Comparative Analysis of Results from a Cognitive Emotion Regulation Questionnaire Between International Students from West Asia and Xinjiang College Students in China.

BACKGROUND: The Cognitive Emotion Regulation Questionnaire (CERQ) is a cognitive and emotional tool measuring how individuals deal with stressful life events. However differences exist in the results of CERQ among individuals.
OBJECTIVE: This study was conducted to investigate the CERQ results and depressive symptoms of students at our university (both local and international students) in order to provide further guidance for psychological interventions.
METHODS: 255 sophomore and junior international students (171 male and 84 female) and 262 sophomore and junior Chinese students (124 male and 138 female) were investigated using CERQ, ASLEC and SDS questionnaires. Results were analyzed using SPSS 16.0. RESULT: Compared to Chinese students, international students more often used cognitive adjustment methods such as "positive refocusing","re-focus on planning" and "catastrophizing". In regression equations where depression symptoms were used as the dependent variable, "self-blaming" and "catastrophizing"positively contributed to depression symptoms in international students, while"acceptance" was negatively correlated with depression symptoms.In Chinese students, "life events score" and "catastrophizing"were positively correlated withdepression symptoms, while "positive re-evaluating" was negatively correlated with depression symptoms.
CONCLUSION: Among students of different races, positive coping methods were negatively correlated with depression symptoms and could possibly prevent the occurrence of depression, while negative coping methods were positively correlated with depression.Encouraging students to use adaptive coping methods during psychological intervention is an effective way to adjust cognitions and behavior for depression prevention.

1. Background

Cognitive and emotional regulation refers to the cognitive approach taken by individuals when dealing with information that causes emotional arousal, which mainly refers to the cognitive part of a coping method. The process of emotion mediation through thinking or cognition is closely related to the life of an individual, which is helpful for emotional regulation after stressful life events.[ Studies have shown that maladaptive cognitions in individuals dealing with negative life events was a strong risk factor for depressive symptoms. [ Results of one study showed that among juveniles aged 13 to 15 years old girls were more likely to have maladaptive cognitions (i.e. negative thinking) than boys, and that they were at a higher risk for depression. [ Maladaptive cognitive methods such as self-blaming, catastrophizing, contemplation, and blaming-others, were related to negative emotions such as depression and anxiety.[ Furthermore, in the face of stressful life events, differences exist in cognitive coping methods between males and females. Some studies showed that males used positive cognitions more often than females[, while others showed that males used unhealthy cognitions more often.[ Therefore, there are differences in cognitive coping methods among different individuals, and among genders as well. When speaking in terms of an individual’s mental health, it is also widely acknowledged that cognitive strategies for dealing with stressful life events can increase or decrease the risk for depression. Schools and universities can be high stress environments in which social and academic pressures are high, but psychsocial support is not always readily available to students in need. In this setting it can also be difficult for staff and fellow students to identify those struggling students if they do not reach out for help on their own. Psychosocial interventions such as support groups or simple cognitive training to reduce stress and increase productivity can be designed to help students. However, there is a lack of data about the cognitive coping methods of Chinese college students and central Asian college students who are studying in China. Therefore, we collected data on these two groups using the Cognitive Emotion Regulation Questionnaire in hopes of designing psychosocial interventions for students at risk for depression or anxiety.

2. Methods

2.1 Participants

Random cluster sampling was conducted on sophomore and junior international students (mainly from Pakistan, and a small number from Afghanistan, Sudan and other countries) enrolled at the International College of Education of Xinjiang Medical University in 2015. A total of 255 (171 males and 84 females)students filled out the questionnaire, among whom 234 students were from Pakistan, 6 were from Afghanistan, 5 were from Mongolia, 3 were from Sudan, 1 was from Mauritius, and 6 were from Kazakhstan. The mean(sd) age was 21.9(1.2) years old. Random stratified cluster sampling was conducted on enrolled sophomore and junior Chinese students using the same method. There were a total of 262 participants (124 male and 138 female) in the sampled Chinese group, among which 96 were ethnic Uygur students and 166 were ethnic Han students. The mean(sd) age in the Chinese group was 21.8(1.0) years old. There was no significant difference in the mean age between the international and Chinese students (t=1.11, p=0.266).

2.2 Questionnaire

College Students’ Life Events Scale (ASLEC) is a selfrating questionnaire, consisting of a total of 27 items. It investigates the impact of negative life events on students in the past 6 months, with a total repeated measure correlation coefficient of 0.69, and an internal consistency Cronbach coefficient of 0.85.[ Each item is graded from 1 to 6 measuring impact of specific life events, with 1 standing for “no occurrence of event”, 2 for “no impact”, to 6 for “very severe impact”. The scale includes 6 factors: (a) interpersonal relationships, (b) study pressure, (c) punishment, (d) loss of relative/ friend/property, health and (e) adjustment problems. Students filled out the questionnaire according to their actual life situation.

Chinese students use the Chinese version of the ASLEC, while the ASLEC scale for international students was translated by two English language professionals according to the Chinese version. After review of this English translation version of the ASLEC the optimal version was determined and used for this study.

A Self-rating Depression Scale (SDS), (i.e. Zung’s Self-rating Depression Scale) consists of 20 items with4 grading levels.[ Cronbach’s α coefficient for this scale was 0.88-0.93, and correlation coefficient among the items is 0.80-0.85. The evaluation cut-off value is 53 points. A higher score reflects a greater tendency towards depression. A score of less than 52 is within normal limits (i.e. no depression), score of 53-62 reflects mild depression, 63-72 reflects moderate depression and a score of greater than 72 indicates severe depression.

Chinese students used the Chinese version of the SDS questionnaire, while international students used the English version of the SDS questionnaire.

The Cognitive Emotion Regulation Questionnaire (CERQ): CERQ questionnaire was compiled by Garnefski to assess the cognitive emotion regulation strategies adopted by individuals when facing negative life events. This scale is shown to have good reliability and validity. Its internal consistency coefficient a is in the range of 0.67 to 0.81, and the correlation coefficient of its sub-scales is -0.02 to 0.55.[ It consists of a total of 36 items, in the form of 9 sub-scales: (a) self blame, (b) acceptance, (c) contemplation, (d) positive re-focus, (e) re-focus on planning, (f) positive re-evaluation, (g) rational analysis, (h) catastrophizing, and (i) blaming others. Each sub-scale consists of 4 items, rated from 1 to 5, with 1 being “rarely” to 5 being “has always been so”. The higher the score on a sub-scale, the more likely the subject is to use this specific cognitive strategy when faced with negative events. A study by Garnefski and colleagues showed that the 9 sub-scales can be divided into adaptive emotion regulation strategies and maladaptive emotion regulation strategies.[ Adaptive strategies include: (a) acceptance, (b) positive re-focusing, (c) re-focus on planning, (d) positive reevaluation and (e) rational analysis. Maladaptive emotion regulation strategies include: (a) self-blaming, (b) contemplation, (c) catastrophizing and (d) blaming- others. Zhu and colleagues studied the Chinese version of the CERQ and found the reliability and validity to be good, with full scale Cronbach coefficient a being 0.81, full scale inter-item correlation coefficient being 0.1, and the inter-item average correlation coefficient of each sub-scales being in the range of 0.19 to 0.71. [ Ethnically Han and Uygur students used the Chinese version of the CERQ, while international students all used the English version of the CERQ.

2.3 Data analysis

SPSS16.0 was used for data processing. Single sample t-test method was used to compare mean scores on the CERQ, SDS and ASLES for international and Chinese students. Logistic stepwise regression analysis was used to analyze factors that affect depressive emotion, using depressive emotion as the dependent variable, and life events as well as individual cognitive emotion regulation methods as the independent variables.

3. Results

3.1 Comparison of international and Chinese students

Table 1 shows the age comparison results between international and Chinese students. There were 171 male international students, with a mean(sd) age of 21.7 (1.5), and 84 female international students, with an average age of 21.4(1.3). There were no significant differences between the two groups in age (t=1.73, p=0.086). There were 124 male Chinese students, with a mean(sd) age of 21.6 (1.0), and 138 female Chinese students, with a mean(sd) age of 21.5(1.1). There was no significant difference between the two groups (t=0.67, p=0.503). The Cronbach a coefficient of the ASLES scale was in the range of 0.812 to 0.869 for international students.

Table 1.

Comparison of the general information of international and Chinese students

	International students		t	p	Chinese students		t	p
	Male (171)	Female (84)			male (124)	female (138)
Age	21.67(1.46)	21.35(1.27)	1.73	0.086	21.56(0.99)	21.47(1.06)	0.67	0.503

Table 2 shows t-test analysis results of the 9 component scales, (ASLES, SDS, CERQ) for international and Chinese students. The CERQ’s Cronbach a coefficient for the foreign students group was 0.734, and 0.733 for the Chinese students group. There were no significant differences in either the life events scale scores or SDS scores between the international student and Chinese student groups. Looking at the CERQ scores results, there were significant differences on items such as “positive refocusing”, “refocusing on planning” and “catrastrophizing” between the international student and Chinese student groups. Compared to Chinese students, international students were more likely to use cognitive regulation methods like “positive re-focusing” (international students 13.92(3.79), Chinese students 12.95(3.63), t=2.86, p=0.004), “re-focus on planning” (international students 15.50(3.95), Chinese students 14.33(3.93), t=3.23, p=0.001), and “catastrophizing” (international students 10.31(4.27), Chinese students 9.09(4.34), t=3.09, p=0.002)

Table 2.

Comparison of mean (sd) CERQ, SDS and ASLES item scores between international and Chinese students

	International students	Chinese students	t	P
ASLES	21.86(11.6)	21.03 (12.70))	0.91	0.382
SDS	43.86(11.17)	42.62(11.50)	1.19	0.233
Self-blaming	10.75(3.65)	10.84(3.61)	-0.28	0.783
Acceptance	13.65(3.36)	13.39(3.43)	0.81	0.417
Contemplation	12.38(3.63)	12.14(3.73)	0.71	0.479
Positive re-focus	13.92(3.79)	12.95(3.63)	2.86	0.004
Re-focus on planning	15.50(3.95)	14.33(3.93)	3.23	0.001
Positive re-evaluation	15.01(4.29)	14.60(3.80)	1.10	0.274
Rational analysis	12.14(3.68)	11.76(3.65)	1.12	0.265
Catastrophizing	10.31(4.27)	9.09(4.34)	3.09	0.002
Blaming others	9.79(3.84)	9.22(3.88)	1.61	0.109

3.2 Comparison of ASLES, SDS and CERQ results between male and female students of different races

The results in Table 3 showed that, between male and female international students, there were significant differences in the scores of the life events scale. Male students had higher mean (sd) scores in life events (male =23.56 (14.16), female =19.03 (11.23), t=2.71, p<0.001). Meanwhile, in the face of life events, there were significant differences between male and female students in items such as “catastrophizing” and “blaming others”. Male students used more cognitive regulation methods such as “catastrophizing” (male mean (sd) score= 11.07(4.22), female mean (sd) score= 8.75(3.95), t=4.21, p<0.001) and “blaming others” (male mean (sd) score=10.17(3.93), female mean (sd) score= 9.02(3.56), t=2.26, p=0.03) than female students. Among Chinese students, there were significant differences in the scores of the life event scale and depression scale between male and female students. Male students had higher mean (sd) ASLES scores (male 23.5 (14.5), female 19.0 (10.6), t=2.68, p<0.001).Meanwhile, in the face of life events, male students used more cognitive regulation methods such as ”catastrophizing” (male mean(sd) score=10.32(4.71), female mean(sd) score 8.07(3.7), t=4.0), p<0.001and “blaming others” (male mean (sd) score=10.0(4.11), female mean (sd) score=8.60(3.58), t=2.68, p<0.001) than female students.

Table 3.

Comparison of mean (sd) ASLES, SDS and CERQ scores between male and female students of different nationalities

	International students		t	P	Chinese students		t	P
	male	Female			male	Female
ASLES	23.56(14.16)	19.03(11.23)	2.71	<0.001	23.52 (14.52)	18.98 (10.62)	2.68	<0.001
SDS	44.53(11.79)	42.51(9.71)	1.36	0.176	45.09(13.15)	40.58(9.52)	2.95	<0.001
Self-blaming	10.87(3.80)	10.50(3.34)	0.75	0.453	10.95(3.97)	10.74(3.29)	0.45	0.652
Acceptance	13.72(3.25)	13.50(3.61)	0.49	0.626	13.19(3.56)	13.56(3.32)	-1.78	0.075
Contemplation	12.43(3.63)	12.30(3.65)	0.27	0.790	12.40(3.71)	11.93(3.75)	0.90	0.368
Positive re-focus	13.68(3.80)	14.42(3.75)	-1.46	0.145	12.92(3.66)	12.97(3.62)	-1.54	0.124
Re-focus on planning	15.63(3.90)	15.24(4.06)	0.74	0.462	14.54(4.09)	14.16(3.80)	-0.25	0.804
Positive re-evaluation	14.95(4.41)	15.14(4.06)	-0.34	0.733	14.26(3.89)	14.88(3.72)	-1.22	0.232
Rational analysis	12.03(3.41)	12.37(4.20)	-0.69	0.490	11.67(3.39)	11.84(3.86)	-0.35	0.734
Catastrophizing	11.07(4.22)	8.75(3.95)	4.21	<0.001	10.32(4.71)	8.07(3.73)	3.97	<0.001
Blaming-others	10.17(3.93)	9.02(3.56)	2.26	0.025	9.98(4.11)	8.60(3.58)	2.68	<0.001

3.3 Regression analysis of depression among students of different ethnicity

Tables 4 and 5 showed the correlation analysis between each item in the scores on the CERQ scale and life events scale and depression scale, for international students and Chinese students. For international students, depressive emotions were positively correlated with self-blaming, catastrophizing, blaming others, and were negatively correlated with acceptance, positive re-focusing, positive re-evaluation, and refocusing on planning. For Chinese students, depressive emotions were positively correlated with self-blaming, contemplation, catastrophizing, and blaming others. These emotions were negatively correlated with positive re-evaluation. Logistic regression analysis was done with SDS score as the dependent variable, and scores on the CERQ’s 9 items and life event scale as independent variables. Tables 6 and 7 showed the results after input into the regression equation of independent variables for international and Chinese students. The regression equation for international students was as follows: Y (depression) =48.48+0.88xself-blaming-0.55xacceptanc e+0.43xdisasterization, with Adjusted R2=0.18, F=6.59, p <0.001, N = 10. For international students, “self- blaming”, “acceptance” and “catastrophizing” were in the regression equation. International students’ depressive emotion was positively correlated with “self-blaming” and “catastrophizing”, and negatively correlation with “acceptance”. The regression equation for Chinese students was as follows: Y (depression) =31.83+0.59xlife events-0.56xpositive re-evaluat ion+0.42xdisasterization, with Adjusted R2=0.63, F=38.96, p<0.001, N=10. Chinese students’ depressive emotions were positively correlated with “life events” and “catastrophizing”, and negatively correlated with “positive re-evaluation”.

Table 4.

Correlation Analysis between CERQ items and life events, SDS for international students

	1	2	3	4	5	6	7	8	9	10	11
Life events	1
SDS	0.00	1
Self-blaming	0.12*	0.29**	1
Acceptance	-0.38	-0.17**	0.23**	1
Contemplation	0.13*	0.07	0.37**	0.36**	1
Positive re-focus	0.09	-0.18**	0.16*	0.50**	0.43**	1
Re-focus on planning	0.07	-0.15**	0.07	0.28**	0.34**	0.37**	1
Positive re-evaluation	-0.01	-0.23**	-0.01	0.26**	0.09	0.31**	0.47**	1
Rational analysis	0.09	-0.08	0.19**	0.24**	0.19**	0.20**	0.33**	0.38**	1
Catastrophizing	0.08	0.23**	0.29**	0.15*	0.34**	0.09	0.16**	-0.06	0.26**	1
Blaming-others	0.08	0.17**	0.27**	0.13*	0.25**	0.09	0.17**	0.02	0.16*	0.52**	1

* p<0.05

** p<0.01

Table 5.

Correlation Analysis between CERQ items and life events, SDS for Chinese students

	1	2	3	4	5	6	7	8	9	10	11
Life events	1.00
SDS	0.78**	1.00
Self-blaming	0.27**	0.28**	1.00
Acceptance	0.01	0.00	0.34**	1.00
Contemplation	0.18**	0.19**	0.26**	0.46**	1.00
Positive re-focus	0.05	-0.02	0.15*	0.38**	029**	1.00
Re-focus on planning	0.04	-0.02	0.10	0.15*	0.22**	0.34**	1.00
Positive re-evaluation	-0.10	-0.24**	0.08	0.15*	0.03	0.35**	0.57**	1.00
Rational analysis	0.01	-0.05	0.19**	0.19**	0.07	0.28**	0.33**	0.54**	1.00
Catastrophizing	0.39**	0.45**	0.25**	0.12	0.42**	0.07	0.20**	-0.02	0.11	1.00
Blaming-others	0.31**	0.34**	0.23**	0.16**	0.36**	0.14*	0.26**	0.04	0.10	0.56**	1.00

* p<0.05

** p<0.01

Table 6.

Regression Analysis of factors influencing depression in international students

	B	SE	β	t	p
Constant	48.48	3.88		12.50	<0.001
Self-blaming	0.88	0.20	0.29	4.45	<0.001
Acceptance	-0.55	0.23	-0.17	-2.42	0.016
Catastrophizing	0.43	0.19	0.16	2.29	0.023

Table 7.

Regression Analysis of factors influencing depression in Chinese students

	B	SE	β	t	p
Constant	31.83	2.76		11.53	<0.001
Self-blaming	0.59	0.04	0.65	14.12	<0.001
Acceptance	-0.56	0.18	-0.18	-3.15	0.002
Catastrophizing	0.42	0.15	0.16	2.84	0.005

4. Discussion

4.1 Main findings

CERQ can effectively reflect the cognitive regulation methods during an individuals’ emotional arousal. Numerous studies have shown that adaptive strategies were negatively correlated with depression and anxiety, while maladaptive strategies were positively correlated with depression and anxiety. Adaptive strategies include acceptance, positive re-focusing, re-focusing on planning, positive re-evaluation, and rational analysis. Maladaptive strategies include self-blaming, rumination, catastrophizing and blaming others.[ We conducted CERQ study on international and Chinese students. Although two questionnaire versions (English and Chinese) were used, a validity check of the Cronbacha coefficients of the two versions were in the range of 0.733 to 0.734, indicating good validity and comparability. In this study, Logistic regression analysis showed that both international students and Chinese students showed a positive correlation between depressive symptoms and the maladaptive strategies of “self-blaming” and “catastrophizing”. In addition there was a negative correlation between depressive symptoms and the adaptive strategies of “acceptance” and “positive re-evaluation”. This correlation held regardless of the ethnicity of the participants.

CERQ is a fairly mature scale to measure individuals’ cognitive emotion regulation methods after stressful events. Numerous studies have shown that adaptive strategies are negatively correlated with depression and anxiety, while maladaptive strategies are positively correlated with depression and anxiety. Adaptive strategies include acceptance, positive re-focusing, refocusing on planning, positive re-evaluation, and rational analysis. Maladaptive strategies include self-blaming, rumination, catastrophizing and blaming others. Our results also showed that depressive emotions were positively correlated with the maladaptive strategies of “self-blaming” and “catastrophizing”, and negatively correlated with the adaptive strategies of “acceptance” and “positive re-evaluation”. This correlation was demonstrated in both international and Chinese students. This relationship is also similar regardless of participants ethnicity. However, there were still some differences in cognitive emotional regulation strategies between participants of different ethnicities. Compared to Chinese students, international students tended to use cognitive emotional regulation methods such as “positive re-focusing”, ”re-focusing on planning” and “catastrophizing” in the face of life events. In the regression analysis of the influences on depressive emotions for international students, “self-blaming” and “catastrophizing” contributed to depression, and “acceptance” was negatively correlated with depression. For Chinese students, life event score and “catastrophizing” contributed to depression, and “positive re-evaluation” was negatively correlated with depression.

In terms of gender differences, both international and Chinese male students’ life event scores were higher than female students’. In the face of life events, male students tended to use maladaptive strategies such as “catastrophizing” and “blaming others” more than female students, which was not the same as some overseas studies. A study by Garnefski and colleagues showed that females tended to use strategies such as “catastrophizing”, “rumination” and “re-focusing on planning” strategy more often than males.[ This difference could be related to sample group and sample size. Based on our apparently quite vaguely conceived notion of social roles we usually think of males as being characteristically more strong, independent and persevering than women. The so called ‘general public’ also assigns qualities to men such as strength, independence, responsibility and commitment to male roles, considering them to be more likely to display calm and problem solving abilities when faced with stressful events. So surprisingly, our results show that men tend to use more negative cognitive coping methods than females when faced with stressful life events. Therefore, men’s mental health issues are equally worthy of attention, if not more so.

4.2 Limitations

This study administered Chinese versions of the measurement tools to Han Chinese and Uygur participants while administering English versions (or translated versions of the tools that had not been validated) to international students studying in China who came from a wide variety of cultural, ethnic and linguistic backgrounds. Given the enormous linguistic and cultural heterogeneity of this sample (including students in the’local’ group) results should be interpreted with caution. In addition, personality tests were not carried out for subjects in this study. Personality may also influence ones cognitive coping methods and emotional state in the face of stressful life events. However comparisons between personality and CERQ, SDS and other measures were not done. Finally this study was cross sectional in nature and therefore the impact of cognitive coping styles have on depressive symptoms over time could not be measured.

4.3 Implications

CERQ can be used to evaluate cognitive emotion regulation methods and strategies in individuals. In the counseling of college students, we may use CERQ to understand frequently used cognitive emotional strategies in individuals facing life events in order to provide appropriate counseling methods such as cognitive therapy. Regardless of an individual’s ethnicity, using cognitively adaptive strategies is a protective factor for depression, whereas using maladaptive strategies is a risk factor for depression. During the course of counseling with college students, encouraging students to engage in cognitively adaptive ways of thinking can serve as solid method to prevent depression.