Lifestyle, sleep quality and mental health of Hong Kong expatriates

Globalization has led to an increase in expatriation for both corporate and personal reasons, and Hong Kong, with over 80,000 expatriate, is an attractive destination. Expatriation is challenging for individuals and their families, and due to the extreme cost of failed expatriations, multinational corporations invest considerable resources into making them successful. Recent research has focused on factors that predict success, including organizational support, work environment, personality characteristics, and family adjustment. However, less is known about lifestyle changes and the accompanying psychological impacts. This research examined the relationships among sleep quality, lifestyle changes, and mental health in 215 Hong Kong expatriates (49.3% males, 50.7% females) from Europe (61.5%) and North America (19.6%), whose mean age was 41.5. Participants completed an online survey consisting of validated measures of mental health (GAD-7; PHQ-9) sleep (ESS, ISI, SHI, PSQI), stress (PSS-10), and alcohol abuse (CAGE-4). Participants also reported help sought for sleep problems and frequency of work-related activities that affect sleep hygiene and work-life balance (e.g., business trips, late night work calls, work-related drinking), frequency of media use, alcohol, stimulant drinks, substance use, and exercise.;Results showed that expatriate lifestyle was characterized by extensive social and travel imperatives, including frequent time zone crossing, work-related alcohol use, and day-to-night responsibilities involving business and personal contacts in the home country, and engagement in both healthy (e.g., exercise; low drug and cigarette usage) and sleep-disruptive behaviors (e.g., quasi-constant media use; high consumption of stimulant drinks and alcohol). Nearly half the participants surpassed PSQI cutoffs for "poor sleepers" (PSQI > 5) and more than a third exceeded cutoffs for depression (42.8%), anxiety (38.1%), and alcohol use problems (34%). Factors predicting poor sleep quality were single marital status; higher perceived stress, depression, and anxiety; presleep problem-solving, negative cognitive states, and daily alcohol consumption. The extent of sleep problems and alcohol use significantly exceeded those reported recently by HK Chinese residents. The results point to need for education and care of corporate expatriates and their families, including regular mental health screenings in primary care settings and reduction in use of alcohol as a sleep aid.