Author’s Note: A previous article in The Costa Rica Star touched on the “Top 10 Things You Should Know Before Moving to Costa Rica.” The most important advice on that article bears repeating at this time:

“A sensible word of advice for anyone who is planning to move here, or to any other nation for that matter: the worst time to undertake a country relocation is whilst experiencing severe emotional turmoil such as depression. In that case, a person should get well and find emotional balance before embarking in the adventure that moving to a foreign land always becomes.”

Carrying emotional baggage from one country to another is not a good idea.

A recent article by Gary Stoller in USA TODAY explains that suicide by Americans in foreign countries is a more common occurrence than might be thought. This sobering realization extends to Costa Rica, one of the countries with a relatively high annual number of suicides by American expats and tourists. The other countries are Mexico, South Korea, Germany, and Thailand. The U.S. Department of State keeps statistics on the number of suicides by Americans abroad, but privacy policies prevent certain information from being divulged to members of the travel medicine community.

Emporiatrics -travel medicine- deals with the physiological and psychological effects of international travel. Globalization trends have turned many people into veritable 21^st century nomads, thereby increasing the rates of mortality and morbidity. Prevention is one of the main topics in emporiatrics, and thus researchers have an inherent interest in finding out more about the phenomenon of Americans leaving their country to end their own lives in another.

USA TODAY compiled statistics from a decade of available data on American suicides overseas. The news daily explained that the State Department did not provide records on suicides by members of the U.S. Armed Forces overseas -that is a separate phenomenon that has seen a sharp increase among those returning from combat operations in Afghanistan and Iraq. The reporting period was from 2002 to the end of 2011, and it yielded 967 suicides by Americans living overseas.

Inaccurate Reporting by Foreign Officials

It is almost impossible to determine accurate counts of American suicides in Costa Rica. USA TODAY mentions that perhaps many suicides go unreported, and that the annual average of 125 incidents reported to the State Department from around the world make them the fourth-leading cause of American mortality abroad. A problem with these figures is that they can often be misreported due to cloudy investigations.

Two notorious cases of possible homicides initially reported as suicides come to mind. One case is that of Kelly Robert Nutting, as reported by The Missing Americans Project, a social network created to track residents and citizens from the U.S. who have been reported as missing abroad at some point. Kelly Robert Nutting was found in March of 2009 in the ocean near Golfito, with hands tied and feet in concrete. That incident was reported as a suicide before it turned to a homicide investigation.

A similar misreported suicide happened in January of 2010, in a spectacular mansion in Perez Zeledon. John Felix Bender was a multimillionaire who had made his fortune as an options trader using the complex mathematical approach of game theory. His death was initially reported as a suicide, based on the statements of those who were close to the deceased, as well as evidence in plain sight. Days later, however, Bender’s widow Ann Maxine Patton was arrested on suspicion of homicide.

It is not clear from the two cases above if the U.S. State Department ever got the story straight from the authorities in Costa Rica, but the news reports clearly indicate that both cases were erroneously reported as suicides in the beginning.

Emotional Risk Factors for Expats Abroad

Travel medicine is a burgeoning field, and the psychiatric data compiled on the effects of international travel and relocation on people is insufficient at this point. What is known with certainty is that mood disorders can be exacerbated by international travel, which is a stressful activity in and of itself.

Expats who arrive in Costa Rica looking for the panacea of Pura Vida are likely to find it, but if they come here running away from deep emotional problems, they may run into them again. This time they would find themselves in a country they are not familiar with, stuck with emotional baggage, and maybe without the immediate support of their social network. As explained to USA TODAY by Ronald Maris, a social psychologist and founder of the Center for the Study of Suicide: “People who are more mobile tend to be more suicidal.”

Such was the case of a 50-year old American man who in 2009 was issued a judicial eviction notice in Hacienda Vieja, in Curridabat. According to Diario Extra, the man took his Tica wife hostage in her father’s home and then released her, but not before telling her that he planned on killing himself in that house. A team of negotiators from the Office of Judicial Investigations (OIJ) arrived to find the heavily armed man barricaded in the house. As the agents took positions to figure out their next move, a gunshot was heard from inside the home.