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Expat mental health: Do you need a check-up?

Mental illness and mental health problems are growing around the world. It’s thought that about 300 million people worldwide have a depressive or anxiety disorder — and the expat community are not immune.

In fact, according to the Worldwide Employee Relocation Council, relocation is the third most stressful life event. Analysis by Aetna International shows that mental health insurance claims increased between 2014-2016 by 33% in Europe, 28% in the Middle East and Africa, 26% in the Americas and 19% Southeast Asia. 

A mental illness is a disease that causes mild to severe disturbances in thought, behaviour or emotions. Some illnesses result in an inability to cope with ordinary day-to-day life and routines. There are more than 200 classified forms of mental illness including bipolar disorder, dementia, schizophrenia and anxiety disorders. 

The UK’s NHS alone found that severe mental illness has risen from 7% of the population in 1993 to more than 9% in 2014. And one report in 2017 estimated that almost 7.5% of the Indian population have a mental disorder requiring intervention.

While living abroad can be exciting and rewarding, many expatriates and/or members of their families often suffer the adverse effects of culture shock, homesickness and social isolation. With a frequent lack of support for expats before, during and after an international move, expats and their family members can suffer from stress, depression, anxiety and other conditions.

So, as an expat, how are you doing?

This article offers advice on becoming more aware of your own mental well-being. It explores some of the physical and mental signs and symptoms of a poor or declining mental well-being. It also includes tips on managing your own mental health and when to talk to your doctor.  

How to tell if you’re suffering from mental illness

An article cannot offer diagnosis, but it can help you to consider your own well-being. Here are symptoms you may have noticed in yourself — or signs that other people have commented on - that could be a warning sign that something’s wrong:

  • Confused thinking
  • Prolonged sadness, irritability, a lack of interest, guilt or feelings of worthlessness, loss of energy
  • Extreme highs and lows in mood
  • Fears, worries and anxieties that affect your daily life
    • Twice as many expatriates as US-based workers expressed feelings of being anxious/nervous
  • Social withdrawal
    • Three times as many expats as US-based workers expressed feelings of being trapped/depressed
  • Dramatic changes in eating (e.g. loss of appetite, overeating, purging) and/or sleeping habits
  • Anger, often sudden — a quick temper, lashing out
    • The expatriate community are at higher risk of externalising problems (e.g. fighting with family members)
  • Growing inability to cope with daily problems and activities
    • Depression is also a significant concern because it can have a snowball effect as expatriates encounter the myriad stressors associated with relocation
  • Suicidal thoughts or thoughts about harming yourself
    • Signs associated with this include: purposelessness, hopelessness, withdrawal and even recklessness
  • Unexplained physical ailments
  • Ongoing lethargy or tiredness, even when you get plenty of sleep
  • Substance use and abuse (including alcohol and reliance on prescription drugs)
    • Without a support network in place, expats rely more heavily on pharmaceuticals than their counterparts at home. Living as an expatriate is often associated with high levels of stress that have been linked to higher substance use
    • Auditory or visual hallucinations, or delusions.

If you recognise one or more of these signs and symptoms in yourself, it’s important to seek help. It may be that there are some simple changes you can make to improve your sense of wellness (see below for some helpful tips) or it may be that you need specialist support or treatment.

Not seeking help can lead to more serious mental and physical illness - for example, a study published in 2007 found that people with depression are 4.5 times more likely to have a heart attack than those without depression. Thankfully, there are people who can help, guide and support you in your quest for good mental health. The important thing to remember is: don’t suffer in silence.

How to prepare for your mental health appointment 

Take notes

It’s a good idea to write down what you'd like to talk about before the appointment, so that you don't forget anything. This will help especially if you’re prone to feeling overwhelmed or stressed as you can read out or show the doctor how you’re feeling.

It’s also helpful to start writing down whenever you or a someone else notices changes in your mood. Note details of any symptoms of how you're feeling, your mood and how it’s affecting day-to-day life, for example:

Why not take notes in your phone? Or try one of the many ‘mood diary’ apps designed to help you track your mental health.

Also, make a list of:

  • Your medical information, including
    • medications (including doses)
    • herbal remedies
    • supplements
  • Existing physical conditions
  • Existing mental health conditions
  • Upsetting events in your past
  • Any current major stressful events

You may not think these aspects are all relevant to your mental health, but it will help your doctor to view your current problems holistically. Considering all aspects of your life is important when treating mental health problems.

Moral support

Many people think that you have to be by yourself at doctor’s appointments, but you can bring a friend or family member if you prefer. There are a range of benefits to taking someone with you. For example: you may feel more at ease, and they can help remember details for you, ask questions, or recall what was said.

During your appointment

During your appointment, it is important to be as open and honest with the doctor; the more accurate information the doctor has, the better they will be able to help. To do this, they will ask questions to build a comprehensive picture of your health — mental and physical - the notes you have prepared can help you.

Questions you may want to ask your doctor during your appointment:

And always remember, you can ask your doctor to clarify anything that you might not understand or that may not be clear.

The role of private medical insurance

Finally, check whether mental health support and treatment are available via your international private medical insurance (iPMI) partner. Most iPMI organisations cater for mental health conditions, but it’s important to be sure. If you travel frequently, it may be wise to check whether your policy is valid outside your country of cover. Certain Aetna International plans will cover access to outpatient treatment including counselling and mental health support.

If your employer provides your medical insurance, you may have access to an Employee Assistance Program (EAP) benefit. EAP is a work-based intervention program that’s designed to help employees resolve a broad range of personal issues that may adversely affect your mental well-being. EAP plans are usually paid 100 percent by the employer, but again, it’s good practise to double check the situation before making use of the service.

To find out more about the health and wellness benefits available with our iPMI plans to support you and your family, our expert sales consultants will be happy to help.

Alternatively, if you’re an employer looking for health and wellness solutions to meet the needs of your employee base, you can contact us here.

Further reading

You may also be interested to read our article: Using tech to tackle mental health.

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