During her first year in college, Yiping Zhong began to have panic attacks every time she walked into class.
For the Beijing native attending Macalester College in St. Paul, Minnesota, the panic attacks were just one symptom of the deep depression she had sunk into since arriving at college in the United States. In addition to binge eating and debilitating stomachaches, she often struggled to get out of bed in the morning and missed weeks of class.
"I start to cry every night," she said, describing the illness, "I don't know why. Every day when it would come to that time, I just start crying for no reason."
Zhong's experience is not uncommon among the more than 300,000 Chinese international students studying in the United States. A study conducted at Yale University in 2013 found that about 45% of Chinese students there experienced depression, while 29% experienced anxiety. Yale's findings echoed that of other colleges, suggesting that many Chinese students — like other foreign students — are at risk for serious mental health issues.
Studying in America as an international student can be lonely and alienating.
"We feel like we don't own this space because we are guests, or we come from the outside," said Ryan Tian from Suzhou, China, a second-year student at Columbia University in New York City. "We would fear that people who live here, own this country or own this space, Americans, would judge us for not understanding their culture."
Tian said that between Chinese international students and domestic students there is a "sense of strangeness from both groups" that can prevent Chinese students from feeling comfortable at American colleges and universities.
"For (Chinese students) who don't understand another country, they would just assume that people have a hostile sentiment because of the trade war or because of the economic and political stuff," Tian said, referring to political tensions between the U.S. and China.
Fear of a new environment, cultural adjustment and homesickness were found to be among the main challenges faced by Chinese international students in a 2017 study conducted by Syracuse University professors Yue Zhang ABD and Eunjoo Jung Ed.D. This was exacerbated by difficulty with English and academic pressure, the study said.
FILE - A student from China, center, walks on campus at the University of Connecticut, in Storrs, Connecticut, Sept. 18, 2015.
For Tian, pressure also comes from elders who constantly remind their children that you "have to find a very good job and make a ton of money."
Yet, Tian said, international students suffer from a lack of nearby family members and friends to turn to for academic support and career opportunities.
"It's very hard because of the visa policies and the lack of networking and connections in this country," he said. "That also adds another layer of pressure to international students. They want to achieve the same success, is how people view it, as domestic students, but they don't really have the same resources."
"Our parents didn't go to college in this country and they don't know how to navigate the system," Tian added.
Being unfamiliar with American culture also places some Chinese international students at a disadvantage among their domestic peers.
"American humor and Chinese humor is totally different." Zhong explained. "Sometimes, people are laughing, and I don't know why they're laughing. Like, why?' Why is that funny?"
Mental health resources can be hard to reach for students not used to having them available. In Chinese culture, a stigma exists about needing mental health support.
"In China, going to a therapist for your mental health problems is not a really popular thing to do. And a lot of times, people would judge you, basically," said Ivy Li, a sophomore at New York University who is originally from Beijing.
Academic pressure in fierce in China. But the emotional strain as a result of this pressure is not acknowledged in Chinese culture.
"A lot of us came from a background where mental health discussions are not a frequent topic in everyday life," Tian explained. "It's even sometimes a social stigma if you show mental vulnerability."
Tian said he believes that de-stigmatizing mental health challenges can help Chinese students.
"I think to overcome the psychological barrier in order to be able to be brave enough to embrace mental health issues, and to talk about mental health issues, is really important," he said.
To Wang, progress can be found in "more awareness and people feeling more comfortable talking about it or just seeking help, knowing where to find resources."
Student groups also can be helpful, said Li.
"For Chinese students, there's the CSSA (Chinese Student and Scholars Association). ... For people who come here for the first time, it's definitely more important to find a student body group that really knows who you are and where you're from."
Some American colleges have mental health resources.
Columbia University, for example, has a full range of services available to students through Columbia Health's Counseling and Psychological Services unit.
"The team is well-equipped to support the mental health needs of international students, yes. And also the diverse backgrounds of domestic students — we have more than 60 providers who collectively speak 16 languages and are from a variety of racial, cultural, and social backgrounds with training in a number of therapeutic methodologies to address student needs," said Gayle Gatchalian, a representative at Columbia.
With the help of counseling and supportive relationships, Zhong said she is preparing for her junior year, and says she feels healthier and more optimistic.