Close

      This website requires cookies. Please accept or refuse these cookies first.
      For more info about our cookies, please read our cookies policy.

      Wanda, homepage
      Make an appointment
      Wanda for travellers

      Mental health when travelling

      Latest update: - Authors: Andreas De Paepe, Ula Maniewski, Nele Alders

      Travelling is a stressful event and can be a threat to psychological well-being. Travelling can be accompanied by several stressors that can lead to problems especially in travellers with pre-existing psychiatric conditions. 

      Risk for the traveller

      Underlying risk factors

      Travellers with a history of psychiatric disorder are at risk of exacerbation of mental symptoms. They represent the largest group of travellers who seek medical attention because of mental health symptoms, but a number of travellers without any history of psychiatric disorder will also develop mental health symptoms during or after a trip. These are either people with a previously undiagnosed disorder, or the trip itself may be an event that triggers the first symptoms of a psychiatric disorder. Elderly people are a separate group of travellers in this group, reduced adaptability and possible (subclinical) cognitive dysfunction imply an increased risk of developing psychological symptoms. In addition, (untreated) somatic conditions, such as thyroid disorders, diabetes mellitus and a history of traumatic brain injury, among others, can also trigger the development of psychiatric symptoms.

      Travel-related risk factors

      Travelling can be very stressful and this stress may have several causes. The impact of some of these stressors can be influenced to a greater or lesser extent. Travel-related risk factors for the development or exacerbation of psychological problems are: 

      • long-term travel (including expatriates and humanitarian workers)
      • culture shock
      • jetlag
      • use or sudden withdrawal of alcohol or narcotics
      • traumatic events
      • loneliness
      • fatigue
      • high altitude
      • mefloquine (Lariam®) as malaria prophylaxis

      Psychiatric syndromes

      In theory, any psychiatric syndrome can occur during a trip, but some are more frequent. Anxiety disorders are the most common, even in travellers without underlying psychopathology. The majority of cases involve fear of flying. Depression can worsen while travelling, partly as a result of loneliness and loss of social network. A quarter of repatriations for psychiatric disorders are due to depression. Acute psychosis occurs in only a minority of travellers, but psychosis can also prompt the patient to travel. Elderly people may have reduced adaptability and possible (subclinical) cognitive dysfunction which may increase the risk of developing psychological symptoms, mainly anxiety, agitation and confusion.

      After arrival, culture shock may occur, in practice, this can happen to any traveller. The culture shock causes a sense of loss of control over one's surroundings which can make even the simplest everyday routine tasks challenging, there may be pronounced fatigue, anxiety, mood swings, sleep problems and feelings of isolation. Lack of contact with the home front, a language barrier and feeling unsafe can exacerbate culture shock. Knowledge about the phenomenon of culture shock and the local culture can reduce this stress experience. As a rule, it is a self-limiting phenomenon. Another phenomenon is reverse culture shock, in which the traveller (mainly long-term travellers) may experience disorientation and depressive symptoms after returning home.

      When travelling to a different time zone, jetlag can occur, causing fatigue, difficulty sleeping in and out among others. Reduced sleep quality and quantity makes people more prone to anxiety disorders and depression. 

      Travelling to high altitude increases the risk of acute psychosis and also increases suicide risk. Moreover, altitude sickness also be associated with a number of psychological symptoms especially fatigue, behavioural changes and confusion.

      The use of mefloquine (Lariam®) as malaria prophylaxis can trigger acute psychosis, depression or other mental problems, especially in travellers with pre-existing psychiatric disorders. The use of mefloquine is therefore a strict contraindication in these travellers.

      Travelling is associated with the loss of daily routine and social network, which can lead to mental imbalance in vulnerable individuals. Traumatic events during travel can also give rise to post-traumatic stress disorder.

      Prevention

      Pre-travel consultation

      The pre-travel consultation provides an opportunity for risk assessment and information provision concerning mental health while travelling. However, prevention in people with pre-existing mental suffering is difficult, as these people are unlikely to seek specific travel advice regarding their mental health. Prevention of an exacerbation of an underlying psychiatric condition will therefore be difficult in practice. During a pre-travel consultation, mental health screening should be considered for certain travellers:

      • frequent travellers
      • long-term travellers
      • humanitarian workers
      • expatriates

      Screening may include enquiring about:

      • previous and current psychiatric problems or symptoms
      • treatment with psychopharmaceuticals

      • the presence of serious mental problems in close family members

      • substance use (including excessive use according to the environment)

      If there are pre-existing or active problems, evaluation by a psychiatrist is recommended. Healthcare workers in travel clinics do not necessarily have sufficient experience and training in dealing with psychiatric problems, as the focus is mainly on the prevention of infectious diseases. A post-travel psychiatric assessment is useful for in people with pre-existing psychiatric suffering, people who experienced traumatic experiences (including humanitarian workers), and people with newly emerging psychiatric symptoms that did not spontaneously improve.

      Take-home messages for travellers:

      • make sure your trip is well prepared
      • do not use mefloquine as malaria prophylaxis unless good tolerance in the past
      • keep in touch with your family and friends back home
      • take rest, moderate alcohol consumption and avoid using narcotics
      • contact your psychiatrist or psychologist before departure if psychiatric problems are already present
      • in case of problems after the trip contact a psychiatrist or psychologist

      Travel administrative formalities and barriers

      Narcotics

      Certain psychotropic pharmaceuticals (sedatives, opiates and stimulants) may be considered as narcotics and are subject to import restrictions.

      Repatriation

      Since symptomatology of a psychiatric condition can in some cases lead to medical repatriation. Not every travel insurance provides medical assistance and repatriation in case of psychiatric problems. It is advisable, especially for travellers with underlying psychiatric conditions, to have a travel insurance that can provide for this. 

      Medication use in travellers

      Therapeutic drug monitoring (e.g., lithium) is often not possible while travelling, high temperatures and excessive sweating may also give rise to fluctuating serum levels.

      For people who will be staying abroad for long periods (e.g., humanitarian workers, expats) it is advisable to check whether the chronic medication is also available at the destination, if necessary an alternative can be sought or arrangements can be made for visiting relatives to bring the medication with them. 

      Additional information


      References

      Back to top