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The expat blind spot

Updated: Jan 26, 2021

Expats are fantastic

Despite, or perhaps because of the challenges faced by living and working abroad, expats are some of the most impressive people you can meet. They are likely to be high achieving, hard-working and often really interesting and empathetic individuals. They have moved themselves, and perhaps their families, to another country with all the associated upheaval and turmoil that comes with organising visas and international logistics. This alone demonstrates bravery and resourcefulness when we all know moving house within your home country is stressful enough.

Consider just a few other challenges expats have to overcome. Things like navigating a foreign healthcare system. A system where not only the process for getting an appointment and paying for treatment is entirely different, but the whole philosophy and approach to healthcare can be completely alien.

Or how about finding somewhere suitable to live without local knowledge of different neighbourhoods? No understanding of what landlords or mortgage lenders consider as ideal candidates. No experience of how utilities are set up and or how to avoid unnecessary fees and get the best deals.

Or what about learning to get along with new work colleagues? Ignorant of how seemingly mundane actions can be perceived, something as simple as eating lunch at one’s desk to meet a deadline could be perceived not as being conscientious and hard-working but someone anti-social and unhygienic. The workplace can really be a cultural minefield!

Successive navigation of these experiences demonstrates the resilience, open-mindedness, creative thinking and resourcefulness of an expat. Studies have shown that expats that learn to speak another language might actually become smarter too. However, expats are only human and they do in fact have an “Achilles heel”: their mental health.

Expat surveys

Expats have been studied by researchers for decades. In recent times, as global enterprise has expanded, surveying expats has been commonplace for many international businesses. Some companies publish their reports online and HSBC and Aetna International, in particular, publish their findings annually.

The actual statistics vary (I advise you to check for yourself, even a simple google search of ‘expat-mental health’ returns over 4.5 million results) but on the whole, research has shown that expats are at higher risk of developing mental health issues than their peers back home.

The latest survey conducted by Aetna International found that expats are two and a half times more likely to have anxiety and depression than their equivalent domestic peers, indicating that it is the move abroad that increases the risk. Additionally, the report showed that only 6% of surveyed expats were concerned about mental health prior to moving to their host country. There is a discrepancy here between what expats think will be a problem and what is statistically likely to be a problem.

It’s important to clarify that expats are not a homogenous group and of course there will be individual differences as in any group of people.

However, given the demographic of those surveyed (three quarters were in full-time employment, all respondents were in the top 25% of incomes for the country they lived in and the lower age limit was 30 years) it’s not unreasonable to assume that these people are well educated and professional. This demographic is very likely to have experienced stress prior to living and working abroad. So why is it that the stress abroad leads to issues with mental health when it doesn’t appear to at home? The reason for this is because it’s not just the volume of stress that being in another country incurs, but the specific type of stress.

Expat stressors

In a new culture where things are unfamiliar, we are forced to use more of our cognitive resources to understand the situation around us. In a familiar environment like our homes, our brains function to a large extent as if they were on autopilot. We don’t process all of the sensory information around us, as our brains cherry-pick the most useful information and fill in the blanks based on previous experience. When you have no previous experience of a situation it can quickly become overwhelming. This is the sensation of your brain working overtime to organise and categorise the new information, making judgements for the first time on what is important or what is junk, and working out the correct cognitive or behavioural responses. This process comes at a significant cost to mental energy - which is finite.

It takes a considerable period of time, anywhere between six months and two years, to feel acclimatised and settled into a new country and culture.

During this time the expat is expending a higher level of mental energy than they would if they were at home carrying out normal, simple tasks. But the expat doesn’t just have day to day tasks. They have all the additional stressful challenges that come with living and working abroad. Expats have to find a new place to live, get on at work, learn a new language and get through a mountain of bureaucratic admin, and they have to do all this while being at a mental energy deficit.

Sleep, exercise and social support have been shown to be the most effective ways of increasing mental energy reserves and preventing stress-related issues. For an expat however these three things can be particularly difficult. In a period of high-stress people often find it difficult to sleep. It takes time to find new gyms or sports teams to join and exercising outdoors may no longer be safe or appropriate. Exercise is often linked to routine and routine is something expats don’t have when they touch down in their new country.

The subject of social support however is of critical importance to an expat’s mental health for a number of reasons. Research in social and evolutionary psychology has shown that neural networks in the brain thought to take part in social functioning are interconnected with our neural networks for reward. Positive social interactions provide us with large emotional reward. Negative social interaction, or a lack of positive social interactions leave us lacking. When our social needs are not met, our moods are worsened, our perspective becomes more negative and we often withdraw, making us more isolated, perpetuating a negative cycle.

Expats often leave their social support networks behind them when they move to a new country. Calling home can be a source of support but it is often tricky because of time differences and a desire to reassure our loved ones that “everything is going great”.

Making new friends and developing a new social network should be a priority for expats and meeting other expats is one of the best ways to do this. Not only can you speak with other expats in your native tongue, helping you feel understood and like you’re making a real social connection, other expats will fully understand the struggles you face and are likely to have useful and practical advice. Sojoourn is building a great community in Lyon, regularly organising networking events, helping you to study French and make you feel home.

Raising awareness

Now we better understand some of the factors contributing to the increased risk to mental health we should consider why it is that only 6% of expats think about this prior to moving? It could be a simple lack of awareness. Expats may never have experienced mental health issues before and therefore they may not be able to identify the symptoms of depression or anxiety.

The attitudes of both the home and host country towards mental health could impact awareness. As a guide, HSBC conducts ranks 33 countries as the “best places to live” based on regular surveys among expats using 15 different criteria. The table below shows the top 10 countries based on criteria related to physical and mental well-being:

A bigger issue for expats than general mental health awareness is being aware of the specific types of stress that come with being in a foreign country with different cultures and how new coping mechanisms, especially social support, will need to be established as quickly as possible to prevent stress leading to issues with mental health.

Sadly, it’s also the case that talking about mental health can be taboo. In fact, it’s likely that such taboos mean the occurrence of mental health issues is a lot higher than reported by Aetna International and other researchers. Moreover, how likely is it that people suffering from mental health issues are to fill out a survey in the first place? Especially after a long, stressful day, acknowledging a problem through an online survey may be the last thing anyone wants to do.

If an expat is aware they are having issues with their mental health, they may not know how to find help in their host country.

The problem is compounded by ignorance of the most valuable resources and knowing effective ways to manage – which will of course vary for individuals. If international employers and companies who work with expats want to get the best out of their employees, they should provide support through understanding the types of stress expats face and facilitate access to appropriate support.

Employers could do this through practical support such as routinely providing relocation services and orientation programs to reduce the initial volume of stress expats face on arrival. They could support social events and promote exercise and relaxation opportunities. Additionally, they could provide information about local physical and mental well-being services.

The expat blindspot

The described multitude of challenges is all within an expat’s capacity to cope. However, issues with mental health can arise when expats face these challenges simultaneously, taking on a large volume of stress, over a prolonged period of time, with lowered day to day mental energy and without the coping mechanisms to mitigate the harmful effects of stress. In this context its clearer to see why the risk of depression and anxiety is so much higher abroad then it is back home.

By shedding some light on this blind spot, hopefully expats can better protect themselves against risks to their mental health. Prioritising sleep, exercise and socialising will help them ensure they are replenishing their mental reserves as much as possible. But it’s also important that those who work with expats are aware of this blind spot.

The potential risk to mental health should not be a deterrent to living and working abroad. There are huge benefits to being expat. Learning a new language, making international friends and working in a different culture are all hugely fulfilling and life-changing experiences. By knowing in advance the likely types of stress and understanding the best ways to manage will likely prevent many issues with mental health and allow expats to thrive.

Thank you to our contributor: Philippa Crichton

About Philippa

She is social psychologist MSc with a corporate background. She works with companies to help them understand social issues challenging their development, working with them to communicate effectively and create a positive change in the behaviour of their employees and clients. She is experienced in multicultural communication and has worked internationally as well as living in Italy and France. She’s passionate about raising awareness of mental health issues concerning expats.


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