Mental Health & Travel

7/28/2019 Mental Health & Travel

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Prof. dr.HM Joesoef Simbolon, SpKJ(K)

Mental Health & Travel


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DESCRIPTION

Although most travelers complete their journeyswith a manageable amount of stress, foreign

travel can produce a wide range of psychiatric,

behavioral, and neurologic issues in travelers.

Any journey can produce challenges, but longerjourneys to more remote and strange

environments can increase the psychological

stresses for travelers.


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RISK FACTORS

Certain drugs can increase the risk of a psychiatricreaction. People with underlying psychiatric disordersshould not receive the antimalarial medication mefloquine(Lariam). The neuropsychiatric side effects associatedwith mefloquine may become pronounced in thesepatients. Neuropsychiatric side effects may also be

compounded when mefloquine is administeredconcurrently with the antiretroviral medication efavirenz(Sustiva), which also carries the risk of neurologictoxicity. Elderly travelers and travelers with memory orcognitive deficits may be more prone to develop delirium

in flight, particularly when combined with dehydration,alcohol, or the use of sleep aids such as zolpidem(Ambien). The use of recreational drugs has also beenfound to be a trigger for psychiatric symptoms intravelers.


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Stress can trigger or exacerbate psychiatricreactions in travelers with preexisting psychiatric or

behavioral conditions. Even in travelers with no

history of psychiatric problems, stressful events

during travel, such as loneliness, a feeling of loss ofcontrol, financial difficulties, or a traumatic event,

such as a serious illness or viewing disturbing sights,

can have behavioral and psychosocial

consequences.


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OCCURRENCE AND RISK FOR

TRAVELERS

Data are limited on the prevalence of travel-related psychiatric and neurologic disorders:

Hartjes et al. conducted a web survey of 318 US

study-abroad students and found that

psychological distress was the second most

commonly perceived travel health risk before

travel and that 10% of students reported

experiencing psychological distress during their

travel, primarily loneliness, depression, or anxiety.


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In Potasman et al., a study of 2,500 Israeli long-term

travelers to Southeast Asia found that 11% reported

psychiatric or neurologic symptoms during travel,most commonly sleep disturbances, fatigue, and

dizziness. Most symptoms were short-lived and

transient, but 3% of travelers reported severe

psychiatric or neurologic symptoms, and 1% hadsymptoms that lasted longer than 2 months.

Patel et al. conducted a study of urgent repatriation

of British diplomats and found that 41% of

evacuations for nonphysical causes were due to

depression.


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PRE-TRAVEL MENTAL HEALTH

EVALUATION

Although it is not practical or appropriate to screen

all travelers for potential mental health problems, the

travel health provider should be alert for the followingconditions and recommend follow-up or further

screening, especially for long-term travel, people

taking up residence overseas, or rescue workers.

The following factors should be assessed:


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Preexisting psychiatric diagnoses, such as depression oranxiety disorders

History of psychosis in the traveler or a close familymember

History of suicide attempts

Evidence of depressed mood at assessment

Exposure to prior traumas (such as disasters, severeinjury, abuse, assault), particularly before travel thatcould involve reexposure to traumatic events or situations

Recent major life stressors or emotional strain

Use of medications that may have psychiatric or

neurologic side effects Pre-travel anxieties and phobias that are severe enough

to interfere with a patients ability to function or to preparefor and enjoy their travel


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Long-term travelers, aid workers, military personnel,

and other travelers likely to be exposed to stressful

situations should be advised that the stresses and

challenges they may face, particularly if combined

with long hours of work, lack of sleep, or fatigue, can

contribute to stress and anxiety. Long-term travelers

should be encouraged to:


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Learn how to recognize signs of stress, exhaustion,

depression, and anxiety in themselves.

Take care of themselves physically by eating and

exercising regularly.

Use their full allotment of time off or annual vacationtime, particularly if they recognize signs of stress or

exhaustion in themselves.


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DURING TRAVEL

Severe mental illness occurring abroad can beextremely stressful for travelers, their families, and

people who try to care for them. Acute psychosis,

leading to disruptive behavior, can land a traveler in

jail in a developing country. Inpatient psychiatricfacilities may be nonexistent or inadequate for a

foreigner. It can be difficult to repatriate a psychotic

person until the symptoms have been brought under

control with medication. Someone will most often

have to accompany the person home. Many

evacuation insurance plans specifically exclude

psychiatric illness from their coverage.


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POST-TRAVEL MENTAL HEALTH

EVALUATION

Returning travelers may have experienced physicalillnesses, personal difficulties, or traumas that couldresult in psychiatric reactions. Travel-related injuries anddiseases that affect quality of life can also have profoundand long-term psychiatric effects. Even in the absence of

trauma, some returning long-term travelers reportexperiencing reverse culture shock after their return,characterized by feelings of disorientation, unfamiliarity,and loss of confidence. Approximately 36% of aidworkers report depression shortly after returning home,

and as many as 60% of returned aid workers havereported feeling predominantly negative emotions onreturning home, even though many reported that theirtime overseas was positive and fulfilling.


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Post-travel evaluations should

assess: Behavioral and psychiatric symptoms, including:

Experiences during or soon after travel that have

been painful or hard to reconcile or that still cause

distress, anxiety, or avoidance Persistent sleep disturbance or unusual fatigue

Excessive use of alcohol or drugs

Behavioral or interpersonal difficulties at home,

school, or work, or in friendships or relationships


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Post-travel evaluations should

assess:

Somatic symptoms that can also be indications of

distress, including:

Unexplained somatic symptoms, such as

headaches, backaches, or abdominal pain, and

somatic disorders, such as fibromyalgia, chronic

fatigue syndrome, temporomandibular disorder, and

irritable bowel syndrome

Rashes, itching, and skin diseases, such aspsoriasis, atopic dermatitis, and urticaria, which can

be exacerbated by stress


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Clinicians should be aware that some travelersmay be reluctant to acknowledge psychiatric

symptoms or distress. For example, many

cultures have stigmas associated with

experiencing or disclosing behaviors associatedwith mental illness, as well as different culturally

appropriate ways of expressing grief, pain, and

loss. In addition, some travelers may fear being

penalized or stigmatized at work if they havepsychiatric diagnoses noted on their medical

records.


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Regardless of the type or duration of travel andwhether or not travelers appear to meet criteria

for a psychiatric diagnosis, returned travelers who

are having difficulties functioning or who appear

to be unduly depressed or distressed should beencouraged to seek appropriate treatment or

counseling


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Thank You

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