International Journal of Intercultural Relations 35 (2011) 534–539

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International Journal of Intercultural Relations

journal homepage: www.elsevier.com/locate/ijintrel

Psychological distress among international students in Turkey

Evrim Cetinkaya-Yildiz a,∗ , S. Gulfem Cakir b , Yasar Kondakci c
a
Department of Educational Sciences, Suleyman Demirel University, Isparta, Turkey
b
Department of Educational Sciences, Akdeniz University, Antalya, Turkey
c
Department of Educational Sciences, Middle East Technical University, Ankara, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: This study examined predictors of psychological distress in a sample of 334 international
Received 10 March 2010 students studying at different public universities in Turkey. The standard multiple regres-
Received in revised form 17 March 2011
sion analysis was used to clarify the contributions of individual characteristics, interaction
Accepted 16 April 2011
with Turkish students, perceived discrimination, Turkish language proficiency, perceived
cultural distance, integration to social life in Turkey, and life satisfaction to psychological
Keywords:
distress of international students. The results revealed that life satisfaction, integration to
Psychological distress
social life in Turkey, Turkish language proficiency, and length of stay in the host coun-
International students
Internationalization try (Turkey) account for 32.8% of the variance in the international students’ psychological
Higher education distress levels. The study concludes that factors contributing to psychological distress of
foreign students are related to some individual characteristics and personal factors. Hence,
foreign students need to go through a preparation process/program in their home country.
Then a guidance and orientation program needs to be provided in the host country.
© 2011 Elsevier Ltd. All rights reserved.

1. Introduction

Internationalization in higher education has increasingly been attracting the interest of the scholars. Various scholars
have elaborated on the issue at system level (e.g., Deem, 2001; Enders, 2004; van der Wende, 2001), documented interna-
tionalization of higher education in different countries (e.g., Huang, 2006; Mizikaci, 2005), pointed out diverse rationales
of internationalization (Knight, 1999), and stated the implications of the issue on managerial practices of individual higher
education organizations (e.g., Kondakci & Van den Broeck, 2009; Poole, 2001; Stromquist, 2007). A particular concern in the
internationalization literature is focused on the international student mobility. The literature on student mobility focuses
on different dimensions of the phenomenon such as global movements of students (e.g., Chen & Barnett, 2000; OECD, 2009)
and pull–push factors affecting students’ country choice (e.g., Chen, 2006; Teichler, 2004; van der Wende, 1996). However,
there are limited number of studies focusing on well-being of foreign students.
It is commonly argued that international students experience more adjustment problems than local students and have
less resource to cope with these problems (e.g., Lee, Koeske, & Sales, 2004; Poyrazli, Kavanaugh, Baker, & Al-Thimimi, 2004).
Several authors argued that foreign students are disadvantaged (e.g., Devos, 2003; Tseng & Newton, 2002; Ultsch & Rust,
2001) mainly because they have to learn different aspects of daily life. Therefore, it is expected that different factors may
play role in emergence of psychological distress in a sojourn experience, such as the extent of life changes (Lin & Yi, 1997),
life stressors (e.g., Nicassio, Solomon, Guest, & McCullough, 1986), cultural distance (Furukawa, 1997; Galchenko & Van de
Vijver, 2007), and language problems (Zheng & Berry, 1991).

∗ Corresponding author at: Suleyman Demirel University, Faculty of Education, Isparta, Turkey. Tel.: +90 530 640 31 47.
E-mail addresses: ecetinkaya@sdu.edu.tr, evrim-cetinkaya@hotmail.com (E. Cetinkaya-Yildiz).

0147-1767/$ – see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijintrel.2011.04.001
 E. Cetinkaya-Yildiz et al. / International Journal of Intercultural Relations 35 (2011) 534–539 535

To begin with, researchers maintained that host country language proficiency, because of its effects in international
students’ social and cultural adaptation in the host country. Different scholars documented the negative impact of limited
proficiency of the host country language proficiency on acculturative stress (Pan, Wong, Joubert, & Chan, 2008) and on
students’ contribution to the academic processes in the classrooms (Kondakci, Van den Broeck, & Yildirim, 2008). Cultural
distance has also been noted by researchers as an important factor in sojourner adjustment (Zheng & Berry, 1991). Ledwith
and Seymour (2001) reported cultural distance as a cause of low academic performance for international students. Other
scholars reported that female students are even more disadvantaged in cultural adaption and adjustment in the host country
(Neto & Barros, 2007; Scheyvens, Wild, & Overton, 2003).
Part of the literature reported that international students’ positive adjustment has been found to be positively
related to their length of sojourn in the foreign cultural context (Ward, Okura, Kennedy, & Kojima 1998; Wilton &
Constantine, 2003). The problems they confront in the period following their arrival tend to diminish as their length
of stay increase (Scheyvens et al., 2003). Another important variable in sojourners’ psychological adaptation is the
intensity and/or quality of the interaction with host country people (Bochner, 2006; Ward & Rana-Deuba, 2000). It is
believed that social interaction with local people constitutes a source of social support for foreign students (Hechanova-
Alampay, Beehr, Cristiansen, & Van Horn, 2002) and a guide for practicalities (i.e., housing, food, shopping) in the
host country (Kondakci et al., 2008). When the perceived social interactions are negative, such as discrimination
against international students, international students tend to experience homesickness (Poyrazli & Lopez, 2007), educa-
tional dissatisfaction (Wadsworth, Hecht, & Jung, 2008), and low psychological well-being (Jung, Hecht, & Wadsworth,
2007).
In sum, the way in which the aforementioned factors are experienced and dealt with will largely influence the quality of
the sojourn experience of the international students. Life satisfaction is viewed as one of the indicators of a positive appraisal
style and linked to adaptive emotional and behavioral coping responses (Huebner, Suldo, Smith, & Mcknight, 2004). Thus, it
can be expected that higher levels of life satisfaction will be associated with less psychological distress among international
students.
In the present study, the focus is on the international students in Turkey. Majority of the studies in the literature
were conducted in economically developed, Anglophone countries with Anglo-Saxon educational systems. Countries like
the USA, the UK, and Australia are traditional destinations of foreign students. Higher education organizations in these
countries are institutionalized in terms of receiving foreign students. Therefore, one may argue that student mobility
is a phenomenon peculiar to Anglophone and economically developed countries with Anglo-Saxon higher education
systems. However, in the literature there are strong evidences that several developments made internationalization
an issue for non-Anglophone countries as well (Altbach & Knight, 2007; Paige, 1990; Sam, 2001) because of inter-
country or regional cooperation schemes (Denman, 2001), developments in technology and transportation (Kondakci
et al., 2008), decline in attractiveness of traditional destinations (Lee & Rice, 2007), increasing demand for higher
education (Li & Bray, 2007; Pokarier, 2006), and globalization (Altbach, 2004; van der Wende, 2003). Nevertheless,
for economically developing and non-Anglophone countries the case could be more challenging for international stu-
dents since these countries are relatively less experienced in receiving foreign students and offer less institutionalized
social, academic, and managerial services to foreign students. Hence, foreign students may confront with problems
in social interaction with local community; they are typically offered local curricula; linguistic problems may give
rise to problems in academic performance and social interaction; their host institutions may fail to consider stu-
dent diversity in developing and delivering student services. Therefore, the results of this study contribute the limited
information about psychological distress of foreign students studying at economically developing and non-Anglophone
countries.
Several characteristics of Turkey in relation to international student mobility make it a unique case to be inves-
tigated. First of all, although Turkey is characterized as a sending country in the global scheme of student mobility,
the number of international students choosing Turkey for study abroad has been increasing steadily (OECD, 2009).
In addition, the predominant dynamics pulling the students to Turkey are quite different to those of core destina-
tions (e.g., USA, UK, Australia, and Canada). In these traditional destinations prestigious universities and programs,
English language, the prospect of finding a job and staying in the host country, and scholarship possibilities are
dominant pulling dynamics. More importantly, these countries possess formal strategies (e.g., organizing fairs) to
attract more international students. However, in Turkey it is very difficult to identify a set of common ratio-
nales for international students originating from different countries. For example, student from Turkic republics
and the Balkans are motivated by cultural and geographical proximity, low tuition fees and the prospect of stay-
ing in Turkey after the study while students from Western and developed countries are motivated by cultural
exchange.
Drawing on this unique position of Turkey in the global international student mobility, the present study was
designed to examine whether psychological distress of international students can be understood on the basis of individ-
ual characteristics (gender and length of stay in the host country-Turkey), interaction with Turkish students, perceived
discrimination, Turkish language frequency, perceived cultural distance, life satisfaction, and integration to social life.
Results obtained from this study could be helpful for institutions and program developers in developing different sup-
port systems for international students in settings where there is a relatively limited experience in hosting international
students.
536 E. Cetinkaya-Yildiz et al. / International Journal of Intercultural Relations 35 (2011) 534–539

2. Method

This study is based on data collected as part of a larger project investigating social, cultural, academic and administrative
experiences of foreign students in Turkey. Below is a brief description of the sample, measures, and procedure of this study.

2.1. Sample

The sample of the study consisted of 334 international students (62.9% male, 37.1% female) studying at 10 different
universities in Turkey. The sample ranged in age from 17 to 36 years (mean = 21.65 years, SD = 2.504). The participants’
average length of stay in Turkey was 2.44 years (SD = 2.384). Only 14 (4.2%) participants were married. In terms of study
level, 294 (88%) participants indicated that they were pursuing their bachelor degree.
The participants of this study came from 55 different countries but the majority of the students came from ex-Soviet Turkic
republics (40%) (Azerbaijan, Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, and Turkmenistan) and the Balkan countries
(19%). Geographical, cultural and national proximity, common history and intense political ties between Turkey and countries
in these two regions (Macfie, 1998; Ortayli, 1995) can be considered as the primary factors making Turkey attractive for
students from these countries.

2.2. Measures

A self-report Likert type questionnaire covering items on demographic information (gender, length of stay in the host
country-Turkey), interaction of foreign students with Turkish students, integration of foreign students to social life, perceived
discrimination and Turkish language proficiency were used in the first part of the questionnaire in order to collect data.
Turkish language proficiency included foreign students’ proficiency in reading, writing and speaking dimension. The second
part of the questionnaire included cultural distance scale life satisfaction scale, and general health questionnaire.

2.2.1. Satisfaction with Life Scale (SWLS)

The SWLS (Diener, Emmons, Larsen, & Griffin, 1985) is a five-item scale that is designed to reveal the participants’ overall
judgment of their life in order to measure the concept of life satisfaction. It invites the participants to indicate their degree of
agreement or disagreement with 5 items on 7-point Likert-type scale. Scores range from 5 to 35 with higher scores indicating
greater life satisfaction. The internal consistency (Cronbach’s alpha) of the SWLS was found .87 in the original study (Diener
et al., 1985) and .83 in the present study.

2.2.2. Cultural Distance Scale

CDS was developed for the purpose of the present study by using the dimensions presented by Ward and Rana-Deuba
(1999) in the Acculturation Index. Respondents were asked to indicate the cultural distance by a 5-point scale “totally
dissimilar” (1), “totally similar” (5) on 15 domains as clothing, communication skills, religious beliefs, family life, values,
friendship, language, food, customs, worldview, social activities, and standard of living. Scores range from 15 to 75 with
lower scores indicating greater cultural distance. The internal consistency (Cronbach’s alpha) of CDS measured in this study
was .90.

2.2.3. General Health Questionnaire

The twelve-item version of General Health Questionnaire (GHQ-12) was used to assess level of psychological distress
among participants. The questionnaire was developed by Goldberg (1972). GHQ-12 consists of items that assess the mental
well-being over the past few weeks using a 4-point scale. The internal consistency of the scale was found to be .78 in the
original study and .85 in the present study.

2.3. Procedure

Before collecting the data the approval of the ethical committee was gathered. In addition, each participant submitted
a written consent to participate in the study. As foreign students form a very fluid group and are not clustered in certain
programs or courses, multiple ways (in-class and web based data collection) were followed to reach this group of student.

3. Results

A total of eight predictor variables, including gender, length of stay in Turkey, interaction with Turkish students, perceived
discrimination, Turkish language proficiency, cultural distance, and life satisfaction were entered in the regression model.
The overall regression model was found to be significant (F = 16.124, p < .001), and account for 32.8% of the variance in
the sojourners’ psychological distress levels. Life satisfaction level (ˇ = −.482, p < .001), integration with social life in Turkey
(ˇ = −.214, p < .001), length of stay in the host country-Turkey (ˇ = −.152, p < .01), and Turkish language proficiency (ˇ = −.129,
p < .05) were found to contribute negatively and significantly to GHQ scores of sojourners in Turkey. Students’ life satisfaction
was found to be the strongest predictor of the psychological distress levels of sojourners and accounted for the 23.3% of the
 E. Cetinkaya-Yildiz et al. / International Journal of Intercultural Relations 35 (2011) 534–539 537

total variance. However, the model did not reveal significant results for gender, interaction with Turkish students, perceived
discrimination, and cultural distance.

4. Discussion

This study examined the factors related to the level of psychological distress among international students. Our findings
revealed that life satisfaction, integration to social life in Turkey, length of stay in Turkey, and Turkish language proficiency
were significant predictors of psychological distress levels of international students studying in Turkey.
Life satisfaction was the strongest predictor of international students’ psychological distress levels and, as expected,
negatively correlated with it. These findings support the notion that life satisfaction, as a positive appraisal style, may
function as a buffer against psychological distress (Huebner et al., 2004). Thus, it can be considered as a protective factor for
positive adjustment or adaptation for international students.
Perceived integration to social life in Turkey is found to be the second strongest predictor of international students’
psychological distress level in our study. Integration to social life was considered as the indication of socio-cultural adaptation
in this study. Thus, the findings of this study may provide evidence in support of the idea that socio-cultural adaptation and
psychological adaptation are related (Ataca & Berry, 2002; Ward & Kennedy, 1993).
Length of stay in the host country was the third strongest predictor of psychological distress levels of international
students, meaning that, the longer the sojourn experience the lower psychological distress reported. These findings sup-
ported that adjustment problems of sojourners were greatest at entry point and decreased over time (Mehta, 1998; Wilton &
Constantine, 2003) and further evidenced that the adjustment process is a linear and positive for most international students
(Hechanova-Alampay et al., 2002).
Our findings also suggested that Turkish language skills (reading, writing, and speaking) of the international students were
a significant predictor of psychological distress. Turkish language skills of foreign students facilitate their daily life which
is not limited to campus life. They need to deal with several daily practicalities (e.g., finding a settlement, opening a bank
account, and transportation) which require constant interaction with local people. In a non-Anglophone and non-traditional
destination of foreign students dealing with these issues require certain level of mastery of local language. Hence, like the
case of traditional destinations (Duru & Poyrazli, 2007; Trice, 2003), certain level of mastery of the host country language in
non-traditional destinations is critical for dealing with daily practicalities and ultimately helps diminishing the psychological
distress levels.
Although the findings from this study add to the existing literature on international students, a number of limitations such
as; having a non-probability sample, measuring “perceived discrimination” and “integration to social life” using one state-
ment, and using a cross-sectional design deserves to be mentioned. Despite these limitations, considering all of the predictors
contributing to psychological distress in our findings, this study suggests several conclusions with regard to accommodating
foreign students in a non-traditional destination, economically developing, and non-Anglophone country. Wiers-Jenssen
(2003) argued that students who choose study abroad are more motivated and ready to undertake the challenges compared
to students choose to study at home country. However, as reported above, some factors contributing to psychological distress
of foreign students are mainly related to personal factors of foreign students. Thus, in line with previous literature (Dipeolu,
Kang, & Cooper, 2007; Mori, 2000), it can be suggested that student counseling services in campuses should designed in a
way to consider student diversity in campuses. Indeed for the case of Turkey, which attracts students from different parts of
the world who have different rationales behind their choices, enriching guidance and support services becomes particularly
important. Hence, unlike a typical Western university, in Turkey universities are expected to develop services responding
to different needs of students coming from different parts of the world. For example, student from Western countries come
with the expectations of intercultural interaction, whereas students from the Balkans and Turkic republics expect wider
financial support. Also, these services need to be broadened to cover services which are typically not served by counseling
units. Such services should particularly focus on special needs of foreign students including orientation and settlement of
foreign students.
In addition, integration to social life in host country may also be important in decreasing psychological distress and, thus
contributing to their adjustment. Hence, it would be suggested to design an integrated support program which covers aspect
related to social, cultural, and political life as well as academic life in the host country. For example, organizing intercultural
events would facilitate interaction of the diversity in the campus, which benefits not only international students but local
students as well. Further, considering our findings on length of stay in the host country, it can also be suggested that
adaptation and guidance programs should be focused more intensely on the beginning of their study period. However,
focusing intensely to the onset of their study abroad journey does not mean that they will not need support services during
the rest of their stay in the host country. Length of time for developing the skills reducing psychological distress is relative,
meaning that every student may need different periods of time to possess qualities dealing with psychological distress.
For example, in this study the average length of stay of the participants in Turkey was 2.44 years, which is considerable a
long period of time compared to the whole duration of an undergraduate study. However, it is difficult to argue that they
have fully developed all necessary skills and abilities to adapt to their life in the host country. As a result, the current study
suggests institutionalizing internationalization in both managerial and academic practices. This is possible by (1) taking
some managerial measures to transform the campus culture into a culture which embraces internationalization as a value,
and (2) distributing support programs and services throughout the stay of foreign students in the host country.
538 E. Cetinkaya-Yildiz et al. / International Journal of Intercultural Relations 35 (2011) 534–539

Acknowledgment

This study was funded by Scientific Research Projects Program of the Middle East Technical University, Ankara, Turkey.

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