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Expat Mental Health

Updated: Jan 11

Your Guide to Expat & Immigration Mental Health & Wellness


Are you wanting to explore an international lifestyle?


I have been helping individuals, families, refugees, and asylees in their immigration, integration, and life journeys since 2008. In 2015 I began the immigration process myself, moving to a small mountain village in the Black Forest of Germany. Following my heart, as an only child, over half way through a doctoral degree in psychology, not able to speak the language, I was told by many I was crazy for upending my life and starting from the beginning again. Since then, I’ve learned a new language, integrated into a new culture, advanced my career, made new connections and friendships, and began a family thousands of miles away from home. There have been many bumps, struggles and times of downright despair- but many more instances of adventure, learning, joy, accomplishment and self discovery.


Whether you are bouncing around starting a life as a digital nomad, planting roots in a new country, surprisingly find yourself in a new land, or planning your transition to a life abroad, I am here to help on your journey. Let’s navigate some of the common immigration and expat difficulties and help you make a great experience.

A bright german village center reflects in fountain. SEELEDU: Expat Mental Health
SEELEDU: Expat Mental Health

While living abroad is a fantastic opportunity for personal growth, professional advancement, seeking a better quality of life, finding refuge and gaining insight into another culture, immigration and expat life can present a unique set of challenges. Expat mental health and well-being can be fragile with unique stressors and experiences. Well-being is “the balance point between an individual’s resource pool and the challenges faced (Dodge, 2012).” Imagine a seesaw with psychological, social, and physical resources stacked on the left and psychological, social, and physical challenges stacked on the right. It’s easy to understand how even a minor stressor can upset a person’s equilibrium and then further compound by the unique stressors of international relocation.


Expat Mental Health: Why do expats experience mental health problems?

The Psychology of Stress

Expat Mental Health: Expat Depression

ExpatMental Health: Expat Anxiety

Expat Mental Health: Expat Isolation

Managing Expat Mental Health

 

Expat Mental Health: Why do expats experience mental health problems?

Moving abroad requires tremendous energy, optimism, self-confidence and independence. There is a normal process of cultural adjustment however individuals can find they don’t seem to be progressing or getting better over time or where suffering affects other areas of life. While moving to another country is one of the most adventurous life decisions you can make, it comes with a long list of stressors both external and internal.


External Stressors are sources of stress that we are aware of around us. In the expat and immigration process these are:

  • Our physical environment: noise, pollution, abrupt change to rural or city lifestyle, new climate, housing etc.

  • Language barriers

  • Activities of everyday life: where are you buying your groceries, how do you register yourself or your child for school, paying bills, transportation challenges, dietary restrictions and lifestyle management etc.

  • Cultural differences: religious expression, opening hours, socializing and eating behavior etc.

  • Bureaucratic management: visas, insurance, residency, coupled with language barriers can be a perfect storm of stress (even the small things can be a major stressor, ex: how do you even find the office you are looking for, which office are you looking for?)

  • Loss of support network- social isolation, cultural isolation, loss of formal support systems such as family, friends etc.

  • Job stress: workplace dissatisfaction, lack of career opportunities, recognition of foreign degrees and training, spouse being unable to find work etc.

  • Money and financial stress

  • Political and/or societal turmoil

  • Homesickness: inability to partake in home activities

  • Racism

  • Sexism

  • Ageism

  • Family: are they moving with you? Are they still back in your home? Are they supportive of your decision or wanting to change the situation the whole time? How are children handling the relocation?

Internal stressors are stress-inducing thoughts or behaviors that arise from one's psychological mindset or expectations. In the expat and immigration process these can be:

  • Identity loss

  • Damage to one’s sense of competency, self esteem and self worth,

  • personal awakening and discovery,

  • Lack of flexibility

  • Unresolved matters from the past

  • Lacking goal setting

  • Expectations management

  • Loneliness

  • Homesickness- FOMO: fear of missing out of home activities


The Psychology of Stress

Stress is your perception of pressure (physical, emotional or psychological), and your body’s physiological response to that perception. On a bodily level, the responses to stress are evolutionary adaptations related to releasing the relevant hormones to mobilize the whole body in order to either be able to escape the danger we’ve encountered or be able to fight it and safe our lives.


This response isn’t just limited to life or death moments, we experience stress in situations when we are faced with something challenging, where we don’t believe we’ve got enough resources to deal with it, a somewhat common thought amongst expats and immigrants. A challenging situation, like navigating the immigration office in a second language with limited verbal skills, while not life or death in the physical sense, stimulates our same sympathetic nervous system and acute stress response. The sympathetic nervous system then stimulates the adrenal glands, triggering the release of catecholamines- including adrenaline and noradrenaline(Goldstein, 2010). This chain reaction brings an increase in heart rate, blood pressure, and breathing. After the perceived threat is gone, it takes your body between 20 to 60 minutes to return to its pre-arousal levels(Gordan, 2015). There are three main phases of stress reactions: alarm, resistance, and exhaustion (Selye, 1946).


Infographic explaining the stress response system by SEELEDU
SEELEDU explains the stress response system

Symptoms commonly associated with expat stress


  • Lack of motivation and productivity

  • Poor sleeping schedule and exhaustion

  • Bad diet, upset stomach, or unexplained appetite changes

  • Energy level changes

  • Unintentional weight gain or loss

  • Mood swings and emotional outbursts

  • Sudden social anxiety and withdrawal

  • Loss of interest or inability to find pleasure and joy in things previously enjoyable

  • Unexplained physical symptoms and pains

  • Difficulty concentrating

  • Difficulty making decisions


Studies conducted recently have shown expatriates may be at greater risk of mental health problems. This most often manifests in the form of expat depression however cases of stress, anxiety and isolation amongst the expatriate community are also on the rise(Foyle, 1998; Walk, 2003; Pascoe, 2009). Research shows that expats are three times as likely to express or endorse feelings of being trapped, isolated or depressed. On a broader level, 50% of expats surveyed in 2018 were found to be at a high risk of internalizing common mental health issues such as anxiety and depression (Truman). In a 2021 survey of 1184 expats globally by William Russel, over a third of expats have noticed a decline in their mental health since the Covid-19 Pandemic.


Expat Mental Health: Expat Depression


According to data, depression and anxiety amongst insurance claims from expats ranked the highest in terms of all mental health claims (Truman, 2018). Expat depression is not unlike depression in general. While living abroad, a person experiences feelings of sustained anxiety, despondency and dejection. Symptoms are similar to those associated with expat stress and also include insomnia and difficulty sleeping where you may struggle to get to sleep or stay asleep at night as you are overwhelmed by the negative thoughts or feelings commonly associated with depression.


Expat Mental Health: Expat Anxiety


Twice as many expats as US-based workers expressed feelings of anxiety or nervousness. Anxiety is one of the consequences of internalizing problems: taking the blame for them, attacking yourself, don’t express how you feel. This internalization can lead to loneliness, sadness, nervousness, anger and ultimately, anxiety. Anxiety can present as concentration problems, fatigue, an individual not wanting to go out anymore, paralyisis or stagnation, and ruminating on the past or worrying about the future.


Anxious thoughts from an expat can look like (but not limited to): “I’m not going to adjust to this country.”

“This language is impossible, how am I expected to learn this.”

“My partner is going to leave me because he/she will not overcome the adaptation process.”“I’ll never find a job”

“I’ll be alone forever because I can’t find any friends/ partner in my host country”


Expat Mental Health: Expat Isolation

In a study of over 5,000 expats over two years, 42.8% of expats surveyed stated that the loss of a support network was cited as their top stressor. The absence of friends and family support networks compound stress and anxiety suffered by expatriates on foreign soil (Patel, 2017). In the last years, expats have been disproportionately impacted by the Covid-19 pandemic as they must cope with social isolation away from the familiarity of their home country. The isolation compounds the feelings of vulnerability of life abroad.


Managing Expat Mental Health

Dealing with expat stress, anxiety and depression is not easy, but you can do it!

Do you want useful and effective ways to manage your mental health & wellness? Download our FREE SEELEDU Expat Toolkit to invest in your mental health, overcome typical expat stressors, and lay the foundations of a powerful enjoyable international experience.


Feel free to reach out to me if you need help to navigate the challenges of your international experience, I’m here for you and you are not alone!

Want your 30-Minute Free Consultation? Book Here! and let’s start the journey of building the international life that YOU want!

Check the testimonials of clients living the life they want!


Mit freundlichen Grüßen,

Justine



Justine began working with immigrants, refugees and asylum seekers at the International Institute of New England (IINE) in 2008 as part of their refugee resettlement program. She then worked in rural Maine public schools with large numbers of refugee children, providing mental health, educational, life and well-being support. As a migrant herself, she finds this topic particularly interesting. In 2015 she moved to Germany with no language skills and experienced all the trials, joys and stresses that relocating brings while working with children representative of over 25 different nations in the local elementary school. A supporter and lover of humanity, Justine has worked with adults, children and families from over 50 countries.



SEELEDU explores the journey of being human and nurtures nature connections for health and well-being.


References

Dodge, R., Daly, A.P., Huyton, J., & Sanders, L.D. (2012). The challenge of defining wellbeing. International Journal of Wellbeing, 2(3), 222-235. doi:10.5502/ijw.v2i3.4


Foyle M.F., & Beer, M.D., Watson, J.P. (1998). Expatriate mental health. ACTA Psychiatrica Scandanavica, 97: (4), 278-283.


Goldstein DS. Adrenal responses to stress. Cell Mol Neurobiol. 2010;30(8):1433-40. doi:10.1007/s10571-010-9606-9


Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015;7(4):204-14. doi:10.4330/wjc.v7.i4.204


Selye H. The general adaptation syndrome and the diseases of adaptation.The Journal of Clinical Endocrinology & Metabolism. 1946;6(2):117-230.

Patel, M. (2017). Expatriate mental health: breaking the silence and ending the stigma. https://www.aetnainternational.com/content/dam/aetna/pdfs/aetna-international/Explorer/MentalHealth-Explore.pdf

Pascoe, R, & Moser, C. (2009). Substance Abuse in Expatriate Life. Living Overseas. Available at: http://www.escape fromamerica.com/2009/03/ abuse-in-expatriate-life/

Truman, S. D., Sharar, D. A. & Pompe, J. C. (2018). The Mental Health Status of Expatriate versus U.S. Domestic Workers: A Comparative Study. International Journal of Health & Productivity, 10(1), 50-58.

Valk, T. (2003). Sending employees and families overseas: Mental health in the workplace abroad. In J. Kahn and A. Langlieb (eds) Mental Health and Productivity in the Workplace. San Francisco: Jossey Bass, 155-168.

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