Expats and mental health

Depression, anxiety and other expat mental health issues

As we approach World Mental Health Day on 10th October 2019, I want to draw attention to an aspect of expat life that isn’t always widely acknowledged. Expat mental health. If you’ve followed ExpatChild for years (thank you!) you’ll know that I have always focused on the reality of relocation. And boy, do I get kicked for it! But I would rather share some of the potential pitfalls, so you know what to expect, than pretend that everything is always rosy. The key word there is ‘potential’ – of course, most people move abroad for a better life, and get exactly that. Some do not get a better life, though.

Being properly and realistically prepared for your new life abroad makes it easier to manage your expectations and hopefully prevent some of negative experiences many encounter.

We tend to think of expats as people who move abroad because they want to explore new opportunities and experience new cultures. We receive comments such as, “Oh, you’re so brave, I could never do that.” Expats naturally have a zest for life that drives them to embrace new ways of living. It’s all about exploring the world and creating a new and hopefully better existence for oneself.

However, while that may be the motivation, expats are at a higher risk of suffering from mental health issues than those who remain in their country of origin.

Expats are at double the risk of mental health conditions compared to people who never move abroad.

Data from The Mental Health Status of Expatriate Versus US Domestic Workers suggests that expats are at double the risk of mental health conditions compared to people who never move abroad. Figures indicate that expats are particularly at risk of developing anxiety and depression after the move. So, while the choices of expats might seem outwardly glamorous, it can mask pain within.

Social media shows the best bits of expat life. The highlights, the happy days, the adventures. It’s rare to read and see the difficulties many expats experience.

I have always aimed to show the reality of living abroad, and in recent years, I’ve definitely seen others share more accurate and honest anecdotes of life overseas and the struggles many experience, which is actually brave, and truly helpful to many.

Why do expats have poorer mental health?

In general, expats have a tendency towards poorer mental health than people who never move. But the picture is more complicated than it first appears. One group of expats – those who move to escape conditions in their country of origin – usually do quite well on the mental health front. Expats fleeing danger and conflict are often grateful for the peace and security of their new home country, particularly those escaping war, poverty or a violent society. In these cases, there’s not an awful lot to miss about the home country, which, in turn, creates a positive outlook.

For others, however, the situation isn’t so rosy. Expats often leave their home country with dreams and expectations of a better life, only to find themselves lonely and isolated. Not speaking the same language or having an established network of contacts can make life tough. Expats can also fall into the trap of thinking about their friends and family back home and wishing for their old life. Feelings of homesickness are common.

Expat depression is more common for the accompanying partner, or trailing spouse, than it is for the working expat. This is often due to the partner having to give up their own career to support their partner in this new, overseas life. From sacrificing a career comes a loss of identity, self-worth and confidence. Sometimes, resentment can build to breaking point.

Family and friends

Another major factor is that, for some reason, we feel we cannot say anything to our friends and family back home when life gets tough. And expat life does get tough.

You may post an irritable comment on social media when you’ve had a particularly hard day, and immediately someone comments, “What are you complaining about? You’re living the dream.” And, “You chose to move away from your friends and family. Suck it up, buttercup!”.

Yep, the expat guilt piles on and we feel we can’t even talk to those closest to us.

Here’s a tip for the families and friends of expats – don’t do this! Do you really think it’s helpful?

Another tip: if you are friends with someone living abroad and they go quiet on social media for a while – reach out. They may be struggling, unable to post ‘the usual pretty pictures of their life’ because, quite frankly, they may not be seeing the ‘glamorous’ side of their life right now. They may be struggling and feel unable to share it with anyone.

Isolation can lead to depression, and family issues can increase the pressure. Not only are you dealing with your own feelings, you’re probably putting your children’s needs and emotions first too.

Younger children often adapt quite quickly to changes in culture and circumstances as their main concern is their relationship with their parents and immediate family. Older kids and teenagers, on the other hand, can struggle to adjust and fit in with new groups of friends. This in turn takes its toll on their mental health and that, of course, impacts you and the rest of the family.

How to find someone to help you with your mental health

Finding data to prove that expats are taking steps to improve their mental health is a challenge. Many destination countries do not collect data on the likelihood that an expat experiencing mental health difficulties will seek treatment. Data from the UK, however, suggests that the majority of people suffering from anxiety and depression do not seek help from professionals. Statistics indicate that 75% of those with a diagnosable mental health condition do nothing about it. This is probably more to do with the severe lack of accessible mental health care services in the UK though, as the NHS continues to struggle with funding. Private mental health care professionals are available to those who can afford it.

For those who emigrate to less developed countries, finding adequate expat mental health services can be an even more significant challenge. Many countries are still trying to get to grip with healthcare priorities, such as infant mortality and infectious disease. Mental health interventions for lonely expats are something of an afterthought. And if you have moved somewhere with a different language, simply accessing available resources will be impossible.

Things are looking up though, with a plethora of specialised expat counselling services springing up as the need has become more obvious. Some practitioners offer Skype counselling too, which helps massively if you can’t find anyone to talk to face-to-face in your host country.

Tips to help protect your mental health

Expats are an at-risk group of developing a variety of damaging mental health conditions. The main conditions are anxiety and depression. Another particularly relevant one to expat life is generally known as ‘expat grief’, when we grieve for the life and friends left behind.

It’s sensible, therefore, to take precautions if you’re thinking about starting a new life abroad. Naturally, nobody expects to experience mental health problems, and nobody can predict how you will cope with your new life, however resilient you think you may be.

To start, make sure you are very well prepared for the realities of expat life. Take a good look through the many articles here on ExpatChild. Make sure your expectations are realistic and you’re not expecting all your troubles to simply evaporate in the sunshine of your new home country.

Then get in touch with me to see if there’s anything you’ve missed!

Find out more here: WORKING WITH ME

Find a mentor

Moving to a new country is a significant life challenge, just like starting a business or having children. You need to make considerable adjustments to your basic style of living, which could be disruptive (understatement!).

As in business and family life, it’s a good idea to have a mentor: somebody who has been there before. A mentor can provide you with first-hand insight into what it’s like to live in a new country and provide you with some much-needed survival advice.

I’m here for you. Let’s chat

Keep an open mind

Intriguingly, many expats experience problems in countries that bear a resemblance to their home country – it’s the small differences that make day to day expat life tough, in this case. When you move to a ‘very foreign’ culture, you’re actually expecting more culture shock and may be surprised not to experience any at all!

Visit a doctor

If you’re really struggling, you do need professional intervention. First of all, visit a doctor to see if there’s any underlying cause and/or medication you need. When I was struggling a few years ago, I discovered that I was actually suffering from physical disorders, rather than a mental health problem – hypothyroidism and rather early menopause – a grim double-whammy! Now I am properly medicated, life is much easier.

Living in a different country, in a different climate can cause its own problems too, so see if any of the points mentioned in this article ring any bells.

Find a counsellor

See if your medical insurance covers mental health care and find a counsellor.

It’s very helpful to find a counsellor who understands expatriation and the difficulties this life can cause. This is even more vital if it’s your children who need help, as TCK and expat life is very hard on the developing psyche. If it helps, your problems are probably related to your self-identity and the way you process your new life. I’ve heard that cognitive behavioural therapy (CBT) is very helpful in this instance. Cognitive behavioural therapy is a talking therapy that can help you manage your problems by changing the way you think and behave.

Telephone or online counselling is a lifeline for expats who are struggling with negative feelings after a move, because you may be living somewhere where the local language could prevent you finding a counsellor. Just having a person that you can talk with on the phone can be a backstop to prevent your mental health from worsening.

Keep your options open to return home

Feeling like you’re trapped in a new place is not a pleasant experience. You always want to have the option of returning home if you can. With cheap flights and flexible working, most people can easily transition between two locations, should your desires change. But it’s prudent to put in place contingencies before making any significant financial or career decisions. Simply knowing that your options are open will help a lot.

In conclusion, moving to a new country can be a challenge. Loss of identity, the struggles of daily life, homesickness and feelings of isolation can lead to expat depression. However, by putting in place sensible strategies to protect your mental health, you can bolster your defences and make your overseas move a healthy one.

And, most importantly, recognise if you need help and act on it sooner, rather than later.


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  1. Carole,

    This article covers SO MUCH without being too long. It summarizes out highs and lows and how only those who have experienced it understand the challenge it is to be an Expat.
    This is our fourth country after we left out home country and I feel every word you write.

    Thank you!


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