Link to Qian Huang user page Qian Huang International Claims Manager Looking after your mental health is just as important as taking care of your physical well-being when you’re living abroad. Being away from familiar routines, support networks and loved ones can make it harder to notice the early signs of stress or depression. Loneliness can also feel more intense at certain times of the year, such as Christmas – particularly if you’re spending the holidays without your family. The good news is there are plenty of practical steps you can take to protect your mental well-being while living overseas. Whether you’re thinking about your own mental health or supporting a loved one, we share some simple, effective tips for expats moving and living abroad, along with guidance on where to find help if you need it. In this article What is expat depression? Why do expats experience mental health issues and depression? Signs and symptoms of expat mental health issues Top tips for good mental health and mental well-being Mental health challenges and depression signs are very common in expats and their spouses / GETTY IMAGES Living abroad and your mental health Living abroad can bring unique and sometimes unexpected pressures. Adjusting to a new culture, navigating unfamiliar systems and being separated from established support networks can take a toll on your mental well-being. Feelings of isolation may develop gradually, particularly if you’re unsure who to confide in or feel disconnected from familiar support networks. These experiences can be especially common among expat spouses or partners who relocate without immediate access to work, routine or a ready-made social circle. Without those anchors, loneliness and low mood can develop more easily. Although life abroad can be hugely rewarding, it’s not unusual to face emotional challenges that friends or family at home may not fully understand. The important thing to remember is that expat depression is common and highly treatable, and that support is available when you need it. You don’t need to struggle alone. What is expat depression? Depression is more than simply feeling unhappy or fed up for a few days. Most people go through periods of feeling down, but when you’re depressed you feel persistently sad for weeks or months, rather than just a few days. Expat depression is a period of feeling despondent or in low spirits experienced by people who move overseas and live abroad for work. Expat depression is very commonly experienced by expat spouses. It is a real illness with real symptoms. Depression is not a sign of weakness or something you can “snap out of” by “pulling yourself together”. Adapting to a new life abroad is often harder for a trailing spouse Here’s how to make the best of your new life as an expat spouse Why do expats and their spouses experience mental health issues and depression? There’s no single cause of depression. It can occur for a variety of reasons and it has many different triggers. Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression. Relocating abroad for work requires significant energy, confidence and optimism, which may be why expats and their spouses with the gumption to make an international move initially respond by trying to sweep the symptoms of depression or anxiety under the rug. Moving to another country comes with a long list of stressors, that’s why it is so important to stay fit working full time. In addition to cultural changes and language barriers, expats are often required to rely extensively on locals to help them navigate the simplest of tasks – from buying medicine at the pharmacy to signing a lease – something that over time can damage one’s sense of competency. You might start to feel less independent (it is called ‘culture shock‘). What is culture shock and how does it affect expats? Read our full guide for dos and don’ts for culture shock as an expat 1/ Spiral of events People often talk about a “downward spiral” of events that leads to depression. For example, if your relationship with your partner breaks down, you’re likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression. 2/ Identity changes Moving abroad can also create immense internal turmoil. On top of navigating the cultural collision, expats quite often go through the process of rediscovering themselves and unveiling who you are as a person within that new context. 3/ External challenges They can also pile up quickly, compounding the situation – from dissatisfaction at work or the lack of career opportunities to political or societal differences in the new country. Expat spouses suffer this quite a lot, because they sometimes struggle to find a new job when they move. To make matters worse, moving abroad pluck expats out of their support system and carry them far from their family. A study by Dr. Mitesh Patel conducted between 2014-2016 on 5,000 expats found that the loss of a support network was cited as a top stressor for 42.8% of the expats surveyed. “As our clinical experts have provided support to our members, they have found that the absence of the friend and family network compounds stress and anxiety suffered by expatriates on foreign soil” the study said. Worried about the cost of living crisis? Our new series looks at the true cost of living abroad Connecting with the family online might help you feel less home-sick / GETTY IMAGES Expat mental health challenges: what recent years have revealed Research has consistently shown that expatriates can face higher levels of stress and emotional strain than those living in their home country. One major study found expats were three times more likely to report feeling trapped, isolated or depressed, with around 50% considered at high risk of internalising mental health challenges such as anxiety or depression. Global disruption in recent years brought these challenges into sharper focus. Periods of restricted travel, uncertainty and reduced social connection highlighted how vulnerable expats can be when support networks are limited. In our own survey of more than 1,100 expatriates worldwide, over a third reported a decline in their mental health during times of increased isolation. Importantly, these issues did not begin overnight. Long before 2020, expat mental health was closely linked to the pressures of international relocation, cultural adjustment and demanding roles abroad. What recent years demonstrated is the importance of having accessible, ongoing support in place. If you’re living abroad, it’s worth checking whether your international health insurance includes access to mental health support services, such as counselling or talk therapy. If you’re struggling, speaking to a doctor is also an important first step; effective help and treatment options are widely available. At William Russell, we cover mental health as part of our international health insurance plan Signs and symptoms of expat mental health issues and depression The symptoms of depression can be complex and vary widely between people. If you’re depressed, you may feel sad, hopeless and lose interest in things you used to enjoy. The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life. There are many other symptoms of depression and you’re unlikely to have all of those listed. According to NHS, the symptoms of depression can be physiological, physical and social. Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realising they’re unwell. It can sometimes take a friend or family member to suggest something is wrong. Look for following signs: Consistent feelings of being sad or down (or the absence of positive feelings) for most of the day, nearly every day, lasting at least a couple of weeks Feelings of hopelessness or worthlessness Sleep issues Changes in energy levels Unexplained changes in appetite Unintentional weight loss or gain Loss of interest or inability to take pleasure in things previously enjoyed Unexplained physical ailments Difficulty concentrating or making decisions The tricky thing for expats is differentiating between the very normal process of cultural adjustment – which takes time and some patience, but which often resolves itself – versus difficulties adjusting that don’t seem to be getting better over time, or where suffering is taking a toll in other areas of life and so requires attention. Dana Nelson, PHD, American psychotherapist based in Lyon, France Expats mental health can be fragile Here’s how to get help with mental health as an expat How to avoid expat depression: Top tips for good mental health and well-being 1/ Seek a connection It might sound obvious, but the more time you spend out in your local community, the more likely you are to make new connections. Attending a language class or joining an activity group is a great way of learning to love something about a new country as well as making friends locally. 2/ Set work-life boundaries It’s so important to set some work-life boundaries, especially if you are working from home full time. Finding that happy state means prioritising what’s important to you, and making sure you’re dedicating enough time and energy to it, rather than sacrificing it at the altar of work. Don’t compromise on quality time with your family or doing other things that are important to you. 3/ Get enough sleep and exercise Similar to setting work-life boundaries, it’s vitally important to make sure you are getting enough exercise and enough sleep. For an expat with a busy schedule, finding the time to exercise can be challenging, but there is an infinite wealth of evidence to show that finding that time is vital. Physical activity and good quality sleep have both been linked to mental well-being. 4/ Ask for advice Join online communities and ask for advice well before you go, and find out about what issues you’re likely to encounter in your chosen destination. Expat Forum, Expat Exchange, The Expat Partner’s Survival Guide and Mumsnet are all great sources of information. Prioritising mental health has never been more important Which countries have the best mental health in the world? 5/ Treat your mind like your body If you had an ongoing pain in your stomach or a constant twinge in your shoulder, you would get it checked out at the doctors. Being mentally unwell should be treated the same as being physically unwell. Find out what help is available to you locally in case you ever have need of it. Help can be sourced through the International Therapist Directory. 6/ Don’t spend your life online Keep up with friends and family at home as much as possible – it’s important! Schedule time for phone calls and video calls with your nearest and dearest – but try to limit the amount of interaction on social media platforms. Social media is designed to be addictive and you can end up losing hours from your day. Curate your social media experience by going through your timeline, unfollowing the accounts with posts that bring up negative energy for you and elevating accounts that inspire you, make you laugh or bring you joy. And balance your time with going out and making new friends locally! 7/ Recognise expat depression Being able to act on negative feelings is an essential part of the expat’s toolkit. If you feel depressed and suspect that you may be suffering any mental health issue, seek help at the earliest opportunity. 8/ Manage your expectations If you’ve experienced mental health issues in the past, make sure you have support in place before you go. Money can also be a worry when you move abroad, particularly early on when you will have to make a lot of payments on essential items and deposits. You may also have to wait for items such as furniture to be shipped from home, and incur extra expenses to source similar ‘comforts’ while you wait for your own to arrive. Never underestimate what an upheaval expatriation is, especially with small children in tow. You need to prioritise self-care so that you can face the challenges that each day inevitably brings. Tavy Expat mother-of-three So, some good forward planning can go a long way to help mitigate some these challenges, with online forums like Expat Forum, Expat Exchange, The Expat Partner’s Survival Guide and Mumsnet helping to paint a realistic picture of what life will really be like. Understanding depression and taking measures to guard against it will help ensure expats in their adopted country make the most of their time overseas. Want more expat content?Subscribe to our fortnightly newsletter! CompanyThis field is for validation purposes and should be left unchanged.Enter your email address Peace of mind when you live overseas No matter where you go, you can take one thing off your mind. William Russell offers international health insurance that covers you for everything from minor injuries to long hospital stays. We can even offer medical evacuation to patients who require treatment in other countries. At William Russell, we have been providing worldwide health cover for over 30 years, helping expats like you and their families to settle into their new homes. Speak to us today to find out more about how global health insurance could support you. Looking for expat health insurance with mental health cover? Learn More Related articles Read More Health & Well-Being A Guide To Healing And Recovery For Expats Recovering from illness, injury or surgery abroad can be challenging. Explore… Read More Health & Well-Being Full Guide – Seeing A Doctor Abroad For Expats Our handy guide will help you find the best local healthcare when living abroad. 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