Subjective Cognitive Concerns and Cognitive Health Literacy Among International and Domestic University Students in Australia

Laura Bird, Monash University, Clayton, Australia
Melinda McCabe, Monash University, Clayton, Australia
Natasha Trika, Monash University, Clayton, Australia
Yen Ying Lim, Monash University, Clayton, Australia
Kim Cornish, Monash University, Clayton, Australia


Rapid adaptation to online and distance learning triggered by COVID-19 instigated unprecedented global effects on the higher education sector, including increased mental health challenges, and more recently, emerging subjective concerns about cognitive health (SCCs) among university students. International students are particularly vulnerable due to culture shock and language barriers, social isolation, poor life satisfaction and social support, engagement in substance use and dysfunctional coping strategies, and low tendency to seek help. Despite this, few studies have determined the nature, prevalence, or factors contributing to SCCs in international students since the pandemic.

This study reports data from two waves of data collection. The first examined the prevalence and correlates (e.g., demographic and psychological) of subjective cognitive concerns (SCCs) in students enrolled at the largest Australian university in Melbourne, 5 weeks following prolonged lockdown in 2020. In addition, it compared the prevalence of SCCs between international and domestic students. The second wave was a qualitative exploration of cultural and psychological factors that contributed to the experience and reporting of SCCs between international and domestic students.

Participants and Methods:

In an online survey in December 2020, 901 students (median age=22 years, 71% female, 36% international) reported the extent of perceived changes in everyday cognitive functions (e.g., memory, concentration) throughout the university semester. Chi2 analyses indicated proportions of students reporting poorer cognition (i.e., SCCs). Hierarchical binary logistic regression analyses examined demographic and enrolment-related characteristics, COVID-19-related experiences, and symptoms of psychosocial distress that were associated with increased SCCs, in addition to the unique impact of international status. Follow-up interviews were conducted with 30 students (n=12 international) between June-August 2023. Mixed deductive-inductive thematic analysis explored individual and cultural factors associated with adjustment to university, coping styles, cognitive health literacy, and attitudes and beliefs regarding cognitive health, and their relationships with students’ experience and reporting of SCCs.


Over 60% of all students endorsed SCCs, and ~25% reported that they spoke to someone about their concerns. They tended to be younger, White/European ethnicity, and in their first year of undergraduate study. International students (47%) demonstrated significantly lower endorsement of SCCs than domestic students (71%), even after controlling for demographic differences, psychosocial distress, stigma, help-seeking, and perceived COVID-19 impact on academic performance and learning. Thematic analyses indicated lower cognitive health literacy among international students, and an influence of higher stigma on their reporting of cognitive concerns. They endorsed frequent use of emotional suppression coping styles, although coping improved beyond the first year of study.


A majority of students were experiencing, but not seeking help for, cognitive concerns. Fewer concerns in international students contrasts with extensive literature outlining the specific challenges of this unique cohort. However, in-depth interviews suggested that this lower endorsement of SCCs is associated with poorer recognition of symptoms due to lower cognitive health literacy, perception of stigma leading to reduced willingness to seek help, and suppressing their cognitive concerns. These studies highlight the need for specific culturally-informed approaches to education regarding cognitive health, to support students’ awareness of cognitive issues and encourage positive help-seeking behaviours.

Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience

Keyword 1: cognitive functioning
Keyword 2: self-report
Keyword 3: cross-cultural issues