An important part of keeping fit and healthy as an expat is to take care of your own mental health and try and notice the first signs of depression. It is especially important during the COVID-19 pandemic when many people working and living abroad have felt isolated, have not had a chance to connect with their family, or become separate from their home countries. During Christmas, you might feel especially lonely abroad without your family.
The good news is, that there are plenty of things you can do to help make sure you keep yourself mentally healthy and avoid depression. We at William Russell support a lot of expats who move and live abroad, so here are our tips for mental health. Whether you’re concerned about yourself or a loved one, find out how you can get help.
Top tips for good mental health as an expat abroad. How to avoid expat depression
The unique, and often unexpected, pressures associated with living abroad can come as a shock, which could lead to mental health issues and depression, stoked by feelings of isolation – which, in turn, can stem from a fear of confiding in other expats or loved ones back at home. It is especially common among expat spouses, who feel lonely when they follow their partner to a new country without having a job and new friends circle themselves. Being an expat abroad is incredibly rewarding, but expat life can present challenges your family at home is not familiar with. The good news is expat depression is highly treatable, so there is no 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”.
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.
Your environment has a huge impact on your mental health
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 while 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‘).
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 they 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 expats 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.
Expat mental health decline and depression during the COVID-19 pandemic
A ground-breaking study explored the levels of stress faced by expats. It found that expats were three times as likely to express or endorse feelings of being trapped, isolated, or depressed. On a broader level, 50% of expats, a study surveyed were found to be at a high risk of internalizing common mental health issues such as anxiety and depression.
Things haven’t changed much since. In fact, the COVID-19 pandemic has made things worse. In May 2021, we asked over 1,100 expatriates worldwide about how the COVID-19 pandemic has affected their mental health. According to our survey, more than a third of expats feel their mental health has worsened during the pandemic.
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.
Pre-2020 this was most often linked to the stress of international moving and the culture shock of living in a new country, coupled with a high-pressure expat role. In the last year, 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.
See if your international health insurance offers an expat assistance program where you can access talk therapy and other support services. If this is not enough, make an appointment to see your doctor, there is so much that can be done to help you feel better.
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 realizing they’re unwell. It can sometimes take a friend or family member to suggest something is wrong. Look for the 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
Top tips for good mental health and mental wellbeing. How to avoid expat depression
- Seek a connection. 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
- Set some work-life boundaries. Don’t compromise on quality time with your family or doing other things that are important to you
- Remember to sleep and exercise. Physical activity and sleep have both been linked to mental wellbeing
- 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
- Treat your mind like your body. Find out what help is available locally in case you ever have need of it and time is not readily available. Help can be sourced through the International Therapist Directory
- Don’t spend your life online. Keep up with friends and family at home as much as possible, but also try going out and making new friends locally
- Recognize 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.
- 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 prioritize self-care so that you can face the challenges that each day inevitably brings.
Expat mother-of-three Tavy
So, some good forward planning can go a long way to help mitigate some of 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.
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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. William Russell can even offer medical evacuation to patients who require treatment in other countries. At William Russell, they have been providing worldwide health cover for 30 years, helping expats like you and their families to settle into their new homes. Speak to them today to find out more about how global health insurance could support you.