Disasters abroad a major trigger for mental illness among expats

The 2020 explosion that rocked Beirut, killing more than 200 people, injuring more than 7,000 and causing millions of dollars in damage had a significant impact on the mental health of Lebanese expats, leaving many struggling with anxiety, depression and post-traumatic stress disorder (PTSD), new survey results show.

The findings underscore the importance of considering the well-being of expatriates facing adverse events in their home country, according to the investigators.

Doctor Gaelle Rached

“Everyone, including doctors, should be more sensitive to the expatriates around them; we need to monitor them, especially when their home country is going through a traumatic event,” said study investigator Gaëlle Rached. , MD, MSc, Postdoctoral Fellow, Northwestern University, Chicago, Illinois, said Medscape Medical News.

The results were presented at the 2022 annual meeting of the American Psychiatric Association (APA).

A historic explosion

It is estimated that around 14 million Lebanese citizens live outside their country of origin, more than double the population of Lebanon. However, the trauma-related mental health of these communities and other expatriates is understudied, Rached said.

“If you look at the literature, hardly anyone has looked at expatriate mental health, and even more so in the context of trauma.”

Rached has personal experience of the event. She was in Beirut on August 4, 2020, when the Lebanese capital was rocked by an explosion attributed to ammonium nitrate stored at the city’s port. It was one of the largest non-nuclear explosions in history and left hundreds of people homeless, killed or injured. Rached saw her father injured and her house destroyed.

She heard anecdotes from Lebanese expatriates, traumatized by the explosion. Many have been unable to contact friends and relatives in the wake of the tragedy.

“It prompted us to look at the mental health of expats following this traumatic incident,” she said.

She and her colleagues used various social media platforms to publicize the investigation. They also contacted the International Lebanese Medical Association, which has “a strong base” in the United States, Rached said.

She was “shocked” by the number of expats who responded. “People really wanted to talk and express themselves” – whether it was because of survivor’s guilt or some other reason, she said.

The survey covered 670 adults of Lebanese or first-generation Lebanese nationality living abroad. The study population had a median age of 31 years and 62.2% were female, with most living in North America or Europe. Over a third of respondents (270) had lived abroad for 1-5 years, but many had been away for over 20 years.

Study participants completed the Hopkins Symptom Checklist (HSCL), which screens for anxiety and depression. On this checklist, a score of 1.75 is a typical cut-off value for symptomatic cases.

Investigators found that 41.2% of participants scored above this threshold. Being younger, being female, and visiting Lebanon at the time of the explosion were factors associated with higher HSCL scores.

No Time Dye

Interestingly, the time elapsed since emigration from Lebanon was not related to the score. “Our results show that no matter how long you’re gone, you’re subject to the same negative outcome,” Rached said.

Of the total study population, 268 people personally experienced the explosion and/or had close friends or family physically affected by it. These expatriates completed the Post Trauma Checklist for DSM-5 (PCL-5).

Here, the analysis showed that many of these respondents (57.5%) scored above 33, which is above the threshold for probable PTSD. Being female was linked to higher PCL-5 scores.

These results suggest that the mental health of expatriates may be negatively affected by traumatic incidents in their home country, even if they did not witness the event and were removed from their home country for a period of time. long period.

The results could be particularly timely as many countries are hosting a flood of refugees fleeing war in Ukraine. However, Rached said, the results of his research may not apply to Ukrainians.

“I don’t think the results can be extrapolated, given that the nature of the trauma is a bit different,” she said. She added that the explosion in Beirut was “monumental” but ended quickly. On the other hand, there is no end in sight for the Russian invasion of Ukraine.

Rached noted that the study data is preliminary and limited because there is no way to determine which respondents had mental health issues before the explosion.

Global shortage of psychiatrists

Commenting on the study, Howard Liu, MD, chair of the department of psychiatry at the University of Nebraska Medical Center and incoming chair of the APA Communications Council, said he found the presentation “fascinating on many levels. “.

It’s increasingly important for psychiatrists to be “trauma-informed,” Liu said during a press briefing highlighting the study. “It’s not just looking at the biological correlates of disease, ie looking at genetic markers and so on, “but also looking at the environment in which people live , working and/or undergoing therapy or treatment”.

In a later interview with Medscape Medical NewsLiu said he was impressed that Rached, who has “a very deep personal connection to this community”, is using his own personal trauma to help identify others at risk who may need future care.

Liu, whose own family sponsors Afghan refugees, said the research points to the need to ensure the training of psychiatrists everywhere to help manage the expatriate population. As it stands, there is “a huge shortage of psychiatrists around the world,” especially in countries that have been affected by trauma, Liu said.

The researchers and Liu report no relevant financial relationship.

2022 Annual Meeting of the American Psychiatric Association (APA). Abstract 5087. Submitted May 24, 2022.

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