Abstract

Introduction: International students are exposed to multiple mental health crises due to social, environmental, and culture shocks in foreign lands but it gets worse in presence of life-threatening disease outbreaks. This research was conducted to evaluate the homesickness, anxiety, and depression among Pakistani international students in Indonesia during Covid-19 Outbreak. The Methodology conducted on 86 random students that are pursuing their studies in different public and private universities in Indonesia. The data were collected by distributing google forms via email and social media groups and the responses from the respondents were recorded and analyzed statistically. Results: The study findings revealed that there is a correlation between the Covid-19 pandemic and the development of various mental health crises where 33 students (38.37%) developed homesickness, 11 students (12.79%) developed anxiety and 2 students (2.33%) manifested low-grade depression. Homesickness was outstandingly observed in females (72.72%) whereas anxiety was highly reported in males (90.90%). The study findings demonstrated that there is a strong negative correlation between student financial statuses and the development of homesickness (r:-0.977, P:0.023) and anxiety (r:-0.944, P:0.056). Conclusion: All in all, the fear to contract coronavirus, lockdowns, financial instability, the death toll of citizens and medical professionals, run out of medical facilities, and social media hoaxes are significant risk factors of mental health crisis among Pakistani international students in Indonesia

Keywords

Mental Health, Homesickness, Anxiety, Depression

Introduction

The global pandemic which is currently threatening human life and causing both social and economic difficulties in both developed and developing countries are attributed to the new type of coronavirus. The coronavirus causes diverse clinical manifestations such as pneumonia, high body temperature and respiratory impairments including difficulty in breathing and infection of the lungs [1]. The majority of these viruses are known to highly affect both domestic and wild animals but some of these viruses were also reported to infect humans and cause the disease called zoonotic diseases. On 29 December 2019, the World Health Organization (WHO) has temporarily named it 2019 novel coronavirus as the coronavirus that started affecting the lower respiratory tract of different patients in Wuhan, China [2]. Later on, WHO officially named it Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is the causative agent of Covid-19 [3].

The lockdown caused by coronavirus disease outbreak is tremendously inconveniencing global citizens in various ways such mental health crisis, fear resulting from the deadliness of the new virus, financial instability, quarantine, contradicting information from different officials in high positions and misinformation from social media. All these factors contribute to the development of depression, homesickness, anxiety and other mental health crises that manifest in citizens but mostly in people who reside far away from their families like students who travelled abroad for further studies [4].

As global citizens are exposed to the consequences of coronavirus outbreak, mental health stability is considered as the most crucial feature of community health and wellbeing. From that perspective, depression is the highly prevalent mental disorder which doesn’t have limit to the time, place, and individual but also it involves all races and ethnicities of people from different demographic regions [5].

In response to the outbreak, the Pakistani students living in Indonesia are very scared about the virus incubation period and questioning themselves if the asymptomatic people could still build out the infection. The serious quarantine measures in different major cities of Indonesia and their home countries which confined residents to their homes also aggravate the student’s condition by adding mental pressures. Apart from that, the reported insufficient medical protective equipment’s few and un-experienced medical staff because SARSCOV-2 is a new virus, shortage of hospital appliances and deaths of medical professionals in Pakistani causes the enormous concerns. In addition to the recent outbreak, the Pakistani students in Indonesia are exposed to psychological tension from the on-going online classes with massive academic workload, living hand to mouth and financial instability due to the delay of their living allowances from the universities. From the above highlighted reasons, the big number of students is exposed to many environmental and academic pressures that could run them the development of various mental health crises such as depression of various types [6].

One of the main challenges that Pakistani students experience during their stays in Indonesia is homesickness. It is explained as defined as a motivational and emotional situation which is characterized by the excessive desire and preoccupation of mind with thoughts of going back to the native countries and eventually lead to the absence of reassurance and increase the probability of developing depression and anxiety [7]. Depression is a disorder that negatively affects the someone’s feeling and characterized by lethargy and the loss of appetite with increased sense of bad thinking and reduced concentration in diverse daily activities, cognitive performances and the development of insomnia [8].

The study findings of published researches disclosed that the higher people get exposed to hard-pressing conditions, the lower his/her happiness will be. This was documented as a potential threat which affects people’s mental health and lead to homesickness, anxiety and depression of different degrees. By giving a great consideration to various published research works from different parts of the world, there are no published findings discussing about the pervasiveness of homesickness, anxiety and depression among Pakistani international students in Indonesia during Covid-19 outbreak. So, this current study is intended to light its beams on that research interest and provide primary data which will highly contribute to the continuous enrichment of the academic literatures and help the professionals to find out the effective solutions.

Materials and Methods

Research design and participants

This descriptive-analytical research was conducted in the duration of two months (from April to May 2020) on 86 (59 males and 27 females) Pakistani international students pursuing their studies in different public and private universities in Indonesia. Stratified randomization was used as a mean of sampling and collection. In this evaluation, the inclusion criteria were related to the active Pakistani international students in Indonesia who are enrolled in undergraduate, postgraduate and doctoral programs. The participants who reside in university hostels and off campus accommodations were all included in the study. As the study was carried with much consideration of the ethical clearance for research, whereby the exclusion criteria were the absence of students’ consent to be a part of this study.

Questionnaires

The distributed Google forms via email and social media groups consisted of closed ended and open-ended questions. The forms were intentionally filled by the participants and those who filled in the forms were considered as the research participants through their intentional consents of participation. Questionnaires were employed to collect demographic data from the consented students including their personal identifications such as name, age, gender, marital status and other information like field of study, semester, level of education, living place, number of siblings and their rankings, financial and health statuses, physical exercise experience at home, hobby of reading novels, watching TV habits, the use of internet and laptop-based game playing during the day.

The questionnaires consisted of other supplementary points which examine the repeatedness of homesickness experience and the severity of homesickness. The questionnaire used to assess the depression among Pakistani international students in Indonesia consists of different scales which are lethargy, fear of contract corona, social media pressures with a lot of hoaxes, cognitive-emotion and academic motivation. Students were also asked about their health status to figure out the symptoms of anxiety like fatigue, irritability, trouble of sleeping or staying awake, panic attacks, excessive worrying and restlessness. All the responses from the respondents on each form were evaluated where the low scales indicated the normal states while from the medium to high scores in terms of symptoms were the perfect indications of homesickness, anxiety and depression of different stages.

Data analysis

SPSS version 23.0 (SPSS Inc., Chicago, IL, USA) was employed to analyse the obtained data whereby nonparametric test was employed to test the normality and Pearson correlation was used to evaluate the correlation between the variables.

Results

The findings of the current research disclosed that there is a strong positive correlation between Covid-19 pandemic and the development of various mental health crisis among Pakistani students where the analysis of obtained data demonstrated that 40 students (46.51%) were free of any mental health problem, 33 students (38.37 %) developed homesickness, 11 students (12.79%) developed anxiety and 2 students (2.33 %) manifested low-grade depression. Of all 33 students who manifested homesickness, 24 (72.72 %) were females whereas the big number of anxious students was males and they occupied 90.90 % of all research subjects who presented anxiety.

As demonstrated by the results presented in table 1, the high prevalence of homesickness was seen among female participants whilst the anxiety was appeared in males and the equal number of low-grade depressions was observed in both sexes (1:1). In reference to the study findings presented in table 2, the research subjects that are less than 25 years of age were highly susceptible to anxiety, 9 (81.81%) whereas the informants that are aged between 25 and 30 years were vulnerable to homesickness, 19 (57.57%) and the respondents above 30 years of age showed a resistance to anxiety and depression. As shown by the findings recorded in table 3, the students with financial instability (weak) manifested the symptoms of homesickness and anxiety compared to others. 

The development of mental health crisis in relation to the use of internet and TV watching habits as described in table 4 was highly observed among the students who frequently use internet and watch TV. Of all 33 students who developed homesickness, 18 (54.54%) of them use internet and 12 (36.36%) use both internet and watch TV.

Discussion

The core results of this evaluation demonstrated that Covid-19 outbreak is highly attributed to the development of various mental health crisis in foreign students due to different environmental pressures such as the increase in number of Covid-19 cases, strict lockdown measures such as strict stay at home directives including home confinement, quarantine, and isolation, conflicting messages from authorities, social media news and other psychological tensions [9].

The study findings revealed great number of homesickness in studied population. This result is in agreement with the research results of Moeini who reported that homesickness is common in foreign students due to the fact that they have a desire to return in their home countries and nostalgia for their respective intimate friends and siblings [7]. The reported homesickness should also be attributed to the loneliness during lockdowns as well as the incompatibility with the new environments. This result is also supported by the study findings published by Terry who showed the presence of homesickness in non-native students due to diversity of cultures and societal health instability [10].

The high prevalence of homesickness observed in females is consistent with past studies that found the vulnerability of females to homesickness in females than males. This statement could be assisted by the results obtained by other researchers who reported the high prevalence of homesickness in girls than boys [7,11,12]. But, the result of current evaluation is also compromising with the findings of Uchenna who did not find significant gender difference in homesickness [13].

The observed anxiety in this evaluation is in conformity with the study results reported by a Chinese researcher from the study that was conducted on Chinese medical staffs. It should be defined by the fact that Covid-19 pandemic has become a potential stressor, particularly as this is a new viral infection which doesn’t have a vaccine or a specific treatment, fear of being infected and the big number of reported deaths globally [14].

In this evaluation, the prevalence of depression was equal between males and females. The observed depression in boys is in tandem with the research findings published in previous studies emphasizing that boys due to their concerns about employment and their future that could be more likely to induce depression [15].

In regard to the obtained results, student’s age could be considered as a major predictor of depression. This is in line with the findings from the study of aid and friends which disclosed that older people should have better mental health statuses, ability to calm themselves during hard conditions and are not highly developing mental health problems due to self-counseling [15]. Apart from the fact that every individual responds to stress in different ways, the Covid-19 pandemic and the lockdowns has caused a lot of worries, hunger, uncertainty, pending death, confusion and chaos which could drive students crazy and highly inconvenience their psychological stress and mental health [8].

By emphasizing on the observed findings, the correlation between the habits of using both internet and TV watching contributed to the development of mental health crisis. These results are in conformity with the study results published by Hokey that the duration spent on the Internet, web based content, the use of social platforms and watching TV programs or news highly contribute to depression and anxiety [16]. The large negative correlation observed between mental disturbance and the use of internet and TV watching is attributed to the fact that social media and various TV stations are broadcasting depressive news and the conflicting messages between government officials and health professionals [17].

Conclusion

The conclusion that can be drawn from the results of this research is that the fear to contract coronavirus, lockdowns, financial instability, death toll of citizens and medical professionals, run out of medical facilities and social media hoaxes are significant factors in mental health crisis of Pakistani international students in Indonesia during Covid-19 pandemic. As mental health crises should be mitigated by having positive opinions and strong feelings of efficacy. From that standpoint, it is recommended to embrace the talking cure with their families, physical exercises and positive thinking to avoid unintended and irreparable consequences.

Conflict of Interest

We declare that there is no conflict of interest.

Source of Funding

None

Ethical Clearance

This research was approved by the ethical committee from RSUD. Dr. Soetomo General Hospital, Surabaya, Indonesia with reference number 070/1013/CRU/IX/2020.

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