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An extensive survey of problems encountered by foreign students of the University of the Ryukyus and the resulting levels of stress was carried out in order to determine the main stressors hindering academic progress and personal adjustment. Subjectively perceived stress levels after arrival in Japan were obtained from 134 subjects through a comprehensive questionnaire for reporting speci®c stressors. The 30-item General Health Questionnaire (GHQ) was included to assess mental health state. Differences in scores by area of origin were also determined for the total GHQ scores and its sub-scales. The GHQ results showed that regardless of length of time in Japan, more than 60% of the subjects scored within a range usually indicative of a mental health risk. Mean scores by area of origin showed a 50% reduction over time for non-Chinese Asians and North American/ Europeans, but only a reduction of 1.1% or less for Chinese, Latin American, Middle/Near Eastern and African subjects. Limitations in achievement of academic goals were reported by the greatest number of students as causing moderate to excessive stress (57.5%); most frequently reported causes were language inadequacy (55.2%), reference materials unavailable (34.3%), unfamiliarity with Japanese study methods (32.1%), and inadequate guidance from teachers/advisors (26.9%). Various social, personal and daily life problems in the non-academic setting were also reported as causing high stress levels. Most of the stressors identi®ed are not considered inevitable and point toward directions to pursue in preventive strategies in mitigating psychological distress and maladjustment of students.

This study was conducted at three universities, two in Japan and one in Thailand, in order to elucidate the effects of medical education, especially with regard to contact experience on medical students' attitudes toward persons with mental disorders. Questionnaires, which included the Attitudes Towards Disabled Persons Scale (ATDP) and the Contact with Disabled Persons Scale (CDP), were distributed to 1st year students prior to the commencement of their medicine/psychiatry studies and distributed to 6th (or 5th) year students who had completed their psychiatric curriculum. The ATDP scores were lower for 6th year students at all universities, suggesting that post-education students had a more unfavorable attitude than pre-education students. Thai students indicated more unfavorable attitudes than did the Japanese students. Three factors were extracted from the ATDP scale and termed: negation of character, negation of ability and affirmation of normality. Four factors from the CDP scale were extracted and labeled intimate contact experience, ordinary contact experience, unpleasant contact experience and pleasant contact experience. Greater negative attitudes of post-education students than pre-education students were thought to attribute mainly to an increase in factor score of negation of ability and this result was correlated with an increase in factor score of ordinary contact experience in post-education students. Of the three ATDP factor scores, the higher score of Thai students for negation of character contributed to their overall unfavorable attitude scores. The cross-national similarities and differences of students' attitudes towards and contact experience with mentally disordered persons were discussed from the viewpoint of medical education.

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