Invisible Barriers: The Psychological Toll of Everyday Discrimination on International Medical Students in Egypt

Nayera Samy Mostafa; Yomna Ayman Ali; Dina Hussien Edarous; Fatma Mokhtar

Abstract

Everyday discrimination significantly predicts psychological distress among international medical students, a growing yet understudied population in Arab contexts. This mixed-methods cross-sectional study assessed discrimination prevalence and its mental health impact in 391 students at Ain Shams University, Egypt, Data collection was conducted between September 2025 to December 2025, using the Everyday Discrimination Scale (EDS), General Health Questionnaire-12 (GHQ-12), sociodemographic survey, and two focus group discussions (FGDs) with 20 participants; quantitative data underwent non-parametric analyses, while qualitative data used thematic analysis. Nearly half (47.6%) reported discrimination (median EDS score 9.0, IQR 4–21), predominantly verbal (26.1%) and skin color-based (20.1%), with higher EDS scores correlating to greater distress (Spearman’s rho = 0.394, p < 0.001; median GHQ-12 = 12, IQR 8–18); females and first-years showed elevated levels (p < 0.001, p = 0.032). FGDs revealed themes of unequal treatment, emotional toll, coping via peer support, and needs for anti-bias training. Discrimination imposes a substantial psychological burden on international medical students in Egypt, especially newcomers and females, necessitating institutional mental health supports and equity policies.

References

1.
Shields, R.; et al. Globalization and international student mobility: A network analysis. Comp. Educ. Rev. 2013, 57, 609–636. https://doi.org/10.1086/671752.
2.
Lazari, E.; Matsoukas, I.G. Bridging divides: The bold new era of university internationalization. Front. Educ. 2024, 9, 1473045. https://doi.org/10.3389/FEDUC.2024.1473045.
3.
Ali, Y.A.; Manzour, A.F.; Mostafa, N.S.; et al. International Medical Students’ Adaptation to University Life in Egypt: A Qualitative Study. J. High Inst. Public Health 2023, 53, 105–113. https://doi.org/10.21608/JHIPH.2024.345058.
4.
Redbird, B.; Harbridge-Yong, L.; Mersey, R.D.; et al. The Social and Political Impact of the COVID-19 Pandemic: An Introduction. RSF: Russell Sage Found. J. Soc. Sci. 2022, 8, 1–29. https://doi.org/10.7758/RSF.2022.8.8.01.
5.
Fu, R.; Leff, S.S.; Carroll, I.C.; et al. Racial Microaggressions and Anti-Racism: A Review of the Literature with Implications for School-Based Interventions and School Psychologists. Sch. Psychol. Rev. 2022, 53, 1. https://doi.org/10.1080/2372966X.2022.2128601.
6.
Xiong, Y.; Rose Parasath, P.; Zhang, Q.; et al. International students’ perceived discrimination and psychological distress during the COVID-19 pandemic. J. Am. Coll. Health 2024, 72, 869–880. https://doi.org/10.1080/07448481.2022.2059376.
7.
Gustavo De Lima, R.; Da, S.; Neiva, S.; et al. Discrimination: Concept, Types, Impact, and Remedies. In Reduced Inequalities; Springer: Cham, Switzerland, 2021; pp. 122–133. https://doi.org/10.1007/978-3-319-95882-8_13.
8.
Banks, K.H.; Kohn-Wood, L.P.; Spencer, M.; et al. An examination of the African American experience of everyday discrimination and symptoms of psychological distress. Community Ment. Health J. 2006, 42, 555–570. https://doi.org/10.1007/S10597-006-9052-9.
9.
Brandt, L.; Liu, S.; Heim, C.; et al. The effects of social isolation stress and discrimination on mental health. Transl. Psychiatry 2022, 12, 398. https://doi.org/10.1038/s41398-022-02178-4.
10.
Wolk, M.W.; Ong, L.Q.; Sin, N.L.; et al. Discrimination in daily life: Effects on sense of purpose and derailment. Curr. Psychol. 2025, 44, 11210–11218. https://doi.org/10.1007/S12144-025-07944-3.
11.
Teshome, B.G.; Desai, M.M.; Gross, C.P.; et al. Marginalized identities, mistreatment, discrimination, and burnout among US medical students: Cross sectional survey and retrospective cohort study. BMJ 2022, 376. https://doi.org/10.1136/BMJ-2021-065984.
12.
Pascoe, E.A.; Richman, L.S. Perceived Discrimination and Health: A Meta-Analytic Review. Psychol. Bull. 2009, 135, 531. https://doi.org/10.1037/A0016059.
13.
Krendl, A.C.; Pescosolido, B.A. Countries and Cultural Differences in the Stigma of Mental Illness: The East–West Divide. J. Cross-Cult. Psychol. 2020, 51, 149–167. https://doi.org/10.1177/0022022119901297.
14.
Smith, R.A.; Khawaja, N.G. A review of the acculturation experiences of international students. Int. J. Intercult. Relat. 2011, 35, 699–713. https://doi.org/10.1016/J.IJINTREL.2011.08.004.
15.
Harnois, C.E.; Bastos, J.L.; Campbell, M.E.; et al. Measuring perceived mistreatment across diverse social groups: An evaluation of the Everyday Discrimination Scale. Soc. Sci. Med. 2019, 232, 298–306. https://doi.org/10.1016/J.SOCSCIMED.2019.05.011.
16.
Gnambs, T.; Staufenbiel, T. The structure of the General Health Questionnaire (GHQ-12): Two meta-analytic factor analyses. Health Psychol. Rev. 2018, 12, 179–194. https://doi.org/10.1080/17437199.2018.1426484.
17.
Lee, J.J.; Rice, C. Welcome to America? International student perceptions of discrimination. High. Educ. 2007, 53, 381–409. https://doi.org/10.1007/S10734-005-4508-3.
18.
Wei, M.; Liao, K.Y.H.; Heppner, P.P.; et al. Forbearance coping, identification with heritage culture, acculturative stress, and psychological distress among Chinese international students. J. Couns. Psychol. 2012, 59, 97–106. https://doi.org/10.1037/A0025473.

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