Discrimination, Mask Wearing, and Self-Harming Thoughts among International Students in the U.S. during COVID-19

Overview: This study examined associations among discrimination, mask-wearing behavior, and self-harming thoughts among 103 international students enrolled in U.S. universities during COVID-19. Discrimination was associated with self-harming thoughts. Discrimination moderated the association between mask wearing and self-harming thoughts. Results suggest the need for culturally appropriate mental health interventions for international students.Proposal text:

Background: An estimated 1 million international students enroll in universities in the U.S., contributing to $41 billion to the economy and supporting 458,000 jobs annually. However, in 2020, the number of international students decreased drastically due to the COVID-19 pandemic. In addition, the society-level discrimination against Asian communities fueled by the Trump administration, and visa restrictions and travel bans contributed to the decline in new enrollment. Anti-Asian hate crimes and discrimination against international students have caused anxiety among international students, specifically of Asian descent, which can contribute to poor mental health and self-harming thoughts. Moreover, although wearing masks is a COVID-19 safety measure suggested by the CDC, reports indicated that Asian Americans who wore masks were frequently targets of discriminatory treatment during the pandemic. Thus, this study examined associations among mask-wearing behavior, perceived discrimination, and self-harming thoughts and explored the moderation effect of perceived discrimination on the association between mask-wearing behavior and self-harming thoughts among U.S. international students during COVID-19.

Methods: Data on undergraduate and graduate students aged 18 or older enrolled in multiple universities in the U.S. were collected via an online survey during July-August 2020 by a nonprobability sampling method (Nf855). For the purpose of this study, we used the subsample of international students (n=103) for analyses. Self-harming thoughts were assessed by a question: “How often have you had thoughts about harming yourself during the COVID-19 pandemic?" This variable was dichotomized to indicate any self-harming thoughts. Mask wearing behavior was assessed by a question that asked how often during the pandemic participants wore a mask. Discrimination was measured by the 9-item Everyday Discrimination Scale. Multivariable logistic regression analyses were conducted while controlling for age, sex, single status, Asian, and level of loneliness.

Results: 18.6% of participants reported self-harming thoughts during the pandemic. Participants were 27.76 years old on average (range = 19—48), and the majority were women (61.2%), single (77.5%), and identified as Asian (58.3%). Higher levels of perceived discrimination (OR = 1.14; 95% CI = 1.01, 1.29) was significantly associated with increased odds of self-harming thoughts. Discrimination (OR = 1.33; 95% CI = 1.01, 1.76) significantly moderated the association between mask wearing and self-harming thoughts. Conclusions and Implications Our study findings provide preliminary evidence that discrimination differentially affected self-harming thoughts among international students who wear masks more frequently than those who do not. During the pandemic, international students have been scapegoated for spreading the virus or attacked for acting differently towards COVID-19, often for preventive measures as wearing masks. Universities need to engage in macro-level advocacy efforts to denounce discrimination and increase feelings of safety and inclusion for international students. Findings suggest the need for university mental health providers to understand the unique needs of international students. Culturally appropriate mental health interventions for international students with a particular focus on healing and empowerment are warranted. Targeted strategies, such as by-stander micro-interventions and mindfulness techniques could be infused into university mental health services to promote overall well-being of international students, create spaces for healing, and empowerment.