Expats mental health can be fragile: living abroad can come with expat problems. Studies suggest depression is more prevalent among expats than those living at home. With restrictions on travel and socialising because of the coronavirus pandemic, many expats may be feeling especially isolated – a feeling that can lead to anxiety and depression. We take a look at the factors that affect expats mental health and the importance of getting the help you need if you’re experiencing expat problems.
Expats face a higher overall risk of mental health problems. Around 1-in-7 people globally (11-18 percent) have one or more mental or substance use disorders. Globally, this means around one billion people in 2017 experienced one.
In the chart below we show the share of the population with a mental health or substance use disorder. By clicking on a given country you can view how this has changed from 1990 through to 2017.
While living and working abroad can be enormously rewarding, it can also come with challenges. According to recent research, 50 per cent of US expats studied were at risk of problems such as anxiety and depression – two-and-a-half times higher than their US-based counterparts.
The study, The Mental Health Status of Expatriate Versus US Domestic Workers, also found that:
- Three times as many expatriates as US-based workers expressed feelings of being trapped or depressed
- Twice as many expats as US-based workers expressed feelings of anxiety or nervousness
“Studies estimate that American expatriates have assignment failure rates as high as 40 per cent, which often results from stress caused by cultural difference and demanding workloads,” says David Sharar, Ph.D, Managing Director of Chestnut Global Partners, the company that co-conducted the research.
Expats mental care: have expats suffered from depression more during the COVID-19 pandemic?
Recent surveys show that employees very often fail to show health support for their expat employees. In addition, the importance of mental health in the workplace is often less acknowledged in comparison to physical health.
Globally, mental health conditions contribute greatly to the burden of workplace disability, lost days and reduced productivity due to ill health at work. At the same time, as mental healthcare needs have increased, mental health services have been disrupted in many countries. This is serious when we consider that the pandemic is likely to leave a lasting impact on the younger generation.
Recent surveys between expats have found that mental health still carries negative stigma to a degree. This is particularly true in countries such as the UAE and Singapore, where half of our respondents found it hard to talk about mental health at work, compared to 40% of employees in the UK and the US. Beyond facing the challenges of moving far from home, expats discover that mental health services are disproportionately distributed across the globe, as is the case with other forms of health care.
The prevalence for depression and anxiety among expats are the highest in terms of all mental health claims prevalence (claims for bipolar, psychoses, dementia, post-partum and eating disorders accounted for comparatively low percentages although were also increasing). Stress, anxiety, and depression are on the rise among expatriate populations.
So why do these mental health issues affect expats? Cultural, climate, religious and language differences between the familiar home environment and the less familiar new country can all play a part. It is also common to be concerned about whether you will be accepted by the host country.
Other common factors that can lead to mental health problems include:
- Separation from family and friends; lack of familiarity and support
- The need to develop a high level of self-sufficiency
- Challenges with the local language, culture and customs
- Depending on the country, anxiety and stress can be caused by exposure to poverty, violence, suffering, death and the risk of disease
Top of the list for many is being homesick. Even if you’re really looking forward to the excitement and novelty of living abroad, it’s inescapable that you’ll miss family and friends. Or simply just the everyday life that you were used to. One thing that many expats do not consider is the isolation from the informal support networks provided by friends and acquaintances that comes from living abroad. While COVID-19 has thrown a new light on virtual connectivity, nothing quite beats face time.
Expats may also experience the fear that everyone at home will quickly forget you. Some choose not to share these fears with their usual confidants because they want them to think they’re new life is perfect and that they’ve made the right decision in moving. it is especially relevant during family holidays (read more about how to survive lonely Christmas abroad as an expat).
It can be tough making new friends, especially if you have built up friendships over many years in your home country. Building friendships in a new country where the local language is not your native tongue can make it even harder to meet new people.
Kristin Ketelslegers, Madrid-based counsellor
Chris Neill, another Spain-based counsellor, agrees that rates of depression – or the feeling that life is meaningless – could be up to 50 per cent higher among expats. He also believes that anxiety is not unusual for people living abroad.
“People with anxiety stop enjoying activities that used to give them pleasure,” he says. “They don’t want to go out anymore and they start ruminating on the past or worrying about the future.”
Stress and anxiety that arise from moving to a new country are common, and a desire to seek a cure for mental health issues can sometimes make the situation worse. Not knowing how to cope with loneliness or how to deal with homesickness can lead to serious problems.
Top tips for good mental health as an expat
Evidence suggests there are 5 steps you can take to improve your mental health and wellbeing. Trying these things could help you feel more positive and able to get the most out of life.
- Get plenty of sleep. Sleep is really important for our physical and mental health. Sleep helps to regulate the chemicals in our brain that transmit information. These chemicals are important in managing our moods and emotions. If we don’t get enough sleep, we can start to feel depressed or anxious, especially if we don’t have the right work-life balance when we are working from home.
- Be physically active. Activity and exercise are essential in maintaining good mental health. Being active not only gives you a sense of achievement, but it boosts the chemicals in your brain that help put you in a good mood. Exercising can help eliminate low mood, anxiety, stress and feeling tired and lazy. It is also linked to living a longer life. You don’t need to run a marathon or play 90 minutes of football; a short walk or some another gentle activity might do the trick.
- Avoid alcohol, smoking and drugs. Drinking and smoking aren’t things which we always associate with withdrawal symptoms, but they can cause some which impact on your mental health. When you’ve had a few drinks you can feel more depressed and anxious the next day, and it can be harder to concentrate.
- Eat well. Eating well isn’t just important for our bodies, but it’s also important for our minds. Certain mineral deficiencies, such as iron and vitamin B12 deficiencies, can give us a low mood. Try to eat a balanced diet. If you find you’re a particularly stressed or anxious person, you should try limiting or cutting out caffeine as this can make you feel jittery and anxious.
- Do something you enjoy. If you like going for a walk, painting or a specific TV show, try to set aside time to enjoy yourself. If we don’t spend any time doing things we enjoy, we can become irritable and unhappy.
If you are suffering with expat mental health issues such as stress and anxiety while living/working overseas you may feel that it’s difficult to find the right help and support. What can you do about it?
Skowronski says that people may have trouble finding appropriate, quality help in small towns and cities, which, combined with their smaller size can make coping with loneliness harder. He also says that many people simply don’t know that there is support available in their host country.
“There are three barriers – the language, the culture and the mental state – to overcome. Many people give up seeking help at the start, believing it is not available for foreigners or they won’t receive the treatment that would suit them,” he says.
But the truth is that many countries have mental health services available. Many major towns and cities offer counselling and mental health support, and treatment at these centres is often covered by international health insurance.
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 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.