In the current study, the majority of the participants were male and married. Among the married participants, 64.3% were living together with their spouse in South Korea. This is in contrast to some study findings where most of the international student sojourners were single [20, 21]. Each cultural group is unique, with specific needs and characteristics ; the higher percentage of married Nepalese students in this study can be attributed to Nepalese culture, where youths get married at an early age, and married couples are encouraged to live together [23, 24]. Additionally, the majority of participants in this study were enrolled in Department of Natural Science and were pursuing doctoral degrees in South Korea. Unlike most English speaking countries, where many students pursue humanities, social science, and health related studies along with technical courses [20, 25], this study showed that most of the Nepalese students were enrolled in technical fields like engineering and natural science. This can be due to the language barrier, which plays a central role in academics and the acculturative process . Analysis of the demographic data also revealed that only 4.6% of the Nepalese students were supporting their educational expenses themselves (parents) as most of the students were receiving educational support either from the government or their respective universities/professors. This is in contrast to the finding reported by Khawaja and Dempsey (2008) where 67.1% of the international students received financial support through their parents. Since Nepal is one of the poorest country in the world, with 55% of the population living below the international poverty line of US $ 1.25 per day , the majority of students are highly dependent on the scholarships provided by the host government and or the host universities.
In the current study, the mean perceived stress score of the participants was lower compared to the doctor of pharmacy students (26.5 ± 8), as reported by Marshall et al. (2008). PSS measures subjective evaluation of the stressfulness of a situation, which can be influenced by daily happenings and major life events . The comparatively low mean perceived stress reported in the current study can be due to the fact that the new semester begins in March in South Korea, and the majority of the data were collected between March through mid April when the academic load is apparently low. The mean perceived stress scores for the female subset in the current study was higher compared to those of the male subset, though the difference between male and female was not statistically significant. This finding is in agreement with reported literature from the USA,  Pakistan , and Egypt . However, it should be pointed out that even though this finding is in line with the previously reported literature, it could also be because of the cultural influence where Nepali men, who are generally the dominant figure in the society, are hesitant to objectively report their perceived stress. This finding can be further validated through qualitative studies. No significant difference was observed in acculturative stress scores between males and females. A study conducted by Constantine et al. with a diverse group of international students has reported acculturative stress among Asian students to be significantly lower compared to Latin American students . The high prevalence of acculturative stress among Nepalese students in this study could partly be due to the fact that Korea is not an English speaking country.
The PCS and MCS scores were lower in the female subset, which is similar to findings reported from previous literature [10, 30–32]. For the total sample, the highest value was reported for the vitality subscale, followed by physical functioning; and the lowest value was reported for the role-emotional. This is in contrast to findings reported by Arslan et al., where the lowest score was reported for the vitality subscale . The finding reported with Belgrade university students  is similar; it also mentions the lowest score on the vitality subscales. A study conducted among a Nepalese sample in Kathmandu by Sakai et al. also reports high scores for physical functioning, body pain, and vitality among the Nepalese male population . Even though there is a general assumption about Nepalese (Gurkhas) being physically strong and brave, there is no scientific finding to support or refute this. Further research can be done to validate higher scores reported for physical functioning and vitality. Sakai, et al. also reports higher scores on the physical functioning subscale in "higher caste groups" when compared to "lower caste groups". Difference in the HRQOL based on caste/ethnic group, being a culturally sensitive issue among the Nepalese, was not explored in this study.
Both perceived stress and acculturative stress was negatively correlated with the physical and mental component summary of the HRQOL, which is in agreement with previously reported literature [2, 10, 33].
In order to identify the determinants of the HRQOL, the analysis was conducted separately for the MCS and PCS as outcome variable. The variables used for the regression model were perceived stress [10, 15, 30], acculturative stress [3, 14, 25, 34], gender [29, 31, 33], relationship with advisor , and marital status [14, 35]. Perceived stress emerged as the strongest determinant of the mental component of the HRQOL. This is in line with the findings reported by Bovier et al. . In the case of PCS, only acculturative stress accounted for a significant portion of the variance in the HRQOL. In the current study, lack of significant contribution by sex in the final regression model could be due to the small sample size of the female participants (n = 27).
As mentioned previously, this study is the first assessing stress and HRQOL in a group of international students in South Korea. Hence, it can be looked upon as an important milestone for planning future research. However, this study was subject to some limitations. First, although the instruments used in this study were proven to have good reliability and validity with other populations, participants in this study might have had difficulty in understanding the English questionnaires. Additionally, the length of the questionnaires might have overwhelmed the participants affecting the internal validity. Hence, the results should be interpreted with caution. International students seeking enrollment in South Korean universities are expected to have either English or Korean language proficiency validated by high scores in language proficiency standard tests like Test of Proficiency in Korean Language (TOPIK) or TOEFL, IELTS, TOEIC, etc., and, hence, it was assumed that the students would have no difficulty using self-reported English questionnaires. Also, the Department of Immigration in South Korea reports the total number of Nepalese students studying in South Korea as 432, but only 140 Nepalese students were accessible for this study. This may have introduced selection bias, and, hence, the observed result may not be representative of all Nepalese students in general. Second, higher perceived stress and acculturative stress among international students are related with negative affects, such as sadness, depression, and suicidal ideations [11, 12, 36, 37]. In this study, variables such as depression, anxiety, negative lifestyle practices, and social support, which are commonly reported to be associated with stress levels and as affecting the HRQOL among university students, were not assessed. Additionally, negative and positive coping strategies, such as use of religion , drinking alcohol , planning, positive reframing of one's thoughts, and denial  have also been reported in the literature. In this study, stress coping strategies adopted by the students were not assessed. In order to elucidate the effect on HRQOL, further studies must be planned with the inclusion of both stress and coping mechanism adopted by the students. Finally, since perceived stress and acculturative stress vary with time period a onetime measurement as a cross-sectional survey can be looked as a limitation.