October 05, 2016

Expat depression is a common health challenge associated with the stresses of global relocation. For the ever-moving global multinational population of expatriate workers, a host of stresses can negatively impact life and work performance, which - more often than most people imagine - can and do lead to a high rate of depression and even suicide if signs and symptoms are ignored.

Moving and living abroad have become very common experiences for the modern worker, with globalization greatly increasing the mobility of national labor. Moreover, new worker migration patterns have been observed in many developed countries due to a decline in working-age populations and fertility which has led to an increasing demand for workers from abroad to sustain national economies. In the US alone, roughly 12 percent of all Americans - an estimated 36 million people - move each year. And these migration events are not uncommon in the rest of the world. In fact, in 2010 the UN estimated that 200 million people - 3 percent of the worlds population have lived abroad.


Relocation Stress

Moving and relocating are extremely stressful life events. In fact, according to the Worldwide Employee Relocation Council, relocation is the third most stressful life event, following death and divorce. 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. It is challenging to think about living abroad and hard to imagine the experience unless one has lived through it. Many workers across the world, however, will experience these stressors a multitude of times during the course of their careers and lives.

When contemplating the myriad activities involved in relocating and assimilating to a new place or culture, the basis for the high levels of stress becomes evident: buying and selling a home, moving a partner and/or children, finding new schools for children, helping a spouse find job opportunities, learning a new language, learning a new culture, adjusting to a new work environment, etc. Upon deeper reflection, each of those tasks can be further subdivided into many more taxing and time-consuming activities; such as, finding a suitable buyer, having strangers packing or hauling possessions, waiting to hear about an offer, waiting to close the sale, saving for a deposit, waiting for contracts, unpacking a new house, waiting for a surveyor report, finding a mortgage deal, finding a good lawyer, and the like. All of these life events add up to many individual activities required to relocate, which cumulatively produce tremendous stress on individuals.

Stress affects multiple systems of the human body, including the heart, brain, immune system, muscles, lungs, stomach, skin, and reproductive organs. Stress is also known to affect human thoughts, actions, and feelings. For people who move, data reveal actual biological effects: 19 percent suffer from symptoms of anxiety; 14 percent suffer short-term memory loss; 10 percent suffer hair loss, and some report feeling older and suffering age-related symptoms.


Expatriate Depression

Stressful life events and the multiple stressful events encountered by the modern expatriate global worker can result in depression. Depression is a real concern in the workplace, because it is triggered by the high levels of stress often encountered by the modern worker, impacts performance, and correlates with a high risk of suicide. Moreover, depression has been observed to be one of the most common psychological problems among expatriates.

Most know that depression is a state of feeling sad and/or blue. Depression is not an uncommon feeling, but can become a serious medical condition when it persists for an extended period of time (e.g. more than two weeks); interferes with daily living; and negatively impacts how one feels, acts, and thinks. 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.

Depression is also a significant concern for expatriate workers because it can have a snowball effect as they encounter the myriad stressors associated with relocation. Depressed individuals are less able to cope with stressors that they would otherwise be able to overcome. As a result, depression makes individuals encountering life-event stressors more susceptible to their physical and psychological effects. When depression renders a person unable to cope with stress, and that person encounters the normal stressors of relocation, the cumulative effect can be overwhelming and debilitating.

Since depressed individuals have a high risk of suicide, it is extremely important to be able to recognize the signs and symptoms of depression in order to prevent suicidal behavior among relocating employees. It is also worth noting that many people can hide emotional pain and pretend to be okay when they are not. Thus, monitoring for symptoms is an important exercise. Depressed individuals may exhibit many of these symptoms, while others may only exhibit a few. Furthermore, the severity of the symptoms can vary individually and over time.



Signs of Suicide

Most people would not be surprised to learn that traffic accidents are the leading cause of non-natural death for US citizens in foreign countries. What would surprise many, however, is that the third highest cause of non-natural death is suicide. Moreover, for most national populations, it is possible to extrapolate that data to the broader body of global travelers.

Similar to depression, suicidal individuals can appear to be perfectly fine while suffering great emotional pain. Thus, a key way to monitor expatriate persons and populations for suicide is to know the signs and symptoms.



Conclusions and Advice

Suicide is the third leading cause of non-natural death in US citizens abroad and is a major risk for other multinational expatriate workers. From the available data, we can surmise that there is a spiraling cycle that can lead from relocation stress to depression and, ultimately, suicide. Expatriate workers and their families experience significant degrees of stress. In this environment, both depression and suicide are risks encountered by all employers. As such, it is critical that employers minimize stress where possible, actively monitor for the warning signs of depression and suicide, and provide counseling programs for expatriates.