Mental Health and Overseas Travel

Anna Kalbarczyk, MPH

Center for Global Health
Johns Hopkins University
 Section A

Mental Health Considerations for Travelers

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rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Occurrence in Travelers

 Quigley et al. (2013) studied repatriations (2010–2012) of American college students

versus American business travelers/expatriates
 They found a 23-times higher rate of repatriation due to mental health problems for
the student population

 Evidence suggests roughly 11% of travelers experience some kind of psychiatric

problem

Source: Quigley, R. L., Copeland, R. Mental health and study abroad: incidence and mitigation strategies. Oral presentation at: 13th Conference of the International Society of
Travel Medicine; 2013 May 19–23; Maastricht, the Netherlands. 3
Occurrence in Travelers

 Depression

 Substance abuse

 Affective disorder

 Anxiety reactions

 Eating disorders

 Schizophrenia
Mental Health and the Pre-Travel Consultation

 Clinical care environment

 Legal environment

 Evacuation insurance

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 Post-Travel
Mental Health

Photo: Johns Hopkins Center for Global Health. 6

 Section B

Burnout and Vicarious Traumatization

The material in this video is subject to the copyright of the owners of the material and is being provided for educational purposes under
rules of fair use for registered students in this course only. No additional copies of the copyrighted work may be made or distributed.
Vicarious Traumatization

 Vicarious traumatization is an occupational hazard for those who work with victims of
trauma, disasters, or torture
 It is not a question of if, but when and to what degree

 Burnout is a prolonged response to chronic emotional and interpersonal stressors on

the job

 It is important to address
 Be proactive
 Take preventive steps to minimize the harm

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Understanding Vicarious Trauma

“I knew nothing about self-care, secondary traumatization [vicarious

trauma], or burnout … I think it is unfortunate that both the French and U.S.
NGOs I worked for did not educate us more about such things. Instead, I
wondered why I was so irritable and tired all the time, and dreaded hearing
one more tragic story…. I saw too many of my fellow relief workers get
totally burned out. I am certain that if they had been more reassured that
their reactions were mostly normal, they would have known how to cope,
rather than internalize their reactions, leading to depression. Being more
knowledgeable can help enormously.”

Source: Pearlman, L. A., McCay, L., for the Headington Institute. (2008). Understanding and addressing vicarious trauma (online training module 4). 3
Risk Factors

The humanitarian
The situation The cultural context
worker
 Personality and  Professional role,  Cultures of
coping style work setting, and intolerance
exposure
 Personal history  Cultural styles of
 Agency support expressing distress
 Current life and extending and
circumstances  Affected receiving
population’s assistance
 Social support responses and
 Spiritual resources reactions  The culture of
humanitarian work
 Work style

Source: Pearlman, L. A., McCay, L., for the Headington Institute. (2008). Understanding and addressing vicarious trauma (online training module 4). 4
Common Signs of Vicarious Trauma

 Overwhelmed, drained, emotionally exhausted

Feelings
 Bystander guilt, shame, self-doubt

 Distancing, detachment
Behavior
 Difficulty maintaining professional boundaries

 Question competence
Cognitions
 Feel heightened sense of vulnerability

Source: Meichenbaum, D. (2007). Self-care for trauma psychotherapists and caregivers: individual, social and organizational interventions. Paper presented at the 11th Annual
Melissa Institute for Violence Prevention and Treatment, Trauma-focused Interventions for Children, Adolescents and Families: School, Clinical and Community Approaches. 5
Prevention/Intervention

 Awareness
 Of one’s needs, limits, and resources
 Of where changes have taken place

 Balance
 Among work, play, and rest

 Connection
 With others professionally and personally

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 Conclusion

Photo: “Simple Pleasures of Life.” Johns Hopkins

Center for Global Health. 7