You are on page 1of 1

48 

SECTION 9 • HEALTH P R O B L E M S W H I L E T R AV E L I N G

Psychiatric Disorders of Travel

Thomas H. Valk

Key points frequency, were schizophrenia, alcohol abuse, anxiety reactions, and
depression.
• Traveling and living overseas involve unique stressors, and Despite the clear stress involved, international travelers generally
frequent international travel may correlate with increased suffer from the same range of disorders as seen in a clinic or hospital.
need for mental health services Rather than deal with all possible psychiatric disorders, this chapter
• There are no data on the epidemiology of psychiatric will focus on a discussion of the psychotic patient, the assessment of
disorders in the population of international travelers, much the suicidal patient, and some further examination of brief psychotic
less on any subtypes disorder, schizophrenia, mania, major depression, and selected sub-
• An inquiry into past psychiatric history and treatment should stance use disorders as they relate to international travel. Sections on
always be a standard part of any pre-travel consultation initial assessment of the traumatic event victim and pre-travel counsel-
• The international traveler and expatriate population ing are included.
generally suffer from the same range of serious mental
disorders as seen in clinics or hospitals
• The clinical operating environment overseas provides Types of International Traveler
clinicians with many challenges, given the wide variation
from country to country in the availability of culturally Typologies of international travelers have been proposed based on
compatible clinicians, hospital and laboratory facilities, and conscious and unconscious motivations for travel.3,4 However, these
medications. Improvised outpatient approaches may be classifications are unlikely to be clinically useful and would be difficult
necessary to define operationally for the purposes of research. Classification
based on the overtly stated reason for travel, e.g., tourism, study over-
seas, business and expatriate travel, is widely used if also not known
to be clinically relevant.
Epidemiologic data based on population surveys of the rates of
psychiatric disorder by type of traveler are non-existent. Anecdotal and
Introduction clinical evidence points to possible differences, but more study is
necessary to establish incidence and prevalence rates. Business and
International travel is a stressful experience. Travelers face separation
expatriate executives are almost certainly less likely to suffer from the
from family and familiar social supports, and must deal with the
more debilitating, chronic mental disorders, such as schizophrenia, if
impact of foreign cultures and language, jet lag, and bewildering,
only because such a disorder is incompatible with high office in the
unfamiliar threats to health and safety. Having to accomplish even
workplace, and because the disorder usually begins in younger patients.
the most mundane tasks of everyday living while overseas can become
Such would not necessarily be true of expatriates’ family members.
a major challenge, leading to a loss of the sense of active mastery over
the environment. Under the stress of travel, pre-existing psychiatric
disorders can be exacerbated and predispositions towards illness may Pre-Travel Screening
emerge for the first time. Reflecting these stressors, international
business travelers have been found to file insurance claims at higher Given the potential consequences of a psychiatric emergency in the
rates than non-traveling counterparts. This effect was greatest for overseas environment, as discussed in this chapter, an inquiry into past
claims for psychological disorders, and increased with the frequency psychiatric history and treatment should always be a standard part of
of travel.1 Streltzer, in his study of psychiatric emergencies in travelers any pre-travel consultation. Any condition that has involved a psy-
to Hawaii, estimated an incidence of emergencies of 220/100 000 chotic or manic state, a major depression, a history of danger to self
population per year for tourists, 2250/100 000 per year for transient or others, psychiatric hospitalization, or substance abuse, dependence
travelers, i.e., those who arrived in Hawaii with no immediate plans or withdrawal would be of substantial concern. Circumstances worthy
to leave, and a rate of 1250/100 000 per year for the non-traveling of particular attention include individuals with bipolar I disorder,
population.2 Diagnostically, the problems seen, in order of decreasing especially if they have not been stable on medications for a substantial
©
2012 Elsevier Inc
DOI: 10.1016/B978-1-4557-1076-8.00048-X

You might also like