International Students' Utilization of Counseling Services.
Utilization rates of counseling services by international students continue to be low despite the growing presence of this population in American colleges and universities. There are a number of adjustment factors and stressors that can have a detrimental impact on the mental health and well-being of international students, as well as a variety of barriers to accessing supports. This study examined international student utilization of counseling services at a Midwestern University over a period of 5 years. Results indicated that international students underutilized counseling services in all but one year examined, more female international students used the service than males, the majority of international students who did access counseling services were Asian, and the majority of students who accessed services kept appointments after intake sessions. Limitations and implications of the study are discussed. Keywords: international students, counseling utilization, university counseling center ********** Enrollment of international students in U.S. universities and colleges has rebounded following a temporary decline in the early part of the last decade. During the 2010-2011 academic year there were 723, 277 international students on U.S. campuses (Open Doors 2011 "Fast Facts," Institute of International Education, 2012). This was a 4.7% increase from the previous year, and 3.5% of the total U.S. higher education enrollment. International students from China, India, and South Korea, the top three countries of origin, constituted 46.3% of the total international student enrollment. Adjustment factors such as new culture, language, and environment, may result in international students being more vulnerable to mental health challenges than American students These acculturative experiences can bring about a host of stressors and psychological issues (Berry, 1997; Sandhu, 1995; Zhang & Goodson, 2011). For example, Yi, Lin, and Kishimoto (2003) divided international students' issues into five categories which include, academic, physical health, financial, vocational, and personal/social. Possible causes were identified related to these five areas of difficulty including; lack of language proficiency, lack of understanding of the health care system, prohibition of working off campus, uncertain geographic location of future employment, and loss of various familiar things. Causes for the difficulties that international students experience while going through acculturation can be defined as "loss of familiarity," which may be tangible or intangible (Rakhsha, 2002). Tangible losses include in-person access to their homes, families, and friends; while intangible losses include self-efficacy, sense of belonging, and relevance of knowledge to effectively navigate their new cultural environment. Due to these losses, international students commonly experience social isolation, loneliness, homesickness, irritability, and tiredness (Das, Chow & Rutherford, 1986; Wehrly, 1986). Despite the fact that professional mental health counselors could help with acculturative difficulties and related mental health challenges, international students often do not to seek help from professionals. Thus, counseling services have been known to be underutilized by international students (Leong & Sedlacek, 1986; Mau et al, 1990). Because of this tendency, when international do seek help from counseling centers, which are often the last resort for addressing their issues, their symptoms tend to be severe, and they may be already in crisis mode (Lin, 1996). Very little empirical research exists that examines the utilization of counseling centers by international students, of which results have been inconsistent. Due to the lack of related research, as well as contradictory findings of existing studies, there is a clear need for further study focusing on counseling service utilization trends by international students in American colleges and universities. …