Discrimination and Self-Harming Thoughts Among International Students during the COVID-19 Pandemic: The Role of Mask-Wearing

Background: An estimated 1 million international students enroll in universities in the U.S., contributing to $41 billion to the economy and supporting 458,000 jobs annually. However, in 2020, the number of international students decreased drastically due to the COVID-19 pandemic. In addition, the society-level discrimination against Asian communities fueled by the Trump administration, and visa restrictions and travel bans contributed to the decline in new enrollment. Anti-Asian hate crimes and discrimination against international students have caused anxiety and feelings of isolation among international students, specifically of Asian descent, which can contribute to poor mental health and self-harming thoughts. Moreover, although wearing masks is a COVID-19 safety measure suggested by the CDC, reports indicated that Asian Americans who wore masks were frequently targets of discriminatory treatment during the pandemic. Thus, this study aimed to examine whether discrimination was associated with self-harming thoughts and whether this association was moderated by high levels of mask-wearing among U.S. international students.

Methods: Cross-sectional data on undergraduate and graduate students aged 18 or older enrolled in multiple universities in the U.S. were collected via an online survey during July-August 2020 by employing a nonprobability sampling method. A total of 855 students completed the survey. For the purpose of this study, we used the subsample of only international students (n=103) for the analyses. Self-harming thoughts were assessed by a question: “How often have you had thoughts about harming yourself during the COVID-19 pandemic?" This variable was dichotomized to indicate any self-harming thoughts. Discrimination was measured by the 9-item Everyday Discrimination Scale. Mask wearing behavior was assessed by a question that asked how often during the pandemic participants wore a mask. This variable was dichotomized to indicate high vs. low levels of wearing masks. Multivariable logistic regression analyses were conducted while controlling for age, sex, Asian, and level of loneliness.

Results: 18.6% of participants reported self-harming thoughts during the pandemic. Participants were 27.76 years old on average (range = 19—48), and the majority were females (61.2%) and identified as Asian (58.3%). High levels of wearing masks (OR = 1.31; 95% CI = 1.01, 1.70) significantly moderated the association between discrimination and self-harming thoughts.

Conclusions and Implications: Findings indicated that as international students experienced higher levels of discrimination, students who wore masks more frequently reported significantly more self-harming thoughts than those who wore masks less frequently. During the pandemic, international students have been scapegoated for spreading the virus or attacked for acting differently towards COVID-19, often for preventive measures as wearing masks. Universities need to engage in macro-level advocacy efforts to denounce discrimination and increase feelings of safety and inclusion for international students. Findings suggest the need for university mental health providers to understand the unique needs of international students. Culturally appropriate mental health interventions for international students with a particular focus on healing and empowerment are warranted. Targeted strategies, such as by-stander micro-interventions and mindfulness techniques could be infused into university mental health services to promote overall well-being of international students, create spaces for healing, and empowerment.