A Systematic Education Model for International Students Mental Health in China During the COVID-19 Pandemic

. The COVID-19 outbreak has a psychological impact on international students in China. Public psychological crisis prevention and intervention, and a timely economic and social restoration have become increasingly important. Focusing on international students in China, this paper summarizes di ﬀ erent types of psychological issues and their causes after surveying the students’ mental health status and behavior changes. It proposes a systematic approach to address international students’ mental issues from three dimensions including government management, university education, and social support. It establishes the education model for international students’ mental health during the COVID-19


Introduction
Since early 2020, the outbreak of COVID-19 has great impact on people's lives all round the world. The statistics shows the cumulative number of confirmed cases worldwide has exceeded 648 million, and the cumulative number of deaths is nearly 6.7 million (as of December 11, 2022) [1]. The pandemic has caused huge losses in health and wealth to the world. As a major infectious public health event, it exposes the public's physical health and mental health to a serious crisis [2]. The government departments take prevention and control measures to minimize the impact of COVID-19 on people's life and economy.
In the past decade, as China opens up its higher education to the world wider, especially with the implementation of the "One Belt One Road" initiative and a continuation of the "Chinese Government Scholarship" program, Chinese universities have seen a fast increasing international students population. According to data from the Ministry of Education, China has become the largest receiving country for international students in Asia since 2018. As China's integrated strength and international influence continue to grow, its capacity in higher education is also increasing. The size of international students in China is picking up rapidly, and they represent a huge demand for education services in Chinese universities [3]. During the COVID-19 pandemic, the differences in regional culture and self-management styles between international students and Chinese students are increasingly prominent. International students are more likely to be affected by the big changes in study and living conditions, which may lead to negative emotions and even psychological crises. It puts forward higher requirements for pandemic prevention and control in higher education institutions. While vigorously expanding the scale of international students and continuously improving international education, it is imperative to solidify the foundation of public health and safety, to build a sound mechanism of mental health education and crisis intervention for international students and play a proper role for universities to improve the quality of international student cultivation. Therefore, it is necessary to learn the mental health status of international students coming to China and establish the psychological health education mechanism.
Research on mental health education of international students mainly focuses on three aspects: the manifestation of international students' psychological issues, the attribution, and related countermeasures. Ji used empirical methods for the research and proposed countermeasures such as strengthening counselors' operational capacity to carry out psychological work and establishing a psychological counseling center for international students [4]. Tan et al. conducted a study on the application of psychological guidance in online education for international students during the pandemic and argued that a theoretical and practical system of psychological guidance should be established to meet their needs [5]. The scholars mainly conducted empirical studies on the impact of COVID-19 on the psychological health of international students. But researches on mental health education for international students domestic and abroad are far from enough. Most research remain focusing on the current situation or a specific countermeasure. There is a short of research on the mental health education model that is more systematic and better adapted to the development trend of the pandemic.
This paper examines the current mental health status of international students in China through a questionnaire, and analyzes key mental health issues of international students in the context of the pandemic to establish a paradigm as a foundation of exploring a more timesensitive mental health education model for international students to effectively alleviate their mental health problems.
The rest parts are organized as follows. Section 2 analyzes the current situation of international students' mental health during COVID-19 based on questionnaire data. Section 3 proposes a systematic educational approach from three dimensions to address mental health issues of international students in China during the COVID-19 Pandemic.

Mental Health Issues and Factors Affecting International Students during COVID-19
From a psychological point of view, the COVID-19 outbreak is a negative stress with characteristics of suddenness, threat, and extensiveness, which easily triggers panic in social groups [2]. When individuals respond to an pandemic crisis, they will have more or less certain stress reactions. Excessive stress reactions can provoke a series of psychological and behavioral issues, and may even develop into psychological disorders. Most international students in China are young, and their self-regulation and management ability, anti-stress ability, and information screening ability are immature. When studying in a foreign country, they have to face various problems such as cultural differences, adaptation to life, and interpersonal interactions, all of which may cause psychological pressure. Especially in the context of the COVID-19 pandemic, the changing prevention and control situation makes it difficult for international students to adjust, and there are increasing challenges for them to face. Therefore, international students are likely to suffer mental health issues such as maladjustment, anxiety, and depression. The mental health issues of international students are categorized as follows according to the main factors influencing the psychological conditions of international students in the context of the pandemic.

Cross-cultural Adaptation Difficulties
"Cross-cultural adaptation" refers to the changes and frictions in cultural values that may cause psychological problems to a large extent in a social environment of a different culture from one's own [6]. International students coming to China may have difficulties in crosscultural adaptation due to the differences in ethnic, culture, religious beliefs and other factors, and they are likely to feel negative emotions such as loneliness.
(1) Management model differences The differences between China and foreign countries in day to day education and management culture are mainly reflected in the management of discipline and safety. Chinese universities have the primary responsibility for students' behavior and safety on campus and thus set a series of daily management rules for students. But most foreign universities emphasize students' individual responsibilities [7]. International students may feel bound by various management regulations in China. During the pandemic, some domestic universities implement centralized and unified management of students due to the requirement for disease prevention and control. Such restrictions may trigger international students' tension, anxiety, irritability and other negative emotions, and even produce psychological stress reactions in serious cases [3].
In addition, different countries exercise different pandemic prevention policies. Some are extremely different from China. A series of measures promulgated by the Chinese government cannot be fully understood and accepted by all international students. This poses a challenge to the implementation of pandemic control work in China.
(2) Cultural differences The cultural differences are reflected in various aspects such as language and culture, behavior, religious beliefs, and value orientation. When facing the social and moral concepts of foreign cultures, the impact caused by internal cultural accumulation and external cultural implantation may cause psychological discomforts such as doubt, anxiety, depression, loneliness, and other negative emotions.
Chinese culture attaches emphasis on collectivism. International students may have different values and individual plans, and participate less in collective activities. In addition, the differences in life style and food culture may have an impact on the psychological adaptation of international students.

Increased Academic Pressure
Completing study is the basic task for international students in China, and it is not an easy task. The challenges faced by international students in China mainly include language barriers, differences in their learning styles and obstacles in communication with teachers, which may result in academic and psychological pressure. After COVID-19 outbreak, many universities launched online teaching, and a large number of international students were unable to return to campus because of the travel restrictions, which increased their anxiety and worries about whether they could accomplish their degree [3]. The study showed that COVID-19 caused much academic-related stress, such as students' changes in their plans, less communication with teachers, increased financial stress, and delays in their studies, which were positively associated with the level of negative psychological symptoms experienced among international students during the pandemic [4].
Affected by the pandemic, the normal teaching in many universities is disrupted and international students who are unable to study in China could hardly improve their Chinese. In addition, the online teaching mode may be less efficient, specifically reflected in unpunctuality, decreased attendance, lower sense of collective participation, which may affect the learning quality and psychological health.

Lack of Social Support
Social support can be divided into host social support and ethnic social support. Most international students are far away from home, thus they have limited access to social support and psychological resources [5], especially when facing physical and psychological issues caused by the pandemic. They could seldom receive timely psychological support and care from their families or friends, so they are very likely to feel lonely and homesick.
Some studies have shown that social support in the local area helps international students adapt and may counter the negative effects of cross-cultural stress. In the context of the pandemic, it becomes more difficult for the international students to interact with Chinese students and establish close contact and good communication with their classmates and teachers. Over time, it will be very hard for international students to integrate into the university and environment and the community, which will aggravate their negative emotions and psychological burdens.

Analysis of Mental Health Situation of International Students in China during COVID-19
This paper investigates the mental health status, social support status, and existing mental health education work mechanisms for international students in China during the pandemic to provide a reference for exploring new paths of mental health education. The study targeted on international students who are studying in Chinese universities, and conducted an online questionnaire in a voluntary and anonymous way. A total of 60 valid questionnaires were collected. Among the international students who participated in the questionnaire, 20 were male and 10 were female, and 6 were undergraduate students and 24 were graduate students. For study control, 30 questionnaires were distributed and collected among a group of Chinese students, including 16 male and 14 female students, and 16 undergraduate students and 14 postgraduate students. The contents of the questionnaire consisted of four parts: basic information, the current situation of mental health, the working mechanism of mental health education in universities, and the social support level. The Anxiety Rating Scale (GAD-7), Depression Rating Scale (PHQ-9), and Quality of Life Scale (SF-8) were used to assess the current mental health status of college students. The social support level of international students in China during the pandemic was assessed using the revised social support scale based on the actual situation of university students [6]. In this study, the data were analyzed by descriptive statistics, t-test, one-way ANOVA, and Pearson correlation analysis using SPSS25.0 software [7].

Mental Health Status of International Students in China
(1) Summary of factors influencing the mental health of international students in China The second part of the questionnaire investigated the factors influencing the mental health of international students in China. In the question about factors that highly influence their mental health (multiple choice), the highest-ranking factor is "anxiety and irritability caused by the changes of the pandemic situation" (66.67%), followed by "loneliness and loss due to missing families" (66.67%) and "poor language communication" (33.33%). It can be seen that the mental health of international students in China is greatly affected by the changes of the pandemic situation, and the lack of social support from their families around also leads to loneliness and a sense of loss to a certain extent, and to overcome the language barrier is also urgent for the sound mental health of international students. Since the outbreak of COVID-19, international students coming to China are most worried about their study pressure (86.67%), psychological condition (83.33%), life security and quality (66.67%), and financial pressure (66.67%). When asked "Are you worried about your studies being affected during the pandemic", 50% of international students said they were extremely worried, 33.33% said they were somewhat worried, and only 16.67% said they were rarely worried. When asked "Do you pay attention to the news on media or social platforms during the pandemic", all international students showed various degrees of concern, with 66.67% of them following the reports and news about the New Coronary Pneumonia pandemic every day.
(2) A comparative analysis of the mental health status among international students and Chinese students The results of the Anxiety Rating Scale (GAD-7) showed that 66.67% of the international students in China had different levels of anxiety, among which 10 (33.33%) might have moderate anxiety and 10 (33.33%) might have severe anxiety, and the overall average anxiety score was (7.77±4.55). The results of the Depression Rating Scale (PHQ-9) showed that 93.33% of the international students in China had different levels of depression, 10 (33.33%) might have mild depression, 13 (43.33%) might have moderate or moderately severe depression, and 5 (16.67%) might have severe depression, with an overall mean depression score of (8.10±4.76). The mean score of the first four items of the Quality-of-Life Scale (SF-8) was the physical health (PCS) score, and the mean score of the last four items was the mental health (MCS) score, with higher scores representing better health status. The score of the mental health dimension (10.00±3.57) was significantly lower than the score of the physical health dimension (13.17±5.71) of international students during the pandemic.
The total scores of anxiety and depression representing the mental health status of international students in China were assessed to be significantly higher than those of the Chinese student group (p < 0.05), and the total scores obtained by international students coming to China in both physical health (PCS) and mental health (MCS) items were significantly lower than those of the Chinese student group (p < 0.01), and the results are shown in table 1. (3) A univariate analysis of the mental health status of international students in China A one-way ANOVA on the group of international students in China showed that there was no significant effect of age, monthly expenses, and whether they were in China at this time on each dimension of their mental health status. However, the differences in the scores of international students' anxiety were significantly affected by their education level and length of time in China (p < 0.01); the differences in the scores of depression were significantly affected by gender, religion, and length of time in China (p < 0.01); the differences in the scores of mental health (MCS) were significantly affected by education level and length of time in China (p < 0.01), and the results are shown in table 2. Note: **p<0.01. Among them, the depression level of male is higher than that of female. The depression level of international students with religious beliefs is higher than that of international students without religious beliefs. The anxiety level of graduate students is higher than that of undergraduate students, and the mental health (MCS) score is lower than that of undergraduate students. The shorter the duration of arrival in China, the higher the anxiety and depression levels of international students, and the longer the duration of arrival in China, the higher the mental health (MCS) score of international students.

Correlation Analysis of Social Support Level and Mental Health Status
The social support scale is used to measure three dimensions of an individual's social relationships, including objective support (the actual support the individual receives), subjective support (the support the individual can experience or emotionally), and the use of social support (reflecting the individual's active use of various social support, including the way to talk, seek help, and motivation to participate in activities). The higher the total score and the scores of each dimension, the better the degree of social support. The total score of social support of international students in China is (30.67±10.65), objective support is (6.33±3.41), subjective support is (18.00±6.24), and the degree of support utilization is (6.33±1.92).
The correlation analysis of each dimension of mental health status and social support level of international students in China showed that the total score of social support, objective support, subjective support, and support utilization scores of international students were significantly negatively correlated with their total score of anxiety and depression (p < 0.01) and were significantly positively correlated with the scores of physical health, mental health, and mental health factors (p < 0.01). The results are shown in Table 3.

Analysis of the Current Situation of Mental Health Work Mechanism for International Students in Universities
The questionnaire investigated the demands and thoughts of international students on mental health working mechanisms. 33.33% of the respondents said they had actively received psychological counseling during the pandemic, and 50% said they had actively learned about the website, APP, or telephone hotline of psychological counseling, and 83.33% of the international students thought universities should further strengthen mental health education. When asked "Do you know whether your university has mental health courses or counseling centers for international students", 66.67% of international students chose "don't know". In summary, international students in China are highly concerned about their mental health problems. They have a certain demand for psychological counseling and its channels of access. They show a strong willingness to further strengthen mental health education in universities, but have less awareness of the existing mental health mechanism in their universities. Therefore, a systematic approach to address international students' mental health issues is in need.
In addition, when asked about "the ways and means you want to get mental health services" (multiple choice), international students most often chose to consult with classmates and peer friends (50%), followed by school teachers and counselors (33.33%) or telephone consultation (33.33%). When asked about "the content and items of mental health services you want to get mental services" (multiple choice), 66.67% of international students chose academic problems, followed by interpersonal relationship problems (50%), physical and mental management (50%), and campus life and adjustment problems (33.33%). In the open-ended question of "Suggestions for universities to carry out mental health education for international students", some international students proposed that universities should organize more interesting outdoor activities and social activities, such as international student tournaments and cultural exchange activities for Chinese and foreign students. Some students also suggested that universities need to keep track of the financial, social, and academic situations faced by international students. In the context of the pandemic, there is a need to explore mental health education for international students in China.

Full Utilization of Government Functions to Improve the Management and Service Level of International Students
With the globalization of higher education, education for international students in China has entered a new stage of quality improvement and efficiency. The impact of the pandemic has exposed to some existing problems such as inadequate management mechanisms of domestic education for international students and the mismatch between expanding the scale of international students and improving the education quality, i.e. the imperfect setting of service institutions for international students and the unclear division of labor among personnel of various departments.
To promote an orderly and effective operation of international student education development, government needs to give full play to its macro-regulation function and improve its management model, and to enhance the public service capacity to meet the diversified development needs of international student education. More specifically, multiple departments such as the foreign affairs office, public security immigration, and disease prevention and control offices should work jointly to establish a sound and effective management and service system, and provide institutional support for international students in China and improve the quality and service. Government has to strengthen collaboration with universities and social organizations to build a stable information linkage mechanism and ecosystem for international students so that the government can provide multi-faceted support and guarantee for international students in terms of policy guidance and handling of emergencies. To tackle the difficulties in policy implementation caused by cultural and value, it is necessary to integrate the interests of multiple subjects in the program development process and actively adopt beneficial suggestions to realize the effective operation of convergence management [8]. Some international students may feel inconvenient in daily life due to the lack of awareness in disease prevention and control. Government and universities should make all efforts to provide logistical support for international students in China, such as timely procurement of daily necessities and pandemic prevention and control materials including masks, disinfectant spray, and thermometers to ease the anxiety of international students in China.

Transforming The Education Model of Universities to Ensure The Quality of Life And Study for International Students
(1) Focusing on the needs of international students and host diverse activities The management mechanism of domestic universities has long been focusing on the protection of international students' safety and the creation of a friendly study environment. However, it is strongly argued that universities should pay more attention to international students' mental health needs particularly during the pandemic. International students in China are more likely to experience mental tension, sensitive interpersonal relationship, and isolation.
Universities should investigate the demands of international students, host student activities and encourage active participation of international students, in order to enrich the after-school life of international students, promote communication between international students and Chinese students, help them adapt to the new environment soon, and release their psychological stress. For example, universities can organize cultural festivals to promote cultural communications between Chinese and international students. Increasing participation in social and cultural activities will help to facilitate the cross-cultural adaptation process of international students in China.
(2) Helping international students to have cross-cultural adaptation In the context of the pandemic, international students in cross-cultural learning in China are affected by the differences in Chinese language level, religious beliefs, traditional culture and management mode, and have some degree of difficulty in adapting to concept perceptions and daily behaviors, which makes them more likely to develop a range of psychological issues.
Universities can offer multicultural courses, such as intercultural communication courses, and integrate cultural penetration into the whole process and all aspects of education so that international students can have in-depth exposure to Chinese traditional culture and be guided to correctly understand Chinese life, communication habits and social development needs. The universities should improve the curriculum of international student training programs to help them achieve cross-cultural adaptation, and practically improve the international education of universities.
(3) Focusing on the quality and plight of education for study abroad in China, exploring flexible and diversified teaching models Due to the outbreak of the pandemic, courses have been shifted to online for a long period of time. Many international students in China are under pressure from the change in teaching methods. They worry about whether they could complete their studies in time. During the special period, universities should keep up with the changes in the latest situation and make all-round preparations to ensure high-quality teaching with various teaching modes.
Given the special characteristics of international students in China, while actively pushing forward online or in-person teaching tasks, universities should pay more attention to international students' mental health in time, and explore education management modes more flexible and diversified so that students could have a sense of belonging and participation in the learning process. Universities should establish an academic support system for international students with faculties as the unit and teachers as the backbone to communicate with students, seek feedback and answer their questions on a timely basis, in order to alleviate international students' concerns over their coursework [2]. (4) Implementing mental health education for international students, raising the subject's self-care Researches show that self-care can protect individuals from over-thinking during negative events and can have a positive impact on their psychological status [9]. During the pandemic, international students need to pay attention to their mental health status, strengthen self-care and emotional guidance and proactively seek and accept help from others when necessary.
On the other hand, universities should adopt diverse ways to raise international students' awareness of mental health, and provide accountable support such as organizing training seminars and counseling sessions.
With the growing external concerns about mental health crises among international students, scholars have started to seek out potential mental health protective factors. Among these, social support is proven to be a predictor of the positive psychological status of individuals and an effective buffer against stressors such as discrimination [5]. It is found that the perceived social support and psychological adjustment of international students are significantly and positively correlated [10]. Individuals with high levels of social support receive more external support resources in their lives and studies and thus can deal with different issues in public health incidents more positively. In this paper, we conducted a correlation analysis based on questionnaire data and found that the higher the total score of social support and each dimension score of international students in China, the better their psychological well-being.

Building A Social Support System to Strengthen Psychological Guidance And Intervention for International Students
(1) Systematization of the psychological crisis intervention mechanism The social buffering hypothesis suggests that the presence of a social support system helps buffer or protect individuals from the negative effects of stressful events [11]. To cope with the impact of the pandemic, universities should build a systematic social support network actively, establish a four-in-one psychological crisis intervention work-group, and improve the work-flow of psychological crisis response including prevention, early warning, response and post-crisis assistance. At the same time, a team approach should be continuously strengthened. The international student representatives and professional psychological teachers can join the intervention team, which both improves the engagement of the international students and ensures the professionalism of psychological services, and bring into play the effectiveness of the system to effectively carry out the psychological crisis intervention work.
In addition, some universities have not established a comprehensive psychological crisis intervention scheme [12]. During a public health event, universities should set up psychological counseling hotlines and counseling centers for international students, and regularly organize activities such as psychological training sessions and courses to ensure international students have easy access to mental health counseling services both online and offline.
(2) Refinement of psychological intervention methods and contents High-quality psychological crisis intervention has to resort to more targeted content and methods. As a result, universities need to strengthen mental health education content for international students China. International student officers in universities should pay closer attention to the latest situation of the pandemic and disease prevention policy, and provide prompt emotional support to international students. The psychological intervention work in universities should apply precise measures to meet psychological needs of international students and can conduct categories to guide students of different education stages and majors, such as targeting to strengthen the intercultural adaptation ability of freshmen in undergraduate programs to help them complete the transition from the psychological adaptation stage as soon as possible. As for international students at the master's and doctoral levels, universities should focus more on their academic pressure, self-orientation, career planning and other issues.
(3) Pro-activity of psychological guidance and intervention During a public health event, university officers need to take the initiative in psychological guidance when communicating with international students. Firstly, to actively help international students to follow accountable information and to raise awareness of network security and information assessing ability. Secondly, officers can provide proactive and multitimes psychological guidance to international students, combine explicit psychological guidance and implicit psychological communication, and gradually solve students' psychological problems by indirectly changing the micro-environment of individuals. Thirdly, universities should follow up on the life and study situation of international students, establish a feedback mechanism for them to obtain an immediate understanding of their emotional condition and psychological needs, identify and intervene in their problems at an early stage, and fully utilize the initiative of psychological support.

Conclusion
This paper investigates and analyzes international student' mental health issues and the causes as the basis for exploring the mental health education management model. To promote international students' mental health, a "trinity" model of government management, university education, and social support should be established to manage the psychological health issues. Firstly, government departments and universities should give full play to the functions to improve the management and service to international students. Secondly, the education model of universities should be transformed to address the quality of life and study for international students. Thirdly, it is necessary to build a social support system to strengthen the psychological help and intervention for international students. A systematic mental health education model is built amid the COVID-19 pandemic to specifically address international students' psychological needs, and to alleviate their mental health problems. It serves to further improve China's international education environment.