Chu Hui Cha - Asian American Therapy

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Asian Expat Series: Expat Mental Health Challenges

What This Series is About

This series explores the diverse array of experiences among Asian American/Canadian expats and nomads. The demographic of people I’m specifically referring to are members of the Asian diaspora who grew up in North America because they or their parents or previous generations were immigrants. After growing up in North America, these Asian folks later live elsewhere and become “expatriates.” Some may be long-term travelers and nomads who move from one country to another. Others may be expats for some time in one location and then return to their home country.

The narratives and images we have of expats are overwhelmingly white. When I look at FeedSpot’s list of the top 70 expat influencers, there are very few who identify as BIPOC. It’s hard to say how many BIPOC or Asian expats there actually are. There aren’t a lot of reliable statistics about American expats. From my research, the most trustworthy estimate is from The Association of Americans Resident Overseas (AARO), whose updated figure was 5.4 million as of 2023. They don’t break this figure down further to look at more specific demographics so it’s not clear how many of these expats identify as Asian American. In my experience of traveling and being an expat, I’ve learned that expats are not a monolith. They are in fact a quite diverse, multi-racial, multi-ethnic group.

Check out the other posts in this series, including Reverse Immigration and My Reckoning With Asianness in Japan and my Introduction to the Series.

Mental Health Challenges for Expats

While the expat or digital nomad lifestyle can be incredibly rewarding, it also presents unique mental health challenges that are important to address. What you may not see on Instagram from your favorite expat/nomad influencer is that being an expat can be lonely, despairing, frustrating, annoying, scary, unpredictable, and confusing. Here are some aspects of expat mental health to take seriously.

  • Higher Mental Health Risk for Expats

    Moving alone is one of the most stressful events in one’s life. Moving transnationally exacerbates the stress and challenges of a move by throwing in language barriers, cultural changes, lack of a community or family, and becoming very distant from the natural supports you have built up in your home country. A study by Truman et al (2018) found that expatriates overall had greater risk for a variety of mental health symptoms than domestic workers. For instance, expats are at three times greater risk for depression than their domestic counterparts and tend to report anxiety at twice the rate of domestic workers. The authors conclude that while many aspects of adjusting to life abroad can be “exciting, engaging, and interesting,” these same factors can be precipitating factors to mental health challenges.

    Also, if an expat moves abroad with some baseline of depression, anxiety, etc., being abroad does not resolve that and can even make it worse. For Asian American expats, there might be additional acculturative stress due to being a person of color or an Asian person in the new place they are living in if they have relocated to a non-Asian country. When we were in Croatia, I hardly saw any other Asian people and had difficulty finding Asian groceries. If I had stayed there longer than a couple months, I think both of those things would have been sources of stress for me. Depending on the context, there can be factors contributing to a “perfect storm” of mental health challenges for Asian American expats.

  • Change in Identity

Travel changes you. If you haven’t encountered the Anthony Bourdain quote about that, look here and get ready to cry a little. I love how I have been changed by travel: I truly believe I’ve become more independent, flexible, and more empathic than I would be without my travel experiences. A study on corporate executives on international assignments found that moving abroad for one’s career was not merely a physical or cultural change but rather, “a psychological adventure that requires the willingness to revise deeply held beliefs concerning one’s own identity.”

But that doesn’t mean change is pretty. You may change in ways that alienate your family or cause problems with them. You may not relate to your friends and peers back home as much as you used to. I can’t tell you the number of times I’ve heard of friends back home being totally bewildered by an expat’s life choices or making passive aggressive comments towards them about how different their lifestyle is. Even if it is you who decides that you can’t connect as much to a friend back home because they have done nothing resembling the things you value or cherish in life, it’s still a loss to realize that because you have changed, the relationship must also change because it relied too much on a similarity that no longer exists. Change is good, change is growth. But we only really know that when we can see it in the rearview mirror. Going through it, in the moment, is so hard and feels so uncertain.

  • Occupational Burnout

    A survey conducted by Cigna among its international employees found that American expats were experiencing unprecedented levels of stress due to worries about mobility between countries because of the pandemic, as well as financial concerns. While expats and the places they reside may have adjusted a bit since this study was conducted, burnout remains a serious concern for workers all over the world. In addition, expectations around work can change depending on the culture. When I’ve worked with expats in Asia, depending on where they worked, the work cultural norms were sometimes much more demanding compared to Western norms, which naturally led people to experience to higher stress and anxiety. For any individual, if work is just one source of stress among multiple stressors, things can pile up and take a serious toll on one’s mental health.

  • Expats Need People Who Really Get Them

Often, your family and your friends back home will not understand what you’re going through as an expat or nomad. They may frame things as “Well, why don’t you just come home?” without simply validating your struggles as normal human struggles. They may not understand that your goal may be to try to make thing work rather than call it quits prematurely. Even therapy for an expat can be fraught. A study by Sterle, Verhofstadt, Bell, and de Mol (2018), found that expats engaging in psychotherapy have better experiences when the therapist could demonstrate accepting and understanding the global context of expat life. These finding suggest that expats seeking mental health support may not feel well understood by a garden variety therapist with little exposure to the expatriate lived experience. Expats live unique, unconventional lives and need support from people who really get them on some level. It takes intention and effort to build a community and network of contacts like that.

Expat Life: Not Just the Fun Parts

Adjusting to life in a country that is different from where you grew up can be a very stressful and demanding experience. In addition, not everyone in your life may understand what you’re going through which can lead to feelings of frustration and alienation even when you try to get support. Being an Asian American expat in particular can come with unique acculturative stressors due to the multicultural make-up of the new country versus the home country.