Learning mode, university students’ mental health, and acculturative stress – a cross-sectional study of Chinese international students in Melbourne, Australia.

Online learning was widely implemented in university teaching activities during the pandemic and remains an important component of education following cessation of pandemic-related restrictions. Although university students reported worsening mental health during the pandemic little is known about how current learning modes (in-person, hybrid and online) are associated with mental health of international students, particularly among Chinese international students (CIS). We conducted a cross-sectional online survey of 122 CIS enrolled at an Australian university between April and May 2024. Depression and anxiety symptoms were measured using the Patient Health Questionnaire (PHQ-9) scale and Generalised Anxiety Disorder Questionnaire (GAD-7) scale. Acculturative stress was assessed using the Acculturative Stress Scale for Chinese Students (ASSCS). Associations between learning mode (in-person vs. hybrid) and mental health outcomes were examined, and the potential mediating role of acculturative stress was explored. Results indicated that compared with students in the in-person learning group, those in the hybrid learning group reported higher scores for depression (geometric mean ratio (GMR) = 1.32, 95% CI: [1.05, 1.65]) and anxiety (GMR = 1.31, 95% CI: [1.03, 1.67]). Only minimal change was observed after adjusting for age, gender, financial difficulties, online learning self-efficacy, and acculturative stress. Mediation analysis showed that acculturative stress may partially account for these differences. While acculturative stress may play a role in this association, longitudinal research is required to clarify directionality and causal pathways. These findings suggest that assistance with effective acculturation could be a potentially important component of university-based mental health programs.