Mental health and depression are topics that have become more popular in recent years, and expatriates are not spared by this disorder. According to the WHO, this mental illness affects 300 million people worldwide. On the occasion of the World Depression Day observed on 27 October, we examine the main causes of depression among expatriates from a psychologist's point of view.
Depression among expatriates
Most people tend to associate expat life with happiness and fulfillment. However, this is not always the case. Culture shock, communication difficulties, disillusionment, and being away from loved ones can lead to depression among expats. The same is true if the move abroad is not necessarily a personal choice but a compulsion, such as being a trailing spouse or fleeing a challenging geopolitical situation.
Everyone is different and does not react the same way to a change in life. Where one person, despite the difficulties encountered, holds on and experiences no significant problems, another may have more difficulty and slowly drift into depression.
Testimony of a specialist
A specialist agreed to share her views on the subject for us to better understand this disorder among expatriates.
Elena Nemilova is a Russian-born psychologist who has been practicing in Italy for 12 years and is a member of the Psychologists' Association of the Lazio Region. She regularly deals with Italians as well as Russian and Ukrainian patients and those from other countries that were formerly a part of the Soviet Union, all of which share the same language. She describes her experience and shares her views on what she has observed with her Russian-speaking and expatriate patients.
"Before getting to the point, it's crucial to stress one important aspect: depression is a clinical term that refers to a person's neurophysiological condition. It's important to understand that moving abroad, a change of country, like any other major life change (such as motherhood, bereavement, an accident, or a traumatic event), can make a person more vulnerable. Therefore, moving to a new country will undoubtedly make someone who is already depressed feel worse.
In this testimonial, I've chosen not to talk about people who already suffer from depression but only about those who didn't suffer from this neurophysiological condition (or who never said they did) before moving to another country. In other words, people who have good cognitive functions, are socially integrated and have fulfilling personal, professional and social lives. I'm referring to so-called 'normal' people (a term that is inappropriate but frequently used).
I've observed over the years that Russian-speaking people who moved to Italy before February 2022 (when the war in Ukraine started) did so voluntarily. They came to get married, to change jobs, or simply to immigrate. In all cases (at least those I've had the opportunity to follow), it was a free decision and not an obligation. As a native of St Petersburg, I picked a date, bought my plane ticket, and was back home in about 3 hours. There was no feeling of restriction.
However, once someone is forced to leave their country, as has been the case over the last two years in ex-Soviet countries, where many people immigrate as they have no other choice, the onset of depressive moods has unfortunately become much more frequent. I'd say that in 100% of cases, those who must relocate abroad due to necessity rather than choice will face depression.
The depression is undoubtedly due to the change in all aspects of everyday life: communication with the local population, the language barrier, the incredible speed with which people have to adapt, and the way Italian institutions operate, which is very different from what my Russian-speaking patients knew. People encounter major problems at police stations, in courts, town halls, etc. All this results in a feeling of rejection, despair, sadness, anxiety, intrusive thoughts, obsessive thoughts and anger towards the country that are not keen to welcome them.
I will focus more on depressed mood, which involves various clinical signs, when discussing the symptoms of depression. The first is a change in the sleep cycle whereby a person sleeps excessively or not at all. Most patients experience sleep difficulty, which later results in chronic fatigue and, as a result, causes them to lose concentration and make mistakes they wouldn't have made otherwise. In addition, there is a loss of motivation to do activities that they enjoyed previously (e.g., drawing, walking, reading, etc.). The patient's preoccupations, anxieties and agitated state make it difficult to focus on these things. Due to all these factors, it takes longer to adapt and integrate into the new country.
One of the symptoms to watch out for is the absence of emotions. Unfortunately, people who live in a state of agitation mistake this as a good sign because, over time, they not only experience unpleasant emotions such as anger or anxiety but also pleasant ones such as joy, excitement, positivity and curiosity. Depressed people are happy with this type of emotion because they perceive less suffering. Unfortunately, these details become clinically relevant. People should focus on their own mental health if they experience these symptoms.
When someone relocates to a new country, they usually lose their regular group of friends, or at least the people with whom they interact daily. A depressed person normally isn't aware of his own condition. It's when the people around them start asking questions like "How come you don't come to meetings anymore?", "Why don't you come and have pizza with us anymore?", "Why are you always late for work?", that the person realizes something is wrong because they won't realize it on their own.
Imagine a person who has recently relocated to a foreign country and, as a result, loses his social circle, professional contacts, or GP, for example. No one can really say that someone hasn't taken a shower in 3 days, that they don't leave the house during weekends, or worse, that they don't get out of bed. It's difficult to identify a negative change in behavior when there is no one to notice it.
One advice that should be given to anyone moving abroad is to integrate as quickly as possible into any social group. Some suggest that these social groups should include people from your own country. Others, including myself, will advise you to understand the local social context and adapt to the society in which you live. In Italy, it may be more challenging to do this because of the language barrier. Nevertheless, anyone moving to a foreign country is advised to maintain their social circle while staying in touch with those who can keep an eye on them. This could be new friends, a new job, or a situation where people can notice something unusual and inform the person concerned.
Social communication is essential when traveling because it allows you to express yourself and learn more about others' perceptions of you. It also gives you the opportunity to discuss your own thoughts, feelings, and experiences. All these factors will help to improve your own mental health and socio-cultural integration, but also to cure any potential mental disorders. Sadly, though, they sometimes appear without the person concerned noticing.
Finally, I'd like to stress that moving to a new country is not always associated with mental disorders. However, specific instructions are needed as it's such a big change. For example, it has become very common to inform expecting mothers that giving birth can be mentally stressful, and the same applies to people who have lost a loved one. There is a real awareness of these issues and of the fact that significant changes can occasionally go wrong. But it's also important to understand that this isn't always true and that changes mark the beginning of an evolutionary process. A person might discover new qualities in their personality, of which they were previously unaware. In fact, people may find that a challenging experience can later play a role in their personal growth.
I encourage people to seek professional help, not only to prevent the onset of mental health issues and challenges but also to normalize the experience through which they are going and to discover that it won't necessarily be challenging and depressing. But also just to appreciate the fact that there are no issues and that this transition will be amazing and an opportunity to grow".
