. The study also put forward suggestions for university staff and students by stating that they have diverse but important roles and accountabilities in supporting and enabling adjustment of immigrant students, enhancing retention, and allowing them to reach their educational and personal goals. However, there is a major limitation in this study in that the study specifically depicts the encounters international students experiencing while transitioning to educational institutes in the UK.

In a similar attempt, Cheng and his companions CITATION Che18 n l 1033 (2018) carried out research on Chinese students across the UK. Their aim was to classify major stressors experienced by postgrad students while studying in their academic institutes in the UK as well as to understand the role-play of emotion regulation in coping with the challenges these international students face in a new country. The authors adopted a qualitative research design while the sample comprised of thirty-three Chinese postgraduate students studying at a university in the UK. The study confirms that Chinese postgraduate students experience key stressors during their study in academic institutions in the United Kingdom. The important stressors were related with interaction with groups from other cultural orientations, interaction with lectures, and language issues. In this regard, universities might want to add emotion coaching as a major aspect of their induction programmes for improving the learning experience of immigrant students. The study also suggests that using emotion regulation approaches can help enhance individual student encounters and their dealings with instructors and colleagues. The importance of the study is limited due to the fact that it researched the emotional stressors faced by completely Chinese postgraduate students in a single university in the UK. This limits its generalizability to other contexts.

The study of Bennouna et al. CITATION Ben19 n l 1033 (2019) is unique as it is the only study in this review that considered school education level to analyse migrant mental health and psychological well-being. In doing so it also evaluated the effectiveness of various school-based programs to support the mental wellbeing and psychosocial welfare of teenager forced migrants in high-income countries. The authors undertook a systematic review on this topic and found that different school-based interventions in high-income countries including UK have huge potential to stop the growth of adverse mental health issues among migrant girls and boys and to promote resilience. Their review had several limitations: the study emphasized on English-language publications and only emphasized on high schools, excluding elementary and middle schools and higher education centres.

Cogan et al. CITATION Cog13 n l 1033 (2023) evaluated the mental condition and help seeking behaviours among students from Asia. Adopting a qualitative approach, the authors conducted semi-structured, individual interviews on a purposive sample of 20 international students studying full-time at higher education institutes in Scotland. They found three master themes: adverse beliefs and fear of discrimination, adjustment and acculturation stresses, and obstacles in communication, social detachment, and isolation (figure 6). Their study advocates adopting a whole systems approach to support mental health of students within and across higher education institutes. The study suggests that for supporting Asian international students, challenging adverse judgements about mental health, increasing mental health literacy, and addressing obstacles which might stop disclosure and help-seeking actions are important. Their study provided various implications for help-seeking, guidance, and support. The study also has its limitations. First, it focused on Asian international students thus its findings cannot be generalized. Second, it was carried out in higher education institutes in Scotland, UK so it is not a representative of UK higher education.

Figure SEQ Figure * ARABIC 7: Schematic Diagram of Themes and Sub-themes Identified CITATION Cog13 l 1033 (Cogan, et al., 2023)Lillyman & Bennette CITATION Lil14 n l 1033 (2014) also conducted a study on immigrant students studying at UK universities. Their study was a literature review that aimed to analyse how a positive learning environment could be provided to these international students to overcome different stressors. The authors argued that foreign students would possibly have various problems and worries to deal with while coming to UK for studies. This study also highlighted the role of planning, encouragement and understanding that universities could offer an optimistic experience for all concerned. As the study was made on students studying in the UK universities only hence its conclusions might not be generalizable to immigrants in other countries.

Discussion and AnalysisThe aim of this research was to assess the effect of migration on mental health status of immigrant students in the UK. This systematic review aimed to gather, assess and report of the results of selected articles and to identify any gaps found in the literature and draw conclusions from the literature associated with mental issues faced by international students who migrated to UK for education. Because of time limitation, the literature search was limited to bibliographic databases such as Google Scholar, Cochrane Library and PubMed and Web of Science.

The statistics for 2022 show that the total number of students in the UK was 679,970 (StudyintheUK.org, 2018). Studying in foreign countries pose major challenges for international students including linguistic, financial, academic, health, and interpersonal problems (Bai, 2016). Students who migrate to other countries are confronted with various migration-related stressors such as loss of family, economic and social issues and challenges related to adapting to the country of destination (van der Ham et al., 2014). Considering this, this study aimed to evaluate if international students face any kind of stress, depression and anxiety while migrating to another country for educational purposes. The focus of this research was the UK because the UK is considered as a top destination for study (Universities and Colleges Admissions Service [UCAS], 2022). A total of 15 articles were extracted from the databases that fulfilled the inclusion criteria.

Key Findings and Themes

Themes One: Stress Among International StudentsThe first theme identified from the systematic literature review was stress among international students who migrated to the UK for higher education. The presence of stress among international students was identified in 10 studies out of 15 studies included in the review. Approximately 10 of the papers identified that students often feel stressed about different conditions such as lack of finances, acculturation stress, psychological distress. Traversing different cultural settings often brings about various issues in adjusting which outcome in poor academic performance, termination, or hostility towards the host countrys culture. The findings of this research are also constant with former studies on psychological well-being of international students (Schwartz and Unger, 2017; Phinney, Sam and Vedder, 2022). Living away from the home country and regular social help could be upsetting for foreign students, so not having any friends in a new country would also outcome in feelings of isolation (Hosseinpur et al., 2023). The results of this study were also supported by Hyun et al., (2007) who found that 44% of the international students face an emotional or stress related issues which affect their mental well-being and academic performance.

There are different factors which might cause undue stress to foreign students and immigrants. For example, the process of visas grants to stay. A major initial stressor is the insecure nature of visa status (McGraw Hill, 2022). King and Bernardo, (2016) argued that academic life and requirements are the main sources of stress for university students as most of these activities revolve around their experiences in the university. The most common stressor as identified in this review and in the literature is acculturation stress (Ecochard & Fotheringham, 2017). It is the concept used for understanding psychosocial issues during acculturation. It is explained as a stress reaction to life experiences that are deep-rooted in the experience of acculturation. The literature also supports the presence of acculturation stress among immigrant students. For example, Smith and Khawaja, (2011) highlighted some major acculturative stressors experienced by international students such as language barriers, educational challenges, academic stress, different teaching styles, and mismatched expectations. Benita, (2021) argued that acculturation stress negatively affects the life satisfaction and prevent students from migrating to other countries.

Studies included in the review by Alharbi and Smith (2018), Saravanan and Subhashini, (2021) and Li et al., (2014) have all highlighted some factors causing stress among international students which include academic stress, language proficiency, social isolation, and cultural shock. Another sub-theme related to stress as identified from the review was presence of suicidal thoughts (Hosseinpur et al., 2023). Taliaferro et al., (2019) has also supported the results of this study and highlighted that unmet interpersonal needs among international students often result in suicidal ideation. Prez-Rojas et al., (2021) revealed that there is a positive and direct link among cross-cultural loss, academic stress, and suicidal ideation. The stress related to language issues was highlighted by Adeoye and Evans (2015). Literature has also supported on the issue of language causing stress, including challenge to write in second language (Evans and Stevenson, 2011). Hosseinpur et al., (2023), Cogan et al., (2023) talked about the presence of financial stress faced by international students in the UK. Financial stress is explained as the difficulty to fulfill the basic financial commitments because of shortage of money. Financial tension upsets health and also disturbs human performance. Extreme levels of economic stress are correlated to social segregation and poor health-being. Financially worried students report less capacity to make close companions, lower satisfaction of living and advanced levels of loneliness (Wilson et al., 2022).

Theme Two: Depression among International StudentsThe second major theme developed from the review was the presence of depression among international students migrating to UK for higher education. Out of 15 articles included in the review, only five articles highlighted depression as a mental health issue found in migrating students. The results of this review revealed a significant relationship among migration of international students and depression. Depression is a common issue which impact an extensive range of groups including students, workers and adolescents, numerous study conclusions have demonstrated that depression is a mental issue found among student population of higher educational institutes (Beiter et al., 2015). The literature has also supported the results of this research and highlighted that international students are susceptible to health issues such as depression and anxiety due to a range of adjustment problems. For instance, in research done by Eskanadrieh et al., (2012) the immigrant students in Japan were found experiencing depressive symptoms. In a similar study done by Lee et al., (2013) conducted in Philippines found higher levels of depressive symptoms among immigrant students because of social and demographic factors and their financial conditions. Despite this, little research has been done to assess the incidence of depressive symptoms among international students (Shadowen et al., 2019).

Li et al., (2014), Bennouna et al., (2019), Chen and Li (2020) Ejim, et al., (2021), Saravanan & Subhashini, (2021), and Hosseinpur, et al., (2023), all have confirmed an effect of migration on mental condition of immigrant students in the UK. All of these studies have confirmed that international students in the UK experience depression. Some of the factors causing depression include difficulties with English, acculturative stress, and discrimination (Shadowen et al., 2019). Depression is a global emotional disorder which affect the adjustment of an individual to school or university and often leads to self-harm or suicide (McMahon et al., 2013). Ejim et al., (2021) concluded that challenges such as need for academic support, language barrier and learning style often led students questioning their academic potential and thus results in increased depression. Similar challenges were reported in the literature by Brown and Holloway, (2008) who carried out ethnographic research of international students in the UK during 2008. The authors found that students struggled with the new and unfamiliar challenges faced in the host countries. International students also face financial issues, uncertain migration status, language barriers and discrimination associated with university life. Earlier studies in literature have also supported the results of this review and highlighted the presence of depression among international students (Khawaja and Dempsey, 2007; Ibrahim et al., 2013; Eskanadrieh et al., 2012).

Theme Three: Anxiety among International StudentsThe last theme developed from the review was anxiety. There are different sources of anxiety for international students such as language anxiety, financial anxiety, and study anxiety. Anxiety is the most common mental health issues faced by university level students (Pereira-Morales et al., 2017). Anxiety can negatively affect a students social functioning, academic achievement, and physical health. Stress is one of the most common risk factors for anxiety as higher levels of stress among students is related with higher levels of anxiety (Pereira-Morales et al., 2017). This review demonstrated a positive relationship among migration of international students and presence of anxiety. Wang et al., (2023) has also supported these outcomes and argued that stressors in university life of international students is positively related with anxiety symptoms.

A similar study by Tan et al., (2022) highlighted that anxiety was found among 707 of 1,090 overseas students and anxiety was higher in in age under 22 years than those over 22 years. Another research by Evans et al., (2018) found that 39% of the respondents scored in severe to moderate depression range and 41% of the graduate students scored high enough to be considered as having moderate to severe anxiety. Lipson et al., (2019) also found that the percentage of international students living with a mental health diagnosis increased from 22% during 2007 to 36% during 2017. These increased rates of stress and anxiety can put students at higher risk for academic failure and graduating. Literature has also revealed that international students might also face discrimination and racism because of their immigration status and race. Such experiences might result in mental distress for the students including anxiety and depression (Koo, 2021)

Conclusion

Internationally students often experience many issues and stressors to deal with when migrating to UK for studying. Mental health is considered as a major factors of quality life and happiness. Poor mental condition is difficult and a common emotional problem among students (Pedrelli et al., 2015). Though the mental state of immigrants is an increasing problem which is drawing much attention from researchers, the same could not be said for mental condition of migrant students, specifically international students (Dombou et al., 2022). The mental health of immigrant students is still poorly documented irrespective of the increase in number of students in higher income countries such as UK, USA and China and Australia (Dombou et al., 2022).

The purpose of this research was to evaluate the impact of migration by students on their mental health status. A systematic review of earlier literature was carried out to collect and synthesize evidence on effect of migration on mental condition of international students in the UK. A total of 15 articles were selected for including in the review considering the inclusion criteria. From these 15 articles, 10 of the articles highlighted the issue of stress, five articles highlighted the issue of depression, and four articles highlighted the issues of anxiety found among international students migrating to the UK. Literature has already established that incidence of stress, anxiety and depression is higher among university students in developed as well as developing countries. The review has concluded that there are a range of factors which cause stress, anxiety, and depression among immigrant students such as challenges with faculty, racial discrimination, language anxiety, financial distress, work-life difficulties, feelings of isolation and acculturation.

Generally, immigrant students demonstrated the similar mental wellbeing issues as other kinds of immigrants, they are normally in a good shape upon their arrival (Dombou et al., 2022). However, their health starts deteriorating once they are in the host country. This decline might outcome from a variety of social factors such as lack of family and social support, non-employability, financial issues, acculturation, and other stresses (Dombou et al., 2022). Most of the earlier studies on migration emphasized the damaging aspects of experience to another culture, and it was continued in much of student sojourner literature (Zhou et al., 2008). The results of this systematic review revealed that international students in the UK faced a range of mental health issues such as stress, depression, and anxiety.

Significance of the study

The significance of this study not only matters individual concern but is also important for the community needs. This group deals with a lot of stressors including cultural and academic pressure, financial challenges and ramification of family support which can elevate on their overall wellbeing.

Policies that can improve stress, anxiety and depression among international students.

Improving the wellbeing and addressing the illness requires a comprehensive approach some policies that can diminish the mental health challenges are mandatory health orientation, peer support and mentoring, counselling therapies and encourage in promoting the lifestyle which is good for all. Collaborative efforts should be considered among institutions, government agencies, mental health organization and student communities to ensure the wellbeing of students.

Study LimitationsThere are different limitations involved in this study. One of the major limitations of this study is the limited number of articles selected for review. Because of the small sample size, this research cannot draw any firm conclusions on the state of the field. Only 15 articles were selected because of time limitations as well as if there was more time allocated maybe policies and strategies selected would have been different. Future research should consider at least 20-25 articles on the topic to acquire more in-extensive understanding. Another limitation of this research was the research design. The study's methodology was also a weak point. Though systematic reviews are invaluable for identifying the techniques used in earlier studies, there is also a risk of bias. Accurate research approaches are critical, and the excellence of research is based on the degree to which the review methods are applied (Yuan and Hunt, 2009). In future, more rigorous research methods such as quantitative or qualitative research methods should be adopted (Yuan and Hunt, 2009).

Another limitation of this research was it may be challenging to put the findings of systematic reviews and could not reply to all questions and their conclusion which might be hard to include into practice (Yuan and Hunt, 2009). Another potential limitation of this research is that some data might be underreported or misrepresented because of the difficult and extremely stigmatized nature of mental health issues among immigrant population including students (Dombou et al., 2023). Another notable limitation of this study is that it focused exclusively on international students coming to UK for higher education. In future, other destinations can be searched such as US and China. Another limitation of this study was that the focus was only on mental health of immigrant students. Future research must compare the mental health conditions among international and non-international students. To sum up the limitations involved duration, focus on international students mainly, language barrier, data availability, stigmatization, cultural linguistic difference and limited articles.

Recommendation

To improve migration and mental health conditions in international students coming from different backgrounds of UK it is important to consider cultural competency training, accessible mental health service should be provided Moreover peer support program along with orientation and integration ,student support related to language support, financial literacy programs, academic support, policy advocacy, feedback from their tutors and encouragement of faculty engagement should be encouraged in order to promote their lifestyle.

This research has major implications for higher educational professionals. Educational institutions are recommended to remove barriers or factors which cause substantial mental health issues among immigrant students (Koo and Nyunt, 2022). To deal with mental health issues, educational institutes must offer healthcare through student health services at a lower cost. Student affair professionals need to develop peer support networks for immigrant students which could help them in building community (Koo and Nyunt, 2022).

To have a better understanding of the three main issues that are mainly stress, anxiety and depression among students would not only help the educational institutes, governments and families and healthcare agencies to recognize the risk factors related to mental health issues, but also offer them with a chance to study how such factors have been changing in the academia (Mofatteh, 2020). The results of this research would help the higher educational institutes to endure to destigmatise mental well-being issue and allow international students to receive more in-campus support by offering time for optimistic activities such as group workouts, physical activities, and counselling services (Mofatteh, 2020).

Improving the migration and mental health of international students in the UK requires a combination of policies and initiatives that address various aspects of their experience. Here are some policies that can help enhance the well-being of international students:

Accessible Mental Health Services: Develop and fund mental health services tailored to the needs of international students. These services should be affordable, culturally sensitive, and multilingual.

Cultural Competency Training: Require universities and healthcare providers to undergo cultural competency training to better understand and address the mental health needs of international students.

Orientation and Integration Programs: Implement comprehensive orientation programs that include information on mental health resources, stress management, and cultural adjustment. Encourage participation in social and cultural activities to foster a sense of belonging.

Language Support: Offer language support programs to help international students improve their English proficiency, reducing language-related stressors.

Financial Literacy Education: Provide financial literacy education to help international students manage their finances and reduce financial stress.

Anti-Stigma Campaigns: Launch campaigns to reduce the stigma associated with seeking mental health support. Encourage open conversations about mental health among international students.

Crisis Response Plans: Develop clear crisis response plans for mental health emergencies, including 24/7 hotlines and resources for immediate assistance.

Academic Support: Offer academic support services, such as tutoring and study skills workshops, to help international students succeed academically and reduce academic stress.

Flexible Visa Regulations: Advocate for more flexible visa regulations that allow international students to work part-time or access additional support without jeopardizing their immigration status. Safe Housing and Accommodation: Ensure access to safe and affordable housing options for international students. Address issues such as housing discrimination or exploitation. Cultural Centres: Establish cultural centres or clubs where international students can connect with peers from their home countries and share their experiences. Mental Health First Aid Training: Offer mental health first aid training to staff and faculty to help them identify signs of mental distress and provide initial support. Research and Data Collection: Continue research efforts to better understand the mental health needs of international students and tailor support services accordingly. Student Support Groups: Facilitate support groups or counselling services specifically for international students to address their unique challenges and concerns. Collaboration with External Organizations: Partner with external organizations, such as mental health nonprofits and community groups, to expand support networks for international students. Feedback Mechanisms: Establish feedback mechanisms where international students can provide input on the effectiveness of support services and suggest improvements. Faculty Engagement: Encourage faculty members to be aware of the unique challenges international students face and to be flexible in accommodating their needs. Pre-Departure Resources: Provide information and resources to international students before they arrive in the UK, helping them better prepare for the challenges they may encounter. Promote Healthy Lifestyles: Encourage healthy lifestyles through wellness programs, physical activities, and nutrition education. Peer Support Programs: Establish peer support programs where current international students can mentor and provide emotional support to incoming students.

Effective policies should address the specific needs of international students, recognizing that their experiences are influenced by cultural, academic, and immigration factors. Collaboration among universities, government agencies, mental health organizations, and student communities is crucial for implementing and sustaining these policies successfully.

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