Factors underpinning international student mental well-being: a UK and China survey.

Authors

Jianyiwen Zhao, Rob Saunders, Phoebe Barnett, Siying Li, Yuqi Niu, Stephen Pilling, Peter Fonagy

Published in

BMJ mental health. Volume 29. Issue 1. Sep 12, 2026. Epub Sep 12, 2026.

Abstract

International students experience a high mental health burden and face barriers to accessing and sustaining support, yet domain-level stress frameworks provide limited guidance on which specific stressors should be prioritised.
To prioritise item-level stressors associated with perceived stress and mental well-being among international students using machine-learning models, and to evaluate cross-site transportability via external testing between Chinese students in the UK and international students in China.
We conducted a cross-sectional online survey of 481 students across two sites, Chinese students in the UK and international students in China. Item-level stressors, perceived stress (PSS 10) and mental well-being (Warwick-Edinburgh Mental Wellbeing Scale; WEMWBS) were assessed. Elastic net and random forest models were evaluated using nested cross-validation, and cross-site external testing was conducted by training in one site and testing in the other.
Across the six models, random forest explained approximately 22%-35% of the variance in perceived stress and 25%-27% of the variance in mental well-being. Concerns about mental well-being, sleep difficulties, physical health and family or self-imposed academic expectations consistently ranked highly across sites. Social isolation and restricted social life were strongly associated with lower mental well-being. Context-specific stressors also emerged: in the UK setting, greater time-management pressure, low confidence in interacting with others and loneliness were more strongly associated with poorer outcomes, whereas in the Chinese setting, difficulties balancing study and personal life and not knowing where to seek help played a larger role. Cross-site validation indicated that a substantial portion of the item-level stressor signal generalised across settings.
Item-level stressor profiles provide informative, partly generalisable evidence on stressors linked to international students' mental health. The identified high-impact stressors offer concrete, context-sensitive targets for prevention and intervention in university mental health services.
These findings can inform how university mental health services prioritise support and prevention by focusing on core stressors while adapting provision to locally salient challenges.

PMID:
42731880
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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