Journal of Travel Medicine, 2020, 1–2
doi: 10.1093/jtm/taaa150
Advance Access Publication Date: 1 September 2020
Editorial
Editorial
Reiseangst: travel anxiety and psychological resilience
during and beyond the COVID-19 pandemic
Submitted 26 August 2020; Accepted 27 August 2020
Downloaded from [Link] by guest on 18 May 2022
As the name ‘pandemic’ (from the Greek π ∼ αν, pan, ‘all’ surround individual traveller decisions about engaging in so-
and δ ∼ ημoς, demos, ‘people’) suggests, nobody has been spared called non-essential travel for leisure purposes, with many people
from the turbulent and far-reaching impact of the current global choosing to wait until an effective vaccine appears on the horizon
scourge of COVID-19. A high population level of anxiety before contemplating a return to international travel. In the
has been a defining feature of this public health emergency.1 meantime, businesses and academia have adapted their inter-
Near universal periods of prolonged domestic confinement, or national operations using online video conferencing facilities,
lockdown, have exacted a heavy toll on global mental health. with resultant decreases in carbon footprints and cost savings
Evidence continues to emerge of higher levels of anxiety, but significant negative economic impacts on the aviation, hotel
depression, post-traumatic stress disorder, insomnia and alcohol and conference sectors. The mantra ‘stay home, stay safe’ seems
abuse, attributed to the effects of societal lockdown, necessary to be at odds with any notion of an early return to anything
of course to suppress viral transmission and flatten epidemic resembling normal global travel patterns. Indeed, non-essential
curves. A national cross-sectional study of 1515 individuals travel is now associated in some quarters with a degree of social
who endured the recent stringent lockdown in Italy uncovered stigma. Fears of becoming ill while abroad, concerns about travel
high rates of mental health symptoms, including depression and insurance coverage, the quality of local health care and the risk
anxiety in a quarter of those surveyed and sleep disturbances in of inadvertently infecting others during transit or on returning
over 40%.2 Female gender and time spent searching the internet home have added new layers of fear to the travel experience
predicted an increased likelihood of at least one adverse mental during this pandemic.
health outcome. The by now well-established public health Travel medicine has a major role to play in addressing and
countermeasures of physical distancing, cancellation of mass mitigating this increased burden of travel anxiety. Having been
gatherings and school closures have led to further social isolation somewhat neglected in the travel medicine literature to date,
and frustration among communities. As countries exit national travel-associated mental health issues are assuming greater
lockdowns and more nuanced public health strategies begin to importance and a subspecialty of travel psychiatry has recently
be applied, the term ‘COVID anxiety’ has entered into common been proposed.4 This journal has led the way in raising the
usage while the object of people’s fears continues to evolve. profile of this sensitive subject. The excitement and anticipation
A century after the great Austrian psychoanalyst, Sigmund of leisure travel often obscures underlying fears, some imaginary,
Freud, coined the term ‘Reiseangst’ (from the German, ‘fear of others legitimate. Travellers worry about their airport transit,
travel’), the word seems more apt than ever in describing a some have a crippling fear of flying,5 while others dread
new wave of travel anxiety that has gripped humanity in the becoming ill and needing medical intervention, or even dying,
throes of this contagion. Absolute restrictions on international while overseas. Cybersecurity is a peculiarly modern focus of
travel are slowly beginning to be eased. However, the travel traveller anxiety. Travel with children or disabled passengers
experience remains greatly curtailed and onerous, with fewer carries its own unique pressures and sources of anxiety. Certain
available flight routes, frequent cancellations, reciprocal travel specialized itineraries are particularly anxiety provoking; one of
corridors, travel green lists, health declarations, passenger locator the authors (G.T.F.) has witnessed high levels of anxiety among
forms, pre-arrival viral screening and post-arrival quarantine in trekkers on high-stakes trips to high altitude, for example. We
both the destination and, in some cases, the traveller’s home should not underestimate the anxiety attendant upon special
country. All of these approaches are effective and based on itineraries such as honeymoons, study abroad opportunities,
sound epidemiological principles.3 They are a necessary bridge business travel and medical tourism, not to mention the perilous
to the resumption of unrestricted travel at some point in the journeys often undertaken by migrants fleeing danger and
future. These days, travel health clinics are either closed or persecution in their countries of origin.
diversifying into viral screening and serology testing for travel- In the pre-pandemic travel era, culture shock, transport
related COVID certification purposes. High levels of uncertainty delays, navigational confusion and language barriers all posed
© International Society of Travel Medicine 2020. All rights reserved. For Permissions, please e-mail: [Link]@[Link].
2 Journal of Travel Medicine, 2020, Vol. 27, 8
an affront to the traveller’s mental health. Vulnerable travellers Author contributions
sometimes engage in drug tourism that may lead to conflict with
G.T.F. was responsible for study conception. G.T.F. and N.N.
local law enforcement and incarceration in a foreign prison.6
conducted the literature search. G.T.F. prepared the first draft of
Travel-related psychosis afflicts some travellers visiting sites of
the manuscript, which was edited for important intellectual con-
high spiritual, cultural or aesthetic value, such as the Jerusalem or
tent by both authors. Both G.T.F. and N.N. read and approved
Paris syndromes.7 For some, travel becomes a means of removing
the final version of the manuscript.
their mental health burden by affording the opportunity to
tragically end their lives. Witness the high proportion of probable
suicides among fatalities involving international travellers at an
iconic natural landmark in Ireland, for instance.8 Gerard T. Flaherty MD
Historically, travel medicine has focused its psychological School of Medicine, National University of Ireland
enrichment efforts on the needs of humanitarian aid workers and Galway, Galway, Ireland,
corporate expatriates, but there is an increasing awareness of the School of Medicine, International Medical University,
impact of mental ill health on all travellers. The International Kuala Lumpur, Malaysia
Downloaded from [Link] by guest on 18 May 2022
Society of Travel Medicine Psychological Health of Travellers Nizrull Nasir MB, BCh, BAO
interest group has as its stated goal the promotion of evidence- School of Medicine and Medical Science, University
based practice that cultivates the psychological resilience of College Dublin, Dublin, Ireland
travellers at all stages of their travel journey. Pretravel consulta-
tions should identify at risk travellers and address psychological *To whom correspondence should be addressed. Email:
coping strategies, the limitations of travel insurance coverage for [Link]@[Link]
mental health emergencies, safe transportation of psychotropic
drugs and access to psychiatric care abroad.9
The fear engendered by this pandemic will eventually be References
replaced by optimism and hope for our future. Achieving this 1. Pierce M, Hope H, Ford T et al. Mental health before and during the
mindset will summon our collective reserves of fortitude and COVID-19 pandemic: a longitudinal probability sample survey of
resilience. Psychological resilience during the COVID-19 shelter- the UK population, Lancet Psychiatry. 2020; S2215-0366:30308–4.
in-place period has been shown to be related to higher levels doi: 10.1016/S2215-0366(20)30308-4.
of exercise, sleep quality, social support and spirituality.10 A 2. Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Effects
greater understanding of the factors that contribute to resilience of Covid-19 lockdown on mental health and sleep disturbances
across the travel spectrum should lead to the development of in Italy. Int J Environ Res Public Health 2020; 17:4779. doi:
tools that can be used during the pretravel consultation and to 10.3390/ijerph17134779.
3. Dickens BL, Koo JR, Lim JT et al. Strategies at points of entry to
support travellers during and post-travel. One such technology
reduce importation risk of COVID-19 cases and re-open travel. J
is virtual reality, which we predict to be capable of transforming
Travel Med 2020; taaa141. doi: 10.1093/jtm/taaa141.
the preparation of future travellers for stressful travel by enabling
4. Flaherty G, Chai SY, Hallahan B. To travel is to live: embracing
them to pre-acclimatize to unfamiliar environments in a safe the emerging field of travel psychiatry. BJPsych Bull 2020; 1–3. doi:
pretravel setting. 10.1192/bjb.2020.32.
Imagine a future scenario where travel medicine practitioners 5. Oakes M, Bor R. The psychology of fear of flying (part II): a critical
will prescribe a specific course of virtual reality sessions for evaluation of current perspectives on approaches to treatment. Travel
anxious travellers using proprietary headsets. These could depict Med Infect Dis 2010; 8:339–63. doi: 10.1016/[Link].2010.10.002.
various aspects of the travel experience, from the airport and 6. Bonny-Noach H, Sagiv-Alayoff M. Cannabis tourist destinations:
commercial flight to busy city streets, high-altitude environments risk for vulnerable travellers with pre-existing mental disorders. J
and remote wilderness settings. Even currently, such technology Travel Med 2019. doi: 10.1093/jtm/taz098.
7. Airault R, Valk TH. Travel-related psychosis (TrP): a landscape
could demonstrate revised port of entry procedures and public
analysis. J Travel Med 2018; 25. doi: 10.1093/jtm/tay054.
health measures at destinations. This would go a long way
8. Flaherty GT, Caumes E. An analysis of international traveller deaths
towards reassuring anxious travellers embarking upon their first at the cliffs of Moher in Ireland, 1993-2017. J Travel Med 2018; 25.
foreign journey since lockdown was lifted. When this pandemic doi: 0.1093/jtm/tay019.
eventually weakens its grip and people feel safe enough to 9. Marcolongo T, Valk T, Jones M. Mind the gap: building the
tentatively resume normal international travel, especially long- psychological capital of travellers. J Travel Med 2019; 26. doi:
haul intercontinental trips, virtual reality may play a prominent 10.1093/jtm/tay142.
role in replacing their current state of heightened ‘Reiseangst’ 10. Killgore WDS, Taylor EC, Cloonan SA, Dailey NS. Psychological
with a far healthier wanderlust. resilience during the COVID-19 lockdown. Psychiatry Res 2020;
Conflict of interest: None declared. 291:113216. doi: 10.1016/[Link].2020.113216.
