Psychosocial Status of Iraqi Students and the Effectiveness of Multicultural Therapy in Improving Psychological and Social Functioning Among Students with Anxiety Disorders
Keywords:
Iraqi students, multicultural therapy, anxiety disorders, psychological functioning, social functioning, social well-being, international studentsAbstract
Purpose: The present study aimed to investigate the psychosocial status of Iraqi students and determine the effectiveness of multicultural therapy in reducing anxiety and psychological distress and improving social well-being and social functioning.
Methods and Materials: This study was conducted in two phases. The first phase used a descriptive–analytical design to assess the psychosocial status of international students at Mohaghegh Ardabili University during the 2025–2026 academic year. From a population of 250 students, 124 were selected through multistage sampling and completed the Beck Anxiety Inventory, Keyes Social Well-Being Scale, Hadian-Nasab Social Functioning Scale, and 28-item General Health Questionnaire. In the second phase, 30 eligible Iraqi students who scored above 17 on the Beck Anxiety Inventory were selected and randomly assigned to an experimental group and a wait-list control group, with 15 participants in each group. The experimental group received a structured multicultural therapy program, whereas the control group received no intervention during the study period. Data were analyzed using descriptive statistics, multivariate analysis of covariance, and univariate analysis of covariance in SPSS version 26.
Findings: The multivariate analysis indicated a significant overall effect of group membership on the combined dependent variables after controlling for pretest scores, Pillai’s trace = .87, F(4, 21) = 35.17, p < .001, partial η² = .87. Univariate analyses showed that multicultural therapy significantly reduced anxiety, F(1, 27) = 72.84, p < .001, partial η² = .730, and general psychological distress, F(1, 27) = 64.35, p < .001, partial η² = .704. It also significantly improved social well-being, F(1, 27) = 58.61, p < .001, partial η² = .685, and social functioning, F(1, 27) = 49.27, p < .001, partial η² = .646.
Conclusion: Multicultural therapy was effective in reducing anxiety and psychological distress and enhancing social well-being and social functioning among Iraqi students, suggesting that culturally responsive interventions can support both psychological adjustment and social adaptation in international student populations.
Downloads
References
Anwar, M., Haq, M. I., Salma, D., & Wang, Z. (2024). Addressing public speaking anxiety in multicultural counselling: The use of cognitive-behavioral therapy for international students. Journal Kajian Bimbingan Dan Konseling, 7(2), 52-61. https://doi.org/10.17977/um001v7i22022p52-61
Arslan, G., & Allen, K. A. (2022). Psychological capital, well-being, and distress of international students. Frontiers in psychology, 13, 886848.
Clark, D. A., & Beck, A. T. (2023). Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Dialogues in clinical neuroscience, 25(1), 32-42.
Davies, S. (2024). Cultural capital and its impact on international students' educational success: Chinese students' experiences in the UK. Journal of Higher Education, 29(2), 235-256.
Escandell, M. J., Prat, G., Garcia-Franco, M., Martin-Martinez, J. R., Ochoa, S., Tortades, I., & Casas-Anguera, E. (2022). Clinical symptoms and social functioning in schizophrenia. Revista de Psiquiatría y Salud Mental (English Edition), 15(4), 251-258. https://doi.org/10.1016/j.rpsmen.2020.05.003
Fu, W., Yan, S., Zong, Q., Anderson-Luxford, D., Song, X., Lv, Z., & Lv, C. (2021). Mental health of college students during the COVID-19 epidemic in China. Journal of affective disorders, 280(Pt A), 7-10. https://doi.org/10.1016/j.jad.2020.11.032
Ghobadian, M., & Javadi, M. (2024). Development and standardization of the Coronavirus Anxiety Scale among nurses and its relationship with demographic characteristics and mental health. Danesh va Pazhuhesh dar Ravanshenasi-ye Karbordi.
Guan, J., Wu, C., Wei, D., Xu, Q., Wang, J., Lin, H., Wang, C., & Mao, Z. (2021). Prevalence and factors for anxiety during the COVID-19 pandemic among college students in China. International journal of environmental research and public health, 18(9), 4974. https://doi.org/10.3390/ijerph18094974
Ha, Y., & Shin, S. (2025). A comparative study of factors associated with generalized anxiety disorder between multicultural and non-multicultural adolescents: 20th (2024) Korea Youth Risk Behavior Web-based Survey. Journal of the Korean Society of School Health, 38(2), 94-105.
Harris, J., Jin, J., Hoffman, S., Phan, S., Prout, T. A., Rousmaniere, T., & Vaz, A. (2024). Deliberate practice in multicultural therapy. American Psychological Association. https://doi.org/10.1037/0000357-000
Hu, H., Vanwing, T., Cai, J., Plackle, I., Wang, Y., & Jacquet, W. (2025). The impact of perceived school climate and socio-demographic factors on immigrant students' engagement in China. Cogent Education, 12(1), 2514343. https://doi.org/10.1080/2331186X.2025.2514343
Javaid, S. F., Hashim, I. J., Hashim, M. J., Stip, E., Samad, M. A., & Ahbabi, A. A. (2023). Epidemiology of anxiety disorders: Global burden and sociodemographic associations. Middle East Current Psychiatry, 30(1), 44. https://doi.org/10.1186/s43045-023-00315-3
Jiang, Y., & Wang, F. (2024). Social media use, social identification, and cross-cultural adaptation among international students in China. Journal of Intercultural Communication Research, 53(1), 81-99.
Jin, L., & O'Regan, D. (2024). Multicultural identity construction and cultural adaptation: The experience of Chinese students in the UK. International Journal of Intercultural Relations, 48, 122-135.
Johns, G., Samuel, V., & Freemantle, L. (2022). The global prevalence of depression and anxiety among doctors during the COVID-19 pandemic: Systematic review and meta-analysis. Journal of affective disorders, 298, 431-441. https://doi.org/10.1016/j.jad.2021.11.026
Kalisch, R., Kober, G., & Binder, H. (2023). The frequent stressor and mental health model: A new paradigm for stress and resilience research. Nature Reviews Psychology, 2, 307-322.
Kazdin, A. E., Wu, C. S., Hwang, I., Puac-Polanco, V., Sampson, N. A., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Benjet, C., de Caldas Almeida, J. M., de Girolamo, G., de Jonge, P., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., Karam, E. G., Karam, G., Kovess-Masfety, V., & Collaborators, W. H. O. W. M. H. S. (2023). Antidepressant use in low-, middle-, and high-income countries: A World Mental Health Surveys report. Psychological medicine, 53(4), 1583-1591. https://doi.org/10.1017/S0033291721003160
Khaled, S. M., Alhussaini, N. W., Alabdulla, M., Sampson, N. A., Kessler, R. C., Woodruff, P. W., & Al-Thani, S. M. (2024). Lifetime prevalence, risk, and treatment of mood and anxiety disorders in Qatar's national mental health study. International Journal of Methods in Psychiatric Research, 33(S1), e2011. https://doi.org/10.1002/mpr.2011
Kim, S. M., & Kim, H. O. (2022). Effect of acculturative stress on multicultural adolescents' life satisfaction: Sequential multiple mediating effects of bicultural acceptance attitude, self-esteem, and social withdrawal using the 2016 Multicultural Adolescents Panel Study. Journal of Korean Academy of Nursing, 52(3). https://doi.org/10.4040/jkan.22030
Kuokim, B. C. (2024). Promoting culturally and socially responsive multicultural training: Reflection, description, and synthesis from a refugee-serving multicultural therapy practicum. Canadian Psychology/Psychologie Canadienne, 65(2), 117. https://doi.org/10.1037/cap0000387
Li, W., & Li, Y. (2023). Social capital, symbolic interactionism, and the social integration of international students: A mixed-methods study in the host society. International Journal of Intercultural Relations, 92, 101734.
Li, W., Zhao, Z., Chen, D., Peng, Y., & Lu, Z. (2022). Prevalence and associated factors of depression and anxiety symptoms among college students: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 63(11), 1222-1230. https://doi.org/10.1111/jcpp.13606
Li, Z., & Li, X. (2024). Acculturative stress and anxiety among international students: A cognitive-behavioral perspective. Journal of anxiety disorders, 101, 102799.
Liu, X. Q., Guo, Y. X., & Xu, Y. (2023). Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives. World Journal of Clinical Cases, 11(7), 1442-1457. https://doi.org/10.12998/wjcc.v11.i7.1442
McGrath, J. J., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Bromet, E. J., Bruffaerts, R., de Almeida, J. M. C., Chardoul, S., Chiu, W. T., Degenhardt, L., Demler, O. V., Ferry, F., Gureje, O., Haro, J. M., Karam, E. G., Karam, G., Khaled, S. M., Kovess-Masfety, V., & Zaslavsky, A. M. (2023). Age of onset and cumulative risk of mental disorders: A cross-national analysis of population surveys from 29 countries. The Lancet Psychiatry, S2215-0366(2223)00193. https://doi.org/10.1016/S2215-0366(23)00193-1
Moreno, O., Sosa, R., Hernandez, C., Nienhusser, H. K., & Cadenas, G. (2022). Immigration status, mental health, and intent to persist among immigrant college students. Journal of Diversity in Higher Education.
Mozafari, N., Kolahi, A. A., & Mozafari, M. (2022). Mental health, coping strategies, and social support among international students at a Canadian university. Canadian Journal of Counselling and Psychotherapy, 56(3), 1-25.
Racine, N., McArthur, B. A., & Cooke, J. E. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatrics, 175, 1142. https://doi.org/10.1001/jamapediatrics.2021.2482
Rana, W., Mukhtar, S., & Mukhtar, S. (2020). Mental health of medical workers in Pakistan during the pandemic COVID-19 outbreak. Asian Journal of Psychiatry, 51, 102080. https://doi.org/10.1016/j.ajp.2020.102080
Ridley, C. R., Sahu, A., Console, K., Surya, S., Tran, V., Xie, S., & Yin, C. (2021). The process model of multicultural counseling competence. The counseling psychologist, 49(4), 534-567. https://doi.org/10.1177/0011000021992339
Santomauro, D. F., Mantilla Herrera, A. M., & Shadid, J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The lancet, 398, 1700-1712. https://doi.org/10.1016/S0140-6736(21)02143-7
Smith, R. C., D'Angelo, A., & Freyd, M. (2023). A revitalized biopsychosocial model: Core theory, research paradigms, and clinical implications. Psychological medicine, 53(16), 7504-7511. https://doi.org/10.1017/S0033291723002660
Smith, R. C., Dwamena, F. C., & Fortin, M. M. (2024). Evolutionary theory can advance and revitalise the biopsychosocial model. World Psychiatry, 23(3), 405-406.
Smith, T. B., & Trimble, J. E. (2023). Multicultural counseling improves social functioning and protective factors among international students: A randomized controlled trial. Journal of counseling psychology, 70(4), 395-408.
Tzouvara, V., Kupdere, P., Wilson, K., Matthews, L., Simpson, A., & Foye, U. (2023). Adverse childhood experiences, mental health, and social functioning: A scoping review of the literature. Child abuse & neglect, 139, 106092. https://doi.org/10.1016/j.chiabu.2023.106092
Vasquez, M. J., & Johnson, J. D. (2022). Multicultural therapy: A practice imperative. American Psychological Association. https://doi.org/10.1037/0000279-000
Velez Agosto, N. M., & Almario-Zgheib, M. C. (2024). Multicultural therapy with vulnerable populations: A narrative case study. In Working with vulnerable populations: A multicultural perspective (pp. 129-144). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-67710-6_10
Vigo, D., Thornicroft, G., & Atun, R. (2024). The social determinants of mental health and disorder: Evidence, prevention and recommendations. World Psychiatry, 23(1), 58-90. https://doi.org/10.1002/wps.21160
Weber Ku, E. B., Hagler, M. A., Parnes, M. F., Schwartz, S. E., Rhodes, J. E., & Erickson, L. D. (2021). Natural mentoring relationships among survivors of caregiver childhood abuse: Findings from the Add Health Study. Annals of the New York Academy of Sciences, 1483(1), 50-66. https://doi.org/10.1111/nyas.14313
Zhai, Y., & Prescod, D. J. (2025). Promoting multicultural and social justice counselling competency of international counselling students. Counselling and Psychotherapy Research, 25(1), e12803. https://doi.org/10.1002/capr.12803
Zhang, X., Li, H., & Wang, M. (2024). The role of social media in enhancing cross-cultural adaptation for international students in China. Journal of International Students, 14(3), 421-439.
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Mamoon Alwan Noori (Author); Akbar Atadokht; Niloofar Mikaeil, Malahat Amani (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
