Any transition is hard, especially one that involves moving from home. Just the thought of moving creates stress. Stress can trigger the blues and even depression. You finally decided to sell your things and live your dream. But aren’t feeling quite yourself. Why? Maybe it’s the blues, maybe it’s culture shock and maybe it’s expat depression. But what is expat depression and how do you know if you have it? Quite simply, the answer is complicated with many factors at play.
Indeed, depression is reported as one of the most common psychological problems among expatriates. Now, with the added stress and anxiety from COVID, the difficulties of the integration process are compounded. This combination is overwhelming and can be a component that triggers depression in many expats.
Experiencing long periods of isolation and social distancing makes matters even worse.
This is the first article in a three part series about expat depression. This series is for anyone who may be experiencing depression related to an international move or life-changing experience.
The information contained in these articles is intended to be educational and not for diagnosis, prescription or treatment of any health disorder whatsoever. This information should not replace consultation with a competent healthcare professional. The content of these articles is intended to be used as an adjunct to a rational and responsible healthcare program prescribed by a healthcare practitioner. The author is in no way liable for any misuse of the material.
My experience with expat depression
After living and working in the Riviera Maya in 2006. I fell head over heels in love with the beauty of Mexico. The people, the culture, and the community connection made a deep impact on me.
So, I set my sights on moving to Mexico at the right time. The right time came in September of 2019 when I arrived in Merida on a research trip. I found everything I wanted and more here. Three months later I arrived in Merida on Christmas Day to start my new life.
What a whirlwind of sights, sounds and smells. I was on top of the world; loving my decision and this chance to start over. There were also days when I would feel out of sorts. Not many out of sorts days but enough to get my attention.
Needing a distraction, I began writing about my new life and my experiences for this website. I wanted to show everyone the wonderful new city I called home while helping people navigate day to day life here.
However, just 3 months after my arrival, COVID appeared. Notably, my world turned upside down.
In May of 2020, my mind and body started to shut down. I lost interest in writing and began going through the motions. Crying easily, drinking more, interrupted sleep and lethargy – this was my life.
When I woke up in the mornings, I wouldn’t feel rested. I went back to bed after a couple of hours. Feeling stress and anxiety from my move along with the unknown of a pandemic was quickly becoming overwhelming.
Recognizing these factors as depression, I started medication. I decided to take care of myself and get healthy. Stepping away from writing was one of the hardest decisions I made.
After several months on pause, I researched expat depression.
My research took me down a long rabbit hole. What started as one article quickly became this series of three. Confirming what I knew from my recent experience, expat depression is exacerbated by life-changing experiences from moving to a new country.
Information that led to writing this article
Reaching out to several expat groups, I asked for information about their experiences with depression and anxiety. Surprisingly, I received a compelling amount of responses and feedback.
As I began to disseminate the information, there was a central theme from the respondents. They wanted a safe place to share, speak up, and provide their personal story and perspective. Depression can make us feel alone, even though we know we are not the only ones who are depressed.
A few said it was a cathartic experience to put their thoughts into words and share with someone else. Seeing the evidence of what they’ve been through became proof of their courage, trials and tribulations.
What is Expat Depression?
Expat depression is not unlike depression in general. While living abroad, a person experiences feelings of sustained anxiety, despondency and dejection. Not surprisingly, expat life comes with obvious challenges in daily life not to mention challenges in emotional and mental health.
It’s natural that going through a period of homesickness and culture shock is normal. Notably while this is difficult, it will pass.
However, sustained and severe feelings of anxiety, despondency and dejection need serious attention.
Why do mental health issues affect expats?
- Separation from family and friends
- Social isolation
- Cultural, climate, religious and language differences
- Concerns about being accepted
- Lack of support
- Difficulty coping with new circumstances
- The need to develop a high level of self-sufficiency
- Increased stress and anxiety
- Inability to cope with loneliness or homesickness
- Trouble finding professional help, especially in the expat’s language
A counselor based in Spain, Chris Neill, states, “The rates of depression – or the feeling that life is meaningless – could be up to 50 per cent higher among expats. I believe that anxiety is not unusual for people living abroad. People with anxiety stop enjoying activities that used to give them pleasure. They don’t want to go out anymore and they start ruminating on the past or worrying about the future.”
“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.
Situational Depression vs. Clinical Depression
Not surprisingly, depression can happen to anyone at any time. Depression isn’t the same as culture shock or homesickness which is more of a blues-type feeling. Someone may be completely suited to being an expat when issues arise causing depression.
Take into account adjustment disorder or situational depression. These are reactions to a major change or source of stress; typically caused by external factors. The symptoms are short term and fade with time and adjustment.
Most commonly, situational depression is caused by where you are:
- Life circumstances
When symptoms arise similar to clinical depression, situational depression evolves into a longer term problem. Furthermore, for any reason or no reason at all, clinical depression can be triggered.
It is estimated that 8 to 20 percent of people risk developing clinical depresson during their lives. A mental disorder can appear at any time in life, with or without warning.
Understandably, depression is not an uncommon feeling.
Consequently, expat depression becomes a serious condition when it:
- Persists for an extended period of time – typically, more than two weeks
- Interferes with daily living
- Negatively impacts feelings, actions and thoughts
“Serious episodes of depression have been described by medical professionals as a lengthy pit of despair marked by irrational thought. The number of depressive episodes a person experiences throughout his or her lifetime can vary and ranges from one episode to many.”
The difference of depression in expats
While depression will never be an exact science, psychologists are getting closer to understanding factors that can predict whether or not someone is suited for expat life. Because being an expat can cause stress, there is an increased risk of physical and mental health problems.
Some of these problems include:
- Mental disorders and illness
- High blood pressure
- Obsessive thoughts
- Heart disease
Notably, anxiety and stress are harder to deal with as an expat. Being in a foreign location can be both exciting and confusing, invigorating and uncomfortable. Day to day circumstances may cause a range of emotions which can be difficult to handle.
Loss of control and the unknown also contribute to apprehension, unease, and agitation. All of these factors come into play with stress that can trigger depression.
In a survey on mental health issues faced by expatriates conducted by Aetna International, depression turned out to be most prevalent condition followed by anxiety (28% prevalence increase). Only 6% of the members surveyed reported being concerned about mental health issues before relocating.
Dr. Mitesh Patel, medical director, of Aetna International, stated: “Part of the reason expats are more susceptible to mental health issues is the absence of the family and friends network they relied on for support back home.”
Signs and Symptoms of Expat Depression
Not surprisingly, depressed individuals have a high risk of suicide. Therefore, it is extremely important to recognize the signs and symptoms of depression. Additionally, many people hide emotional pain; pretending to be okay when they are not.
For example, depressed individuals may exhibit symptoms, while others may not. Severity of symptoms can vary individually and over time.
Signs and symptoms of depression:
- Sleep disturbance
- Diminished interest in activities or interactions
- Feelings of guilt or worthlessness
- Loss of energy
- Difficulty concentrating
- Changes in appetite or weight loss/gain
- Suicidal thoughts
- Slowing down of thoughts, physical movement or emotional reactions
- Increase in alcohol or drug consumption
Why do expats resist admitting they are depressed?
A new country, a new culture, a new life. What could be better?
The integration of everything new can be extremely stressful in many areas. Confronted with the unexpected, unknown or where an expat is unprepared causes stress, anxiety, and a plethora of other feelings and thoughts.
Take into account the judgement of others and this can push an expat over the edge.
After all, why would an expat be depressed when they are living their dream?
It’s actually hard to recognize expat depression. Often, expats are resistant to admitting they feel depressed and, surprisingly, may not even know it.
Take into account what an expat experiences:
- Excitement about the opportunity to be an expat.
- Pressure to be happy for the oppportunity.
- Expectation to be happy with new circumstances.
- Duress of being constantly happy with the fortunate opportunity.
How could an expat be depressed when they get to do
most people only dream of?
But then, the excitment wears off and real life begins. Many expats internalize their problems, stresses, strains, and hardships. It’s hard to admit feeling depressed when living a dream.
Explaining these feelings to those who are not expats is stressful as well. There is no way for someone to understand the situation unless they’ve been an expat. Then, once in the expat community, it can be difficult to share with others.
Confidentiality, trust and non-judgment must be present for the expat to feel comfortable sharing their feelings and thoughts.
I believe the most important reason expats resist admitting they are depressed is a false expectation of happiness. Leaving their lives to make a new life means a huge adjustment.
The high of the excitement associated with the move often comes crashing down when reality hits.
Difficulties associated with life abroad
Sean Truman, a US-based clinical psychologist, has personal experience with difficulties associated with expat life. Growing up in Nairobi, Truman runs a mental health care practice providing services to English-speaking expats.
He co-authored a study focused on how likely expats are to develop depression and other disorders compared to US-based workers.
“The study revealed that US expats were 2.5 times more at risk of internalizing problems and developing substance abuse compared to their counterparts who stayed home – increasing their risk for anxiety and depression. There has always been anecdotal evidence that people who live their live overseas struggle but there wasn’t much research into the topic,” he explained.
“The ways people get to depression is varied – there’s no one pathway there,” he adds.
“It’s sort of like dominos – there is a cascading effect and the trick is figuring out how to interrupt them. There really is a need for mental health support in the international expat community,” says Truman.
The Unknowns of Expat Life
While planning is a necessary part of becoming an expat, it’s impossible to plan for everything. Many unknowns reveal themselves once you settle into your new destination and home.
Any transition, whether it is to another country, a new home or another job, involves preparation. However, there is also only so much one can do to prepare. Additionally, being an expat in one country does not prepare you for life in a another country.
Activities causing stress and anxiety include:
- Assimilating to a new place or culture
- Searching for the right neighborhood
- Selling a home in order to move
- Looking for a home to purchase or rent in the new location
- Moving a partner, children or pets
- Finding new schools for children
- Researching job opportunities, if applicable
- Learning a new language and a new culture
- Deciding what items to take with you
- Determing how to disseminate the remainder of your possessions
- Loss of identity
- and the list goes on and on
There’s no doubt, relocating is an extremely stressful life event. Notably, in many of these activites there are unknowns. Experiencing the unknowns of the environment compounded with the unknowns of how you or others may react is stressful just to think about.
In fact, according to the Worldwide Employee Relocation Council, following death and divorce, relocation is the third most stressful life event.
Moving, for many, is comparable to the death of a loved one. In other surveys, people have ranked moving households more stressful than having a baby or getting married.
Frequently Asked Questions Related to Expat Depression
You’ve removed yourself from every single thing you know. Your environment is different. Another circle of friends is forming. Everything familiar has changed. There is a certain comfort in nesting and having a place to call home.
Creating a stable home environment promotes a healthy and balanced life. Now uprooted, you may experience some (or alot) anxiety, stress, or fear.
Unfortunately many factors, internal and external, contribute to and can quickly spiral into expat depression.
Why do some expats experience depression?
Moving abroad requires courage, energy, optimism, self-confidence and independence. It’s difficult to admit when things don’t go the way as planned. The initial response is keeping the difficulities to one’s self.
Additionally, studies and research found the same:
American expats were 2.5 times more likely to develop internalizing behaviors
and substance abuse than Americans who did not move abroad research found.
“High risk internalizing problems were also related to greater rates of dissatisfaction with work, marital relationships, family relationships and job performance,” the study said.
“Taken together, these findings suggest that the experience of living overseas is a difficult and demanding one and that if things begin to degrade for individuals emotionally, a cascade of problems can be expected to accompany the emotional shift,” it added.
Global Business News.net states, “During the course of the last 25 years, published reports have suggested that living overseas as an expatriate conveys risk for stress that exceeds those for individuals living in their home country… Experts also have suggested that the rate of mental health problems for expatriates is higher than for their counterparts living at home. However, there has been no empirical study of whether expatriates living overseas actually do experience higher levels of stress that contribute to a range of problems—including adjustment and affective disorders, depression and anxiety, marital issues, and substance abuse.
Read the full article here:
What about returning to your home country?
While this may be the first thought when experiencing expat depression, returning home is not an easy solution. If the relocation is due to a job move, this may not even be possible.
Take into account, when mental issues arise, treatment is priority.
Additionally for some expats, returning home is not an option. Nor is it something they want to do. While going home may temporarily fix the primary issue, more problems may arise upon returning.
Keep in mind, when a mental illness develops, depression, anxiety and other issues require treatment.
Moving again will not fix the problem.
Yes, going home may cure homesickness. But depression is a deeper matter. In fact, repatriation causes additional stresses associated with relocating back home.
There are fewer programs for repatriation than there are for expatriation. Feelings of loneliness and isolation are common for many who return home.
Returning to your home country may sound like a quick, easy solution. However, it is yet another move, another transition, and more unknowns causing stress and anxiety.
Take into account, reverse culture shock is very stress inducing with a negative effect on mental health.
Does everyone experience homesickness?
Homesickness is also a natural part of the expatriate experience. However, it differs from depression.
Being separated from your home environment is described as homesickness. Yes, it makes life difficult but it’s normal and usually temporary.
Many people mistake their expat depression as homesickness. When feelings of homesickness do not subside over time, then it’s time to explore the possibility of depression.
Why is loss of identity common?
Identity loss can create immense internal and emotional turmoil. You are in a new place where everything is new and different. Your personal operating systems don’t function as they have in the past.
Once you strip away your former life, who are you?
Identity is tied to jobs, family, home life, community activism and other interests. Once an expat leaves all those things behind, then what?
Relying on others for help navigating simple things like finding a grocery store or transportation can cause stress. Especially if the person was super independent before leaving their home country.
Many times, you become more of who you are once all external things are removed. And, understandably, that can be a process.
But at the end of the day, it’s a liberating process as well.
Can expat depression be ongoing or is it temporary?
Depression related to a life circumstance is most often referred to as situational depression. Situational depression is typically temporary. Once the life circumstances become stablized or improve, the depression decreases and eventually goes away.
However, this type of depression can present again when challenging circumstances arise.
In the case of chemical imbalance related depression, the depression can be ongoing. This is important to pay particular attention to and have a doctor advise on the best forms of treatment.
Notably, coping mechanisms in depressed individuals are reduced. As a result, depression makes individuals encountering life-event stressors more susceptible to their physical and psychological effects.
Unfortunately, it’s a vicious cycle:
- The expat encounters normal stress and anxiety of relocation.
- Stress and anxiety can cause situational depression or trigger chemical depression.
- Feeling overwhelmed adds to the depression and can be debilitating.
- When the mind and body are weakened, it causes stress and anxiety.
- And the cycle begins again.
Is culture shock always present when relocating?
Culture shock is a natural part of the expat experience. Excitement and the rush of adrenaline quickly wear off. When real life happens, it feels like a dramatic drop similar to a roller coaster.
Ups and downs of daily life may seem more pronounced in a foreign country. Life becomes tough impacting emotions, responses and reactions.
As things start to improve, a second drop occurs. Eventually life stabilizes. But the timeline and severity are different for everyone. This is considered the 4 stage cycle of culture shock.
Consequently, it’s easy to write off expat depression as culture shock. Hence, it’s normal to feel defeated and emotionally spent from culture shock.
It should be noted, culture shock is markedly different than a prolonged period
of severe despondency. The latter is expat depression.
Four Phases of Expat Culture Shock
Culture shock refers to the impact of moving from a familiar culture to one that is unfamiliar. When a person must adapt to a different and unknown cultural or social environment, it can cause anxiety, surprise, disorientation, uncertainty, and confusion.
Culture shock comes from being cut off from familiar cultural cues and patterns. Especially subtle, indirect ways people have when expressing their feelings. The nuances of meaning that are understood instinctively are suddenly taken away.
Common symptoms of culture shock:
- Extreme homesickness
- Feelings of helplessness
- Disorientation and isolation
Phase 1 – The Honeymoon
During this stage, you are still on vacation. Everything is new, shiny, and exciting.
The adrenaline rush of finding a place to live, exploring restaurants, situating yourself in your new environment. This phase is simply magnificent.
This phase can last for several weeks to several months.
Phase 2 – Frustration
The honeymoon is over and now reality sinks in. Confusion and irritation rear their ugly heads when things go wrong.
While comparing the new country to the old one, you are annoyed by the differences. If there is a language barrier, it becomes all the more difficult.
Little things are frustrating. Small misunderstandings cause tremendous stress. Daily tasks feel monumental.
Homesickness begins in this phase. Followed by self-doubt, you might forget all the reasons you left your old home in the first place.
This phase can last for a few months.
Phase 3 – Adjustment
Thankfully, this stage is where life gradually gets better and routines begin.
Problem-solving skills develop for dealing with the new way of life. Acceptance of the new culture and a positive attitude appear.
While there are good days and bad days, the good days begin to become prevalent. What you feel is normal and your new friends concur.
You have help learning local customs, language, and the lay of the land. Ease and familiarity with your surroundings becomes part of your daily life.
This phase normally lasts between 6 to 12 months.
Phase 4 – Adaptation
Finally, you’ve adapted and have a daily routine. You get out on a regular basis and have a circle of friends.
The comparisons to your home country stop, recognizing that your new culture is just different. You’ve accepted the differences and even love some of them.
You may even start feeling like this is home. This is your new life and it brings joy to you. You miss home but don’t want to go home.
This phase just appears . . . one day you move from feeling frustrated and annoyed to adapting to your surroundings with ease.
This phase is where the magic of living the dream happens and it is oh so worth it!
Final Thoughts on Expat Depression
Of course, dealing with depression, stress and anxiety requires emotional honesty. You may or may not have resources including a support system. It is difficult and, at times, impossible to reach out to people you don’t know or only know socially.
The most critical period after moving to another country is the first two years. Getting through the first year can be tough. However, some say the second year is even tougher.
I read an article recently that supported most expats leave within the first two years abroad.
- Unrealistic expectations about the cost of living
- Culture barrier, including unwillingness to learn a new language
- Family responsibilites at home
Exploring these thoroughly in the preparation phase is key. Just one of these can trigger expat depression. But add on one or two more and the issue is compounded.
Of course, the sooner you identify the root cause of depression, the sooner you enjoy living your new dream life.
Be aware of how stress affects multiple systems of the human body, including the heart, brain, immune system, muscles, lungs, stomach, skin, and reproductive organs. Keep in mind, stress is known to affect thoughts, actions, and feelings.
When you don’t feel “right”, find a support group, get treatment, and take special care of yourself.
Moving abroad presents so incredible opportunities: extensive personal growth, an expanded social circle, deeper cultural knowledge and even spirituality. A feeling of freedom, courage, inspiration and joy is present. Most of the time, every insurmountable problem can be conquered with patience, treatment, support and stick to itiveness.
For more resources and support, join my private Facebook Group – Life in Merida: Visitor & Resident Resources