Stress in expatriates.

With economic globalization, the rate and effects of culture shock stress in expatriates and their families are expected to increase. The stressor may occur from the micro-environment, the macro-environment, or the mega-environment. The effects of stress are frequently due to predictable reactions such as insecurity, distress, and homesickness. These symptoms can progress to more severe psychosomatic symptoms, including depressive reactions and overt psychopathic behavior. Cross-cultural training programs are currently the best preventive strategy for culture shock and subsequent stress; however, the true efficacy of these programs is not well characterized. Substance abuse is probably a significant underlying problem for international business travelers; however, the true magnitude and effects of this issue are not well characterized in the expatriate community. There are substantial opportunities for additional medical research in these areas.