Introduction
Over the past few decades, Russia has become a popular destination for Chinese students seeking higher education. However, living and studying in a different cultural environment presents a number of challenges: the language barrier, differences in educational traditions and norms of academic interaction, and variations in daily life and climate. All of this often leads to increased stress and a range of emotional difficulties, including anxiety, depression, and loneliness. The urgent need for psychological support is evident, but seeking help from professionals is often difficult. Researchers (Shi et al., 2020; Chen et al., 2013) emphasize that in Chinese culture, there remains a stigma surrounding mental health issues, and seeking help from a psychologist may be viewed as a “loss of face”—that is, an admission of one’s own “weakness”.
The research interest in this issue lies in determining the extent to which Chinese students are inclined to use the services of psychologists at Russian universities and how their distress manifests itself. According to some data (Smith, Khawaja, 2011), international students from China are more likely to experience acculturation stress and less likely to seek out counselors, preferring instead to turn to fellow countrymen for advice. As a result, hidden emotional conflicts accumulate, and the likelihood of a decline in academic performance and overall well-being increases.
The purpose of this study is to 1) provide a comprehensive description of Chinese students’ attitudes toward psychological counseling at Russian universities, 2) identify the nature of their distressing experiences, and 3) determine the extent to which levels of stress (related to adaptation, academics, and culture) influence their intention or reluctance to seek help. The study is based on a multi-component concept of attitudes toward psychotherapy (IASMHS) and takes into account cultural characteristics in the spirit of the Confucian tradition, including the concept of “saving face”.
In the first part of the study, following the statement of the problem, a brief overview of key studies and approaches to attitudes toward psychological help from a cross-cultural perspective is presented, and the theoretical foundations of the concept of “problematic experiences” are analyzed. Next, the methodology and the process of collecting empirical data involving 80 Chinese students are described. Finally, the “Results and Discussion” section presents a correlation analysis between the components of attitudes toward counseling and the severity of stress-related experiences, as well as practical conclusions for improving university counseling services.
In recent years, Russian research on the sociocultural adaptation of international students has shifted its focus from describing barriers to comparative reviews and support practices. In particular, systemic differences in adaptation challenges and in the availability of support services at universities are noted; the need for institutional measures (navigating services, the work of academic advisors, digital communication channels) and regular monitoring of the well-being of international students is emphasized (Dyachenko, 2024). Practical support measures also include the use of social media as a tool for sociocultural integration, which can reduce stress and expand the scope of social interaction (Ovchinnikova, 2023). Along with this, the study describes typical adaptation challenges at Russian universities and a lack of information about the services available to international students (Ouheish Taha, 2022).
Recent reviews emphasize that emotional factors—such as loneliness, anxiety, and others—are key mediators of academic and social adjustment (Undusk, 2021). A comparative analysis of domestic and international studies highlights a growing body of research on the phenomenon of loneliness among students and its connection to indicators of well-being and academic motivation, making the topic of psychological support significant from both methodological and practical perspectives (Nabieva, 2023). These findings align with the Russian context, where the emotional and social difficulties of international students are recognized on par with their academic challenges (Tikhonova, 2023).
Beyond ethnocultural specifics, modern university services are guided by the principles of accessibility and short-term counseling. This is reflected in the implementation of tiered support models and flexible service formats, which are designed to expand reach, reduce wait times, and maintain service quality amid growing demand. The publications demonstrate the feasibility and effectiveness of such approaches in a university setting and describe the organizational elements of implementation: initial screening, triage based on intensity levels, and variability in session duration (Marques, 2024).
Among the student population, regardless of ethnocultural differences, similar reasons for seeking help and barriers are consistently observed: the primary reasons for seeking help are anxiety, depressive symptoms, and academic stress, while the main barriers remain stigma, low awareness of available services, time constraints, and doubts about the accessibility and acceptability of the service. Moreover, it is precisely the perception of accessibility and quality that is statistically linked to actual service use. These findings are consistently supported by systematic reviews and large-scale surveys of the student population in recent years (Cerolini, 2023; Alvarez-Hernandez, 2024; Eisenberg, 2024).
These findings are corroborated by the national Healthy Minds Study 2023–2024: in a sample of N = 104729 students from 196 colleges and universities, high prevalence rates of depression and anxiety were recorded (PHQ-9 ≥ 10 in 38%, GAD-7 ≥ 10 in 34%), moderate actual utilization of services over the course of the year (counseling: 36%; among students who screened positive for depression/anxiety, 61% sought some form of help), as well as a significant role of stigma as a barrier to seeking help: 41% agree with the statement regarding “public” stigma, while 7% report experiencing personal stigma. At the same time, organizational and motivational barriers are evident: 24% report a lack of time, 22% cite financial reasons, and 14% do not know where to turn, even though a total of 76% report being aware of channels for accessing resources, and 19% prefer to cope on their own. This macro-level profile directly aligns with our data on the effects of awareness and stigmatization on help-seeking behavior and supports the emphasis on bilingual information provision and stigma reduction in university services (Eisenberg, 2024).
With regard to Chinese students studying abroad, recent publications highlight culturally-driven barriers to seeking help: fear of “losing face”, self-stigmatization, and a preference for informal sources of support. It has been shown that such attitudes reduce the intention to seek help from professionals, especially in the face of language difficulties and distrust of local services (Qin et al., 2023; Li et al., 2022). At the same time, the data indicate that increased awareness and the opportunity to receive counseling in one’s native language have a positive impact on attitudes and actual help-seeking behavior (Tan et al., 2021).
Recent studies (2021–2025) have identified the following key areas: (1) the importance of institutional accessibility and awareness of support services at the university; (2) the central role of emotional states (including loneliness) in adaptation; (3) cultural barriers to seeking help among Chinese students and the potential of bilingual formats. This study builds on these findings by comparing attitudes toward psychological support and distress among Chinese students at Russian universities, taking into account awareness of services and the language factor.
This study tested the following hypotheses: (1) Chinese students are predominantly influenced by culturally conditioned stigmatizing attitudes and a fear of “losing face”, which reduce their willingness to seek help; (2) the severity of distressing experiences intensifies negative attitudes and anxiety; (3) high awareness of psychological support options contributes to a greater willingness to seek professional help; (4) a positive experience with seeking help increases the likelihood of seeking help again.
Thus, a review of the literature shows that Chinese students’ attitudes toward psychological support are shaped not only by individual attitudes but also by cultural norms, stigmatization, language barriers, and the challenges of adapting to the host educational environment. This determined the choice of methodological tools that allow for the simultaneous assessment of the components of attitudes toward psychological support, behavioral indicators of seeking help, and the severity of distressing experiences.
Materials and methods
The study was conducted as a cross-sectional survey, involving the administration of questionnaires and an analysis of the relationships between two sets of indicators: attitudes toward psychological help—measured using the IASMHS questionnaire scales (Mackenzie et al., 2004; adapted by Weinstein et al., 2015)—and an additional questionnaire developed by the authors. The level of distress was assessed using a typology-based questionnaire (Regush et al., 2023). A total of 80 students from the People’s Republic of China (39 men and 41 women) aged 20 to 33 (mean age M = 25,0 years; SD = 2,59), who were enrolled in bachelor’s, master’s, and doctoral programs at various universities in St. Petersburg and Moscow.
The fields of study (based on self-reports in an open-ended question) were diverse; the broad distribution was as follows: art/music—19 participants (23,8%), economics/social sciences/communications – 17 (21,2%), education/linguistics – 12 (15,0%), psychology – 11 (13,8%), technical/engineering – 6 (7,5%), IT/technology – 1 (1,3%), humanities (philosophy) – 1 (1,3%); the responses of 13 participants (16,3%) were too general to be reliably classified into the specified categories.
The length of stay in Russia ranged from less than half a year to more than two years (72,5% had lived in the country for more than two years). Breakdown by category: less than 6 months – 2 people (2,5%), 6–12 months – 7 (8,8%), 1–2 years – 13 (16,3%), more than 2 years – 58 (72,5%). This variable was recorded as an ordinal variable with 4 categories; consequently, the mean and standard deviation for length of stay were not calculated.
The first instrument was the Inventory of Attitudes toward Mental Health Services (IASMHS). An adapted version (Weinstein et al., 2015), translated into Chinese using the back-translation method, was used. The questionnaire was administered to participants in Chinese. It includes three main scales:
- Psychological Openness,
- Help-Seeking Propensity,
- Indifference to Stigma.
The total score reflects the overall attitude toward seeking psychological help. Responses are rated on a 5-point scale.
An original questionnaire was developed by the study’s author to elicit details about actual experiences of seeking help (number of times, reasons, formats), willingness to seek help (1–5), and barriers (language, financial, fear of “losing face”). The questionnaire consisted of 15 questions. The questionnaire was administered in Chinese; the text was translated and back-translated by independent translators, with any discrepancies subsequently reconciled.
The “Challenging Experiences” methodology was used in a modified form: it was supplemented with sections devoted to social and cultural adaptation; communication and relationship issues; academic and administrative adaptation; health issues and adaptation to the climate; safety issues; issues related to the use of the Internet and technology; and anxiety about the future. The thematic blocks from the original version were retained as a foundation and supplemented with cross-culturally relevant questions identified following the pilot study. No comparable data were found in publications applying L.A. Regush’s methodology to student samples; the available reports describe an adolescent sample, so a direct comparison with our modules is not yet possible (Regush et al., 2023).
Each item is rated on a 5-point scale (1 – “strongly disagree”, 5 – “strongly agree”).
The questionnaire was administered in Chinese; a back-translation procedure (Russian–Chinese–Russian) was used, followed by linguistic review by bilingual experts.
Preliminary data analysis (descriptive statistics, distribution checks) was performed using SPSS Statistics 26. The choice of nonparametric tests was due to the ordinal nature of the scales and the deviation of distributions from normality in a number of variables. Spearman’s correlation was used for ordinal variables (the experience scales and IASMHS components), and the ϕ coefficient was used for binary variables. Comparisons between groups using ordinal criteria were performed using nonparametric methods. The effect of the binary factor “presence of a positive previous experience with seeking help” on the ordinal assessment of readiness to seek help again was tested using the Mann–Whitney U test (due to non-normal distributions and the ordinal nature of the scale).
All participants provided written informed consent in accordance with the university’s approved procedures. The study adhered to the principles of anonymity and voluntary participation. Data were collected exclusively for research purposes without any medical interventions. All instruments were adapted to account for cultural and linguistic characteristics.
Given the study’s objective, further analysis focused on identifying the most pronounced problematic experiences, assessing the components of attitudes toward psychological assistance, and examining the relationships among these groups of indicators.
Results
Based on the final “Index of Problematic Experiences” (the arithmetic mean of the seven thematic blocks), it was found that, among the blocks examined, students rated the following aspects most highly.
- Safety concerns (M = 3,12; SD = 1,01), with fears of theft and fraud being the highest (M = 3,20, SD = 1,37).
- Academic and administrative adjustment (M = 2,91; SD = 0,93). The most common difficulties were understanding lectures (M = 3,24; SD = 1,32) and interacting with administrative offices (M = 2,81; SD = 1,28).
- Anxiety about the future (M = 2,96; SD = 0,93): concerns about one’s career (M = 3,54; SD = 1,29) and doubts about the recognition of one’s degree (M = 2,88; SD = 1,35) predominate.
On the IASMHS questionnaire, the average total score (sum of the three scales) was 85,95 (SD = 12,52) on a scale ranging from 24 to 120. This corresponds to a moderately positive attitude toward seeking psychological help on the IASMHS scale.
Specifically:
- Psychological Openness (PO): M = 25,71, SD = 5,74;
- Help-Seeking Propensity (HSP): M = 31,48, SD = 4,82;
- Indifference to Stigma (IS): M = 28,76, SD = 6,38.
According to the authors’ behavioral preferences questionnaire, some respondents indicated that they primarily seek to resolve difficulties on their own (qualitative responses). Additionally, on the scale measuring the importance of a specialist’s proficiency in Chinese, the score was high: M = 4,13; SD = 0,99 (on a scale of 1 to 5), reflecting the perception that the counselor’s language proficiency is an important factor in seeking psychological help. Willingness to seek help in the future: M = 3,72; SD = 0,93; distribution: 2 – 10,0%, 3 – 28,7%, 4 – 40,0%, 5 – 21,2%.
Correlation analysis showed that higher scores in the “Health and Climate”, “Internet and Technology”, “Anxiety about the Future”, and “Safety” clusters are associated with less indifference to stigma. The IASMHS total score is lower when “Internet and Technology”, “Health and Climate”, and “Future” are more pronounced, whereas no associations were found with “Psychological Openness” and “Help-Seeking Propensity” (p > 0,05).
Table
Spearman’s rank correlation (r) between “Problematic experiences” blocks and IASMHS indicators (IS and total score) (N = 80)
|
Блок «Проблемных переживаний» / Problematic experiences block |
«Indifference to Stigma» (IS), r; p |
Итоговый балл IASMHS / Total IASMHS, r; p |
|
Проблемы здоровья и климата / Health and climate problems |
r = –0,329; p = 0,003 |
r = –0,233; p = 0,037 |
|
Интернет- и технологические трудности / Internet and tech difficulties |
r = –0,327; p = 0,003 |
r = –0,244; p = 0,029 |
|
Беспокойство о будущем / Worries about the future |
r = –0,281; p = 0,010 |
r = –0,226; p = 0,044 |
|
Проблемы безопасности / Safety problems |
r = –0,251; p = 0,024 |
r = –0,036; p = 0,751 |
|
Индекс проблемных переживаний (интегральный) / Problem experiences index (overall) |
r = –0,323; p = 0,003 |
r = –0,207; p = 0,065 |
Let’s examine the results regarding the behavioral aspect: experience with and willingness to seek help when facing difficult emotions.
In total, 37,5% (30 people) had sought help from psychologists or psychotherapists at least once, with 61,3% of them having done so only once. The main reasons were academic stress (34%), personal problems (26%), and emotional distress (23%). About 80% considered it extremely or very important for a specialist to speak Chinese. “Most likely” to seek help—40%; “Very likely”—21,3%. Nearly 40% feel uncertain. Face-to-face individual counseling is the most preferred option (M = 4,66; SD = 0,78). Group sessions received low ratings (M = 2,44; SD = 1,52), as did peer support groups (M = 2,74; SD = 1,50). Online formats received average ratings, though text-based chats elicited polarized opinions—chat (M = 2,75; SD = 1,53). Factors motivating people to seek help: a guarantee of confidentiality (53,8%), the option to receive counseling in Chinese (43,8%), and positive past experiences (40,0%).
Main barriers: fear of judgment (32,5%), language barrier (30%), and doubts about the professionals’ competence (22,5%).
An analysis of the effect of “positive treatment experiences” on willingness to return (using the Mann–Whitney U test) revealed a trend (p = 0,144), while a statistically significant difference was found only in the level of comfort with consultations (p = 0,006), indicating that: people with positive experiences are less anxious about judgment and perceive the assistance as more “culturally acceptable”.
The empirical data obtained require interpretation within a cross-cultural context, as the identified associations reflect not only individual differences but also the influence of linguistic, social, and cultural barriers to seeking psychological help.
Discussion
The results partially confirmed hypotheses (1)–(3): moderately negative associations were found between the severity of distressing experiences and indifference to stigma/overall attitude toward seeking help, and a significant association was demonstrated between awareness of counseling options and actual help-seeking (ϕ = 0,868; p < 0,01); hypothesis (4) regarding the influence of positive experiences on repeat help-seeking did not receive statistically significant support (p = 0,144).
Our findings highlighting administrative barriers, language difficulties, and a lack of information are consistent with Russian reviews on the sociocultural adaptation of international students: navigating university services, the work of academic advisors, and transparent communication from universities remain key factors in reducing stress and increasing help-seeking (Dyachenko, 2024). Similar conclusions are presented in practice-oriented studies on typical difficulties at Russian universities and the role of information provision: a lack of knowledge about available services acts as an independent barrier, even when there is a need for support (Ouheish Taha, 2022).
The findings confirm that Chinese students studying at Russian universities do indeed face the challenge of dual adaptation—both academic and cultural (Berry, 2007; Xu et al., 2017). At the same time, there remains a cultural stigma associated with seeking help from a psychologist (Shi et al., 2020), although the level of “Help-Seeking Propensity” is relatively high—31,48 out of 40. This may indicate that some students are not opposed to the idea of psychotherapy in principle but fear “losing face” in the eyes of society, friends, or relatives (Esipov, 2022). In line with Eisen’s Theory of Planned Behavior (1991), low “Indifference to Stigma” can act as a barrier even when there is a positive assessment of utility. The identified correlation (r = –0,29; p = 0,003) between the composite measure of distress and “Indifference to Stigma” (IS) is consistent with the finding that, in stressful situations, people are more vulnerable to the opinions of others and less willing to risk their reputation (Corrigan et al., 2015).
The data on the “Indifference to Stigma” (IS) component and the importance of confidentiality align with the findings of Russian studies on students’ attitudes toward psychological support: expectations of judgment from others and trust in the format or channel of interaction with a specialist play a significant role (Esipov, Nesterova, 2022). This is also consistent with a model in which negative social norms and fears of “losing face” deter even those who generally view the benefits of counseling support positively.
The observed need for counseling in Chinese underscores the importance of establishing bilingual psychological support services (Chen et al., 2013). Furthermore, the issue of low awareness of university services (ϕ = 0,868; p < 0,01) confirms that the mere availability of information can serve as a strong motivator for seeking help (Semenova, 2021). In terms of service formats, our findings regarding the preference for in-person individual counseling and the importance of the counselor’s native language are complemented by Russian observations on the effectiveness of digital channels, provided that anonymity and user-friendly navigation are ensured: some students prefer online services and counseling in secure environments (Semenova, 2021). At the same time, studies emphasize that social media and online communities can facilitate sociocultural integration and reduce the subjective stress of international students when properly moderated and linked to university services (Ovchinnikova, 2023).
It is necessary to improve the quality of the initial consultation, as a superficial, one-time meeting does not always build sufficient trust in the system (Fung et al., 2007).
Conclusions
The study’s objective was achieved: the study identified the characteristics of Chinese students’ attitudes toward psychological support while studying at Russian universities and established connections between specific components of these attitudes, behavioral indicators of seeking help, and distressing experiences. The results showed that respondents’ overall attitude toward psychological support is moderately positive; however, it is accompanied by a pronounced sensitivity to stigma, fear of “losing face”, language difficulties, and a lack of awareness regarding available forms of support.
The first hypothesis was partially confirmed: culturally-based barriers and fear of stigmatization were indeed identified, but they do not lead to an entirely negative attitude toward psychological help. The second hypothesis was also partially confirmed: more severe distress is associated with less indifference to stigma and a lower IASMHS total score; however, no significant associations were found with psychological openness or the propensity to seek help. The third hypothesis was confirmed with regard to actual help-seeking behavior: awareness of counseling options is significantly associated with seeking psychological help. The fourth hypothesis was not statistically significantly confirmed regarding willingness to seek help again, although a positive experience was associated with a greater sense of comfort regarding counseling.
The recommendations include developing bilingual one-on-one counseling, creating anonymous online services, organizing information campaigns, and incorporating culturally sensitive elements (a combination of European and Chinese self-regulation practices). It is important to ensure complete confidentiality and work to reduce stigma.
Further research should focus on evaluating the effectiveness of the proposed measures, analyzing trends in the number of requests for assistance, and monitoring Chinese students’ satisfaction with the counseling services. A preliminary analysis of gender differences in the experience of seeking psychological help did not reveal a statistically significant effect: 33,3% of men had such an experience, compared to 41,5% of women; χ²(1) = 0,564; ϕ = 0,084; p = 0,453. Given the small effect size and sample size, it would be advisable to repeat the analysis using a larger sample. It would also be interesting to compare these findings with those of other groups of international students at Russian universities.
Limitations. The sample size (n = 80) limits the possibility of detailed analysis of individual subgroups (for example, according to different levels of Russian language proficiency). The study was conducted on the basis of self-reports, which can lead to subjective distortions.