Cultural Background, Social Support and Mental Health of College

Students

Marthoenis

Department of Psychiatry and Mental Health Nursing, Syiah Kuala University

Jl. Tgk Tanoh Abee, Darussalam, Banda Aceh, Indonesia, 23111

Keywords: Cultural Background, Social Support, Mental Health, College Student

Abstract: The present study aims to examine perceived social supports, self-esteem and perceived stigma by different

cultural groups of student and its consequences to their mental health. Methods: Students with German,

Indonesian and Turkish backgrounds studying in Berlin were invited to participate in the study. The

students were requested to complete four instruments: General health questionnaire, Rosenberg self-esteem

scale, social strain (F-Sozu), and devaluation discrimination scale in their own languages. Correlation

analysis, independent sample t-test and analysis of variance were used according to the type of data.

Results: Cultural background was associated significantly with psychological distress, personal self-esteem,

perceived social support and devaluation discrimination towards mental illness. Student from Indonesia had

a lower self-esteem and lower perceived social support but also had a less psychological distress and fewer

stigmas towards people with mental disorder. Conclusion: Cultural background of students has a significant

impact to their psychological distress, self-esteem, perceived social support and stigma towards mental

disorder. The Indonesian student studying in Berlin should improve their self-esteem and social supports.

1 INTRODUCTION

Social support is increasingly believed as a

noteworthy determinant of a person mental health

(Leach 2014; Hendryx et al. 2009; Davis & Brekke

2014). Social support correlates positively with self-

esteem or optimism (Symister & Friend 2003; Kong

et al. 2014; Karademas 2006), but negatively with

psychological distress (Bíró et al. 2011; Chao 2012;

Luo & Wang 2009; Horton & Wallander 2001) and

stigma toward mental illness (Denenny et al. 2015).

Those with low quality of social support were likely

to experience mental problem compared to those

with a better social support (Hefner & Eisenberg

2009). The perceived social support was also

different between gender (Vaux 1985; Landman-

Peeters et al. 2005; Matud et al. 2003), age and

ethnicity (Vaux 1985). Previous studies suggest that

social supports could improve cognitive functioning,

self efficacy, confidence and reduces emotional

conflict, distress and depression (DiMatteo 2004).

Furthermore, the prevalence mental problems is high

among college students (Hunt & Eisenberg 2010),

thus having good social supports is essential.

International students are at a greater risk of

suffering from such a mental problem compared to

the students in general (Mori 2000). Cultural issues,

language barriers, social connectedness and lack of

social support can all leads to an acculturation stress

(Yeh & Inose 2003; Poyrazli et al. 2004). The

students’ acculturative stress is associated with

feeling of loneliness, homesickness, anxiety and

depression (Yue et al. 2013). Unfortunately, despite

the mental problems, the students tend to delay

treatment seeking (Hunt & Eisenberg 2010;

Eisenberg et al. 2007).

A number of studies have investigated the role of

social supports and other health determinants

towards the mental health condition of the

international students (Allgöwer et al. 2001; Taylor

et al. 2004; Constantine et al. 2004; Misra & Castillo

2004; Yeh & Inose 2003; Yeh & Inose 2002; Bovier

et al. 2004; Crockett et al. 2007; Torres & Solberg

2001). Nevertheless, study that involves Indonesian

students studying abroad is scarce and therefore their

mental health status is rather unknown. This survey

Marthoenis, .

Cultural Background, Social Support and Mental Health of College Students.

DOI: 10.5220/0008396700002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 221-227

ISBN: 978-989-758-413-8

221

aimed to unveil the minor psychological distress,

self-esteem, perceived social support and stigma

towards mental illness and to compare the

differences between the students of Indonesian,

German and Turkish backgrounds in Berlin.

2 METHODS

This cross sectional study was conducted in the area

of Berlin.

2.1 Participants

A total of 149 students from three different

backgrounds (German, Indonesia and Turkish)

studying in any university in Berlin - Brandenburg

were included. They were recruited in various

places, but mostly in campus settings. There was no

specific inclusion and exclusion criteria for

prospective respondents, but the Indonesian student

group should at least had been living around six

months in Germany. All respondents were requested

to complete self-rating questionnaires for minor

psychological distress, self esteem, perceived stigma

and social supports.

2.2 Settings

Data was collected from July 2012 to February 2013

in the area of Berlin. The ethics committee of

Charité University, Berlin, approved the study.

Written informed consent was obtained from all

participants.

2.3 Measures

2.3.1 Socio Demographic Variables

The first part of questionnaires consists of socio-

demographic information; age, gender, cultural

background, marital status, living with and source of

income.

2.3.2 Translation of Survey Instruments

The language of questionnaires was provided in

German and Bahasa Indonesia (Indonesian

language). The German and Turkish background

students filled the questionnaire in German, while

the Indonesian student did it in Bahasa Indonesia.

Several instruments in German were already existed

from a previous study (Bromand et al. 2012).

Translation of the instruments from German to

Bahasa Indonesia used the standard procedure

“forwards-backward”: German to Bahasa Indonesia,

and then translated back to German. A native

speaker and a Bahasa Indonesia expert proved the

final version of instruments Bahasa Indonesia.

2.3.3 General Health Questionnaire (GHQ

12)

The general health questionnaire was used to

measure the minor psychological distress. Since its

development in 1970s (Goldberg & Blackwell

1970), the GHQ has been used in many studies. The

12 items of GHQ also has been translated and

validated various languages and used in various

settings (Montazeri et al. 2003; Quek et al. 2001;

Sánchez-López & Dresch 2008). Each item of GHQ

12 was scored from 0 to 3, which makes the overall

possible score ranged from 0 to 36. Higher score

refers to the higher psychological distress.

Reliability of the present study was 0.89 in German

and 0.82 among Indonesian.

2.3.4 Rosenberg Self Esteem Scale (RSE 10)

Self-esteem of the student in the current study was

measured with the Rosenberg self-esteem scale. The

questionnaire has been validated in various

languages and used in several previous studies

(Piyavhatkul et al. 2011; Martín-Albo et al. 2007;

Schmitt & Allik 2005). The current study uses items

scoring from 0 to 3, which makes a possible

summed score from 0 to 30. The higher score refers

to the higher self-esteem. Reliability of the present

study was 0.87 in German and Turkish and 0.83 in

Bahasa Indonesian.

2.3.5 Social Support (F-SOZU)

The German social support questionnaire was used

to identify the perceived social support among the

students. The instrument consists of 22 items of

expression such as “I know someone to whom I can

ask for help whenever I need” (Q5) in a positive

form or “I often feel like an outsider”(Q12) in a

negative form. The items are rated in Likert scale

from 5 (Totally Agree) to 1 (totally disagree). The

possible summed score was between 22 and 110.

The higher score refers to the higher perceived

social supports. Reliability of the current study was

0.89 among Turkish, and 0.75 among German and

Indonesian students.

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2.3.6 Devaluation Discrimination (D-D 12)

The perceived public stigma was measured using a

12 items of devaluation discrimination

questionnaire. The instrument was developed by

Link and colleagues, and has been used in several

previous studies (Link 1987; Link et al. 1989;

Eisenberg et al. 2009). The current study uses the

scoring of 1 to 4 of each item, which makes a

possible summed score of 12 to 48. The higher score

defines the higher perceived devaluation and

discrimination towards people with mental

disorders. Additionally, two extra questions were

asked to Indonesian group concerning their

perception on mental health treatment in Germany,

and the support they received from the fellow

Indonesians in Berlin

2.4 Data Analysis

Demographic variables were investigated by

descriptive analyses. The Kolmogorov-Smirnov was

used to inspect the distribution of the data.

Correlations between numerical variables were

tested using the Pearson correlation coefficient test

in items that were normally distributed, or using the

Spearman test when data was not normally

distributed. The independent sample t-test or the

Mann Whitney test was used where appropriate. The

association between more than two background

variables (cultural backgrounds, living partner and

sources of income) and the score of the scales

(psychological distress, self-esteem, social support,

and devaluation discrimination) was tested using the

one-way ANOVA, with Tukey post hoc correction.

Data was analyzed using the STATA 13 software.

3 RESULTS

3.1 Respondents Characteristics

The sample consists of 48 (32.2%) of each German

and Indonesian and 53 (35%) of Turkish background

university students. Mean age was 24േ4.4 years and

87 (58.4%) were female. The vast majority was

single (91.3%) and only 11 (7.4%) were married.

Some 61 (40.9%) of them obtained money from

parent, while other obtained it from working (n = 48,

32.2%), government loan (n = 28, 18.8%, and from

scholarship (n = 10, 6.7%) (Table.1).

Table 1: Socio-demographic Characteristic of the Respondents

Characteristics Number % or SD

Mean of age (yrs) 24 4.4

Female gender 87 58.4

Background

German 48 32.2

Indonesian 48 32.2

Turkish 53 35.6

Marital Status

Single 136 91.3

Married 11 7.4

Divorce 1 0.7

Living with

Alone 29 19.5

With Partner or friend 44 29.5

With Family 44 29.5

In Student-Wohnheim 30 20.1

Source of Income

Working 48 32.2

Scholarship 10 6.7

Government loan 28 18.8

Parent 61 40.9

Others 2 1.3

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3.2 Psychological Distress

There was sufficient evidence of association

between student’s psychological distress and gender

(U = 1.95, p = 0.01) cultural background (F (2, 143)

= 12.86, p = 0.001), living partner (F (3, 140) = 5.78,

p = 0.001), but not with marital status and source of

income (p > 0.05). Psychological distress was also

correlated with age (r = 0.19, p = 0.01). Older age

and female gender suffered psychological distress

more than the younger age and male students. When

the cultural backgrounds were compared, the

Indonesian students had the lowest mean of distress

score compared to German and Turkish students.

Students living with family also had the highest

distress, followed by living alone, living in student-

wohnheim and living with partner.

3.2.1 Self Esteem

Self-esteem was significantly different between

cultural background groups (F (2, 141) = 18.04,

p=0.001). The Indonesian student had the lowest

mean of self esteem score compared to German and

Turkish students (mean = 19.09 vs. 23.55 vs. 23.38).

Older age was also related to self-esteem (r = 0.21, p

= 0.008), where those with older age had a higher

self-esteem compared to the younger. Lastly, there

was insufficient evidence of association between

self-esteem and any other demographic variables

(p൒0.05).

3.2.2 Social Support

The student’s perceived social support was

associated with gender (U = 157, p = 0.001), cultural

background (F (2, 135) = 34.48, p = 0.001), living

partner (F (3, 132) = 5.3, p = 0.002) and source of

income (F (4, 133) = 3.65, p = 0.007). Female

students reported better social support compared to

the male (Mean Rank = 79.02 vs. 55.96). Indonesian

students also reported the least social support, while

the German and Turkish did not significantly

different. Student living with family also reported

the highest social support, while those who live in a

student wohnheim reported the least. On the other

hand, student who received money from parent

reported the least social support, while those who

obtained a government loan reported the best social

support. Nevertheless, post hoc analysis in a Tukey

Homogeneous Subsets table suggests that the entire

variable shared the same column, which also means

that no significant different between the sources of

income towards perceived social support.

Furthermore, perceived social support was also

positively correlated with age (r = 0.22, p = 0.009),

where older age students tend to perceived better

social support than younger students.

3.2.3 Devaluation Discrimination

Devaluation and discrimination was significantly

associated with the cultural background (F (2, 140) =

5.56, p = 0.005) and not with any other demographic

variables (p ൒ 0.05). Indonesian students have the

least stigma and discrimination towards mental

illness and the people with mental disorders,

followed by German and Turkish Students (mean =

42,89 vs. 44.94 vs. 47.29). Post hoc analysis in

Tukey Homogeneous subsets table shows that the

German and Indonesian groups share the same

column. At the same time, the German group also

shares the same column with Turkish group, which

suggest that the most significant difference was

found between Indonesian and Turkish students.

Additionally, around two-third (74.5%) of

Indonesian student reported that the community

treats the person with mental problem differently

compared to the condition in Germany. Also, almost

all Indonesian students (93.2%) believed that mental

treatment was far better in Germany compared to the

services in Indonesia.

3.2.4 Social Support and Psychological

Distress

The perceived social support did not associate with

the psychological distress, and neither with self-

esteem and devaluation discrimination (p൒0.05).

4 DISCUSSION

The current study highlights several important

findings: (a) cultural background of the college

students was associated significantly with

psychological distress, personal self-esteem,

perceived social support and devaluation

discrimination towards mental illness; (b) the

Indonesian students in Berlin had a lower self-

esteem and lower perceived social support but also

had a less psychological distress and fewer stigmas

towards people with mental disorder compared to

the German student and students with Turkish

background; and (c) the score of measured

instruments was not significantly difference between

German and Turkish students, which also suggests

that only Indonesian students had a different values

of all variables.

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Considering the Indonesian students as a group

of migrants in Germany, the finding of low

perceived social support and low self-esteem among

them is fairly reasonable. As part of international

students, they live in a new environment with no

family or the important other, all of which could

alter their sense of self and resulting in significant

distress (Yeh & Inose 2003). On the other hand, the

German and the Turkish background students have

considered Berlin as their home, where many of

them were born and raised. Most of the Turkish

students in the current study were also born in

Germany, which also explains why the difference of

perceived social support, self-esteem and

psychological distress between them is not obvious.

Furthermore, inconsistent with previous studies

which suggest an association between the student’

mental health and the social support (Bovier et al.

2004; Bíró et al. 2011; Hefner & Eisenberg 2009),

the current study did not revealed any statistical

association between the two variables. Nevertheless,

the findings that social support associate with gender

and age are consistent with previous reports (Cheng

& Chan 2004; Matud et al. 2003). Larger network

among older age students might also explain why

they perceived better social support. Female is also

reported to have a larger social network and thus

reported better social support (Landman-Peeters et

al. 2005). Living with family also means that family

support is almost always available for both German

and Turkish background students, a condition that is

rarely happening among Indonesian students.

The nature of cross sectional design of the

current study serves as a limitation, thus the

causality between variables cannot be examined.

Other limitation includes a small sample size and

applying convenience-sampling methods. A larger

sample size should be considered in the further

studies. Using the convenience sampling method and

longitudinal methods are also recommended. Further

study should also consider the role of acculturation

as a determinant of social support and mental

problem among international students.

5 CONCLUSION

Cultural background of students has a significant

impact to their psychological distress, self esteem,

perceived social support and stigma towards mental

disorder. The Indonesian student studying in Berlin

should improve their self-esteem and social

supports.

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