Expat Mental Health in Singapore

Dan Crittenden

Life as an expat in Singapore comes with privilege and pressure. If mental health depends on the balance between our challenges and resources, then making a life away from home can upset this balance. Research suggests that, on average, expats struggle more with mental health than their domestic peers.


Practically, arrivals must navigate new jobs, homes, schools and spousal employment. Beyond the basics, it takes time to build friendships and support networks, and these need continual refreshing as peers return home. Foreigners must adapt to cultural differences, such as language, local customs and even sense of humour. Expats, new and old, can experience homesickness and a sense of isolation, which can contribute to anxiety and depression. Interestingly, even positive change can generate stress. Follow-ups on lottery winners in the UK, a year after their life-changing wins, showed that over half had developed a stress-induced illness. Our bodies and nervous systems can take time to accommodate the change we have sought.


Expats must tackle new pressures without their usual resources. Friends and family are far away and recreational activities at home may no-longer be possible. Inevitably, Covid restrictions on travel and socialising have exacerbated constraints. The emphasis on employment in Singapore’s ‘core’ population has also created visa complications for expat job-seekers, especially for spouses on lower salaries. The inability of a spouse to find work locally can be a key concern for international assignees.


Research from the International Journal of Health & Productivity suggests that US expats are three times more likely to express feelings of being trapped or depressed as their domestic counterparts. Twice as many US expats express feelings of anxiety or nervousness. In the workplace, research from Right Management suggests that companies will judge 40% of international assignments as failures. The ratio is consistent for moves from west-to-east and vice-versa. This may be unsurprising given only one-in- nine movers benefit from ongoing mentorship. Pressures can creep into the family unit too. A survey by Sofres suggests that divorce rates are nearly 50% higher for expat couples. Since the pandemic, a third of expats consider their mental health to have declined, according to William Russell.


Expats in Singapore can find it difficult to raise mental health issues. Research by Aetna International suggests that more than half of respondents in Singapore find it hard to discuss mental health at work, versus around 40% in the UK and US. The good news is that help is available and increasingly encouraged. People are progressively willing to talk about psychological well-being and Covid is forcing this issue. Companies have woken up to the importance of mental health to staff turnover, productivity and the bottom line. Starbucks spends more on employee healthcare than coffee beans! In Singapore, the government has launched a national well-being campaign: “It’s ok to reach out for help”. The NUS is also running series of “k(no)w stigma” events to demystify the topic of mental wellness. In short, key stakeholders for expats in Singapore are aligned on the need to move from a culture of “don’t ask, don’t tell” to “do ask, do tell, let’s talk”.


How can expats reset the balance between their challenges and resources? For many, counselling is a powerful resource. It may be a resource they never considered back at home. It could also be the discovery that helps navigate the challenges of a new life in the Lion City.


If you are interested in expat counselling, please contact us via email, phone or WhatsApp to arrange a consultation with one of our supportive professional therapists.


About the Author: Dan's counselling experience builds on 20 years of international finance experience. He is a coach and mentor to professionals across Asia and has served on various forums to support employee wellness. Dan is a yoga and mindfulness practitioner, mental health advocate and student. He is currently studying for a Master's Degree in Counselling. Read Full Bio >

By Bernardette Yzelman 02 May, 2024
Anxiety in children can manifest in various ways, and more often than not, a child might not have the language to communicate what they are experiencing. Signs of anxiety in children can take the form of: Physical : Complaints of headaches, stomach aches, fatigue, muscle tension, trembling, or other physical discomforts without any underlying medical cause. Emotional : Heightened emotions such as irritability, moodiness, or frequent crying. Behavioral: Changes in behavior such as increased or recently developed avoidance of certain situations or activities, increased clinginess to caregivers, or becoming withdrawn from social interactions. Difficulty falling asleep, staying asleep, or experiencing nightmares. Academic Challenges : Difficulties with staying focused which impacts their studies or a fear of going to school altogether. Just as we coach our children to take their first step, parents and caregivers are their children's first role models in how to respond to the stressors in our lives. While everyone's situation is unique, there are some things that all of us can do to be better coaches for our children who are dealing with anxiety! Create a Supportive Environment : Encourage your child to express their feelings and fears openly. Listen attentively and validate their emotions without judgment. Talk to them about when worry and fear, can be helpful or unhelpful. Let them know that it is okay to feel anxious and that you will support them through it. Model Healthy Coping Strategies : Teach your child simple relaxation techniques such as 4-7-8 breathing (breathing in through the nose for four counts, holding your breath for seven counts, and breathing out for eight counts). For little ones, blowing bubbles or having them imagine that they are blowing bubbles can be a fun alternative. Another technique is to ground your senses in the present moment by acknowledging five things you can see, four things you can touch, three things you can hear, two things you can smell, and, one thing you can taste. If keeping count is difficult or distracting, you can get them to name as many things as they can see/hear/smell/touch. Children often learn by example, so let your child witness you practicing these techniques to manage anxiety in your own life. Establish Routines : Creating regular routines for meals, bedtime, and daily activities, provides a sense of stability and security. Encourage Independence : Avoidance perpetuates the cycle of anxiety. Where possible, encourage your child to gradually face their anxieties and develop independence. Help them build resilience by praising their efforts and successes, no matter how small.  If your child's anxiety is significantly impacting their daily life, or perhaps, you're struggling to cope with your own anxiety and supporting your child concurrently, don't hesitate to seek professional help. A counsellor or therapist can provide guidance and strategies tailored to your unique needs and circumstances. Parenting is a journey, and we all experience stumbles along the way. Be patient with yourself and your child, and celebrate the progress you make together!
By Jeannette Qhek 26 Apr, 2024
Are you frequently fatigued in the morning, even after getting ample hours of sleep at night? While it can be a frustrating situation, there may be a simple explanation: you might be having poor sleep quality. Poor sleep quality can lead to a variety of health problems, including weight gain, depression, and heart disease. Identifying the reasons for insufficient sleep is straightforward, but determining why our sleep isn’t restful is often trickier. Nonetheless, it is still possible to do so. This article explores the importance of sleep quality, potential causes of poor sleep, and offers strategies to enhance your sleep quality. Why is Sleep Quality Important? During sleep, the body undergoes important physiological processes that are necessary for various functions such as cognitive functioning, immune function, and physical health. Here are a few reasons why sleep quality is important: 1. Allow Our Bodies to Repair and Restore When we sleep, our bodies release hormones that promote tissue growth and repair, as well as regulate our metabolism and immune system. This means that if we don't get good quality sleep, our bodies may not be able to repair themselves properly, leaving us vulnerable to a variety of physical health issues. 2. Keep Our Mental Health in Check Studies have shown that poor sleep quality is associated with a higher risk of depression and anxiety. Individuals with poor sleep quality were more likely to experience negative emotions and less likely to experience positive emotions the following day [1]. With poor sleep quality, we may also feel irritable, moody, and find it difficult to concentrate, which can negatively impact our overall wellbeing and productivity. 3. Maintain a Healthy Weight When we don't get enough quality sleep, our bodies produce more of the hormone ghrelin, which stimulates hunger, and less of the hormone leptin, which tells our bodies that we are full. This can lead to overeating and weight gain. What Could be Causing Your Poor Sleep? Several factors may contribute to poor sleep quality, including: Stress: High levels of stress can make it difficult to fall asleep and stay asleep throughout the night. Poor Sleep Habits: Irregular sleep schedules, excessive caffeine or alcohol consumption, and using electronic devices before bedtime can all interfere with sleep. Environmental Factors: Noise, light, and temperature can all affect sleep quality. Not everyone has the luxury of getting a good night's sleep. Sleep disorders like insomnia, sleep apnea, and restless leg syndrome can further impair sleep quality. If you are having trouble sleeping, speak with your healthcare provider to identify any underlying conditions and determine the best course of treatment. How to Improve Your Sleep Quality? The good news is that enhancing the quality of our sleep might be as simple as improving our sleep hygiene. Similar to maintaining dental hygiene by regularly brushing and flossing, we can improve our sleep hygiene by adopting these few ideas: 1. Regular Sleep Schedule One way is to establish a regular sleep schedule, which means going to bed and waking up at the same time each day. Individuals who maintained a consistent sleep schedule had better cognitive performance and were less likely to experience mood disturbances compared to those with an irregular sleep schedule [2]. 2. Sleep-friendly Environment Creating a sleep-friendly environment entails keeping our bedroom cool, dark, and quiet. This can help minimise distractions and make it easier to fall asleep and stay asleep throughout the night. 3. Relaxing Bedtime Routine Heard of the 3-2-1 technique for better sleep? It is an effective method that can help you to wind down and get ready for sleep. Here are the steps: 3 - Wind Down: Spend 3 minutes winding down before bedtime by engaging in a calming activity, such as reading a book, taking a warm bath, or practising relaxation techniques like deep breathing or gentle stretching. 2 - Unplug: Spend 2 minutes unplugging from electronic devices, such as phones, laptops, and tablets. The blue light emitted by these devices can interfere with the production of the sleep hormone melatonin, making it harder to fall asleep. 1 - Visualise: Spend 1 minute visualising yourself in a peaceful and comfortable sleeping environment. Imagine yourself feeling relaxed and comfortable, sinking deeper and deeper into a peaceful sleep. Let’s not forget that when it comes to our overall health and wellbeing, good sleep quality is just as important as getting enough sleep. By establishing healthy sleep habits, such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and a sleep-friendly environment, we can improve the quality of our sleep and reap the benefits of a good night's rest! About the Writer Jeannette Qhek is a dedicated Counsellor and Psychotherapist at Counselling Perspective , where she guides individuals towards mental and emotional well-being. Additionally, she serves as the Wellbeing Strategy Lead and Trainer at Actxa Wellness , curating and delivering science-backed wellness curriculum and wellbeing programs/ workshops for corporations. As the founder of Chill By Nette , a wellness space in Singapore, she offers trauma-informed counselling services and enriching wellness workshops. With more than 6 years of experience in the corporate wellness industry and a deep passion for individual well-being, she hopes to make psychological concepts and wellness research knowledge more accessible, relatable and fun to the public Connect more with Jeannette Qhek and book a session here . References [1] Mauss, I. B., Troy, A. S., & LeBourgeois, M. K. (2013). Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm. Cognition & emotion , 27(3), 567–576. https://doi.org/10.1080/02699931.2012.727783 [2] Alhola, P., & Polo-Kantola, P. (2007). Sleep deprivation: Impact on cognitive performance. Neuropsychiatric disease and treatment , 3(5), 553–567. 
By Claudia Correia 26 Apr, 2024
Eating habits and preferences can vary widely across individuals, and this is especially true for those on the autism spectrum. Autism is a neurodevelopmental disorder that affects communication, social interaction, and behaviour. It is characterized by a wide range of symptoms and behaviours, which can include difficulties with sensory processing, repetitive behaviours, and challenges with communication and social interaction. In recent years, there has been a growing recognition of the importance of adopting an affirming approach to eating for individuals with autism. This approach recognizes that people on the autism spectrum may have unique needs and preferences when it comes to food and eating, and that these needs should be respected and accommodated. About 90% of parents report to have feeding difficulties and 70% of Autistic children have atypical eating behaviours such as: · Selective eating · Strong food preferences · Rapid or slow eating · Lack of interested in eating · Loss of control while eating · Pocketing food in month This happens due to sensory processing difficulties; cognitive rigidity; social communication differences and/or poor executive function. Medications may also affect appetite and food intake. Also, some autistic individuals might experience interoceptive confusion, which means that they have difficulty to connect sense of hunger and/or satiety and fullness feeling and meal times. SO WHAT TO DO? Lower your expectations. Understand the challenges that your child goes through because of autism. Any force-feeding might lead to food trauma, sensory trauma (when forced to be in overwhelming environments) or traumatic childhood experiences. Accept that your neurodivergent child refusal to eat in a way that is accepted by society (neuronormative) is not because he/she is manipulative, maladapted. WHAT NOT TO DO? Don’t expect neuronormative family feeding practices to work on your child. It will only increase frustration and stress in your family. Don’t force feed your child – whether neurotypical or not. Don’t routinely reprimanded your child for authentic neurodivergent behaviours at table (rocking, fidgeting, not being able to sit still, clumsiness when using cutlery, problems swallowing food). Understand what are the coping mechanisms that your child uses to overcome the sensory overload that he/she is constantly facing. Look for strategies that will support this rather than persuading masking. NEUROAFFIRMING STRATEGIES Here are some tips – remember to use them if makes sense for your child. Discuss these with your healthcare professional and dietitian. · Set alarms to eat; · Use body doubling – eat with a friend, family member to support intake; · Change the size and timing of meals if needed to help with satiation experience; · While preference to eat might change, consider some of these (alert – can be very different from neuronormative “normal” feeding goals): o Quieter eating environment o Dimmable light o Avoid music or use a preferable music o Eat alone or use headphones when not possible o Eat in venues at times of the day that are less busy o Eat standing, walking, while laying down. Allow them to choose what works best to facilitate a pleasant eating experience o Eat which a distraction – sensory toys, iPad o Change textures of foods to match their preferences/unique sensory profile. If you are concerned about the variety of foods consumed, check with a dietitian that can support you. BE AWARE THAT EATING DISORDERS ARE MORE PRESENT IN DIVERDIVERGENT INDIVIDUALS Eating disorders affect more neurodivergent individuals than neurotypicals. Here is some data: · In a study find our that 30% women seeking weight loss treatment were ADHD. Also, de dopamine de-regulation might lead to impulsivity and emotional distress that can increase the odds of loss of control while eating and binge eating. · 20-37% of individuals with anorexia nervosa are also autistic. · ARFID (Avoidant Restrictive Food Intake Disorder) accounts for 22.5% childhood eating disorders. 21% of ARFID patients are autistic. It affects only 0.3% of general population. If at any point you find that your child is developing an eating disorder or at risk, talk with your healthcare team. References: Cobbaert, L. & Rose, A. (2023). Eating Disorders and Neurodivergence: A Stepped Care Approach.
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