The globalization of markets that has taken place in recent decades was a great opportunity for companies to become known and to operate in a wider context (Biemann and Andresen, 2010; Andresen et al., 2014). This phenomenon led to the possibility that many of the managers who served in a national territory could be transferred to foreign countries, characterized by different cultures and work processes (Sims and Schraeder, 2005).

However, working globally involves changes in occupational dynamics and in the levels of job complexity, and it also requires great skills of adaptation and adjustment (Black et al., 1991; Black and Gregersen, 1999). Most of the researches conducted on adjustment in a foreign country concerned so-called expatriate workers or expatriates (Sims and Schraeder, 2005), who are those workers sent from their own organization to follow projects or to lead company sectors abroad. An expatriate can be properly defined as one who works in a foreign country for a period of at least 6 months (Birdseye and Hill, 1995; Jones, 2000; Chan et al., 2015). However, shorter forms of expatriation also exist, as shown in the present study.

Supporting expatriates in performing their tasks in a new environment is nowadays essential for companies. Accordingly, researchers have studied expatriated performance and adaptation and evaluated the influence of specific practices of human resource management on their behavior. Relevant dimensions have been identified (Mol et al., 2005; Cheng and Lin, 2009), such as training, to support expatriates in dealing with different cultural values, unexpected behavioral rules, and language barriers. On the other hand, the dark sides of the expatriation experience have also been studied, such as the possible failure of the assignment, leaving without having finished the task, or psychologically withdrawing and performing worse than they usually would. Failure may be particularly expensive in human and monetary terms (Baruch, 2004).

However, adaptation/adjustment may be defined as the comfort degree (or the stress absence) associated with the role of the expatriate (Bhaskar-Shrinivas et al., 2005); expatriates who fail to face the demands of a job and do not properly adapt to a new environment may experience high levels of stress (Perone et al., 2008).

The scenario of stressors among expatriates seems complex, from the micro-environment and the macro-environment to the mega-environment (Lei et al., 2004). In particular, according to Bhaskar-Shrinivas et al. (2005), work assignments to be carried out abroad lead to greater stress when the following situations occur:

Black et al. (1991) observed that expatriates tend to suffer a greater number of relapses after periods of stress. Jones (2000), in a review, identified some risk factors that could not only adversely affect health, but could also lead to developing fear and anxiety of expatriation: risk of being involved in accidents; quality of living conditions; working conditions; risk of disease contagion; fear of being involved in violence; kidnappings and terrorist acts.

These risk factors are analyzed below:

Given that anxiety could significantly decrease people’s psychological well-being and mental health, there is increasing empirical research on the effect of fear in the workplace (Mueller and Tschan, 2011). Fear, especially if chronic, may damage, in particular, the immune, the nervous and the cardiovascular systems (Shiba et al., 2016).

The human body may be weakened by states of fear, especially if chronic. In particular, the immune, the nervous and the cardiovascular systems are damaged, but equally, the gastrointestinal tract and the reproductive system are not spared. In particular, the fear may compromise the decoding of emotions and decision making processes, making the subject susceptible to intense emotions and impulsive reactions and, consequently, to making inappropriate actions. Fatigue, depression, accelerated aging, and even premature death may be the further consequences of long-term fear (Shiba et al., 2016).

Furthermore, the literature shows that expatriate workers have an increased risk of consuming psychotropic and narcotic substances as well as of abusing of psychotropic drugs (Aubry et al., 2012; Bianchi et al., 2014; Kaeding and Borchers, 2016).

Our study enhanced the literature by being the first to look at a set of important fears among expatriates. In particular, we aimed to find out how the emergence of fear of expatriation, induced by mental health problems, might impact on the expatriate’s further fears in the workplace, using data from a survey of 265 Italian expatriate workers.

Building on the stress perspective (Lazarus and Folkman, 1984; Lazarus, 1991), we have, in particular, examined the following issues: how mental health is associated with fear; the relationship between fear of expatriation and fear of economic crisis as well as perceived dangerous working conditions; the mediation of fear with mental health and the development of further fears.

We intend to conceptualize fear of expatriation due to the risk factors discussed above. Indeed, this study contributes to the literature on expatriates’ health by testing an emergent model for the prevention of mental health issues. This paper proceeds as follows. First of all, we present the conceptual model and the derived hypotheses. Then, we explain the methodology used. Finally, the results and discussion (including limitations and research perspectives) are considered.

Following Anderson and Gerbing’s (1988) two-step structural equation modeling (SEM) procedure, we tested a measurement model (CFA) by determining whether each measure’s estimated loading on its expected underlying factor was significant. This allowed us to establish discriminant validity among the study constructs. Then, a structural model was performed to estimate the fit to the data of the hypothesized model in which fear of expatriation mediates the relationship of mental health problems with economic stress and perceived dangerous working conditions (Hypotheses 1 and 2). A CFA was, therefore, performed with Mplus, version 7.11 (Muthén and Muthén, 1998–2010), with the four variables measuring mental health problems, fear of expatriation, economic stress, and perceived dangerous working conditions. Moreover, the variables’ dimensions were used as indicators of their corresponding latent constructs in the measurement and structural models. These dimensions were formed by averaging the items of each sub-scale for the four latent variables. We therefore obtained three indicators for mental health problems, two indicators for fear of expatriation, two indicators for economic stress, and two indicators for perceived dangerous working conditions.

To evaluate the model fit, we considered chi-square (the higher the values are, the worse is the model’s correspondence to the data), and used both absolute and incremental fit indexes. Absolute fit indexes evaluate how well an a priori model reproduces the sample data. In our study, we focused on three absolute fit indexes: the standardized root mean square residual (SRMR), for which values of less than 0.08 are favorable, and the root-mean-square error of approximation (RMSEA), which should not exceed 0.10 (Browne and Cudeck, 1993; Kline, 2011). Incremental fit indexes measure the proportionate amount of improvement in fit when a target model is compared with a more restricted, nested baseline model (Schreiber et al., 2006). We considered the comparative fit index (CFI), for which values of 0.90 or greater are recommended (Schreiber et al., 2006).

As expected, the hypothesized four-factor model yielded a good fit to the data: χ²(20) = 61.17, CFI = 0.95, RMSEA = 0.09, SRMR = 0.05 (Table 1). Additionally, as shown in Table 2, this model had a significantly better fit than alternative, more parsimonious models (p < 0.01), supporting the distinctiveness of the study variables. Table 2 displays the descriptive statistics, correlations, and reliability coefficients of the variables.

In order to examine the hypothesized model, we performed SEM with Mplus. SEM offers the following advantages:

Thus, we tested our proposed structural model and compared it with alternative models. Additionally, when conducting SEM analyses, we controlled for the effects of age and organizational tenure on both the mediator and the dependent variables. Fit indexes for each tested model are presented in Table 3.

The hypothesized model (Model 1), which is a full mediation model, displayed a good fit to the data: χ²(35) = 70.37, CFI = 0.96; RMSEA = 0.06; SRMR = 0.06. Specific inspection of direct relationships further revealed that mental health problems were positively associated with fear of expatriation (β = 0.64, p < 0.01), thus supporting Hypothesis 1. Additionally, fear of expatriation, in turn, was positively related to economic stress (β = 0.40, p < 0.01) and perceived dangerous working conditions (β = 0.66, p < 0.01), thus providing preliminary support for Hypothesis 2. Completely standardized path coefficients for Model 1 are depicted in Figure 2.

To assess whether the hypothesized model was the best representation of the data, we then compared its fit to that of different alternative models. First, we assessed a partial mediation model, which included two additional direct paths from mental health problems to economic stress and perceived dangerous working conditions. This model yielded an adequate fit to the data (χ²[33] = 67.21, CFI = 0.96; RMSEA = 0.06; SRMR = 0.05), but it was not significantly better than Model 1, as revealed by the chi-square difference (Δχ²[1] = 3.16, ns). Moreover, the additional direct relationships of workplace mental problems with economic stress (β = 0.13, ns) and dangerous working conditions were not significant (β = 0.03, ns).

Next, we compared the hypothesized model with a non-mediation model (Model 3), which only included direct paths from mental health problems and fear of expatriation to economic stress and perceived dangerous working conditions. Results revealed that the non-mediation model was a slightly worse fit to the data than the hypothesized fully-mediated model (χ²[35] = 81.61, CFI = 0.95; RMSEA = 0.07; SRMR = 0.06). However, because this model had the same degrees of freedom as the hypothesized model, the statistical significance of the chi-square difference could not be calculated. Accordingly, we used the Akaike Information Criterion (AIC), instead of the chi-square, to compare the two models. The hypothesized model is considered to be superior to the non-mediation model if the former has an AIC value lower than the latter by four or more units (Burnham and Anderson, 2002). Results revealed that Model 3 had an AIC of 7301.58 compared to an AIC of 7290.35 for Model 1, suggesting that the hypothesized full mediation model represents a superior fit to the data than the non-mediation model (ΔAIC = 11.23).

Furthermore, because mental health problems, fear of expatriation, economic stress, and perceived dangerous working conditions were all measured at the same time, reverse relationships could also be expected between the four variables. In order to rule out this possibility, we therefore compared the hypothesized model against a set of alternative models that specified all the possible reverse indirect relationships among the study variables, namely: the indirect relationship of economic stress and perceived dangerous working conditions with fear of expatriation via mental health problems (Model 4); the indirect relationship of economic stress and perceived dangerous working conditions with mental health problems via fear of expatriation (Model 5); the indirect relationship between mental health problems and fear of expatriation via economic stress and perceived dangerous working conditions (Model 6); the indirect relationship of fear of expatriation with economic stress and perceived dangerous working conditions via mental health problems (Model 7); the relationship between fear of expatriation and mental health problems via economic stress and perceived dangerous working conditions (Model 8). Again, because Models 6–8 had the same degrees of freedom as the hypothesized model, we compared the model fit by using the AIC difference test. As can be seen from Table 3, Models 4–8 all yielded a worse fit to the data than the hypothesized model. Overall, results from model comparison suggested that Model 1 was the best fitting model. We therefore retained the hypothesized fully-mediated model.

Finally, in order to assess whether the indirect relationship of mental health problems with economic stress and perceived dangerous working conditions through fear of expatriation was significant (Hypothesis 2), we calculated 95% bootstrapping confidence intervals (Preacher and Hayes, 2008; Preacher and Kelley, 2011). Based on 5,000 bootstrap replications, results indicated that mental health problems had an indirect positive effect on economic stress (indirect effect = 0.18; 95% CI = 0.12, 0.24) and perceived dangerous working conditions (indirect effect = 0.18; 95% CI = 0.12, 0.24) via fear of expatriation. Hypothesis 2 was therefore fully supported.

In a globalized working environment with turbulence in the economy and in the security expatriate workers are confronted with several stressors, making international assignments potentially stressful. Accordingly, expatriate managers might report lower psychological well-being and anxiety (Wang and Kanungo, 2004; Shaffer et al., 2006; Wang and Nayir, 2006).

At the same time, fears are now increasing in the workplace, marked by emotional discomfort, apprehension, or concerns about the internal and external environment, and expatriates seem particularly at risk. These symptoms can progress to more severe psychosomatic symptoms, including further anxiety and additional fears (Blum et al., 2010; Besnard and Sahay, 2016).

In our model, fear of expatriation is particularly associated with mental health problems. This result is in line with the field literature (i.e., Perone et al., 2008; Andresen et al., 2014; Aracı, 2015). In addition, an expatriate might go through several personal and professional problems. In fact, expatriation is associated with a lot of unhealthy issues such as stress, anxiety, loneliness and homesickness, generating a sort of potential and prolonged cultural shock (Barón et al., 2014). Finally, it must be emphasized that expatriates cannot count on the support of family and/or other trusted people if they need it (Bhaskar-Shrinivas et al., 2005).

Fear of expatriation might generate a spiraling effect in which people, feeling more anxious, might become less engaged in the workplace, developing beliefs that money and extrinsic reward are the most important aspects of employment (Gerhart and Fang, 2015). At the same time, they may be more worried about their financial situation and their ability to hold on to their jobs and their benefits, developing their fear of economic crisis.

On one hand, from a subjective point of view, H&S measures – under certain circumstances (for instance, the emergence of fear in the workplace) – do not necessarily express feelings of safety, but rather can be interpreted as latent danger (Bader and Berg, 2012) generating a widespread anxiety. On the other hand, from an objective point of view, expatriates are often exported to societies with weaker and less expensive H&S policies and less organized labor forces, bringing potentially stressful and unsafe working conditions (Heymann, 2003) to expatriates. This might raise a perception of dangerous working conditions. Moreover, H&S procedures are usually highly specific to each country and with very important differences – related to the various national legislations and traditions – and working conditions abroad are generally perceived as less familiar and presenting higher risk (Taylor et al., 2007).

Expatriates are a group of people with a high cumulative risk of exposure to illness and injury (including the increased risk of certain vaccine-preventable illnesses) due to changes in travel patterns and activities, lifestyle alterations, and increased interaction with local populations. Pre-travel immunization management provides one safe and reliable method of preventing infectious illness in this group; however, this might not be enough to cope with anxiety (Vaid et al., 2013; Shepherd and Shoff, 2014). In addition, there are diseases that are not preventable with vaccines. These diseases, in particular of a viral nature, seem to spread faster nowadays – such as, for example, the recent Ebola or Middle East Respiratory Syndrome (MERS) outbreaks – and might be frightening for expatriates (Cohen et al., 2016; Regan et al., 2016).

In summary, the non-optimal H&S perception (Beeley et al., 1993), the risk of contracting infectious diseases (Jones, 1999; Hamlyn et al., 2007) and the unsuitability of medical care (Pierre et al., 2013) were also evaluated under the construct of the fear of expatriation.

In our study, expatriates reported being frightened by the risk of becoming involved in accidents during their frequent moves from one country to another. In particular, this fear seemed to be greater for traffic accidents (Wilks et al., 1999), but a fear of flying was also described (Hack-Polay, 2012).

A further and significant stress factor for expatriate workers is the managers’ fear of terrorist attacks or other fatal events involving the governments of countries where there are companies’ headquarters (Leistedt, 2013; Bader and Schuster, 2015). Finally, in our model we consider the concerns about the working and living conditions (Costa et al., 2015; Zhu et al., 2016).

In addition, our model has shown that the presence of fear of expatriation may, in turn, generate further fears in the workplace. In particular, fears of both the economic crisis and of the foreign working conditions are mediated by fear of expatriation. In fact, fear could adversely disturb human thinking and decision-making processes, leaving the individual more susceptible to generating further fears, as in a vicious circle (Barón et al., 2014; Besnard and Sahay, 2016).

Our findings are in line with the basic propositions of Lazarus and the “affective events theory” (AET; Weiss and Cropanzano, 1996). The latter pointed out that an emotion experienced by a worker (e.g., fear) may impact on later within-person emotions (e.g., fear again), influencing different organizational outcomes.

As far as economic crisis is concerned, economic stress might be more frightening for those who have more invested in the company, such as expatriates. In fact, these workers, being away from home for extended periods of time, are completely absorbed by their job and, therefore, they may be an easier target for contagious negative emotional cycles (Quantin et al., 2012). Moreover, they could be most affected by the psychological impacts of the economic crisis and its consequences as they have lower levels of social support (Fernandez et al., 2015).

Similarly, fear of expatriation may significantly lead to perceiving a priori all foreign working conditions as being more dangerous. These findings support our assumption and the literature (Perone et al., 2008; Andresen et al., 2014). The impact of working and living conditions – resulting, for instance, in perceived risks of harms – might be higher if expatriates are scared by the impeded living conditions or by the threat of violence. This might have several negative implications as often expatriates have the tendency to “get the job done” as smoothly as possible, so they can return home again (Aracı, 2015). However, this specific issue should be investigated in future studies.

Our findings provide interesting contributions both to the literature and to the managerial practices in the field of foreign work.

First, we believe that the subjects in the process of leaving their own country should be mentally healthy and not feeling frightened by either the place of destination or the assigned tasks. According to Lazarus and Folkman (1984), if an expatriate is worried and anxious, it is less likely that he/she will ever adjust. Therefore, it is essential to help expatriates to prevent the development of any type of fear. Strategies of prevention and rationalization, particularly useful in this sense, can be implemented through several instruments: specific training for foreign services, company’s reference facilities in countries where employees come to work, remote counseling (on-line/phone) provided by occupational physicians and psychologists affiliated with the company, company procedures for immediate repatriation in the case of adverse events (e.g., terrorism, infective outbreaks, and health problems), etc.

In the second place, stress management training is also recommended. From this perspective, issue-focused coping strategies seem crucial to counteract fearful feelings as well as to minimize the states of anxiety and distress (Folkman et al., 1986).

Thirdly, companies should conduct preventive screening to identify the human resources to be sent to foreign countries, favoring those who have demonstrated both a highly qualified professionalism in their field and robust mental health (Stone, 1991; Di Fabio, 2014, 2015).

Consequently, a process for the successful management of expatriation needs to be adopted using both individual and organizational strategies to reduce the possibilities of stress among expatriates. At the organizational level, selection, training, healthcare activities, and counseling need to be implemented and monitored in order to prevent the diffusions of workplace fears. At the individual level, expatriates should be psychologically supported, e.g., with mentoring and coaching, analyzing competencies, health perceptions, and mood over time (De Paul and Bikos, 2015).

Our study has many and innovative strengths but is not without limitations. Although the expatriates worked worldwide, the sample was limited to a single company, limiting the generalizability of the results. In addition, the sample was composed only of men. However, by virtue of family demands, men expatriate much more frequently than women. Our scale fear of the expatriation is new in the literature and, consequently, a replication of this study is needed. In addition, we look forward to more large studies whose starting points are the results of the first application of our scale. In particular, comparative research evaluating stress responses between Italian and other ethnic populations around the world would be particularly helpful.

This study used a cross-sectional design, resulting in the impossibility of determining causal relationships. Longitudinal research is needed in order to provide further evidence that mental health problems cause fear of expatriation, which, in turn, may generate additional workplace fears.

In summary, following this new research path, we have developed a new model, formulated a new theory that found an association between mental health and fears in the workplace, and explored different fears in the workplace and their links.

Our results confirmed our innovative hypothesis and we suggest that companies’ key people take into account the construct of fear of expatriation for business health purposes. With this in mind, companies need proper advice from qualified consultants such as occupational physicians and industrial psychologists. An investment dedicated to the prevention and protection of the H&S of expatriate workers is not only an instrument of risk assessment – in the context of the obligations under the laws of EU countries in the field (e.g., the Italian Legislative Decree n. 81 and subsequent amendments) – but also, and moreover, a significant tool to improve the company’s business.

Some studies have estimated that the cost associated with the failure of expatriation would be about one million USD (Insch and Daniels, 2002; Wentland, 2003). Overall, considering the aggregate data about the American situation, Punnett (1997) has calculated that US companies spend a total of up to two billion USD annually to address the failures of their expatriate managers. In such a context, it is legitimate to expect that intervention strategies – such as a careful selection of personnel to be devoted to foreign missions and the development of actions aimed at improving the real and perceived well-being in destination countries – will lead to significant returns on investment (ROI) for the companies.

GG, FM, JF-P, GA, and NM equally contributed to all the following issues of the research: conception and design of the work; acquisition, analysis, or interpretation of data for the work; drafting the work and critically revising it; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.