mental health and phd students

PhD students’ mental health is poor and the pandemic made it worse – but there are coping strategies that can help

Senior Lecturer in Technology Enhanced Learning, The Open University

Assistant Professor in Strategy and Entrepreneurship, UCL

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A pre-pandemic study on PhD students’ mental health showed that they often struggle with such issues. Financial insecurity and feelings of isolation can be among the factors affecting students’ wellbeing.

The pandemic made the situation worse. We carried out research that looked into the impact of the pandemic on PhD students, surveying 1,780 students in summer 2020. We asked them about their mental health, the methods they used to cope and their satisfaction with their progress in their doctoral study.

Unsurprisingly, the lockdown in summer 2020 affected the ability to study for many. We found that 86% of the UK PhD students we surveyed reported a negative impact on their research progress.

But, alarmingly, 75% reported experiencing moderate to severe depression. This is a rate significantly higher than that observed in the general population and pre-pandemic PhD student cohorts .

Risk of depression

Our findings suggested an increased risk of depression among those in the research-heavy stage of their PhD – for example during data collection or laboratory experiments. This was in contrast to those in the initial stages, or who were nearing the end of their PhD and writing up their research. The data collection stage was more likely to have been disrupted by the pandemic.

Our research also showed that PhD students with caring responsibilities faced a greatly increased risk of depression. In our our study , we found that PhD students with childcare responsibilities were 14 times more likely to develop depressive symptoms than PhD students without children.

This does align with findings on people in the general UK population with childcare responsibilities during the pandemic. Adults with childcare responsibilities were 1.4 times more likely to develop depression or anxiety compared to their counterparts without children or childcare duties.

It was also interesting to find that PhD students facing the disruption caused by the pandemic who did not receive an extension – extra financial support and time beyond the expected funding period – or were uncertain about whether they would receive an extension at the time of our study, were 5.4 times more likely to experience significant depression.

Our research also used a questionnaire designed to measure effective and ineffective ways to cope with stressful life events. We used this to look at which coping skills – strategies to deal with challenges and difficult situations — used by PhD students were associated with lower depression levels. These “good” strategies included “getting comfort and understanding from someone” and “taking action to try to make the situation better”.

Interestingly, female PhD students, who were slightly less likely than men to experience significant depression, showed a greater tendency to use good coping approaches compared to their counterparts. Specifically, they favoured the above two coping strategies that are associated with lower levels of depression.

On the other hand, certain coping strategies were associated with higher depression levels. Prominent among these were self-critical tendencies and the use of substances like alcohol or drugs to cope with challenging situations.

A supportive environment

Creating a supportive environment is not solely the responsibility of individual students or academic advisors. Universities and funding bodies must play a proactive role in mitigating the challenges faced by PhD students.

By taking proactive steps, universities could create a more supportive environment for their students and help to ensure their success.

Training in coping skills could be extremely beneficial for PhD students. For instance, the University of Cambridge includes this training as part of its building resilience course .

A focus on good strategies or positive reframing – focusing on positive aspects and potential opportunities – could be crucial. Additionally, encouraging PhD students to seek emotional support may also help reduce the risk of depression.

Another example is the establishment of PhD wellbeing support groups , an intervention funded by the Office for Students and Research England Catalyst Fund .

Groups like this serve as a platform for productive discussions and meaningful interactions among students, facilitated by the presence of a dedicated mental health advisor.

Our research showed how much financial insecurity and caring responsibilities had an effect on mental health. More practical examples of a supportive environment offered by universities could include funded extensions to PhD study and the availability of flexible childcare options.

By creating supportive environments, universities can invest in the success and wellbeing of the next generation of researchers.

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About the PhD in Mental Health Program

The PhD degree is a research-oriented doctoral degree. In the first two years, students take core courses in the Departments of Mental Health, Biostatistics, and Epidemiology, in research ethics, and attend weekly department seminars. Students must complete a written comprehensive exam (in January of their second year), a preliminary exam, two presentations and a final dissertation including presentation and defense. Throughout their time in the department, we encourage all doctoral students to participate in at least one research group of the major research programs in the department: Substance Use Epidemiology, Global Mental Health, Mental Health and Aging, Mental Health Services and Policy, Methods, Prevention Research, Psychiatric and Behavioral Genetic Epidemiology, Psychiatric Epidemiology, and Autism and Developmental Disabilities.

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We are the only department of mental health at a school of public health in the U.S.

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Get research experience and mentorship from renowned public mental health experts

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Judith K. Bass

Judith Bass, PhD '04, MPH, MIA, is an implementation science researcher, with a broad background in sociology, economic development studies, and psychiatric epidemiology.

Renee M. Johnson

Renee M. Johnson, PhD, MPH, uses social epidemiology and behavioral science methods to investigate injury/violence, substance use, and overdose prevention.

George W. Rebok

George Rebok, PhD, MA, is a life-span developmental psychologist who develops community-based interventions to prevent age-related cognitive decline and reduce dementia risk.

Heather E. Volk

Heather Volk, PhD, MPH, seeks to identify factors that relate to the risk and progression of neurodevelopment disorders.

Per the Collective Bargaining Agreement (CBA) with the JHU PhD Union, the minimum guaranteed 2025-2026 academic year stipend is $50,000 for all PhD students with a 4% increase the following year. Tuition, fees, and medical benefits are provided, including health insurance premiums for PhD student’s children and spouses of international students, depending on visa type. The minimum stipend and tuition coverage is guaranteed for at least the first four years of a BSPH PhD program; specific amounts and the number of years supported, as well as work expectations related to that stipend will vary across departments and funding source. Please refer to the CBA to review specific benefits, compensation, and other terms. Need-Based Relocation Grants Students who  are admitted to PhD programs at JHU   starting in Fall 2023 or beyond can apply to receive a need-based grant to offset the costs of relocating to be able to attend JHU.   These grants provide funding to a portion of incoming students who, without this money, may otherwise not be able to afford to relocate to JHU for their PhD program. This is not a merit-based grant. Applications will be evaluated solely based on financial need.  View more information about the need-based relocation grants for PhD students .

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• Open access
• Published: 26 August 2020

Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis

• Cassie M. Hazell   ORCID: orcid.org/0000-0001-5868-9902 1 ,
• Laura Chapman 2 ,
• Sophie F. Valeix 3 ,
• Paul Roberts 4 ,
• Jeremy E. Niven 5 &
• Clio Berry 6  

Systematic Reviews volume  9 , Article number:  197 ( 2020 ) Cite this article

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Data from studies with undergraduate and postgraduate taught students suggest that they are at an increased risk of having mental health problems, compared to the general population. By contrast, the literature on doctoral researchers (DRs) is far more disparate and unclear. There is a need to bring together current findings and identify what questions still need to be answered.

We conducted a mixed methods systematic review to summarise the research on doctoral researchers’ (DRs) mental health. Our search revealed 52 articles that were included in this review.

The results of our meta-analysis found that DRs reported significantly higher stress levels compared with population norm data. Using meta-analyses and meta-synthesis techniques, we found the risk factors with the strongest evidence base were isolation and identifying as female. Social support, viewing the PhD as a process, a positive student-supervisor relationship and engaging in self-care were the most well-established protective factors.

Conclusions

We have identified a critical need for researchers to better coordinate data collection to aid future reviews and allow for clinically meaningful conclusions to be drawn.

Systematic review registration

PROSPERO registration CRD42018092867

Peer Review reports

Student mental health has become a regular feature across media outlets in the United Kingdom (UK), with frequent warnings in the media that the sector is facing a ‘mental health crisis’ [ 1 ]. These claims are largely based on the work of regulatory authorities and ‘grey’ literature. Such sources corroborate an increase in the prevalence of mental health difficulties amongst students. In 2013, 1 in 5 students reported having a mental health problem [ 2 ]. Only 3 years later, however, this figure increased to 1 in 4 [ 3 ]. In real terms, this equates to 21,435 students disclosing mental health problems in 2013 rising to 49,265 in 2017 [ 4 ]. Data from the Higher Education Statistics Agency (HESA) demonstrates a 210% increase in the number of students terminating their studies reportedly due to poor mental health [ 5 ], while the number of students dying by suicide has consistently increased in the past decade [ 6 ].

This issue is not isolated to the UK. In the United States (US), the prevalence of student mental health problems and use of counselling services has steadily risen over the past 6 years [ 7 ]. A large international survey of more than 14,000 students across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the United States) found that 35% of students met the diagnostic criteria for at least one common mental health condition, with highest rates found in Australia and Germany [ 8 ].

The above figures all pertain to undergraduate students. Finding equivalent information for postgraduate students is more difficult, and where available tends to combine data for postgraduate taught students and doctoral researchers (DRs; also known as PhD students or postgraduate researchers) (e.g. [ 4 ]). The latest trend analysis based on data from 36 countries suggests that approximately 2.3% of people will enrol in a PhD programme during their lifetime [ 9 ]. The countries with the highest number of DRs are the US, Germany and the UK [ 10 ]. At present, there are more than 281,360 DRs currently registered across these three countries alone [ 11 , 12 ], making them a significant part of the university population. The aim of this systematic review is to bring attention specifically to the mental health of DRs by summarising the available evidence on this issue.

Using a mixed methods approach, including meta-analysis and meta-synthesis, this review seeks to answer three research questions: (1) What is the prevalence of mental health difficulties amongst DRs? (2) What are the risk factors associated with poor mental health in DRs? And (3) what are the protective factors associated with good mental health in DRs?

Literature search

We conducted a search of the titles and abstracts of all article types within the following databases: AMED, BNI, CINAHL, Embase, HBE, HMIC, Medline, PsycInfo, PubMed, Scopus and Web of Science. The same search terms were used within all of the databases, and the search was completed on the 13th April 2018. Our search terms were selected to capture the variable terms used to describe DRs, as well as the terms used to describe mental health, mental health problems and related constructs. We also reviewed the reference lists of all the papers included in this review. Full details of the search strategy are provided in the supplementary material .

Inclusion criteria

Articles meeting the following criteria were considered eligible for inclusion: (1) the full text was available in English; (2) the article presented empirical data; (3) all study participants, or a clearly delineated sub-set, were studying at the doctoral level for a research degree (DRs or equivalent); and (4) the data collected related to mental health constructs. The last of these criteria was operationalised (a) for quantitative studies as having at least one mental health-related outcome measure, and (b) for qualitative studies as having a discussion guide that included questions related to mental health. We included university-published theses and dissertations as these are subjected to a minimum level of peer-review by examiners.

Exclusion criteria

In order to reduce heterogeneity and focus the review on doctoral research as opposed to practice-based training, we excluded articles where participants were studying at the doctoral level, but their training did not focus on research (e.g. PsyD doctorate in Clinical Psychology).

Screening articles

Papers were screened by one of the present authors at the level of title, then abstract, and finally at full text (Fig. 1 ). Duplicates were removed after screening at abstract. At each level of screening, a random 20% sub-set of articles were double screened by another author, and levels of agreement were calculated (Cohen’s kappa [ 13 ]). Where disagreements occurred between authors, a third author was consulted to decide whether the paper should or should not be included. All kappa values evidence at least moderate agreement between authors [ 14 ]—see Fig. 1 for exact kappa values.

PRISMA diagram of literature review process

Data extraction

This review reports on both quantitative and qualitative findings, and separate extraction methods were used for each. Data extraction was performed by authors CH, CB, SV and LC.

Quantitative data extraction

The articles in this review used varying methods and measures. To accommodate this heterogeneity, multiple approaches were used to extract quantitative data. Where available, we extracted (a) descriptive statistics, (b) correlations and (c) a list of key findings. For all mental health outcome measures, we extracted the means and standard deviations for the DR participants, and where available for the control group (descriptive statistics). For studies utilising a within-subjects study design, we extracted data where a mental health outcome measure was correlated with another construct (correlations). Finally, to ensure that we did not lose important findings that did not use descriptive statistics or correlations, we extracted the key findings from the results sections of each paper (list of key findings). Key findings were identified as any type of statistical analysis that included at least one mental health outcome.

Qualitative data extraction

In line with the meta-ethnographic method [ 15 ] and our interest in the empirical data as well as the authors’ interpretations thereof, i.e. the findings of each article [ 16 ], the data extracted from the articles comprised both results/findings and discussion/conclusion sections. For articles reporting qualitative findings, we extracted the results and discussion sections from articles verbatim. Where articles used mixed methods, only the qualitative section of the results was extracted. Methodological and setting details from each article were also extracted and provided (see Appendix A) in order to contextualise the studies.

Data analysis

Quantitative data analysis, descriptive statistics.

We present frequencies and percentages of the constructs measured, the tools used and whether basic descriptive statistics ( M and SD ) were reported. The full data file is available from the first author upon request.

Effect sizes

Where studies had a control group, we calculated a between-group effect size (Cohen’s d ) using the formula reported by Wilson [ 17 ], and interpreted using the standard criteria [ 13 ]. For all other studies, we sought to compare results with normative data where the following criteria were satisfied: (a) at least three studies reported data using the same mental health assessment tool; (b) empirical normative data were available; and (c) the scale mean/total had been calculated following original authors’ instructions. Only the Perceived Stress Scale (PSS) 10- [ 18 ] and 14-item versions [ 19 ] met these criteria. Normative data were available from a sample of adults living in the United States: collected in 2009 for the 10-item version ( n = 2000; M = 15.21; SD = 7.28) [ 20 ] and in 1983 for the 14-item version ( n = 2355; M = 19.62; SD = 7.49) [ 18 ].

The meta-analysis of PSS data was conducted using MedCalc [ 21 ], and based on a random effects model, as recommended by [ 22 ]. The between-group effect sizes (DRs versus US norms) were calculated comparing PSS means and standard deviations in the respective groups. The effect sizes were weighted using the variable variances [ 23 ].

Correlations

Where at least three studies reported data reflecting a bivariate association between a mental health and another variable, we summarised this data into a meta-analysis using the reported r coefficients and sample sizes. Again, we used MedCalc [ 21 ] to conduct the analysis using a random effects model, based on the procedure outlined by Borenstein, Hedges, Higgins and Rothstein [ 24 ]. This analysis approach involves converting correlation coefficients into Fisher’s z values [ 25 ], calculating the summary of Fisher’s z , and then converting this to a summary correlation coefficient ( r ). The effect sizes were weighted in line with the Hedges and Ollkin [ 23 ] method. Heterogeneity was assessed using the Q statistic, and I 2 value—both were interpreted according to the GRADE criteria [ 26 ]. Where correlations could not be summarised within a meta-analysis, we have reported these descriptively.

Due to the heterogenous nature of the studies, the above methods could not capture all of the quantitative data. Therefore, additional data (e.g. frequencies, statistical tests) reported in the identified articles was collated into a single document, coded as relating to prevalence, risk or protective factors and reported as a narrative review.

Qualitative data analysis

We used thematic analytic methods to analyse the qualitative data. We followed the thematic synthesis method [ 16 , 27 ] and were informed by a thematic analysis approach [ 28 , 29 ]. We took a critical realist epistemological stance [ 30 , 31 ] and aimed to bring together an analysis reflecting meaningful patterns amongst the data [ 29 ] or demi-regularities, and identifying potential social mechanisms that might influence the experience of such phenomena [ 31 ]. The focus of the meta-synthesis is interpretative rather than aggregative [ 32 ].

Coding was line by line, open and complete. Following line-by-line coding of all articles, a thematic map was created. Codes were entered on an article-by-article basis and then grouped and re-grouped into meaningful patterns. Comparisons were made across studies to attempt to identify demi-regularities or patterns and contradictions or points of departure. The thematic map was reviewed in consultation with other authors to inductively create and refine themes. Thematic summaries were created and brought together into a first draft of the thematic structure. At this point, each theme was compared against the line-by-line codes and the original articles in order to check its fit and to populate the written account with illustrative quotations.

Research rigour

The qualitative analysis was informed by independent coding by authors CB and SV, and analytic discussions with CH, SV and LC. Our objective was not to capture or achieve inter-rater reliability, rather the analysis was strengthened through involvement of authors from diverse backgrounds including past and recent PhD completion, experiences of mental health problems during PhD completion, PhD supervision experience, experience as employees in a UK university doctoral school and different nationalities. In order to enhance reflexivity, CB used a journal throughout the analytic process to help notice and bracket personal reflections on the data and the ways in which these personal reflections might impact on the interpretation [ 29 , 33 ]. The ENTREQ checklist [ 34 ] was consulted in the preparation of this report to improve the quality of reporting.

Quality assessment

Quantitative data.

The quality of the quantitative papers was assessed using the STROBE combined checklist [ 35 ]. A random 20% sub-sample of these studies were double-coded and inter-rater agreement was 0.70, indicating ‘substantial’ agreement [ 14 ]. The maximum possible quality score was 23, with a higher score indicating greater quality, with the mean average of 15.97, and a range from 0 to 22. The most frequently low-scoring criteria were incomplete reporting regarding the management of missing data, and lack of reported efforts to address potential causes of bias.

Qualitative data

There appeared to be no discernible pattern in the perceived quality of studies; the highest [ 36 , 37 , 38 , 39 , 40 ] and lowest scoring [ 41 , 42 , 43 , 44 , 45 , 46 ] studies reflected both theses and journal publications, a variety of locations and settings and different methodologies. The most frequent low-scoring criteria were relating to the authors’ positions and reflections thereof (i.e. ‘Qualitative approach and research paradigm’, ‘Researcher characteristics and reflexivity’, ‘Techniques to enhance trustworthiness’, ‘Limitations’, ‘Conflict of interest and Funding’). Discussions of ethical issues and approval processes was also frequently absent. We identified that we foregrounded higher quality studies in our synthesis in that these studies appeared to have greater contributions reflected in the shape and content of the themes developed and were more likely to be the sources of the selected illustrative quotes.

Mixed methods approach

The goal of this review is to answer the review questions by synthesising the findings from both quantitative and/or qualitative studies. To achieve our goal, we adopted an integrated approach [ 47 ], whereby we used both quantitative and qualitative methods to answer the same review question, and draw a synthesised conclusion. Different analysis approaches were used for the quantitative and qualitative data and are therefore initially reported separately within the methods. A separate synthesised summary of the findings is then provided.

Overview of literature

Of the 52 papers included in this review (Table 1 ), 7 were qualitative, 29 were quantitative and 16 mixed methods. Most articles (35) were peer-reviewed papers, and the minority were theses (17). Only four of the articles included a control group; in three instances comprising students (but not DRs) and in the other drawn from the general population.

Quantitative results

Thirty-five papers reported quantitative data, providing 52 reported sets of mental health related data (an average of 1.49 measures per study): 24 (68.57%) measured stress, 10 (28.57%) anxiety, 9 (25.71%) general wellbeing, 5 (14.29%) social support, 3 (8.57%) depression and 1 (2.86%) self-esteem. Five studies (9.62%) used an unvalidated scale created for the purposes of the study. Fifteen studies (28.85%) did not report descriptive statistics.

Of the four studies that included a control group, only two of these reported descriptive statistics for both groups on a mental health outcome [ 66 , 69 ]. There is a small (Cohen’s d = 0.27) and large between-group effect (Cohen’s d = 1.15) when DRs were compared to undergraduate and postgraduate clinical psychology students respectively in terms of self-reported stress.

The meta-analysis of DR scores on the PSS (both 10- and 14-item versions) compared to population normative data produced a large and significant between-group effect size ( d = 1.12, 95% CI [0.52, 1.73]) in favour of DRs scoring higher on the PSS than the general population (Fig. 2 ), suggesting DRs experience significantly elevated stress. However, these findings should be interpreted in light of the significant between-study heterogeneity that can be classified as ‘considerable’ [ 26 ].

A meta-analysis of between-group effect sizes (Cohen’s d ) comparing PSS scores (both 10- and 14-item versions) from DRs and normative population data. *Studies using the 14 item version of the PSS; a positive effect size indicates DRs had a higher score on the PSS; a negative effect size indicates that the normative data produced a higher score on the PSS; black diamond = total effect size (based on random effects model); d = Cohen’s d ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

To explore this heterogeneity, we re-ran the meta-analysis separately for the 10- and 14-item versions. The effect size remained large and significant when looking only at the studies using the 14-item version ( k = 6; d = 1.41, 95% CI [0.63, 2.19]), but was reduced and no longer significant when looking at the 10-item version only ( k = 3; d = 0.57, 95% CI [− 0.51, 1.64]). However, both effect sizes were still marred by significant heterogeneity between studies (10-item: Q = 232.02, p < .001; 14-item: Q = 356.76, p < .001).

Studies reported sufficient correlations for two separate meta-analyses; the first assessing the relationship between stress (PSS [ 18 , 19 ]) and perceived support, and the second between stress (PSS) and academic performance.

Stress x support

We included all measures related to support irrespective of whom that support came from (e.g. partner support, peer support, mentor support). The overall effect size suggests a small and significant negative correlation between stress and support ( r = − .24, 95% CI [− 0.34, − 0.13]) (see Fig. 3 ), meaning that low support is associated with greater perceived stress. However, the results should be interpreted in light of the significant heterogeneity between studies. The I 2 value quantifies this heterogeneity as almost 90% of the variance being explained by between-study heterogeneity, which is classified as ‘substantial’ (26).

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and perceived support. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Stress x performance

The overall effect size suggests that there is no relationship between stress and performance in their studies ( r = − .07, 95% CI [− 0.19, 0.05]) (see Fig. 4 ), meaning that DRs perception of their progress was not associated with their perceived stress This finding suggests that the amount of progress that DRs were making during their studies was not associated with stress levels.

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and performance. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Other correlations

Correlations reported in less than three studies are summarised in Fig. 5 . Again, stress was the most commonly tested mental health variable. Self-care and positive feelings towards the thesis were consistently found to negatively correlate with mental health constructs. Negative writing habits (e.g. perfectionism, blocks and procrastination) were consistently found to positively correlate with mental health constructs. The strongest correlations were found between stress, and health related quality of life ( r = − .62) or neuroticism ( r = .59), meaning that lower stress was associated with greater quality of life and reduced neuroticism. The weakest relationships ( r < .10) were found between mental health outcomes and: faculty concern, writing as knowledge transformation, innate writing ability (stress and anxiety), years married, locus of control, number of children and openness (stress only).

Correlation coefficients testing the relationship between a mental health outcome and other construct. Correlation coefficients are given in brackets ( r ); * p < .05; each correlation coefficient reflects the results from a single study

Several studies reported DR mental health problem prevalence and this ranged from 36.30% [ 54 ] to 55.9% [ 67 ]. Using clinical cut-offs, 32% were experiencing a common psychiatric disorder [ 64 ]; with another study finding that 53.7% met the questionnaire cut-off criteria for depression, and 41.9% for anxiety [ 67 ]. One study compared prevalence amongst DRs and the general population, employees and other higher education students; in all instances, DRs had higher levels of psychological distress (non-clinical), and met criteria for a clinical psychiatric disorder more frequently [ 64 ].

Risk factors

Demographics Two studies reported no significant difference between males and females in terms of reported stress [ 57 , 73 ], but the majority suggested female DRs report greater clinical [ 80 ], and non-clinical problems with their mental health [ 37 , 64 , 79 , 83 , 89 ].

Several studies explored how mental health difficulties differed in relation to demographic variables other than gender, suggesting that being single or not having children was associated with poorer mental health [ 64 ] as was a lower socioeconomic status [ 71 ]. One study found that mental health difficulties did not differ depending on DRs’ ethnicity [ 51 ], but another found that Black students attending ‘historically Black universities’ were significantly more anxious [ 87 ]. The majority of the studies were conducted in the US, but only one study tested for cross-cultural differences: reporting that DRs in France were more psychologically distressed than those studying in the UK [ 67 ].

Work-life balance Year of study did not appear to be associated with greater subjective stress in a study involving clinical psychology DRs (Platt and Schaefer [ 75 ]), although other studies suggested greater stress reported by those in the latter part of their studies [ 89 ], who viewed their studies as a burden [ 81 ], or had external contracts, i.e. not employed by their university [ 85 ]. Regression analyses revealed that a common predictor of poor mental health was uncertainty in DR studies; whether in relation to uncertain funding [ 64 ] or uncertain progress [ 80 ]. More than two-thirds of DRs reported general academic pressure as a cause of stress, and a lack of time as preventing them from looking after themselves [ 58 ]. Being isolated was also a strong predictor of stress [ 84 ].

Protective factors

DRs who more strongly endorsed all of the five-factor personality traits (openness, conscientiousness, extraversion, agreeableness and neuroticism) [ 66 ], self-reported higher academic achievement [ 40 ] and viewed their studies as a learning process (rather than a means to an end) [ 82 ] reported fewer mental health problems. DRs were able to mitigate poor mental health by engaging in self-care [ 72 ], having a supervisor with an inspirational leadership style [ 64 ] and building coping strategies [ 56 ]. The most frequently reported coping strategy was seeking support from other people [ 37 , 58 ].

Qualitative results

Meta-synthesis.

Four higher-order themes were identified: (1) Always alone in the struggle, (2) Death of personhood, (3) The system is sick and (4) Seeing, being and becoming. The first two themes reflect individual risk/vulnerability factors and the processes implicated in the experience of mental distress, the third represents systemic risk and vulnerability factors and the final theme reflects individual and systemic protective mechanisms and transformative influences. See Table 2 for details of the full thematic structure with illustrative quotes.

Always alone in the struggle

‘Always alone in the struggle’ reflects the isolated nature of the PhD experience. Two subthemes reflect different aspects of being alone; ‘Invisible, isolated and abandoned’ represents DRs’ sense of physical and psychological separation from others and ‘It’s not you, it’s me’ represents DRs’ sense of being solely responsible for their PhD process and experience.

Invisible, isolated and abandoned

Feeling invisible and isolated both within and outside of the academic environment appears a core DR experience [ 39 , 43 , 81 ]. Isolation from academic peers seemed especially salient for DRs with less of a physical presence on campus, e.g. part-time and distance students, those engaging in extensive fieldwork, outside employment and those with no peer research or lab group [ 36 , 52 , 68 ]. Where DRs reported relationships with DR peers, these were characterised as low quality or ‘not proper friendships’ and this appeared linked to a sense of essential and obvious competition amongst DRs with respect to current and future resources, support and opportunities [ 39 ], in which a minority of individuals were seen to receive the majority share [ 36 , 74 ]. Intimate sharing with peers thus appeared to feel unsafe. This reflected the competitive environment but also a sense of peer relationships being predicated on too shared an experience [ 39 ].

In addition to poor peer relations, a mismatch between the expected and observed depth of supervisor interest, engagement and was evident [ 40 , 81 ]. This mismatch was clearly associated with disappointment and anger, and a sense of abandonment, which appeared to impact negatively on DR mental health and wellbeing [ 42 ] (p. 182). Moreover, DRs perceived academic departments as complicit in their isolation; failing to offer adequate opportunities for academic and social belonging and connections [ 42 , 81 ] and including PGRs only in a fleeting or ‘hollow’ sense [ 37 ]. DRs identified this isolation as sending a broader message about academia as a solitary and unsupported pursuit; a message that could lead some DRs to self-select out of planning for future in academia [ 37 , 42 ]. DRs appeared to make sense of their lack of belonging in their department as related to their sense of being different, and that this difference might suggest they did not ‘fit in’ with academia more broadly [ 74 ]. In the short-term, DRs might expend more effort to try and achieve a social and/or professional connection and equitable access to support, opportunities and resources [ 74 ]. However, over the longer-term, the continuing perception of being professionally ‘other’ also seemed to undermine DRs’ sense of meaning and purpose [ 81 ] and could lead to opting out of an academic career [ 62 , 74 ].

Isolation within the PhD was compounded by isolation from one’s personal relationships. This personal isolation was first physical, in which the laborious nature of the PhD acted as a catalyst for the breakdown of pre-existing relationships [ 76 ]. Moreover, DRs also experienced a sense of psychological detachment [ 45 , 74 ]. Thus, the experience of isolation appeared to be extremely pervasive, with DRs feeling excluded and isolated physically and psychologically and across both their professional and personal lives.

It’s not you, it’s me

‘It’s not you, it’s me’ reflects DRs’ perfectionism as a central challenge of their PhD experience and a contributor to their sense of psychological isolation from other people. DRs’ perfectionism manifested in four key ways; firstly, in the overwhelming sense of responsibility experienced by DRs; secondly, in the tendency to position themselves as inadequate and inferior; thirdly, in cycles of perfectionist paralysis; and finally, in the tendency to find evidence which confirms their assumed inferiority.

DRs positioned themselves as solely responsible for their PhD and for the creation of a positive relationship with their supervisor [ 36 , 52 , 81 ]. DRs expressed a perceived need to capture their supervisors’ interest and attention [ 36 , 52 , 74 ], feeling that they needed to identify and sell to their supervisors some shared characteristic or interest in order to scaffold a meaningful relationship. DRs appeared to feel it necessary to assume sole responsibility for their personal lives and to prohibit any intrusion of the personal in to the professional, even in incredibly distressing circumstances [ 42 ].

DRs appeared to compare themselves against an ideal or archetypal DR and this comparison was typically unfavourable [ 37 ], with DRs contrasting the expected ideal self with their actual imperfect and fallible self [ 37 , 42 , 52 ]. DRs’ sense of inadequacy appeared acutely and frequently reflected back to them by supervisors in the form of negative or seemingly disdainful feedback and interactions [ 41 , 76 ]. DRs framed negative supervisor responses as a cue to work harder, meaning they were continually striving, but never reaching, the DR ideal [ 76 ]. This ideal-actual self-discrepancy was associated with a tendency towards punitive self-talk with clear negative valence [ 38 ].

DRs appear to commonly use self-castigation as a necessary (albeit insufficient) means to motivate themselves to improve their performance in line with perfectionistic standards [ 38 , 41 ]. The oscillation between expectation and actuality ultimately resulted in increased stress and anxiety and reduced enjoyment and motivation. Low motivation and enjoyment appeared to cause procrastination and avoidance, which lead to a greater discrepancy between the ideal and actual self; in turn, this caused more stress and anxiety and further reduced enjoyment and motivation leading to a sense of stuckness [ 76 ].

The internalisation of perceived failure was such that DRs appeared to make sense of their place, progress and possible futures through a lens of inferiority, for example, positioning themselves as less talented and successful compared to their peers [ 37 ]. Thus, instances such as not being offered a job, not receiving funding, not feeling connected to supervisors, feeling excluded by academics and peers were all made sense of in relation to DRs’ perceived relative inadequacy [ 36 ].

Death of personhood

The higher-order theme ‘Death of personhood’ reflects DRs’ identity conflict during the PhD process; a sense that DRs’ engage in a ‘Sacrifice of personal identity’ in which they feel they must give up their pre-existing self-identity, begin to conceive of themselves as purely ‘takers’ personally and professionally, thus experiencing the ‘Self as parasitic’, and ultimately experience a ‘Death of self-agency’ in relation to the thesis, the supervisor and other life roles and activities.

A sacrifice of personal identity

The sacrifice of personal identity first manifests as an enmeshment with the PhD and consequent diminishment of other roles, relationships and activities that once were integral to the DRs’ sense of self [ 59 , 76 ]. DRs tended to prioritise PhD activities to the extent that they engaged in behaviours that were potentially damaging to their personal relationships [ 76 ]. DRs reported a sense of never being truly free; almost physically burdened by the weight of their PhD and carrying with them a constant ambient guilt [ 37 , 38 , 44 , 76 ]. Time spent on non-PhD activities was positioned as selfish or indulgent, even very basic activities of living [ 76 ].

The seeming incompatibility of aspects of prior personal identity and the PhD appears to result in a sense of internal conflict or identity ‘collision’ [ 59 ]. Friends and relatives often provided an uncomfortable reflection of the DR’s changing identity, leaving DRs feeling hyper-visible and carrying the burden of intellect or trailblazer status [ 74 ]; providing further evidence for the incompatibility of their personal and current and future professional identities. Some DRs more purposefully pruned their relationships and social activities; to avoid identity dissonance, to conserve precious time and energy for their PhD work, or as an acceptance of total enmeshment with academic work as necessary (although not necessarily sufficient) for successful continuation in academia [ 40 , 52 , 77 ]. Nevertheless, the diminishment of the personal identity did not appear balanced by the development of a positive professional identity. The professional DR identity was perceived as unclear and confusing, and the adoption of an academic identity appeared to require DRs to have a greater degree of self-assurance or self-belief than was often the case [ 37 , 81 ].

Self as parasitic

Another change in identity manifested as DRs beginning to conceive of themselves as parasitic. DRs spoke of becoming ‘takers’, feeling that they were unable to provide or give anything to anyone. For some DRs, being ‘parasitic’ reflected them being on the bottom rung of the professional ladder or the ‘bottom of the pile’; thus, professionally only able to receive support and assistance rather than to provide for others. Other DRs reported more purposefully withdrawing from activities in which they were a ‘giver’, for example voluntary work, as providing or caring for others required time or energy that they no longer had [ 38 , 44 ]. Furthermore, DRs appeared to conceive of themselves as also causing difficulty or harm to others [ 81 ], as problems in relation to their PhD could lead them to unwillingly punishing close others, for example, through reducing the duration or quality of time spent together [ 38 ].

Feeling that close others were offering support appeared to heighten the awareness of the toll of the PhD on the individual and their close relationships, emphasising the huge undertaking and the often seemingly slow progress, and actually contributing to the sense of ambient guilt, shame, anger and failure [ 38 ]. Moreover, DRs spoke of feeling extreme guilt in perceiving that they had possibly sacrificed their own, and possibly family members’, current wellbeing and future financial security [ 49 ].

Death of self-agency

In addition to their sense of having to sacrifice their personal identity, DRs also expressed a loss of their sense of themselves as agentic beings. DRs expressed feeling powerless in various domains of their lives. First, DRs positioned the thesis as a powerful force able to overwhelm or swallow them [ 46 , 52 , 59 ]. Secondly, DRs expressed a sense of futility in trying to retain any sense of personal power in the climate of academia. An acute feeling of powerlessness especially in relation to supervisors was evident, with many examples provided of being treated as means to an end, as opposed to ends in themselves [ 39 , 42 , 62 ]. Supervisors did not interact with DRs in a holistic way that recognised their personhood and instead were perceived as prioritising their own will, or the will of other academics, above that of the DR [ 39 , 62 ].

Furthermore, DRs reported feeling as if they were used as a means for research production or furthering their supervisors’ reputations or careers [ 62 ]. DRs perceived that holding on to a sense of personal agency sometimes felt incompatible with having a positive supervisor relationship [ 42 ]. Thus whilst emotional distress, anger, disappointment, sadness, jealousy and resentment were clearly evident in relation to feeling excluded, used or over-powered by supervisors [ 37 , 42 , 52 , 62 ], DRs usually felt unable to change supervisor irrespective of how seriously this relationship had degraded [ 37 , 62 ]. Instead, DRs appeared to take on a position of resignation or defensive pessimism, in which they perceived their supervisors as thwarting their personhood, personal goals and preferences, but typically felt compelled to accept this as the status quo and focus on finishing their PhDs [ 42 ]. DRs resignation was such that they internalised this culture of silence and silenced themselves; tending to share litanies of problems with supervisors whilst prefacing or ending the statements with some contradictory or undermining phrase such as ‘but that’s okay’ [ 42 , 52 ].

The apparent lack of self-agency extended outward from the PhD into DRs not feeling able to curate positive life circumstances more generally [ 76 ]. A lack of time was perhaps the key struggle across both personal and professional domains, yet DRs paradoxically reported spending a lot of time procrastinating and rarely (if ever) mentioned time management as a necessary or desired coping strategy for the problem of having too little time [ 46 ]. The lack of self-agency was not only current but also felt in reference to a bleak and uncertain future; DRs lack of surety in a future in academia and the resultant sense of futility further undermined their motivation to engage currently with PhD tasks [ 38 , 40 ].

The system is sick

The higher-order theme ‘The system is sick’ represents systemic influences on DR mental health. First, ‘Most everyone’s mad here’ reflects the perceived ubiquity mental health problems amongst DRs. ‘Emperor’s new clothes’ reflects the DR experience of engaging in a performative piece in which they attempt to live in accordance with systemic rather than personal values. Finally, ‘Beware the invisible and visible walls’ reflects concerns with being caught between ephemeral but very real institutional divides.

Most everyone’s mad here

No studies focused explicitly on experiences of DRs who had been given diagnoses of mental health problems. Some study participants self-disclosed mental health problems and emphasised their pervasive impact [ 50 ]. Further lived experiences of mental distress in the absence of explicit disclosure were also clearly identifiable. The ‘typical’ presentation of DRs with respect to mental health appeared characterised as almost unanimous [ 39 ] accounts of chronic stress, anxiety and depression, emotional distress including frustration, anger and irritability, lack of mental and physical energy, somatic problems including appetite problems, headaches, physical pain, nausea and problems with drug and alcohol abuse [ 39 , 46 , 59 , 76 ]. Health anxiety, concerns regarding perceived new and unusual bodily sensations and perceived risks of developing stress-related illnesses were also common [ 46 , 59 , 76 ]. A PhD-specific numbness and hypervigilance was also reported, in which DRs might be less responsive to personal life stressors but develop an extreme sensitivity and reactivity to PhD-relevant stimuli [ 39 ].

An interplay of trait and state factors were suggested to underlie the perceived ubiquity of mental health problems amongst DRs. Etiological factors associated with undertaking a PhD specifically included the high workload, high academic standards, competing personal and professional demands, social isolation, poor resources in the university, poor living conditions and poverty, future and career uncertainty [ 36 , 41 , 43 , 46 , 49 , 76 ]. The ‘nexus’ of these factors was such that the PhD itself acted as a crucible; a process of such intensity that developing mental health problems was perhaps inevitable [ 39 ].

The perceived inevitability of mental health problems was such that DRs described people who did not experience mental health problems during a PhD as ‘lucky’ [ 39 ]. Supervisors and the wider academic system were seen to promote an expectation of suffering, for example, with academics reportedly normalising drug and alcohol problems and encouraging unhealthy working practices [ 39 ]. Furthermore, DRs felt that academics were uncaring with respect to the mental challenge of doing a PhD [ 39 ]. Nevertheless, academics were suggested to deny any culpability or accountability for mental health problems amongst DRs [ 39 , 59 , 74 ]. The cycle of indigenousness was further maintained by a lack of mental health literacy and issues with awareness, availability and access to help-seeking and treatment options amongst DRs and academics more widely [ 39 ]. Thus, DRs appeared to feel they were being let down by a system that was almost set up to cause mental distress, but within which there was a widespread denial of the size and scope of the problem and little effort put into identifying and providing solutions [ 39 , 59 ]. DRs ultimately felt that the systemic encouragement of unhealthy lifestyles in pursuit of academic success was tantamount to abuse [ 62 ].

A performance of optimum suffering

Against a backdrop of expected mental distress, DRs expressed their PhD as a performative piece. DRs first had to show just the right amount of struggle and difficulty; feeling that if they did not exhibit enough stress, distress and ill-health, their supervisors or the wider department might not believe they were taking their PhD seriously enough [ 40 ]. At the same time, DRs felt that their ‘researcher mettle’ was constantly being tested and they must rise to this challenge. This included first guarding against presenting oneself as intellectually inferior [ 36 ]. Yet it also seemed imperative not to show vulnerability more broadly [ 74 ]. Disclosing mental or physical health problems might lead not only to changed perceptions of the DR but to material disadvantage [ 74 ]. The poor response to mental health disclosures suggested to some DRs that universities might be purposefully trying to dissuade or discourage DRs with mental health problems or learning disabilities from continuing [ 74 ]. The performative piece is thus multi-layered, in that DRs must experience extreme internal psychological struggles, exhibit some lower-level signs of stress and fatigue for peer and faculty observance, yet avoid expressing any real academic or interpersonal weakness or the disclosure of any diagnosable disability or disease.

Emperor’s new clothes

DRs described feeling beholden to the prevailing culture in which it was expected to prioritise above all else developing into a competitive, self-promoting researcher in a high-performing research-active institution [ 39 , 42 ]. Supervisors often appeared the conduit for transmission of this academic ideal [ 74 ]. DRs felt reticent to act in any way which suggested that they did not personally value the pursuit of a leading research career above all else. For example, DRs felt that valuing teaching was non-conformist and could endanger their continuing success within their current institution [ 55 ]. Many DRs thus exhibited a sense of dissonance as their personal values often did not align with the institutional values they identified [ 74 ]. Yet DRs expressed a sense of powerlessness and a feeling of being ‘caught up’ in the values of the institution even when such values were personally incongruent [ 74 ]. The psychological toll of this sense of inauthenticity seemed high [ 55 ]. Where DRs acted in ways which ostensibly suggested values other than prioritising a research career, for example becoming pregnant, they sensed disapproval [ 76 ]. DRs also felt unable to challenge other ‘institutional myths’ for example, the perceived institutional denial of the duration of and financial struggle involved in completing a PhD [ 49 ]. There was a perceived tendency of academics to locate problems within DRs as opposed to acknowledging institutional or systemic inequalities [ 49 ]. DRs expressed strongly a sense in which there is inequity in support, resources and opportunities, yet universities were perceived as ignoring such inequity or labelling such divisions as based on meritocracy [ 36 , 74 ].

Beware the invisible and visible walls

DRs described the reality of working in academia as needing to negotiate a maze of invisible and visible walls. In the former case, ‘invisible walls’ reflect ephemeral norms and rules that govern academia. DRs felt that a big part of their continuing success rested upon being able to negotiate such rules [ 39 ]. Where rules were violated and explicit or implicit conflicts occurred, DRs were seen to be vulnerable to being caught in the ‘crossfire’ [ 36 ]. DRs identified academic groups and departments as being poor in explicitly identifying, discussing and resolving conflicts [ 37 ]. The intangibility of the ‘invisible walls’ gave rise to a sense of ambient anxiety about inadvertently transgressing norms and divides, such that some DRs reported behaving in ways that surprised even themselves [ 37 ].

Gendered and racial micropolitics of academic institutions were seen to manifest as more visible walls between people, with institutions privileging those with ‘insider’ status [ 36 ]. Women and people of colour typically felt excluded or disadvantaged in a myriad of observable and unobservable ways, with individuals able to experience both insider and outsider statuses simultaneously [ 36 , 37 ], for example when a male person of colour [ 36 ]. Female DRs suggested that not only must women prove themselves to a greater extent than men to receive equal access to resources, opportunities and acclaim but also are typically under additional pressure in both their professional and personal lives [ 37 , 52 , 76 ]. Women also felt that they had to take on more additional roles and responsibilities and encountered more conflicts in their personal lives compared to men [ 52 ]. Examples of professionally successful women in DRs’ departments were described as those who had crossed the divide and adopted a more traditionally male role [ 40 ]. Thus, being female or non-White were considered visible characteristics that would disadvantage people in the competitive academic environment and could give rise to a feeling of increased stress, pressure, role conflicts, and a feeling of being unsafe.

Seeing, being and becoming

The higher-order theme of ‘Seeing, being and becoming’ reflects protective and transformative influences on DR mental health. ‘De-programming’ refers to the DRs disentangling their personal beliefs and values from systemic values and also from their own tendency towards perfectionism. ‘The power of being seen’ reflects the positive impact on DR mental health afforded by feeling visible to personal and professional others. ‘Finding hope, meaning and authenticity’ refers to processes by which DRs can find or re-locate their own self-agency, purpose and re/establish a sense of living in accordance with their values. ‘The importance of multiple goals, roles and groups’ represents the beneficial aspects of accruing and sustaining multiple aspects to one’s identity and connections with others and activities outside the PhD. Finally, ‘The PhD as a process of transcendence’ reflects how the struggles involved in completing a PhD can be transformative and self-actualising.

De-programming

DRs reported being able to protect their mental health by ‘de-programming’ and disentangling their attitudes and practices from social and systemic values and norms. This disentangling helped negate DRs’ adopting unhealthy working practices and offered some protection against experiencing inauthenticity and dissonance between personal and systemic values.

First, DRs spoke of rejecting the belief that they should sacrifice or neglect personal relationships, outside interests and their self-identity in pursuit of academic achievement. DRs could opt-out entirely by choosing a ‘user-friendly’ programme [ 44 ] which encouraged balance between personal and professional goals, or else could psychologically reject the prevailing institutional discourse [ 40 ]. Rather than halting success, de-programming from the prioritisation of academia above all else was seen to be associated not only with reduced stress but greater confidence, career commitment and motivation [ 40 , 50 ]. It was also suggested possible to ‘de-programme’ in the sense of choosing not to be preoccupied by the ‘invisible walls’ of academia and psychologically ‘opt out’ of being concerned by potential conflicts, norms and rules governing academic workplace conduct [ 36 ]. Interaction with people outside of academia was seen to scaffold de-programming, by helping DRs to stay ‘grounded’ and offering a model what ‘normal’ life looks like. People outside of academia could also help DRs to see the truth by providing unbiased opinions regarding systemic practices [ 39 ].

A further way in which de-programming manifested was in DRs challenging their perfectionist beliefs. This include re-framing the goal as not trying to be the archetype of a perfect DR, and accepting that multiple demands placed on one individual invariably requires compromise [ 40 , 76 ]. DRs spoke of the need to conceptualise the PhD as a process, rather than just a product [ 46 , 82 ]. The process orientation facilitated framing of the PhD as just one-step in the broader process of becoming an academic as opposed to providing discrete evidence of worth [ 82 ]. Within this perspective, uncertainty itself could be conceived as a privilege [ 81 ]. The PhD was then seen as an opportunity rather than a test [ 37 , 46 ]. Moreover, the process orientation facilitated viewing the PhD as a means of growing into a contributing member of the research community, as opposed to needing to prove oneself to be accepted [ 82 ]. Remembering the temporary nature of the PhD was advised [ 45 ] as was holding on to a sense that not completing the PhD was also a viable life choice [ 76 ]. DRs also expressed, implicitly or explicitly, a decision to change their conceptualisation of themselves and their progress; choosing not to perceive themselves as stuck, but planning, learning and progressing [ 38 , 39 , 81 , 82 ]. This new perspective appeared to be helpful in reducing mental distress.

The power of being seen

DRs described powerful benefits to feeling seen by other people, including a sense of belonging and mattering, increased self-confidence and a sense of positive progress [ 37 ]. Being seen by others seems to provoke the genesis of an academic identity; it brings DRs into existence as academics. Being seen within the academic institution also supports mental health and can buffer emotional exhaustion [ 37 , 52 , 55 , 81 ]. DRs expressed a need to feel that supervisors, academics and peers were interested in them as people, their values, goals, struggles and successes; yet they also needed to feel that they and their research mattered and made a difference within and outside of the institution [ 42 , 52 , 81 ]. It was clear that DRs could find in their disciplinary communities the sense of belonging that often eluded them within their immediate departments [ 42 ]. Feeling a sense of belonging to the academic community seemed to buffer disengagement and amotivation during the PhD [ 81 ]. Positive engagement with the broader community was scaffolded by a sense of trust in the supervisor [ 81 ]. DRs often felt seen and supported by postdocs, especially where supervisors appeared absent or unsupportive [ 50 ].

Spending time with peers could be beneficial when there was a sense of shared experience and walking alongside each other [ 39 ]. Friendship was seen to buffer stress and protect against mental health problems through the provision of social and emotional support and help in identifying struggles [ 39 , 43 ]. In addition to relational aspects, the provision of designated physical spaces on campus or in university buildings also seemed important to being seen [ 37 ]. Peers in the university could provide DRs with further physical embodiments of being seen, for example, gift-giving in response to their birthdays or returning from leave [ 37 , 50 ]. Outside of the academic institution, DRs described how being seen by close others could support DRs to be their authentic selves, providing an antidote to the invisible walls of academia [ 50 ]. Good quality friendships within or outside academia could be life-changing, providing a visceral sense of connection, belonging and authenticity that can scaffold positive mental health outcomes during the PhD [ 39 ]. Pets could also serve to help DRs feel seen but without needing to extend too much energy into maintaining social relationships [ 50 ].

Finally, DRs also needed to see themselves, i.e. to begin to see themselves as burgeoning academics as opposed to ‘just students’ [ 81 ]. Feeling that the supervisor and broader academic community were supportive, developing one’s own network of process collaborators and successfully obtaining grant funding seemed tangible markers that helped DRs to see themselves as academics [ 37 , 81 ]. Seeing their own work published was also helpful in providing a boost in confidence and being a joyful experience [ 42 ]. Moreover, with sufficient self-agency, DRs can not only see themselves but render themselves visible to other people [ 37 ].

Multiple goals, roles and groups

In antidote to the diminished personal identity and enmeshment with the PhD, DRs benefitted from accruing and sustaining multiple goals, roles, occupations, activities and social group memberships. Although ‘costly’ in terms of increased stress and role conflicts, sustaining multiple roles and activities appeared essential for protecting against mental health problems [ 50 , 68 ].

Leisure activities appeared to support mental health through promoting physical health, buffering stress, providing an uplift to DRs’ mood and through the provision of another identity other than as an academic [ 44 , 50 , 76 ]. Furthermore, engagement in activities helped DRs to find a sense of freedom, allowing them to carve up leisure and work time and psychologically detach from their PhD [ 68 , 76 ]. Competing roles, especially family, forced DRs to distance themselves from the PhD physically which reinforced psychological separation [ 50 , 59 ]. Engaging in self-care and enjoyable activities provided a sense of balance and normalcy [ 39 , 44 , 68 ]. This normalcy was a needed antidote to abnormal pressure [ 59 ]. Even in the absence of fiercely competing roles and priorities, DRs still appeared to benefit from treating their PhD as if it is only one aspect of life [ 59 ]. Additional roles and activities reduced enmeshment with the PhD to the extent that considering not completing the PhD was less averse [ 40 ]. This position appeared to help DRs to be less overwhelmed and less sensitive to perceived and anticipated failures.

Finding hope, meaning and authenticity

Finding hopefulness and meaning within the PhD can scaffold a sense of living a purposeful, enjoyable, important and authentic life. Hopefulness is predicated on the ability to identify a goal, i.e. to visualise and focus on the desired outcome and to experience both self-agency and potential pathways towards the goal. Hopefulness was enhanced by the ability to break down tasks into smaller goals and progress in to ‘baby steps’ [ 38 , 59 ]. In addition, DRs benefitted from finding explicit milestones against which they can compare their progress [ 59 ], as this appeared to feed back into the cycle of hopeful thinking and spur further self-agency and goal pursuit.

The experience of meaning manifested in two main ways; first as the more immediate lived experience of passion in action [ 76 ]. Secondly, DRs found meaning in feeling that in their PhD and lives more broadly they were living in accordance with their values, for example, experiencing their own commitment in action through continuing to work on their PhD even when it was difficult to do so [ 76 ]. DRs who were able to locate their PhD within a broader sense of purpose appeared to derive wellbeing benefits. There was a need to ensure that values were in alignment, for example, finding homeostasis between emotional, intellectual, social and spiritual parts of the self [ 46 , 59 , 90 ].

The processes of finding hopefulness and meaning appear to be largely relational. Frequent contact with supervisors in person and social and academic contact with other DRs were basic scaffolds for hope and meaning [ 52 ]. DRs spoke of how a sense that their supervisors believed in them inspired their self-agency and motivation [ 42 , 62 , 76 ]. Partners, friends and family could also inspire motivation for continuing in PhD tasks [ 44 , 76 ]. Other people also could help instil a sense of motivation to progress and complete the PhD; a sense of being seen is to be beholden to finish [ 39 ]. Meaning appeared to be scaffolded by a sense of contribution, belonging and mattering [ 81 ] and could arise from the perception of putting something into the collective pot, inspiring hopefulness and helping others [ 39 , 42 ]. Moreover, hopefulness, meaning and authenticity also appeared mutually reinforcing [ 81 ]. Finding meaning and working on a project which is in accordance with personal values, preferences and interests is also helpful in completing the PhD and provides a feedback loop into hope, motivation and agentic thinking [ 39 , 81 ]. Furthermore, DRs could use agentic action to source a community of people who share their values, enabling them to engage in collective authenticity [ 39 ].

The PhD as a process of transcendence

The immense challenge of the PhD could be a catalyst for growth, change and self-actualisation, involving empowerment through knowledge, self-discovery, and developing increased confidence, maturity, capacity for self-direction and use of one’s own autonomy [ 44 , 82 ]. The PhD acted as a forge in which DRs were tested and became remoulded into something greater than they had been before [ 44 , 82 , 90 ]. The struggles endured during the PhD caused DRs to reconsider their sense of their own capacities, believing themselves to be more able than they previously would have thought [ 50 ]. The struggles endured added to the sense of accomplishment. A trusted and trusting supervisor appears to aid in the PhD being a process of transcendence [ 62 ].

More broadly, the PhD also helped DRs to transcend personal tragedy, allowing immersion in a meaningful activity which begins as a means of coping and becomes something completely [ 39 ]. The PhD could also serve as a transformative selection process for DRs’ social relationships, with some relationships cast aside and yet others formed anew [ 39 ]. Overall, therefore, the very aspects of the PhD which were challenging, and distressing could allow DRs to transcend their former selves and, through the struggle, become something more.

Summation of results

The findings regarding the risk and protective factors associated with DR mental health have been summarised in Table 3 in relation to (1) the type of research evidencing the factor (i.e. whether the evidence is quantitative only, part of the meta-synthesis only, or evident in both results sections); and (2) the volume of evidence (i.e. whether the factor was found in a single study or across multiple studies). The factors in the far-right column (i.e. the factors found across multiple research studies utilising both qualitative and quantitative methods) are the ones with the strongest evidence at present.

This systematic review summarises a heterogeneous research area, with the aim of understanding the mental health of DRs, including possible risk and protective factors. The qualitative and quantitative findings presented here suggest that poor mental health is a pertinent problem facing DRs; stress appears to be a key issue and significantly in excess of that experienced in the general population. Several risk and protective factors at the individual, interpersonal and systemic levels emerged as being important in determining the mental health of DRs. The factors with the strongest evidence-base (i.e. those supported by multiple studies using qualitative and quantitative findings) denote that being female and isolated increases the risk of the mental health problems, whereas seeing the PhD as a process, feeling socially supported, having a positive supervisor relationship and engaging in self-care is protective.

Results in context

Stress can be defined as (1) the extent to which a stimulus exerts pressure on an individual, and their propensity to bear the load; (2) the duration of the response to an aversive stimuli, from initial alert to exhaustion; or (3) a dynamic (im)balance between the demands and personal resource to manage those demands [ 91 ]. The Perceived Stress Scale (PSS) [ 18 , 19 ] used in our meta-analysis is aligned with the third of these definitions. As elaborated upon within the Transactional Model of Stress [ 92 ], stress is conceptualised as a persons’ appraisal of the internal and external demands put upon them, and whether these exceed their available resources. Thus, our results suggest that, when compared to the general population, PhD students experience a greater maladaptive imbalance between their available resources and the demands placed upon them. Stress in itself is not a diagnosable mental health problem, yet chronic stress is a common precipitant to mental health difficulties such as depression and posttraumatic stress disorder [ 93 , 94 ]. Therefore, interventions should seek to bolster DRs’ resources and limit demands placed on them to minimise the risks associated with acute stress and limit its chronicity.

Individual factors

Female DRs were identified as being at particular risk of developing mental health difficulties. This may result from additional hurdles when studying in a male-dominated profession [ 95 , 96 , 97 ], and the expectation that in addition to their doctoral studies, females should retain sole or majority responsibility for the domestic and/or caring duties within their family [ 52 , 76 ]. It may also be that females are more willing to disclose and seek help for mental health difficulties [ 98 ]. Nevertheless, the World Health Organisation (WHO) mental health survey results indicate that whilst anxiety and mood disorders are more prevalent amongst females, externalising disorders are more common in males [ 99 ]. As the vast majority of studies in this review focussed on internalising problems (e.g. stress, anxiety and depression) [ 37 , 64 , 79 , 80 , 83 , 89 ], this may explain the gender differences found in this review. Further research is needed to explore which perspective, if any, may explain gender gap in our results.

Perhaps unsurprisingly, self-care was associated with reduced mental health problems. The quantitative findings suggest that all types of self-care are likely to be protective of mental health (i.e. physical, emotional, professional and spiritual self-care). Self-care affords DRs the opportunity to take time away from their studies and nurture their non-PhD identities. However, the results from our meta-synthesis suggest that DRs are not attending to their most basic needs much less engaging in self-care behaviours that correspond to psychological and/or self-fulfilment needs [ 100 ]. Consequently, an important area for future enquiry will be identifying the barriers preventing DRs from engaging in self-care.

Interpersonal factors

Across both quantitative and qualitative studies, interpersonal factors emerged as the most salient correlate of DR mental health. That is, isolation was a risk factor, whereas connectedness to others was a protective factor. There was some variability in how these constructs were conceptualised across studies, i.e. (1) isolation: a lack of social support, having fewer social connections, feeling isolated or being physically separate from others; and (2) social connectedness: multiple group membership, academic relationships or non-academic relationships; but there was no indication that effects varied between concepts. The relationship between isolation and negative health consequences is well-established, for example both physical and mental health problems [ 101 ], and even increased mortality [ 102 ]. Conversely, social support is associated with reduced stress in the workplace [ 103 , 104 ]. Reducing isolation is therefore a promising interventional target for improving DRs’ mental health.

The findings regarding isolation are even more alarming when considered alongside the findings from several studies that PhD studies are consistently reported to dominate the lives of DRs, resulting in poor ‘work-life balance’ and losing non-PhD aspects of their identities. The negative impact of having fewer identities [ 105 ] can be mitigated by having a strong support network [ 106 ], and increasing multiple group memberships [ 107 ]. But for DRs, it is perhaps the absence of this social support, combined with identity impoverishment, which can explain the higher than average prevalence of stress found in our meta-analysis.

Systemic factors

DRs’ attitudes towards their studies may be a product of top-down systemic issues in academia more broadly. Experiencing mental health problems was reported as being the ‘norm’, but also appeared to be understood as a sign of weakness. The meta-synthesis results suggest that DRs believed their respective universities prioritise academic success over workplace wellbeing and encourage unhealthy working habits. Working in an unsupportive and pressured environment is strongly associated with negative psychological outcomes, including increased depression, anxiety and burnout [ 108 ]. The supervisory relationship appeared a particularly important aspect of the workplace environment. The quantitative analysis found a negative correlation between inspirational supervision and mental health problems. Meta-synthetic finding suggested toxic DR-supervisor relationships characterised by powerlessness and neglect, as well as relationships where DRs felt valued and respected—the former of these being associated with poor mental health, and the latter being protective. The association between DR-supervisor relationship characteristics needs to be verified using quantitative methods. Furthermore, DRs’ sense that they needed to exhibit ‘optimum suffering’, which appears to reflect a PhD-specific aspect of a broader academic performativity [ 109 ], is an important area for consideration. An accepted narrative around DRs needing to experience a certain level of dis/stress would likely contribute to poor mental health and as an impediment to the uptake and effectiveness of proffered interventions. Although further research is needed, it is apparent that individual interventions alone are not sufficient to improve DR mental health, and that a widespread culture shift is needed in order to prevent the transmission of unhealthy work attitudes and practices.

Limitations of the literature

Although we found a respectable number of articles in this area, the focus and measures used varied to the extent that typical review analysis procedures could not be used. That is, there was much heterogeneity in terms of how mental health was conceptualised and measured, as well as the range of risk and protective factors explored. Similarly, the quality of the studies was hugely variable. Common flaws amongst the literature include small sample sizes, the use of unvalidated tools and the incomplete reporting of results. Furthermore, for qualitative studies specifically, there appeared to be a focus on breadth instead of depth, particularly in relation to studies using mixed methods.

The generalisability of our findings is limited largely due to the lack of research conducted outside of the US, but also because we limited our review to papers written in English only. The nature of doctoral studies varies in important ways between studies. For example, in Europe, PhD studies usually apply for funding to complete their thesis within 3–4 years and must know their topic of interest at the application stage. Whereas in the US, PhD studies usually take between 5 and 6 years, involve taking classes and completing assignments, and the thesis topic evolves over the course of the PhD. These factors, as well as any differences in the academic culture, are likely to affect the prevalence of mental health problems amongst DRs and the associated risk and protective factors. More research is needed outside of the US.

‘Mental health’ in this review was largely conceptualised as a type of general wellbeing rather than a clinically meaningful construct. None of the studies were ostensibly focused on sampling DRs who were currently experiencing or had previously experienced mental health problems per se, meaning the relevance of the risk, vulnerability and protective factors identified in the meta-synthesis may be more limited in this group. Few studies used clinically meaningful measures. Where clinical measures were used, they captured data on common mental health problems only (i.e. anxiety and depression). Due to these limitations, we are unable to make any assertions about the prevalence of clinical-level mental health problems amongst DRs.

Limitations of this review

As a result of the heterogeneity in this research area, some of the results presented within this review are based on single studies (e.g. correlation data; see Fig. 5 ) rather than the amalgamation of several studies (e.g. meta-analysis/synthesis). To aid clarity when interpreting the results of this review, we have (Table 3 ) summarised the volume of evidence supporting risk and protective factors. Moreover, due to the small number of studies eligible for inclusion in this review, we were unable to test whether any of our findings are related to the study characteristics (e.g. year of publication, country of origin, methodology).

We were able to conduct three meta-analyses, one of which aimed to calculate the between-group effect size on the PSS [ 18 , 19 ] between DRs and normative population data. Comparing these data allowed us to draw some initial conclusions about the prevalence of stress amongst DRs, yet we were unable to control for other group differences which might moderate stress levels. For example, the population data was from people in the United States (US) in 1 year, whereas the DR data was multi-national at a variety of time points; and self-reported stress levels may vary with nationality [ 110 ] or by generation [ 111 , 112 ]. Moreover, two of the three meta-analyses showed significant heterogeneity. This heterogeneity could be explained by differences in the sample characteristics (e.g. demographics, country of origin), doctoral programme characteristics (e.g. area of study, funding status, duration of course) or research characteristics (e.g. study design, questionnaires used). However, due to the small number of studies included in these meta-analyses, we were unable to test any of these hypotheses and are therefore unable to determine the cause of this heterogeneity. As more research is conducted on the mental health of DRs, we will be able to conduct larger and more robust meta-analyses that have sufficient power and variance to statistically explore the causes of this heterogeneity. At present, our findings should be interpreted in light of this limitation.

Practice recommendations

Although further research is clearly needed, we assert that this review has identified sufficient evidence in support of several risk and protective factors to the extent that they could inform prevention and intervention strategies. Several studies have evidenced that isolation is toxic for DRs, and that social support can protect against poor mental health. Initiatives that provide DRs with the opportunity to network and socialise both in and outside of their studies are likely to be beneficial. Moreover, there is support for psychoeducation programmes that introduce DRs to a variety of self-care strategies, allow them to find the strategies that work for them and encourage DRs to make time to regularly enact their chosen strategies. Finally, the supervisory relationship was identified as an important correlate of DR mental health. Positive supervision was characterised as inspirational and inclusive, whereas negative supervision productised DRs or neglected them altogether. Supervisor training programmes should be reviewed in light of these findings to inform how institutions shape supervisory practices. Moreover, the initial findings reported here evidence a culture of normalising and even celebrating suffering in academia. It is imperative therefore that efforts to improve and protect the mental health of DRs are endorsed by the whole institution.

Research recommendations

First, we encourage further large-scale mental health prevalence studies that include a non-PhD comparison group and use validated clinical tools. None of the existing studies focused on the presence of serious mental health problems—this should be a priority for future studies in this area. Mixed-methods explorations of the experiences of DRs who have mental health problems, including serious problems, and in accessing mental health support services would be a welcome addition to the literature. More qualitative studies involving in-depth data collection, for example interview and focus group techniques, would be useful in further supplementing findings from qualitative surveys. Our review highlights a need for better communication and collaboration amongst researchers in this field with the goal of creating a level of consistency across studies to strengthen any future reviews on this subject.

The results from this systematic review, meta-analysis and meta-synthesis suggest that DRs reported greater levels of stress than the general population. Research regarding the risk and protective factors associated with the mental health of DRs is heterogenous and disparate. Based on available evidence, robust risk factors appear to include being isolated and being female, and robust protective factors include social support, viewing the PhD as a process, a positive DR-supervisor relationship and engaging in self-care. Further high-quality, controlled research is needed before any firm statements can be made regarding the prevalence of clinically relevant mental health problems in this population.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Confidence intervals

Doctoral researchers

Higher Education Statistics Agency

Perceived Stress Scale

Standard deviation

United Kingdom

United States

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Acknowledgements

Thank you to the Office for Students for their funding to support this work; and thank you to the University of Sussex Doctoral school and our steering group for championing and guiding the ‘Understanding the mental health of Doctoral Researchers (U-DOC)’ project.

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CH contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. LC contributed to the data curation, investigation, project administration, validation and writing—review and editing of this paper. SV contributed to the data curation, formal analysis, investigation, project administration, validation and writing—review and editing of this paper. PR contributed to the funding acquisition, project administration, supervision and writing—review and editing of this paper. JN contributed to the conceptualisation, funding acquisition, methodology, project administration, supervision, validation, writing—original draft preparation and writing—review and editing of this paper. CB contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. The author(s) read and approved the final manuscript.

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Hazell, C.M., Chapman, L., Valeix, S.F. et al. Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis. Syst Rev 9 , 197 (2020). https://doi.org/10.1186/s13643-020-01443-1

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Social predictors of doctoral student mental health and well-being

1 School of International Studies, Binzhou Medical University, Shandong, China

2 Department of Instructional Technology and Learning Sciences, Utah State University, Logan, Utah, United States of America

Kaylee Litson

David f. feldon, associated data.

All data and analysis files are publicly available on Open Science Framework ( https://osf.io/p7vje/ ).

Graduate students’ mental health and well-being is a prominent concern across various disciplines. However, early predictors of mental health and well-being in graduate education, specifically doctoral education, have rarely been studied. The present study evaluated both the underlying latent classification of individuals’ mental well-being and predictors of those classifications. Results estimated two latent classes of students’ mental health and well-being: one class with generally high levels of mental well-being and one with lower levels of mental well-being. Regression analyses showed that mentoring in the second year of doctoral study, certainty of choice in the third year, and both academic development and sense of belonging in the fourth year were positive predictors of membership in the higher mental well-being class. In contrast to some prior studies, demographic variables were not related to the identified well-being classifications. Regression analyses further showed that mental well-being was negatively related to participants’ number of publications and research self-efficacy, indicating a problematic relationship between scholarly productivity and confidence and well-being. These findings may be used to identify and provide targeted support for students who are at-risk for having or developing lower levels of mental well-being in their graduate programs.

Introduction

Mental health and well-being is an increasingly prominent concern in graduate education [ 1 ]. Sixty-eight percent of university presidents acknowledged that, during the COVID-19 pandemic, student mental health ranked among their most pressing issues [ 2 ]. Doctoral students are an at-risk population with respect to mental health, illustrated by a study of over two thousand Ph.D. students showing that students in graduate programs are six times as likely as the general population to experience both depression and anxiety [ 3 ]. Similarly, recent literature reported high levels of burnout and mental health problems in doctoral biomedical students [ 4 , 5 ]. Further, doctoral students’ research activity may exacerbate depression [ 6 ]. The National Academies of Sciences, Engineering, and Medicine [ 7 ] recently released results of an 18-month survey on mental health, substance abuse, and well-being in higher education, and urged institutions, faculty, and staff to take action in facilitating and addressing the substantial mental health and well-being concerns of students within higher education.

Graduate students, especially doctoral students, report stressors such as peer pressure [ 8 ], high workload [ 9 , 10 ], feelings of uncertainty [ 11 ], lack of work-life balance [ 3 ], and unproductive mentor-mentee relationships [ 12 ]. However, experiences of social support [ 13 , 14 ], academic engagement, financial stability [ 15 , 16 ], appropriate work–life balance [ 17 ], and satisfactory supervisory relationships [ 18 ] show positive effects on mental well-being either directly or through their mitigation of external stressors. Similarly, a sense of belonging to department, degree program, or laboratory, mitigates negative mental health symptoms [ 18 , 19 ] and correlates positively with academic success and mental well-being [ 20 ]. To date, it is unclear when and how such supportive structures impact students’ mental well-being as they navigate through graduate education.

Accordingly, understanding the ways in which aspects of doctoral students’ experiences impact mental well-being is vitally important to assess potential harms or identify positive influences in graduate education processes and structures. Social-environmental factors are highly influential, because socio-psychological well-being hinges on “having supportive and rewarding relationships, contributing to the happiness of others, and being respected by others” (p. 144) [ 8 ]. To link the mechanisms and functions of graduate socialization and well-being, this study examines 1) which social-environmental factors impact doctoral student mental health and 2) when during doctoral study do these factors have the largest impact on doctoral student mental health. Specifically we examine the patterns and predictors of Ph.D. student mental well-being in their fifth year of doctoral education by evaluating latent profiles of mental well-being and assessing which factors over time predict students’ membership within those profiles.

Socialization as a framework for understanding doctoral student experiences

Graduate socialization is defined as “a process of internalizing the expectations, standards, and norms of a given society (discipline), which includes learning the relevant skills, knowledge, habits, attitudes, and values of the group that one is joining” [ 21 ]. This process typically unfolds over time as students engage in coursework and supervised research. As students acquire more knowledge and personal autonomy over their research, they gradually internalize a scholarly identity and take on the role of independent scholar. However, individual experiences in these settings vary widely, and maladaptive socialization experiences—such as lack of social support, lack of sense of belonging to departments or labs, and unsatisfactory mentor-mentee relationships—can introduce difficulties or completely derail progress toward degree attainment. Such maladaptive experiences are reported across students from all backgrounds, but those from historically marginalized demographic groups (e.g., women, first-generation college students, people of color) are significantly more likely to experience such difficulties [ 22 – 26 ].

Multiple individuals play important roles in doctoral student socialization. The primary faculty advisor or supervisor (also referred to as “principal investigator” [PI] in some disciplines due to their provision of grant-funded research opportunities and monetary support for the students they supervise) is often considered to have the greatest influence on socialization, due to their direct oversight of students’ scholarly activities and access to resources that shape the development of a research career [ 27 , 28 ]. Similarly, departmental structures and supports can impact the ease and clarity with which students navigate degree requirements [ 29 ]. Further, peer interactions both within and outside the immediate research environment can impact day-to-day experiences that influence sense of belonging and emotional well-being [ 30 ].

Predictors of doctoral student mental health

Correlative and predictive studies of graduate and doctoral student mental health have identified multiple relationships with socialization factors. For example, detachment from program activities and negative perceptions of campus atmosphere increase graduate students’ stress levels [ 31 ]. Likewise, 44% of doctoral students in another study regarded positive academic socialization as empowering, which correlated positively with research performance and negatively with stress and anxiety [ 32 ]. However, doctoral students also identify anxiety related to uncertainty regarding the quality and quantity of their scholarly work as common challenges to their mental health and well-being [ 33 ].

Mentorship by supervising faculty likewise plays a major role in graduate, especially doctoral, students’ well-being. High quality mentorship is associated with high levels of mental well-being and life satisfaction, while low quality mentorship can result in stress and depletion [ 32 , 34 , 35 ]. Positive supervisory faculty relationships are closely associated with increased self-efficacy [ 36 ], which, in turn, has a positive relationship with mental well-being [ 37 , 38 ]. Moreover, McAlpine and McKinnon [ 39 ] found that when doctoral mentors did not intellectually support students’ work, those students reported elevated levels of both frustration and isolation.

Some studies have suggested that gender and other identity-based demographic characteristics may exacerbate mental health challenges and affect perceived fit in graduate school. Evans et al. [ 3 ] reported that transgender students and cis-gendered women were significantly more likely to experience anxiety and depression than cis-gendered men. Likewise, the well-being of women in doctoral programs was hindered by the conflicts they perceived between their own values and priorities and the social structures they depended on [ 8 ]. Other external stressors, such as conflicting responsibilities [ 40 ], and difficulties in navigating institutional climate [ 41 , 42 ] might deliver more challenges to women compared to men and result in lower level of life satisfaction and mental well-being. International students also encounter elevated stress and mental health challenges due to social isolation and pressures to adapt to new cultural norms [ 43 , 44 ]. Some frequently mentioned stressors that lead to mental health and well-being problems for international students include acculturation difficulties [ 45 – 47 ], lack of social and financial support [ 48 , 49 ], perceived discrimination [ 50 ] and marginalization [ 51 , 52 ].

Current study

Despite high levels of concern, most work previously conducted has evaluated predictors and correlates of mental health and well-being within cross-sectional research. As such, there is little known about the antecedents of mental health and well-being as a function of students’ specific experiences within their doctoral training over time, specifically identifying early predictors that might impact doctoral students’ positive or negative mental well-being. Using the lens of graduate socialization theory in this study [ 53 , 54 ], we use a latent profile approach to identify distinct subpopulations on the basis of mental health and well-being, then examine potential predictors and outcomes of latent profile membership based on primary mechanisms of socialization within doctoral programs.

In the biological sciences, most fifth year Ph.D. students have finished coursework and are working on their dissertations with an eye toward upcoming career opportunities. Consequently, it is a period of multiple potentially stressful transitions and events. For most people, such periods of transition often exacerbate mental health struggles [ 55 ]. Thus, the present study has several specific aims: First, based on responses to a survey assessing mental health and well-being, we assess the number of latent profiles that best characterize mental well-being within our national sample. Second, we assess the likelihood of profile membership as a function of demographic variables such as gender, first-generation student status, race/ethnicity, and international student status. Third, we examine the ability of key socialization variables to predict the likelihood of mental health profile membership, including sense of belonging, commitment to degree completion, academic and intellectual development, and mentoring relationships. Lastly, we assess the extent to which mental health profile membership was differentially predicted by academic outcomes, including research skill development, publication output, research self-efficacy, and program attrition.

Materials and methods

Utah State University IRB has approved our research involving human participants. IRB number is 9317. The written form of consent has obtained.

Participants and procedures

This study was part of a larger, longitudinal study on Ph.D. student skill development in cellular and molecular biological sciences. Participants were recruited upon entering their doctoral programs in the Fall of 2014 and screened upon entering the study to ensure they met the study criteria of being a doctoral student in the biological sciences in the United States (more information about study criteria can be found in [ 56 ]). In total, 336 participants were recruited from 53 institutions across the United States. Of the institutions represented, 42 are classified as R1 (highest research activity), 7 institutions are R2 (higher research activity), and the remaining 4 institutions fall in other Carnegie categories (i.e., Doctoral/Professional Universities).

The present study utilized demographic data collected at the outset of the study, as well as students’ self-reported sense of belonging, certainty of choice, academic development, and mentoring satisfaction collected in the second, third, and fourth year of doctoral study as predictors. The present study further used students’ self-reported mental well-being data collected in students’ fifth year of doctoral study as the primary outcome.

Participants were recruited through one of two methods. First, department chairs and program directors for the 100 largest biological sciences Ph.D. programs across the U.S. were contacted and asked to inform entering doctoral students of the study. Second, emails were sent to listservs relevant to doctoral students in the sciences. To incentivize study participation, students received a $400 annual payment. The full procedure was approved by the Utah State University Institutional Review Board. Participants completed an annual battery of surveys, in addition to providing writing samples and an account of their scholarly productivity each year.

During the first year of the study, students completed a demographic questionnaire that included questions about their race/ethnicity, gender, parents’ education level, and international student status. Each year, participants completed annual surveys about their experiences and productivity. Participants were excluded if they did not respond to at least one item on the mental well-being questionnaire used in the present study, thus a total of N = 206 doctoral students were included in the present study. Participants included 40% men, 60% women, and less than 1% non-binary persons; 83% white and Asian students, 17% racially/ethnically minoritized students; 73% continuing-generation students, 27% first-generation students; and 79% domestic students, 21% international students. When assessing the gender and generation status composition across race/ethnicity, the sample included 31 women and 19 men from Black, Latino/a, and Native groups, and 139 women and 84 men from white and Asian groups, 44 women and 30 men who were first-generation college students, and 126 women and 73 men who were continuing-generation college students.

Demographics

Students indicated their race/ethnicity by selecting one or more of the following: American Indian or Alaska Native; Asian or Asian American; black or African American; Latino/a; Native Hawaiian or other Pacific Islander; white. Students’ responses were aggregated to create a measure of racially/ethnically minoritized status (RMS), where students who selected only a white and/or Asian identity were coded as majority; all other students were coded as RMS (0 = majority; 1 = RMS). To evaluate gender, students self-reported their gender as female, male, and/or other/nonbinary (female = 0; male = 1, other/nonbinary = 2). To evaluate which students were first- compared to continuing-generation college students, students were asked to indicate the highest degree obtained by their parent(s); students who had no parent with a 4-year college degree were coded as first-generation (0 = continuing-generation; 1 = first-generation). Finally, students self-reported whether or not they were an international student (0 = no; 1 = yes).

Mental health and well-being

Mental health according to the American Psychological Association, is defined as “a state of mind characterized by emotional well-being, good behavioral adjustment, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life.” [ 57 ] In the current study, mental well-being was assessed using both a scale of items and a general single-item. The scale of items included 8 items related to mental well-being [ 58 ]:

• I lead a purposeful and meaningful life.
• My social relationships are supportive and rewarding.
• I am engaged and interested in my daily activities.
• I actively contribute to the happiness and well-being of others.
• I am competent and capable in the activities that are important to me.
• I am a good person and live a good life.
• I am optimistic about my future.
• People respect me.

Items were evaluated on a 5-point Likert scale, from 1 = Strongly disagree to 5 = Strongly agree . Assuming a single factor structure, the composite reliability was very good (McDonald’s Ω = 0.91). In addition to the mental well-being scale, participants were asked the single question about their mental health “In general, how is your mental health?” with responses ranging from 1 = Poor to 5 = Excellent . This single item was evaluated in all analyses that included the pre-established measure of mental well-being to evaluate a more robust construction of self-reported mental health alongside mental well-being.

Sense of belonging

Sense of belonging to a lab is a subscale of three items from Bollen & Hoyle [ 59 ], with an example item of “I see myself as part of the lab/research group community” measured on an 11-point scale with responses ranging from 0 = Strongly disagree , 5 = Neutral , to 10 = Strongly agree . Within the present study, this scale showed high reliability, McDonald’s Ω = 0.96.

Certainty of choice

Certainty of choice is a subscale of three items from Nora & Cabrera [ 60 ], with an example item of “I am certain this institution is the right choice for me” measured on a 3-point Likert scale with responses ranging from 1 = Strongly disagree , 2 = Neutral , to 3 = Strongly agree . Within the present study, this scale showed adequate reliability, McDonald’s Ω = 0.86.

Academic development and satisfaction

Academic development and satisfaction is a three item subscale from Nora & Cabrera [ 60 ], with an example item of “I am satisfied with my academic experience at this institution” measured on a 3-point scale with responses ranging from 1 = Strongly disagree , 2 = Neutral , to 3 = Strongly agree . Within the present study, this scale had adequate reliability, McDonald’s Ω = 0.87.

Mentoring relationships

Mentoring relationships were evaluated using 35 items from Graduate Advising Survey for Doctoral Students (GASDS) [ 61 ]. The scale utilized four subscales relevant for the doctoral-advisor mentoring relationship: advisor selection criteria (8 items), function of advisor (16 items), satisfaction with advisor (7 items), and time to degree (4 items). Item responses ranged from 1 = Disagree to 3 = Agree . Advisor selection criteria represents the match or fit between mentors and mentees, and an example item of this subscale is “My primary advisor is doing research that interests me.” Function of advisor represents actions an advisor does or does not do that impacts the advisee, and an example item of this subscale is “My primary advisor teaches me strategies for succeeding in my field.” Satisfaction with advisor exemplifies a mentee’s satisfaction with their primary advisor, and an example item of this subscale is “I currently have the primary advisor I want.” Time to degree is representative of the support structures implemented to help students progress toward their degree, with an example item being “How helpful has your primary advisor been to you in terms of progressing toward the completion of your degree?” Item subscales (average of each subscale) were evaluated in analyses.

Research skills

Year 5 research skills were measured by doctoral students’ sole-authored research paper that was submitted in their fifth year of doctoral study, and were not to have been edited or contributed to by others. Two independent reviewers rated each document on 12 research skills on a scale from 0 to 3.25 according to rubrics [ 56 , 62 , 63 ]. Interrater reliability as measured by intraclass correlations was good, 0.818 to 0.969. Skills included: introducing/setting the study in context (INT); appropriately integrating primary literature (LIT); establishing testable hypotheses (HYP); using appropriate experimental controls and replication (CTR); experimental design (EXP); selecting data for analysis (SEL); data analysis (ANA); presenting results (PRE); basing conclusions on results (CON); identifying alternative explanations of findings (ALT); identifying limitations of the study (LIM); discussing implications of the findings (IMP) [ 56 ]. Skills were evaluated as a composite score in the present study. More information about the measure of research skills are provided in detail in [ 56 ].

Publication output

A survey on the publication details of the participants was annually administered from year one to year six (2014–2020). Publications were assessed by whether a respondent has a publication or not in a given year (binary variable: 0 for no, and 1 for yes); the number of publications a respondent had each year; total number of authors for each publication; author number of the respondent on each publication (first author, second author, etc.); the titles and journal names of each publication, and the journal impact factor by year for each publication. The publications were then cross-checked with Web of Science and additional sources such as Google Scholar after data collection (see Roksa et al. [ 64 ] for more details). Publications within and up to year 5 were included in the present analyses.

Self-efficacy

Year 5 research self-efficacy was evaluated using the Research Experience Self-Rating Survey [ 65 ]. Questions from this survey asked students to self-rate their ability to perform ten specific research tasks on a 5-point Likert scale (1 = not at all to 5 = a great deal). Items include the ability to complete skills necessary for producing research publications, such as “To what extent do you feel you can understand contemporary concepts in your field?” and “To what extent do you feel you can statistically analyze data?”

Statistical analysis approach

The primary focus of the study was to examine correlates and predictors of mental health and well-being. We used a person-centered approach to first evaluate mental well-being in order to understand the extent to which we could classify individuals into groups with varying and potentially different responses to the mental well-being questions. Therefore, we first used latent profile analysis to identify latent subgroups of mental well-being and mental health. Latent profile analysis (LPA) is a person-centered quantitative approach used to identify unmeasured subgroups of participant responses to continuous items. Participants were then assigned to a profile with the highest likelihood of resembling their responses to the items, allowing for interpreting results in terms of categorical grouping differences.

After identifying and describing the number of latent profiles, we assigned individuals to profiles and evaluated predictors of the profiles using logistic regression analysis. Specifically, we ran nine logistic regression models to examine predictors of the latent profiles of mental health profiles. Model 1 evaluated static predictors of mental well-being classifications, such as gender, first-generation student status, racially minoritized student status, and international student status. Models 2 through 8 evaluated longitudinal predictors of mental well-being classifications, with Model 2 evaluating the doctoral students’ certainty of choice across years as predictors of mental well-being classifications, Model 3 evaluating Academic Development, Model 4 evaluating Sense of Belonging to a lab, Model 5 evaluating Advisor Selection Criteria, Model 6 evaluating Satisfaction with Advisor, Model 7 evaluating Function of Advisor, and Model 8 evaluating time to degree. Models 9, 10, and 11 respectively evaluated within time predictors of mental health and well-being, including number of publications, research self-efficacy, and research skills. For models that used repeated measures, predictors were evaluated as discrete variables (e.g., Year 2 Certainty of Choice was one variable and Year 3 Certainty of Choice was a separate variable) and were allowed to correlate across all time points. All analyses were conducted in M plus version 8.4 [ 66 ]. Missing data was handled using full information maximum likelihood with robust standard errors and Montecarlo integration in M plus .

The first step in our analyses entailed evaluation of statistical latent profile models, comparing alternatives that estimated from one to four classes. Next, logistic regression analyses were used to estimate the likelihood of belonging to one of the identified latent profiles as a function of independent variables of interest.

Identifying profiles of doctoral student mental health

Table 1 shows the model fit indices across these four models, and we evaluated these fit indices in combination with theoretical interpretability of the classes. When evaluating model fit, the Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test was used to evaluate the best-fitting model, likewise indicating that the 2-class model was better fitting than the one-class model (VLMR = -2399.49, p = .0014), but showing that the three-class model did not fit better than the two-class model. Additionally, the Bayesian Information Criteria (BIC) values continually decreased as more classes were added though the values flattened and created an “elbow” at the 2-class model. Entropy and classification indices were then evaluated, where values closer to 1.0 for both indicate greater accuracy of classification. Entropy was the highest for the two-class model at .95 and classification probabilities for classes 1 and 2 respectively were .97 and .99, indicating very good classification rates of individuals to latent classes. Thus, the two-class model was selected as the best-fitting model and was used in further analysis.

The two latent classes that emerged included a class with lower and more variable levels of well-being and a class with higher and more stable levels of well-being (see Fig 1 ). Specifically, all items showed higher mean values in the “higher well-being” profile ( n = 160) compared to the “lower well-being” profile ( n = 46). Notably, there is less variability and very high means in the high well-being class, indicating that most students in this class selected maximum values across mental well-being questions. Conversely, the lower mental well-being class showed greater variability in their average scores across items. We additionally evaluated latent profiles examining only the 8 items from mental well-being subscale [ 55 ], dropping the self-report mental health item. Results showed essentially the same two profiles. Participant classifications obtained from the 8-item LPA and the reported 9-item LPA were correlated at r = .989.

Items correspond to the order of items in the mental well-being scale in the methods section.

Predicting doctoral student mental health

Logistic regression analyses were used to assess socialization, skill, and demographic predictors of profile classification. Results were evaluated by examining the 95% confidence interval of the odds ratio (OR). Confidence intervals containing 1.0 indicated that the predictor did not differentially predict classification, while confidence intervals that did not contain 1.0 did differentially predict classification. Results ( Table 2 ) showed no differences in profile classification across gender in reference of men vs other genders (OR = 1.05, 95% CI [0.53, 2.07]), first-generation student status (OR = 0.87, 95% CI [0.45, 1.65]), underrepresented minority status (OR = 1.58, 95% CI [0.68, 3.68]), and international student status (OR = 1.01, 95% CI [0.48, 2.09]). Thus, no differences in the likelihood of being included within either of the mental well-being profiles were associated with demographic characteristics.

* = 95% CI does not contain 1.0. Results should be interpreted as follows: e.g., As certainty of choice in year 3 increases, the odds of being in the higher mental well-being profile are 2.56 that of being in the low mental well-being class.

Logistic regression analysis of socialization variables across years yielded many effects ( Table 2 ) that were determined interpretable. To better interpret values, results were all divided by 1 and interpreted accordingly. Certainty of choice in year 3 predicted differences in mental well-being profile classification (OR = 2.56, 95% CI [1.18, 5.59]), indicating that the odds of being in the higher well-being profile was 2.56 times that of being in the lower well-being profile. In year 4, both academic development (OR = 3.13, 95% CI [1.20, 8.20]) and sense of belonging (OR = 1.32, 95% CI [1.01, 1.69]) predicted differences in mental well-being profile classification. One facet of mentorship, satisfaction with advisor, in year 2 was the strongest predictor at the mental well-being classifications (OR = 4.35, 95% CI [1.18, 16.67]).

Logistic regression analysis to evaluate the association between doctoral students’ mental health membership and the number of peer-review publications in year five yielded significant results ( Table 3 ). The number of peer-review publications in year five was related to different mental well-being profile classifications (OR = 0. 61, 95% CI 0.40, 0.91]), indicating a negative association between higher mental well-being and the number of publications in the same year, and the odds for participants with more publications of being in the higher well-being profile was 0.61 times that of being in the lower well-being profile; alternatively, this can be interpreted as the odds for participants with more publications of being in the lower well-being profiles was 1.64 (1/0.61) times that of being in the higher well-being profile. When assessing the research self-efficacy in year five, results likewise showed negative relationships between research self-efficacy and mental well-being (OR = 0.23, 95% CI 0.14, 0.39]), and the odds of being in the higher well-being profile was 0.23 times that of being in the lower well-being profile; in other words, the odds of being in the lower well-being profile was 4.35 (1/0.23) times that of being in the higher well-being profile. Logistic regression analysis results showed that demonstrated research skills in year five did not differentially predict classification in doctoral students’ mental health and well-being.

* = 95% CI does not contain 1.0.

Discussion and conclusions

Results identified two stable profiles of doctoral student mental health and well-being, one that reflected consistently positive responses to each item included in the Diener et al. [ 58 ] scale (item means from 3.5–4.5 out of 5) as well as a general self-report item of mental health, and one that reflected lower and more variable item responses (item means from 2.2–3.6 out of 5). The odds of belonging to either profile did not differ significantly by doctoral students’ demographic characteristics. These findings are contrary to prior studies which have reported gender differences of experiencing anxiety and depression [ 3 ] or mental conflicts in fulfilling multiple roles to maintain life balance [ 8 , 67 ]. Unlike much of the prior research reported on graduate student mental health and well-being, our sample is derived from doctoral students primarily at high research activity (R1) institutions as well as students only from one field of research: lab-based biological sciences. As such, students within this sample may differ from the general doctoral student population. Consequently, finding no demographic differences in mental health and well-being among bioscience doctoral students in this study implies that students have similar levels of mental health and well-being regardless of gender, race, and ethnicity within this population. It is also possible that the present sample size was too small to detect minute differences in mental health and well-being across demographic groups. Future research should take these interpretations and limitations into consideration moving forward.

In contrast, the socialization variables certainty of choice, academic development, sense of belonging, and satisfaction with advisor predicted significant differences in the likelihood of belonging to one latent profile over the other in earlier years of doctoral study. In each case, more favorable scores significantly predicted membership in the latent profile with higher scores on the mental health and well-being scale. Notably, satisfaction with a primary advisor (i.e., dissertation chair, research supervisor) was a significant, positive predictor of positive mental well-being in early years of doctoral education. These results align with prior research that positive, high quality mentoring contributes to positive mental well-being [ 34 ]. Further, the satisfaction with advisor subscale is designed to represent actions that the mentor does to help and encourage their student’s success. Results thus show that students who are satisfied with the mentorship they receive in year two are more likely to have greater levels of positive mental well-being, supporting, highlighting the importance of positive, high-quality mentoring experiences between Ph.D. students and their primary advisor as a preventative measure for negative mental health and well-being. Future work on mentorship networks (e.g., receiving mentorship from postdocs, peers, dissertation committee members, etc. in addition to mentorship from the primary advisor) is needed to more fully understand the extent to which mentorship impacts student mental health and well-being.

Of note is that these data were collected longitudinally rather than at a single point in time, which allowed us to assess early predictors of positive and negative mental health and well-being. Specifically, mental health and well-being were evaluated in students’ fifth year of doctoral study, which is a transient time when doctoral students begin their transition to professional careers [ 12 ]. Predictors of mental health and well-being, however, were evaluated as early as the second year of doctoral study and were specifically chosen because they are relevant to socialization theory and have the potential to act as intervening variables. For example, the finding that students with positive mentoring relationships in year two were 4.4 times as likely to belong to the high mental health and well-being profile in year five suggests that it may be possible for administrators, student support services, department heads, and other mentors to provide additional support to students who are unsatisfied with their mentor as early as year two. Such intervention may reduce these students’ chances of having negative mental well-being in later years of their graduate education. Further, the finding that participants with lower certainty about their choice to pursue their Ph.D. in year three were 2.6 times as likely to belong to the lower mental health and well-being profile the following year indicates a potentially important risk factor. These factors could potentially be assessed to provide targeted support for students who are more at-risk for having or developing lower levels of mental well-being.

While we are hesitant to claim these relationships as causal, there is one early, strong predictor of student mental well-being in year five; that is satisfaction with the primary advisor in year two. Administrators of doctoral programs may use these findings to implement simple program evaluation assessments to understand student-advisor interactions in the early years of doctoral education to determine whether students are satisfied with their mentorship, to what extent students require additional mentorship or support, and/or to help mentors meet the needs of individual students with the intention to improve (or at least not impair) student mental well-being as students progress through their doctoral programs. Asking questions about students’ mentorship experiences as part of a routine assessment will 1) remove the onus from the student, 2) can help administrators identify students who may be most at risk for reporting negative mental well-being, 3) help mentors identify what their students need since this is not always clear nor communicated, and 4) can provide students with ways to redress mentorship issues, find additional mentorship support, or potentially change mentors. Such intervention programs addressing graduate student and postgraduate mental health have begun to emerge (e.g., [ 68 , 69 ]), and results from studies such as the one presented here show important, early socialization predictors of mental well-being that can and should be addressed at a systematic level to better support doctoral student mental well-being. Intervention programs for mentorship are beyond the scope of this study but may be beneficial for addressing student concerns when unsatisfactory mentorship emerges. Practically speaking, attending to the ways that social-psychological factors influence the well-being of STEM doctoral students points to important ways that faculty PIs and institutional leaders can fine-tune their policy making and (re)shape the values permeating their lab environments, student productivity, and how these features intersect with student mental health and well-being.

Unexpectedly, we found that membership in the more positive mental health and well-being profile was less likely for Ph.D. students who were highly productive in terms of scholarly productivity and for those who were highly confident in their research skills. While it might be assumed that individuals with better mental health are more resilient, confident, and productive, this assumption is not supported by the present data. Thus, it is possible that the pressures associated with sustaining high levels of productivity ultimately erode students’ well-being, even when they are successful in meeting expectations, and perhaps requires a shift in the ideology surrounding academic productivity and positive work environments. Accordingly, faculty mentors and administrators should not assume that simply because a student is demonstrating success in commonly valued metrics such as publication rate that the individual is thriving. Indeed, it may be that an important but neglected aspect of effective mentoring is to guide students to focus their productivity on fewer publications of greater impact. If consistent messaging to students about success as a researcher focuses predominantly on the quantity of publications, it would further explain the finding that students highly confident in their research abilities exhibit lower levels of well-being overall. While the ever-increasing pressure to publish is a normative element of the academy, it may be that endorsing or permitting it to increase unchecked will undermine the scientific enterprise in the long run by harming the very workforce that doctoral education seeks to train as the next generation of scientists.

While the association of these variables with the differential likelihood of being in one of the two latent profiles identified cannot be interpreted as causal in the current study, it can inform the direction of future research intended to foster effective interventions. Future research should ascertain to what extent the findings presented are unidirectional or reciprocal over the course of graduate education. It is additionally important for future research to examine potential differences among mental health and mental well-being, which were not differentiated nor should be interpreted separately in the present study. In addition, it will be important for future research to investigate different possible interventions targeting sense of belonging, mentoring relationships, and perceptions of academic development—constructs central to socialization—as a means of supporting doctoral students’ mental health and well-being. Findings from such work could provide evidence about the function of mental well-being as it manifests during graduate education and identify social factors that can mitigate negative mental well-being and promote positive mental well-being.

Funding Statement

This material is based upon work supported under National Science Foundation ( https://www.nsf.gov/ ) Awards 1431234(DF) and 1760894(DF). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Mental Health in Grad School Recognizing, Understanding & Overcoming Mental Health Issues in Grad School

Graduate school is tough. Not only is the curriculum challenging, but grad students often have other obligations, such as full- or part-time work or a family to raise. Add in a few other worries, like paying off those student loans, and it’s no surprise that tensions run high.

Reports of mental illness among grad school students is rising, and quickly. This guide will cover common mental health concerns for grad students, expert advice on where to find help, and more. Let’s take a look at what every grad student needs to know about their mental health.

Is Graduate School Taking a Toll on My Mental Health?

Understanding common mental health issues for graduate students, how to navigate & receive accommodations in graduate school, mental wellness strategies & support for graduate students, ashleigh ostermann: my experience with depression and anxiety in grad school.

If you’re reading this, you probably already know the answer to that question. But it can be helpful to look at a few questions that help gauge just how serious a mental health issue might be. This self-assessment is a good way to get honest with yourself about how grad school might be affecting your mental health.

• School often feels overwhelming, but lately, so does life in general.
• My sleeping habits have changed – I’m sleeping too much, or I’m not sleeping enough.
• I’ve lost interest in doing things I used to enjoy. It’s safe to say I sometimes feel empty.
• Sometimes I feel like a fraud. I keep waiting for everyone else to see how worthless I am.
• I worry so much that sometimes those worries take over my life.
• Friends and family have noticed concerning changes in me.
• Self-doubt has been overwhelming me since I started grad school.
• Sometimes I’m on a “high” and can’t slow down; other times I’m so depressed that I don’t want to get out of bed.
• I turn to alcohol or drugs more and more often these days.
• I find myself staying up way too late to work on assignments and then worrying that I didn’t spend enough time on them.

If you DISAGREE with most of these statements…

We’re glad you feel good! Even if you disagree with most of these statements, it’s always good to keep tabs on your well-being. Continue reading to learn what you can do to keep yourself mentally healthy.

If you AGREE with most of these statements…

You could be facing the challenges of mental illness. Keep reading to learn more about what you can do to find the proper help and treatment, so you can feel like yourself again.

Mental health in general is not something that we should blame people for, or just expect them to get over it. If someone says they have anxiety or depression, or any other mental health issue, it's not because they aren't trying their best, or they're "choosing" to feel that way.

Though every student is different and the mental health challenges they might face will be quite different as well, some mental health difficulties tend to show up more often among grad students. It’s important to know what to look out for so that it becomes easier to recognize the symptoms and get help.

A Look at Graduate Mental Health & Why It Matters

Wondering why graduate mental health matters so much? Let’s take a look at the numbers.

of counseling center directors believe the availability of psychiatric resources on campus is inadequate to meet student needs. American Psychological Association

Graduate student’s risk of anxiety and depression is more than six times higher than that of the general public. Among graduate students who reported suffering from depression or anxiety, more than 55 percent also reported an unhealthy work-life balance. Inside Higher Ed

of Ph.D. students are at risk of developing depression or another common psychiatric condition. Research Policy

Between 2010 and 2016, the number of students seeking mental health services has steadily increased, as has the rate of hospitalizations and suicide attempts. Penn State Center for Collegiate Mental Health

It’s okay to not be okay. It’s not okay to struggle alone. Speaking up and reaching out helps to break the stigma of mental health being negative.

Addiction & Substance Use Disorders

It isn’t unusual for a college student to try new things. But it’s important to note that for some, addiction and substance abuse problems can be lurking in the wings, waiting to take hold. Those in the grip of addiction will continue reaching for the addictive substance, even as it causes more and more problems in their lives. Those in college are more likely to drink and abuse substances. Graduate students, in particular, are more likely to use prescription stimulants – about 15 percent of grad students reported using stimulants improperly during their lifetime, with 67 percent of users turning to them for an academic boost.

Much more than a fleeting moment of sadness, depression is one of the most prevalent disorders. Those who suffer from it might seem perfectly fine to anyone else, but inside, they are struggling. The symptoms of depression include feelings of sadness or emptiness, losing pleasure in hobbies and time spent with friends, and prolonged trouble with eating or sleeping. It is thought to be triggered by a combination of genetic, biologic, environmental and psychological factors. Estimates say about 36 percent of all college students and 39 percent of graduate students suffer from depression.

When mental health disorders begin, unfortunately, some might consider harming themselves. A study of more than 300 graduate students at Emory University found that over 7 percent of them had suicidal thoughts. It’s important to remember that there is always someone ready and willing to listen and help you find the assistance you need.

If you are contemplating suicide, please drop everything right now and get help. Dial 911, call the crisis center at your college or university, or turn to the Lifeline at 800-273-TALK(8255). There are many people who want to help you, no matter what you’re going through, and they are available right now – all you have to do is pick up the phone.

Sleeping Issues & Disorders

Though many college students often choose to go without sleep, those with insomnia and other sleeping disorders might have no choice in the matter. Insomnia is likely the most commonly known sleeping disorder, but there are several others, such as narcolepsy, sleepwalking or restless leg syndrome. Studies have found that 27 percent of college students suffer from various sleeping disorders and those students had lower GPAs that put them at risk for academic failure. Sleep disorders are often accompanied by other psychiatric issues , so students might find that one exacerbates the other.

Stress & Anxiety Disorders

When in college, having some level of stress and anxiety is a given. But when those issues begin to take over a person’s life, it might be more than just worry about the next test. Those with stress and anxiety disorders suffer from worries that don’t get better with time. They might feel constantly on edge, have trouble sleeping, suffer from fatigue, find it impossible to concentrate and feel tense and irritable. Some might even suffer from panic attacks or social anxiety. Anxiety is the most prevalent mental health issue among college students, with over 41 percent seeking help for the condition.

Sara Stanizai: Why Graduate Students are At-Risk for Mental Health Concerns

Sara Stanizai is a licensed Marriage & Family Therapist, a Diplomate of the Academy of Cognitive Therapy, and the owner of Prospect Therapy , an LGBTQ+ affirming practice in Long Beach, California, focused on serving high-achievers and first-generation Americans as they manage expectations of their families and themselves.

There is lots of research that says graduate students now more than ever are experiencing mental health issues. That could mean more graduate students are reporting mental health issues, and/or seeking help for those issues.

There could be many things causing this:

• More visibility and less stigma of seeking treatment.
• Recognizing mental health issues and calling them what they are. 
• Understanding that they are a serious concern that can be life threatening, and not just "someone not trying hard enough." 
• An increase in exposure to stress related to personal, local, and world events. We're more inundated with information now, and much of it is stressful!
• We're up all night on our phones reading about events within our social circles, but also about national and world events.
• Comparing ourselves to others on social media, where people can curate the "greatest hits" of their lives.

The same pressure that earlier generations felt on the need for a college degree, now younger generations are feeling regarding graduate school. College was a place to "find yourself" and explore your interests, but graduate school is more focused and there is more pressure. Additionally, graduate students are not living in a dorm and maybe working on the weekend. Graduate students have families, jobs, and more responsibilities, so there is more pressure on them.

Start to pay attention to your own habits, and those of your friends and colleagues. A balanced lifestyle, even for a busy student, involves some amount of self-care and scheduled down time. If you're not able to find time to take care of yourself, or if you find the time but when the time comes you skip the self-care and anxiety makes you fixate on your research, you might be experiencing a serious problem. 

People sometimes skip meals or social events because "they'll feel better if they just finish this assignment." But when they finish the assignment, they don't actually feel better! Unrealistic expectations or comparing yourself to others can contribute to depression and anxiety.

If you notice changes in your mood, if you struggle to identify or rely on a support system, or you find that you are using something to "escape" more and more frequently - video games, social media, alcohol or drugs - you might be on the path to a mental illness.

As a private practice clinician, I partner with many local college and university campuses, and know that they employ and refer out to high quality providers. 

In many cases, students can expect an experience very similar to going to any other provider. Any counselor or therapist anywhere is bound by state and federal privacy laws regarding confidentiality of your treatment, so the concern about going on campus vs. going to a private practice across town isn't necessary. The on-campus provider is just as confidential as anyone else you might go to.

Students can save on the cost of seeing a therapist, as campus-sponsored counseling centers offer services for no cost or low cost. The quality of clinicians is generally quite good, whether the counselors are licensed or pre-licensed. The nice thing about pre-licensed clinicians is that they get regular supervision each week, so you can be sure you are getting high quality care.

When you need accommodations to help you get through grad school, the law is on your side. State-funded institutions are usually required to provide reasonable accommodations or adjustments for students with disabilities, including mental illnesses. This falls under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973 . It’s vitally important to understand your rights, as well as your responsibilities. Keep reading to learn more about potential accommodations for you while in grad school.

Mental Health Accommodation Examples for Graduate Students

Sometimes a simple accommodation can mean the difference between a good school experience and a bad one. These reasonable accommodations and modifications can make life much easier for graduate students.

During difficult periods, some students might benefit from reducing their course load. Many schools will be amenable to this, especially since graduate programs often have a window of completion; for instance, a doctoral candidate might be allowed to take up to seven years to complete the work.

Some programs will require hands-on work, such as master’s programs that require a certain number of supervised hours to earn the degree. Students who are struggling with the workload required by these programs might be able to receive an accommodation that allows them to spread out the required hours.

If short deadlines lead to crippling anxiety, students might be able to get more flexible deadlines that allow them adequate time to plan and coordinate their schedule. However, students should expect that even extended deadlines are reasonable enough that they are still learning at roughly the same pace as their classmates.

While tutoring is often available to all students, this accommodation can allow for even more hours with a tutor. This can reduce anxiety, alleviate stress and potentially even help a student avoid triggers that could make existing mental illnesses worse.

A strong mentor can help grad students see their studies through, and can also give them a boost regarding networking, post-graduate plans and job opportunities. These mentors can often help ground the grad student when they are feeling overwhelmed.

Requesting private space and time to take a test, give a presentation or otherwise complete an assignment can make life easier for those who suffer from anxiety or other serious mental illnesses.

Requesting Mental Health Academic Accommodations in Grad School

Students deserve the opportunity for reasonable accommodations – and the law recognizes that. But how should someone go about getting the accommodations they need? Here’s a brief step-by-step guide to help get the process started.

Some accommodations will come naturally, such as taking the online version of a course or using the extended completion time to finish a degree. If there are some accommodations that need extra input and attention from the school, those are the ones you should target.

Though they might go by a variety of names, each institution should have an office dedicated to providing accommodations for those with disabilities, including mental health challenges. You can find this office and the proper contact person by asking the student health center or admissions office.

In order to receive accommodations, students are often required to prove must prove they have of a mental illness necessitating the accommodation. The disability resource center can tell you exactly what documentation you must provide. An in-depth application might also be required.

Though schools will try their best to honor your request for accommodations, sometimes you will have to meet them halfway – for instance, if you ask for an accommodation that the school can’t provide due to the nature of the program you’re in, they might offer a different accommodation that could work just as well. Be open to the possibilities.

If it appears that an accommodation just isn’t going to work after you’ve tried it for a few weeks or months, get in touch with the disability resource center and let them know. They will work with you to find a better solution.

There is a misconception of what depression looks like. I have a bubbly personality, am educated and look like I have my life together.

Finding the right support system and wellness strategies is vitally important for anyone facing mental health issues. Luckily, there are a plenty of options, both on and off campus, to help graduate students stay as healthy as possible.

8 Wellness Strategies for Graduate Students

Creating strategies for good mental health can make getting through grad school much easier. Here are some tips.

“It doesn't have to be daily, but it should be a pattern of self-care that creates some relief in your week or month,” Stanizai said. “Make sure you treat self-care, socializing, rest, and hobbies just as you do homework assignments and class time. You can't have one without the other!”

Your physical health has a direct impact on your mental health. Get plenty of exercise, eat healthy foods, lay off the caffeine and avoid drugs and alcohol. Make a point of getting physicals every year, and don’t hesitate to go to the doctor when something seems amiss.

“Sometimes we don't realize how nervous or withdrawn we are until it's been a few weeks or months. If you can routinely check in with your mood and energy levels, you can notice small changes much earlier, before they become big changes,” Stanizai said. She suggests keeping a journal, meeting regularly with friends and practicing meditation as good ways of keeping tabs on your mental health.

Sometimes the terrible things happening in the world take center stage, and that can wear down even the most mentally-healthy person. There is no shame in taking an extended break from social media when the news becomes too much to handle.

Those who know you outside of academics can offer a unique perspective. “They will be the best to tell you if you don't seem like yourself,” Stanizai said. “Others who are in the same grind as you may not notice, or may even have their own issues clouding their judgment.”

Getting help academically can lessen the mental toll taken by grad school. Furthermore, reaching out for help with mental illness can have a positive effect on your academics. Bottom line: Getting help when you need it is a win-win situation.

If you are prescribed medication to help with mental health issues, take it as directed. Never stop taking a medication simply because you feel better and wonder if you still need it – you likely feel better because of the medication, not in spite of it. If a medication isn’t working for you, tell your physician as soon as possible.

“It's not a sustainable lifestyle,” Stanizai pointed out. “Just ask any grad student in their last year of their program! Recognizing that it's a limited period of time can help put things in perspective.”

On-Campus Resources

Most schools have a student health center; from there, you can find counseling and mental health centers that are ready to assist you. If you’re not sure where to find them, start with the admissions office.

Each school should have a center or department with the sole purpose of meeting the needs of students with a variety of disabilities, including mental illnesses. These centers provide students with the information they need to make informed decisions about their education, accommodations, special adjustments and more.

Many schools have advocacy groups for students with a variety of issues. Look for one that offers help for those with mental illness. You can usually find a good lead through the campus counseling service, student health center or disability resource center. If there isn’t an advocacy group on your campus, consider starting one, such as creating a chapter of Active Minds .

From those who suffer from serious mental illness to those who need an occasional boost in mood, there is probably a support group for them. Check out the National Alliance on Mental Illness for a comprehensive list of support groups and clubs available on campuses across the nation.

Off-Campus Resources

There are numerous online communities and resources for those suffering from mental illness. Some of them, like the National Grad Crisis Line , focus on graduate students. Others, like Mental Health America , are more general but provide active message boards and other ways to connect with individuals going through the same challenges.

There are thousands of apps available that focus on everything from connecting students with mental health resources to self-guided assistance through panic attacks. Apps like Talkspace , Headspace and AnxietyCoach are great places to begin.

Locating care providers for mental illness can be tough, especially if a student lives far away from a large metro area, as is often the case for online students. Try the Substance Abuse and Mental Health Services Administration to find a provider near you.

Those seeking a support group in their local community can ask their physician or counselor about the various options available. Students can also find a community support group through Mental Health America , which provides a comprehensive list of support groups that focus on certain issues.

The best strategy is a preventative strategy. Burn out is much harder to recover from if you're already there. It's much easier to prevent ahead of time than to recover from it after the fact.

Ashleigh Ostermann is from St. Petersburg, Florida and currently resides in Orlando. She is the marketing manager for Schoolhaus, a communications agency. Ashleigh is passionate about her clients as she continuously builds relationships with each and every one of them to develop their brand’s story and build strategic content marketing.

I have been diagnosed with major depressive disorder and anxiety. I believe it's been about 5 years since I started medication. I knew that something was wrong from a young age though, maybe 14 years old and just dealt with it internally. I called it ‘white knuckling’ because I would just push through to still get good grades in college, and at least look like I was okay. Anyways, back to graduate school. I started in January 2015 and earned a Master of Arts in Mass Communication (MAMC) with a specialization in Social Media from the University of Florida in August 2017.

During that time I was working full-time, dealing with a breakup with someone I was with for over eight years and was committed to maintaining a 4.0 GPA. Talk about triggers, right? But the good thing was that I was aware of my mental illness and that I had to take the steps to be proactive about handling it. 

It wasn't easy. I repeat, not easy, but I found a medication combo that works for me, I reached out to friends and family when I was fighting a depressive episode and I would go to counseling, as needed. I did also do a little of the ‘grin and bear it’ when needed.

I found resources such as in-person counseling and smartphone applications to be helpful for my mental health. I think that it’s really important to find a counselor that you click with, as I had tried a few in the past that I just didn’t feel like I could openly talk to. Being open and upfront (not being afraid of being vulnerable) with your counselor is key. Otherwise, they won’t know how to help you.

With that said, mental illness is isolating. I felt embarrassed at times, ashamed even, that I was battling such dark things. On the outside, I looked cheery, bubbly and happy, yet I wasn’t feeling that way on the inside. Using mobile applications helped me connect with others going through similar situations and let me know that I wasn’t alone.

Absolutely there were times where I thought I couldn’t continue grad school. Those negative thoughts that I didn’t deserve to be furthering my education, that I wasn’t good enough or smart enough, times where I just didn’t have any emotion towards anything and the thought of “why am I even doing this” came up.

Ways I pushed through these moments was to let myself feel how I felt and then once it wasn’t as bad, think through why I was in grad school, what I was gaining from it. I also journaled through a personal blog . Writing out – unfiltered – of what I was experiencing and feeling helped me a lot. Looking back on different posts where I was battling a depressive episode, I see how far I’ve come and that while I have low points in my life, I also have high points.

Take it one step at a time and find out what works for you. If you know that you’re proactive and are able to speak up when you need help, then rely on your support system. If you know that you internalize and it’s hard to speak up, look for an app or resource that you like and feel comfortable with and try it out. That way there’s no extra pressure of doing something you’re uncomfortable with when you’re already struggling.

Mental health is just as important as physical health. If a student was physically injured and it interrupted their studies, you wouldn’t say to get over it. You would work with the student to find a solution for the problem or obstacle. I strongly feel that this should be the same as if a student comes to a school with mental health struggles. It’s not an excuse, just something to work out.

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Cassie M Hazell

January 12th, 2022, is doing a phd bad for your mental health.

9 comments | 77 shares

Estimated reading time: 6 minutes

Poor mental health amongst PhD researchers is increasingly being recognised as an issue within higher education institutions. However, there continues to be unanswered questions relating to the propensity and causality of poor mental health amongst PhD researchers. Reporting on a new comparative survey of PhD researchers and their peers from different professions, Dr Cassie M Hazell and Dr Clio Berry find that PhD researchers are particularly vulnerable to poor mental health compared to their peers. Arguing against an inherent and individualised link between PhD research and mental health, they suggest institutions have a significant role to play in reviewing cultures and working environments that contribute to the risk of poor mental health.

Evidence has been growing in recent years that mental health difficulties are common amongst PhD students . These studies understandably have caused concern in academic circles about the welfare of our future researchers and the potential toxicity of academia as a whole. Each of these studies has made an important contribution to the field, but there are some key questions that have thus far been left unanswered:

• Is this an issue limited to certain academic communities or countries?
• Do these findings reflect a PhD-specific issue or reflect the mental health consequences of being in a graduate-level occupation?
• Are the mental health difficulties reported amongst PhD students clinically meaningful?

We attempted to answer these questions as part of our Understanding the mental health of DOCtoral researchers (U-DOC) survey. To do this we surveyed more than 3,300 PhD students studying in the UK and a control group of more than 1,200 matched working professionals about their mental health. In our most recent paper , we compared the presence and severity of mental health symptoms between these two groups. Using the same measures as are used in the NHS to assess symptoms of depression and anxiety, we found that PhD students were more likely to meet criteria for a depression and/or anxiety diagnosis and have more severe symptoms overall. We found no difference between these groups in terms of their overall suicidality. However, survey responses corresponding to past suicidal thinking and behaviour, and future suicide intent were generally highly rated in both groups.

42% of PhD students reported that they believed having a mental health problem during your PhD is the norm

We also asked PhD students about their perceptions and lived experience of mental health. Sadly, 42% of PhD students reported that they believed having a mental health problem during your PhD is the norm. We also found similar numbers saying they have considered taking a break from their studies for mental health reasons, with 14% actually taking a mental health-related break. Finally, 35% of PhD students have considered ending their studies altogether because of their mental health.

We were able to challenge the working theory that the reason for our findings is that those with mental health difficulties are more likely to continue their studies at university to the doctoral level. In other words, the idea that doing a PhD doesn’t in any way cause mental health problems and these results are instead the product of pre-existing conditions. Contrary to this notion, we found that PhD students were not more likely than working professionals to report previously diagnosed mental health problems, and if anything, when they had mental health problems, these started later in life than for the working professionals. Additionally, we found that our results regarding current depression and anxiety symptoms remained even after controlling for a history of mental health difficulties.

The findings from this paper and our other work on the U-DOC project  has highlighted that PhD students seem to be particularly vulnerable to experiencing mental health problems. We found several factors to be key predictors of this poor mental health ; specifically not having interests and relationships outside of PhD studies, students’ perfectionism, impostor thoughts, their supervisory relationship, isolation, financial insecurity and the impact of stressors outside of the PhD .

the current infrastructure, systems and practices in most academic institutions, and in the wider sector, are increasing PhD students’ risk of mental health problems and undermining the potential joy of pursuing meaningful and exciting research

So, does this mean that doing a PhD is bad for your mental health? Not necessarily. There are several aspects of the PhD process that are conducive to mental health difficulties, but it is absolutely not inevitable. Our research (and our own experiences!) suggests that doing a PhD can be an incredibly positive experience that is intellectually stimulating, personally satisfying, and gives a sense of meaning and purpose. We instead believe a more appropriate conclusion to draw from our work is that the current infrastructure, systems and practices in most academic institutions, and in the wider sector, are increasing PhD students’ risk of mental health problems and undermining the potential joy of pursuing meaningful and exciting research.

Reducing this issue to the common rhetoric that “PhD studies cause mental health problems” is problematic for several reasons: Firstly, it ignores the many interacting moving parts at work here that variably increase and reduce risk of poor mental health across people, time, and place. Secondly, it does not acknowledge the pockets of incredibly good practice in the sector we can learn from and implement more widely. Finally, it reinforces the notion that poor mental health is the norm for PhD students which then becomes a self-fulfilling prophecy- and itself ignores the joy of pursuing a thesis in something potentially so personally meaningful. Nonetheless, a significant paradigm shift is needed in academia to reduce the current environmental toxins so that studying for a PhD can be a truly enjoyable and fulfilling process for all.

Note: This article gives the views of the author, and not the position of the Impact of Social Science blog, nor of the London School of Economics. Please review our  Comments Policy  if you have any concerns on posting a comment below.

Image Credit: Geralt via Pixabay. 

About the author

Dr Cassie M Hazell (she/her) is a lecturer in Social Sciences at the University of Westminster. Her research is on around mental health, with a special interest in implementation science. She is the co-founder of the international Early Career Hallucinations Research (ECHR) group and Early-Mid Career representative on the Research Council at her institution.

Dr Clio Berry is a Senior Lecturer in Healthcare Evaluation and Improvement in the Brighton and Sussex Medical School. She is interested in the application of positive and social psychology approaches to mental health problems and social outcomes for young people and students. Her work spans identification of risk and resilience factors in predicting mental health and social problems and their outcomes, and in the development and evaluation of clinical and non-clinical interventions.

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My own experience of doing a PhD (loneliness, the lack of routine, imposter syndrome) has led to my discouraging my daughter, who has a history of mental health issues, from considering it at the moment, despite her having the academic aptitude and even a topic. I would hazard a guess that the problems are worse in the humanities than in the applied sciences, where most PhD students tend to work as part of research teams and be well supported in more structured environments.

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Fascinating research… I had a terrible PhD, but most of the mental health issues arose after the fact. If you ever conducted another survey it would be interesting to include those who had recently finished a PhD.

Looking at your follow up BJPsyche paper, I noticed you haven’t gone into the correlation between subject and mental health. I’d be interested to know how sciences vs humanities compared.

I see that your work is very restrained in discussing the causes of mental health issues, and I’m sure you have plenty of hypothesis. In my experience, a key factor is that there is no mechanism to hold supervisors to account for the quality of their supervision. (Linking to the point above, I believe in the sciences supervisors with poor outcomes do suffer repetitional damage – not so in the humanities.)

I’d also add that the UK’s Viva system, which I believe is unique globally, is a recipe for disaster – years of work evaluated over the course of just a couple of hours by examiners who, again, are not held accountable in any way.

I wrote my experience up here: https://medium.com/the-faculty/i-had-a-brutal-phd-viva-followed-by-two-years-of-corrections-here-is-what-i-learned-about-vivas-5e81175aa5d

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Mental health and the phd: insights and implications for political science.

Published online by Cambridge University Press:  07 December 2021

There is a severe mental health crisis among graduate students in political science. We present findings from an original survey on the mental health of political science PhD students at seven US universities. Our results are concerning: 15.8% expressed thoughts of suicide in the two weeks prior to taking the survey. About 30% of respondents met the criteria for depression and only a third of those were receiving treatment. Approximately 32% met the criteria for anxiety and fewer than half were receiving treatment. We also found that students with poorer mental health were more isolated, had fewer friends in their department and fewer people to turn to for help, and were more likely to contemplate dropping out of their program. Our study raises important questions about the experiences of graduate students during the PhD program and serves as an urgent call to action to address the well-being of our colleagues.

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• Volume 55, Issue 2
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• DOI: https://doi.org/10.1017/S1049096521001396

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Student mental health is in crisis. Campuses are rethinking their approach

Amid massive increases in demand for care, psychologists are helping colleges and universities embrace a broader culture of well-being and better equipping faculty to support students in need

Vol. 53 No. 7 Print version: page 60

• Mental Health

By nearly every metric, student mental health is worsening. During the 2020–2021 school year, more than 60% of college students met the criteria for at least one mental health problem, according to the Healthy Minds Study, which collects data from 373 campuses nationwide ( Lipson, S. K., et al., Journal of Affective Disorders , Vol. 306, 2022 ). In another national survey, almost three quarters of students reported moderate or severe psychological distress ( National College Health Assessment , American College Health Association, 2021).

Even before the pandemic, schools were facing a surge in demand for care that far outpaced capacity, and it has become increasingly clear that the traditional counseling center model is ill-equipped to solve the problem.

“Counseling centers have seen extraordinary increases in demand over the past decade,” said Michael Gerard Mason, PhD, associate dean of African American Affairs at the University of Virginia (UVA) and a longtime college counselor. “[At UVA], our counseling staff has almost tripled in size, but even if we continue hiring, I don’t think we could ever staff our way out of this challenge.”

Some of the reasons for that increase are positive. Compared with past generations, more students on campus today have accessed mental health treatment before college, suggesting that higher education is now an option for a larger segment of society, said Micky Sharma, PsyD, who directs student life’s counseling and consultation service at The Ohio State University (OSU). Stigma around mental health issues also continues to drop, leading more people to seek help instead of suffering in silence.

But college students today are also juggling a dizzying array of challenges, from coursework, relationships, and adjustment to campus life to economic strain, social injustice, mass violence, and various forms of loss related to Covid -19.

As a result, school leaders are starting to think outside the box about how to help. Institutions across the country are embracing approaches such as group therapy, peer counseling, and telehealth. They’re also better equipping faculty and staff to spot—and support—students in distress, and rethinking how to respond when a crisis occurs. And many schools are finding ways to incorporate a broader culture of wellness into their policies, systems, and day-to-day campus life.

“This increase in demand has challenged institutions to think holistically and take a multifaceted approach to supporting students,” said Kevin Shollenberger, the vice provost for student health and well-being at Johns Hopkins University. “It really has to be everyone’s responsibility at the university to create a culture of well-being.”

Higher caseloads, creative solutions

The number of students seeking help at campus counseling centers increased almost 40% between 2009 and 2015 and continued to rise until the pandemic began, according to data from Penn State University’s Center for Collegiate Mental Health (CCMH), a research-practice network of more than 700 college and university counseling centers ( CCMH Annual Report , 2015 ).

That rising demand hasn’t been matched by a corresponding rise in funding, which has led to higher caseloads. Nationwide, the average annual caseload for a typical full-time college counselor is about 120 students, with some centers averaging more than 300 students per counselor ( CCMH Annual Report , 2021 ).

“We find that high-caseload centers tend to provide less care to students experiencing a wide range of problems, including those with safety concerns and critical issues—such as suicidality and trauma—that are often prioritized by institutions,” said psychologist Brett Scofield, PhD, executive director of CCMH.

To minimize students slipping through the cracks, schools are dedicating more resources to rapid access and assessment, where students can walk in for a same-day intake or single counseling session, rather than languishing on a waitlist for weeks or months. Following an evaluation, many schools employ a stepped-care model, where the students who are most in need receive the most intensive care.

Given the wide range of concerns students are facing, experts say this approach makes more sense than offering traditional therapy to everyone.

“Early on, it was just about more, more, more clinicians,” said counseling psychologist Carla McCowan, PhD, director of the counseling center at the University of Illinois at Urbana-Champaign. “In the past few years, more centers are thinking creatively about how to meet the demand. Not every student needs individual therapy, but many need opportunities to increase their resilience, build new skills, and connect with one another.”

Students who are struggling with academic demands, for instance, may benefit from workshops on stress, sleep, time management, and goal-setting. Those who are mourning the loss of a typical college experience because of the pandemic—or facing adjustment issues such as loneliness, low self-esteem, or interpersonal conflict—are good candidates for peer counseling. Meanwhile, students with more acute concerns, including disordered eating, trauma following a sexual assault, or depression, can still access one-on-one sessions with professional counselors.

As they move away from a sole reliance on individual therapy, schools are also working to shift the narrative about what mental health care on campus looks like. Scofield said it’s crucial to manage expectations among students and their families, ideally shortly after (or even before) enrollment. For example, most counseling centers won’t be able to offer unlimited weekly sessions throughout a student’s college career—and those who require that level of support will likely be better served with a referral to a community provider.

“We really want to encourage institutions to be transparent about the services they can realistically provide based on the current staffing levels at a counseling center,” Scofield said.

The first line of defense

Faculty may be hired to teach, but schools are also starting to rely on them as “first responders” who can help identify students in distress, said psychologist Hideko Sera, PsyD, director of the Office of Equity, Inclusion, and Belonging at Morehouse College, a historically Black men’s college in Atlanta. During the pandemic, that trend accelerated.

“Throughout the remote learning phase of the pandemic, faculty really became students’ main points of contact with the university,” said Bridgette Hard, PhD, an associate professor and director of undergraduate studies in psychology and neuroscience at Duke University. “It became more important than ever for faculty to be able to detect when a student might be struggling.”

Many felt ill-equipped to do so, though, with some wondering if it was even in their scope of practice to approach students about their mental health without specialized training, Mason said.

Schools are using several approaches to clarify expectations of faculty and give them tools to help. About 900 faculty and staff at the University of North Carolina have received training in Mental Health First Aid , which provides basic skills for supporting people with mental health and substance use issues. Other institutions are offering workshops and materials that teach faculty to “recognize, respond, and refer,” including Penn State’s Red Folder campaign .

Faculty are taught that a sudden change in behavior—including a drop in attendance, failure to submit assignments, or a disheveled appearance—may indicate that a student is struggling. Staff across campus, including athletic coaches and academic advisers, can also monitor students for signs of distress. (At Penn State, eating disorder referrals can even come from staff working in food service, said counseling psychologist Natalie Hernandez DePalma, PhD, senior director of the school’s counseling and psychological services.) Responding can be as simple as reaching out and asking if everything is going OK.

Referral options vary but may include directing a student to a wellness seminar or calling the counseling center to make an appointment, which can help students access services that they may be less likely to seek on their own, Hernandez DePalma said. Many schools also offer reporting systems, such as DukeReach at Duke University , that allow anyone on campus to express concern about a student if they are unsure how to respond. Trained care providers can then follow up with a welfare check or offer other forms of support.

“Faculty aren’t expected to be counselors, just to show a sense of care that they notice something might be going on, and to know where to refer students,” Shollenberger said.

At Johns Hopkins, he and his team have also worked with faculty on ways to discuss difficult world events during class after hearing from students that it felt jarring when major incidents such as George Floyd’s murder or the war in Ukraine went unacknowledged during class.

Many schools also support faculty by embedding counselors within academic units, where they are more visible to students and can develop cultural expertise (the needs of students studying engineering may differ somewhat from those in fine arts, for instance).

When it comes to course policy, even small changes can make a big difference for students, said Diana Brecher, PhD, a clinical psychologist and scholar-in-residence for positive psychology at Toronto Metropolitan University (TMU), formerly Ryerson University. For example, instructors might allow students a 7-day window to submit assignments, giving them agency to coordinate with other coursework and obligations. Setting deadlines in the late afternoon or early evening, as opposed to at midnight, can also help promote student wellness.

At Moraine Valley Community College (MVCC) near Chicago, Shelita Shaw, an assistant professor of communications, devised new class policies and assignments when she noticed students struggling with mental health and motivation. Those included mental health days, mindful journaling, and a trip with family and friends to a Chicago landmark, such as Millennium Park or Navy Pier—where many MVCC students had never been.

Faculty in the psychology department may have a unique opportunity to leverage insights from their own discipline to improve student well-being. Hard, who teaches introductory psychology at Duke, weaves in messages about how students can apply research insights on emotion regulation, learning and memory, and a positive “stress mindset” to their lives ( Crum, A. J., et al., Anxiety, Stress, & Coping , Vol. 30, No. 4, 2017 ).

Along with her colleague Deena Kara Shaffer, PhD, Brecher cocreated TMU’s Thriving in Action curriculum, which is delivered through a 10-week in-person workshop series and via a for-credit elective course. The material is also freely available for students to explore online . The for-credit course includes lectures on gratitude, attention, healthy habits, and other topics informed by psychological research that are intended to set students up for success in studying, relationships, and campus life.

“We try to embed a healthy approach to studying in the way we teach the class,” Brecher said. “For example, we shift activities every 20 minutes or so to help students sustain attention and stamina throughout the lesson.”

Creative approaches to support

Given the crucial role of social connection in maintaining and restoring mental health, many schools have invested in group therapy. Groups can help students work through challenges such as social anxiety, eating disorders, sexual assault, racial trauma, grief and loss, chronic illness, and more—with the support of professional counselors and peers. Some cater to specific populations, including those who tend to engage less with traditional counseling services. At Florida Gulf Coast University (FGCU), for example, the “Bold Eagles” support group welcomes men who are exploring their emotions and gender roles.

The widespread popularity of group therapy highlights the decrease in stigma around mental health services on college campuses, said Jon Brunner, PhD, the senior director of counseling and wellness services at FGCU. At smaller schools, creating peer support groups that feel anonymous may be more challenging, but providing clear guidelines about group participation, including confidentiality, can help put students at ease, Brunner said.

Less formal groups, sometimes called “counselor chats,” meet in public spaces around campus and can be especially helpful for reaching underserved groups—such as international students, first-generation college students, and students of color—who may be less likely to seek services at a counseling center. At Johns Hopkins, a thriving international student support group holds weekly meetings in a café next to the library. Counselors typically facilitate such meetings, often through partnerships with campus centers or groups that support specific populations, such as LGBTQ students or student athletes.

“It’s important for students to see counselors out and about, engaging with the campus community,” McCowan said. “Otherwise, you’re only seeing the students who are comfortable coming in the door.”

Peer counseling is another means of leveraging social connectedness to help students stay well. At UVA, Mason and his colleagues found that about 75% of students reached out to a peer first when they were in distress, while only about 11% contacted faculty, staff, or administrators.

“What we started to understand was that in many ways, the people who had the least capacity to provide a professional level of help were the ones most likely to provide it,” he said.

Project Rise , a peer counseling service created by and for Black students at UVA, was one antidote to this. Mason also helped launch a two-part course, “Hoos Helping Hoos,” (a nod to UVA’s unofficial nickname, the Wahoos) to train students across the university on empathy, mentoring, and active listening skills.

At Washington University in St. Louis, Uncle Joe’s Peer Counseling and Resource Center offers confidential one-on-one sessions, in person and over the phone, to help fellow students manage anxiety, depression, academic stress, and other campus-life issues. Their peer counselors each receive more than 100 hours of training, including everything from basic counseling skills to handling suicidality.

Uncle Joe’s codirectors, Colleen Avila and Ruchika Kamojjala, say the service is popular because it’s run by students and doesn’t require a long-term investment the way traditional psychotherapy does.

“We can form a connection, but it doesn’t have to feel like a commitment,” said Avila, a senior studying studio art and philosophy-neuroscience-psychology. “It’s completely anonymous, one time per issue, and it’s there whenever you feel like you need it.”

As part of the shift toward rapid access, many schools also offer “Let’s Talk” programs , which allow students to drop in for an informal one-on-one session with a counselor. Some also contract with telehealth platforms, such as WellTrack and SilverCloud, to ensure that services are available whenever students need them. A range of additional resources—including sleep seminars, stress management workshops, wellness coaching, and free subscriptions to Calm, Headspace, and other apps—are also becoming increasingly available to students.

Those approaches can address many student concerns, but institutions also need to be prepared to aid students during a mental health crisis, and some are rethinking how best to do so. Penn State offers a crisis line, available anytime, staffed with counselors ready to talk or deploy on an active rescue. Johns Hopkins is piloting a behavioral health crisis support program, similar to one used by the New York City Police Department, that dispatches trained crisis clinicians alongside public safety officers to conduct wellness checks.

A culture of wellness

With mental health resources no longer confined to the counseling center, schools need a way to connect students to a range of available services. At OSU, Sharma was part of a group of students, staff, and administrators who visited Apple Park in Cupertino, California, to develop the Ohio State: Wellness App .

Students can use the app to create their own “wellness plan” and access timely content, such as advice for managing stress during final exams. They can also connect with friends to share articles and set goals—for instance, challenging a friend to attend two yoga classes every week for a month. OSU’s apps had more than 240,000 users last year.

At Johns Hopkins, administrators are exploring how to adapt school policies and procedures to better support student wellness, Shollenberger said. For example, they adapted their leave policy—including how refunds, grades, and health insurance are handled—so that students can take time off with fewer barriers. The university also launched an educational campaign this fall to help international students navigate student health insurance plans after noticing below average use by that group.

Students are a key part of the effort to improve mental health care, including at the systemic level. At Morehouse College, Sera serves as the adviser for Chill , a student-led advocacy and allyship organization that includes members from Spelman College and Clark Atlanta University, two other HBCUs in the area. The group, which received training on federal advocacy from APA’s Advocacy Office earlier this year, aims to lobby public officials—including U.S. Senator Raphael Warnock, a Morehouse College alumnus—to increase mental health resources for students of color.

“This work is very aligned with the spirit of HBCUs, which are often the ones raising voices at the national level to advocate for the betterment of Black and Brown communities,” Sera said.

Despite the creative approaches that students, faculty, staff, and administrators are employing, students continue to struggle, and most of those doing this work agree that more support is still urgently needed.

“The work we do is important, but it can also be exhausting,” said Kamojjala, of Uncle Joe’s peer counseling, which operates on a volunteer basis. “Students just need more support, and this work won’t be sustainable in the long run if that doesn’t arrive.”

Further reading

Overwhelmed: The real campus mental-health crisis and new models for well-being The Chronicle of Higher Education, 2022

Mental health in college populations: A multidisciplinary review of what works, evidence gaps, and paths forward Abelson, S., et al., Higher Education: Handbook of Theory and Research, 2022

Student mental health status report: Struggles, stressors, supports Ezarik, M., Inside Higher Ed, 2022

Before heading to college, make a mental health checklist Caron, C., The New York Times, 2022

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College students’ mental health improving, more finding support

• Kim North Shine

The latest annual Healthy Minds Study , which surveyed 100,000-plus college students from 200 universities across the United States, has good news to report: There are decreases in symptoms of anxiety, depression and thoughts of suicide, and increases in receiving mental health care and support.

In general, the latest report from the Healthy Minds Network found that college students seem to be flourishing more but mental illness and related issues for this age group remain a pressing concern.

“Mental health problems continue to be highly prevalent in college student populations, but the reports from students for this year’s study are promising,” said Justin Heinze of the University of Michigan, one of four principal investigators along with Daniel Eisenberg of UCLA, Sarah Ketchen Lipson of Boston University and Sasha Zhou of Wayne State University.

The study data, which was gathered through confidential online surveys taken by undergraduate and graduate students randomly selected by each school’s administrations, boiled down the students’ responses on: depressive symptoms, anxiety, eating disorders, diagnoses of mental illness, suicidal thoughts and nonsuicidal self-injury, history of mental illness, use of therapy or counseling, and stigma.

Some 104,000 students’ responses were used for the 2023-24 study. The emailed, web-based surveys are timed to avoid the first two weeks of the term, the final week of the term and holidays. This is the 15th year of the study and report, which is produced by the Healthy Minds Network. More than 850,000 students at 600-plus colleges and universities have participated.

Relative to previous years, students’ responses this year showed:

• A decrease in severe depressive symptoms from 23% in 2022 and 20% in 2023 to 19% in 2024.
• Moderate depressive symptoms decreased from 44% in 2022 and 42% in 2023 to 38% in 2024.
• After remaining unchanged at 14% in 2022 and 2023, reports of eating disorders dropped 1%.
• Nonsuicidal self-injury dropped to 13% in 2024, 2% less than 2022 and 1% less than last year.
• Among students with depressive or anxiety symptoms, more students (61%) are using mental health therapy or counseling. In 2022, the number was 60% and in 2023 the number dropped to 59%.
• More students reported taking psychiatric medication: 31% this year vs. 29% in 2022 and 2023.
• Attitudes about mental health remain generally positive. Only 7% of students agree that they would think less of someone who has received mental health treatment, a slight uptick from 6% in prior years. However, the number who reported that others would think less of someone who received mental health treatment was 41%, the same as last year and a percentage point higher than two years ago.

“For the first time in roughly 15 years of collecting Healthy Minds data, we have seen two consecutive years of improved outcomes from fall 2022 through spring 2024,” said Ketchen Lipson, BU associate professor of health law, policy and management.

The improvements might also be related to students bouncing back from the effects of the COVID-19 pandemic.

“This positive trend probably reflects more stability and social connection after the pandemic, as well as institutions’ greater efforts to support student mental health,” said Eisenberg, UCLA professor of health policy and management. “One of our major goals in the coming years is to help clarify which population-level strategies are most effective for supporting student mental health.”

The detailed picture of mental health and related issues provided by the Healthy Minds Study is typically used by schools to identify needs and priorities, benchmark against peer institutions, evaluate programs and policies, plan for services and programs, and advocate for resources.

“The Healthy Minds Study serves as a barometer for student mental health across the nation,” said Heinze, associate professor of health behavior and health equity in U-M’s School of Public Health. “While we’re excited to see this progress, higher education institutions need to continue to prioritize their students’ mental well-being and ensure they have the support services they need to succeed.”

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College students’ mental health improving, more finding support

September 11, 2024

The latest annual Healthy Minds Study , which surveyed 100,000-plus college students from 200 universities across the United States, has good news to report: There are decreases in symptoms of anxiety, depression and thoughts of suicide, and increases in receiving mental health care and support.

In general, the latest report from the Healthy Minds Network found that college students seem to be flourishing more but mental illness and related issues for this age group remain a pressing concern.

“Mental health problems continue to be highly prevalent in college student populations, but the reports from students for this year’s study are promising,” said Justin Heinze of the University of Michigan, one of four principal investigators along with Daniel Eisenberg of UCLA, Sarah Ketchen Lipson of Boston University and Sasha Zhou of Wayne State University.

The study data, which was gathered through confidential online surveys taken by undergraduate and graduate students randomly selected by each school’s administrations, boiled down the students’ responses on: depressive symptoms, anxiety, eating disorders, diagnoses of mental illness, suicidal thoughts and nonsuicidal self-injury, history of mental illness, use of therapy or counseling, and stigma.

Some 104,000 students’ responses were used for the 2023-24 study. The emailed, web-based surveys are timed to avoid the first two weeks of the term, the final week of the term and holidays. This is the 15th year of the study and report, which is produced by the Healthy Minds Network. More than 850,000 students at 600-plus colleges and universities have participated.

Relative to previous years, students’ responses this year showed:

• A decrease in severe depressive symptoms from 23% in 2022 and 20% in 2023 to 19% in 2024.
• Moderate depressive symptoms decreased from 44% in 2022 and 42% in 2023 to 38% in 2024.
• After remaining unchanged at 14% in 2022 and 2023, reports of eating disorders dropped 1%.
• Nonsuicidal self-injury dropped to 13% in 2024, 2% less than 2022 and 1% less than last year.
• Among students with depressive or anxiety symptoms, more students (61%) are using mental health therapy or counseling. In 2022, the number was 60% and in 2023 the number dropped to 59%.
• More students reported taking psychiatric medication: 31% this year vs. 29% in 2022 and 2023.
• Attitudes about mental health remain generally positive. Only 7% of students agree that they would think less of someone who has received mental health treatment, a slight uptick from 6% in prior years. However, the number who reported that others would think less of someone who received mental health treatment was 41%, the same as last year and a percentage point higher than two years ago.

“For the first time in roughly 15 years of collecting Healthy Minds data, we have seen two consecutive years of improved outcomes from fall 2022 through spring 2024,” said Ketchen Lipson, BU associate professor of health law, policy and management.

The improvements might also be related to students bouncing back from the effects of the COVID-19 pandemic.

“This positive trend probably reflects more stability and social connection after the pandemic, as well as institutions’ greater efforts to support student mental health,” said Eisenberg, UCLA professor of health policy and management. “One of our major goals in the coming years is to help clarify which population-level strategies are most effective for supporting student mental health.”

The detailed picture of mental health and related issues provided by the Healthy Minds Study is typically used by schools to identify needs and priorities, benchmark against peer institutions, evaluate programs and policies, plan for services and programs, and advocate for resources.

“The Healthy Minds Study serves as a barometer for student mental health across the nation,” said Heinze, associate professor of health behavior and health equity in U-M’s School of Public Health. “While we’re excited to see this progress, higher education institutions need to continue to prioritize their students’ mental well-being and ensure they have the support services they need to succeed.”

Read the 2023-2024 Healthy Mindy Study Data Report.

Media Contact Kim North Shine Senior Public Relations Representative, Health Sciences Michigan News [email protected] 313-549-4995

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Youth, Mental Health, and Social Justice: How Schools and Communities Can Better Support Students

Youth mental health and social justice are critical topics that intersect in numerous ways. As schools and communities strive to create supportive environments for students, understanding and addressing these intersections can lead to more effective strategies for promoting well-being and equity. 

Understanding the Connection Between Mental Health and Social Justice

Mental health and social justice are deeply interconnected. Students from marginalized communities often face unique stressors that can impact their mental health, including discrimination, socioeconomic challenges, and a lack of access to resources. Addressing these issues requires a comprehensive approach that includes mental health support and efforts to promote social justice.

The Impact of Inequity on Youth Mental Health

Research has shown that systemic inequities can contribute to higher rates of mental health issues among marginalized youth . For example, students from low-income families or those belonging to racial and ethnic minorities are more likely to experience anxiety, depression, and trauma. Experiences of discrimination and exclusion within the school environment can exacerbate these mental health challenges.

Community Involvement in Supporting Youth Mental Health

Communities play a vital role in supporting the mental health of youth. Here are some ways that communities can contribute:

• Provide access to mental health services
• Advocate for policy changes
• Foster community support networks
• Implement strategies for schools to support student mental health

School Involvement in Supporting Youth Mental Health

Schools also play a crucial role in supporting the mental health of students. Here are several strategies that can help create a more inclusive and supportive environment:

• Implement comprehensive mental health programs
• Promote social-emotional learning (SEL)
• Train educators on cultural competence
• Create safe and inclusive school environments

Count on RADIAS Health

Supporting students’ mental health requires a multifaceted approach that addresses individual needs and systemic issues. Communities and schools can play a crucial role by providing access to mental health services, advocating for policy changes, and fostering support networks. Together, schools and communities can create a more equitable and supportive environment for all students.

RADIAS Health provides person-centered, integrated healthcare services to people experiencing mental illness, substance use, or co-occurring disorders. Compassionate, skilled health care and support staff deliver our behavioral health services. Our care also includes supplementary services, such as case management, supportive housing, homeless services, residential services, and outpatient DBT treatment.

If you or someone you know could benefit from our mission, contact us today or consider donating !

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Strategies for effective change in mental health and substance use disorder advocacy, key benefits and challenges of family involvement in community-based substance use disorder treatment programs, the impact of community support in overcoming substance abuse.

University of Guelph Mental Health Training

2024-25 University of Guelph Mental Health Training Programs

The following training programs are available for current University of Guelph students, staff, and faculty. Students can see currently available training opportunities on GryphLife , and Faculty and Staff should check the Learning & Development event calendar . 

Looking for a training for your team or department?   Email [email protected] to book a training or discuss which option is suitable for your group.

Upcoming Trainings:

• Available On-Demand - Email [email protected] to be granted access.
• Tuesday, August 20th from 10:30 am -12:00 pm. Register Now!
• Wednesday, September 25th from 3:00 - 4:30 pm. Register Now!
• Monday, October 21st from 9:00-10:30am. Register Now!
• If you are unable to attend the current sessions and are interested in hearing about future opportunities, please email [email protected] to be added to the list.
• Wednesday, September 18th from 8:30am - 12:00pm. Register Now!
• Tuesday, October 15th from 1:00 - 4:00pm. Register Now!
• Note: ASIST is a 2-day training, and you must be able to attend both days in full
• Note: In addition to the full-day training, a 2-hour online module must be completed during the two weeks before the training.

More Feet on the Ground

More Feet on the Ground is an educational website on how to recognize, respond and refer students experiencing mental health issues on campus.

Recommended for:  All members of the University community, including students, staff and faculty. Registration:  Complete the online module independently at  morefeetontheground.ca Cos t: None Length:  Less than 30 minutes

Beyond the Books

Beyond the Books is a face-to-face session that will first provide participants with general information on the prevalence of mental challenges and illness. It will then help participants to identify signs of troubling behaviour and give them skills to engage in a preliminary discussion to determine if referral to a professional is necessary.  Participants will also learn how and where to refer appropriately in a compassionate and effective manner. This session is designed for individuals who do not have ongoing relationships with individuals but whose roles are such that they may have one-off, in-depth conversations. 

Trauma-Informed Care Training - Launching Fall 2024!

This two-hour, in-person training is designed to help all staff and faculty increase their knowledge and awareness about trauma and its impacts. The training provides strategies for implementing the Six Principles of Trauma-Informed Care, including self-regulation and self-care practices, to improve competency in working with and supporting students who have experienced trauma.

 This training consists of four modules; 1) Realizing the prevalence of trauma, 2) Recognizing the effects of trauma, 3) Responding: From knowledge to practice, and 4) Self-Regulation and self-care practices. 

Recommended for : Any staff and faculty who interact with students, whether formally (such as Instructors, Adminstrative Assistants, those in 1-1 advising/support roles, etc.) or informally (such as Hospitality Staff, Custodians, etc.). This training is not currently offered to students.

Registration : Email [email protected] to book a personalized session for your department or team.

Length: 2 Hours

LivingWorks Start

LivingWorks Start is an online alertness training that prepares anyone, regardless of prior experience or training, to recognize when someone is thinking about suicide and connect them to help and support.

Recommended for:  Individuals who are not mental health experts but who might have on-going relationships with people who have mental health issues and/or where the individual is in a position of authority.  Examples might include: Faculty Advisors and Graduate Assistants, Chairs/Directors, Deans, Supervisors, RAs, varsity coaches, Program Counsellors, Union/employee group leaders, individuals involved in Human Resources, and Faculty and Academic Staff Relations. All U of G Students, staff and faculty are welcome to participate! Registration:  Email [email protected] to request access Cost:  None Length:  1.5 hours

Designed by Living Works, SafeTALK is a 3.5 hours alertness training and certification that prepares anyone, regardless of prior experience or training, to become a suicide-alert helper. The SafeTALK trainer will demonstrate the importance of suicide alertness, assist participants to identify ways people invite help, and connect them with resources to help them when they are at risk.

Beyond the Books - Level 2

Mental health first aid, applied suicide intervention skills training (asist).

Developed by Living Works, ASIST is a two-day interactive workshop that teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety.

Mental Health Module Series

This series of online mental health modules is freely accessible, and aims to improve students' education on a number of topics related to mental health and mental illness.

These trainings are offered through the Student Mental Health Network .

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Depression and anxiety ‘the norm’ for UK PhD students

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PhD students in the United Kingdom are more likely than other educated members of the general public to report symptoms of depression or anxiety, according to a survey.

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SKY Mental Health Wellbeing Intro Talk for Graduate Students

Gryphon Gallery Mezzanine Level Building 1888 (Building 198) Parkville campus

All University of Melbourne graduate students are warmly invited to the SKY mental health talk on how lead a stress-free life. The talk includes introductory activities such as breathing exercises and meditation. Evening snacks will be served.

SKY Health Institute is an NGO that runs a wellness program for students. The program incorporates the SKY Breath Meditation Technique and is currently available in 108 universities across the United States.

We are excited to announce the launch of this program in universities in Australia. This initiative aims to promote holistic well-being among students through practical and effective breath-based practices and stress-management tools.

Some recent research on SKY breath meditation

Harvard University on SKY breathwork:

https://hbr.org/2020/09/research-why-breathing-is-so-effective-at-reducing-stress

New book by education researcher explores college mental health issues

Jeffrey Hayes   Credit: Provided . All Rights Reserved .

September 10, 2024

By Stephanie Koons

UNIVERSITY PARK, Pa. — Recent data indicates that certain mental health issues are on the rise on college campuses and minoritized students tend to struggle more, according to a new book by a Penn State College of Education professor. The book is intended to help readers understand college mental health issues so that they can more effectively work with students and those who support them.

“The book is really infused with findings pertaining to culture,” said Jeffrey Hayes , professor of education (counselor education) and author of “College Student Mental Health and Wellness: Coping on Campus.”

“What can colleges and universities do to enhance students’ well-being if we know they’re struggling and how might the college environment be contributing to those struggles?” Hayes asked.

According to Hayes, the book “will speak to anyone who wants a comprehensive college mental health resource at their disposal.” Data suggest there is a strong need to address college student mental health, he added. From 2009 to 2014, institutional enrollment in higher education grew by 6% nationally and the number of students seeking counseling on campuses grew by 29%.

“There’s this huge imbalance between demand for services and supply at university counseling centers,” he said. “Studies indicate that the longer students have to wait between counseling sessions, the less effective counseling becomes.”

Hayes conducts research on psychotherapy, with an emphasis on therapist factors that affect treatment outcomes. He also researches college student mental health, particularly among culturally diverse students.

Since 2008, he has helped run the Center for Collegiate Mental Health (CCMH) under Penn State Student Affairs. CCMH is a multidisciplinary, member-driven, practice-research network focused on providing accurate and up-to-date information on the mental health of today’s college students. The collaborative efforts of more than 800 college and university counseling centers and supportive organizations have enabled CCMH to build the nation’s largest database on college student mental health. Hayes largely drew from this database, which includes data from about 2 million college students across the U.S., to write his book.

Chapters in “College Student Mental Health and Wellness” cover theories of college student development and common psychological problems among college students — including anxiety, depression and substance abuse — and important aspects of college student well-being, such as identity, peer relationships and career preparedness.

In addition to his work with CCMH, an impetus for Hayes to write the book was his experiences teaching his signature course in the College of Education, “RHS 226: College Student Mental Health and Wellness.”  

“I decided to write the book to accompany the class, so it really helped the students by summarizing the important points in articles I was having them read,” he said.

One of the main points that emerged from the data, Hayes said, is that “the sky is not falling” and issues need to be explored on a granular level. In the last decade, there has been a gradual decrease in student alcohol use/abuse although there has been dramatic rise in cannabis use, which could be related to changes in state laws.

On the other hand, Hayes said, suicidal ideation and social anxiety among college students have gotten worse. Students spend an enormous amount of time on social media, he added, and “clearly it’s a double-edged sword.”

“College students might have 843 electronic friends and yet have great difficulty having a conversation with someone across the table from them at lunch or dinner,” he said.

An interesting finding in his research, Hayes said, is that the COVID-19 pandemic wasn’t universally negative for college students. His data analysis showed that during the pandemic, social anxiety went down as students faced no pressure to make new friends while living at home. Social anxiety levels have risen since students have come back to campus, he added.

Overall, Hayes said, minoritized students struggle more with mental health than students in the majority on virtually any dimension of culture, largely due to experiences of discrimination and difficulty fitting in on many college campuses. The book explores how intersecting identities contribute to mental health problems. For example, while women college students struggle more with eating disorders than men, when sexual orientation is taken into account, an interesting picture emerges, Hayes explained. Lesbian women have low rates of eating disorders and gay men have high rates, similar to those of heterosexual women.

“In other words, the common factor seems to be attraction to men,” Hayes said.

Although research has clearly established that counseling centers provide effective services for students seeking psychological help, Hayes said, the excessive demand for counseling center services suggests that other campus offices need to offer coordinated care. At Penn State, these offices include the Paul Robeson Cultural Center, the Center for Sexual and Gender Diversity, the Center for Spiritual and Ethical Development, the Gender Equity Center and Student Disability Resources.

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September 11, 2024

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We must give students a mental health lifeline for the school year, says expert

by Alison Malmon, Chicago Tribune

As students return to school, it's crucial to recognize the invisible struggles they may be facing, especially after the summer break. Navigating new academic and social environments can intensify mental health challenges or even trigger new ones.

Providing students with tools and emotional literacy to support one another and address feelings of loneliness is vital to building a culture of care and resilience that can genuinely make a long-lasting difference in their well-being.

The reality is stark: Youth suicide rates have risen steadily over the last 15 years and are currently the second leading cause of death for children ages 10 to 14 and the third for those ages 15 to 24. These statistics are more than just numbers—they're deeply personal to me.

Young adults are most likely to turn to a friend first when struggling with their mental health, yet 70% of peers do not feel prepared to provide support. Peer-based emotional support is not about solving someone's problems; it's about creating an environment in which emotions can be openly shared and help can be sought without fear of judgment.

The need for such safe spaces is urgent. More than one-fifth of high school students have seriously considered suicide. In college, nearly 30% of students report severe psychological distress associated with an increasing feeling of loneliness. Now more than ever, youths need safe spaces to express their feelings, establish support systems and build emotional literacy within their communities.

Emotional support has a profound impact on mental health. With the proper knowledge, young people can be powerful agents for change. Peer-led organizations such as Active Minds illustrate how student networks can break down mental health stigma and build trust and respect within their communities. These systems educate students about mental health awareness, decrease stigma and increase behaviors that establish a solid foundation for a supportive network.

Since half of all mental health issues begin by age 14 and 75% by age 24—critical years when connections among peers are strongest—these relationships can offer crucial lifelines. To prepare students for the new school year, they need resources to guide their mental health throughout the year. By consistently checking in, offering a safe space and maintaining open communication, youths can help peers who might be struggling.

Its essential to recognize that not all challenges are experienced equally. Social stigma is a significant barrier to mental health care , but it disproportionately affects communities of color, where preconceived notions and biases create substantial obstacles to receiving appropriate support.

Black Americans are 20% more likely to experience mental health challenges and face a higher risk of suicide compared with members of other racial groups. Despite this, Black college students are statistically less likely to receive a mental health diagnosis. To address this disparity, targeted support and culturally responsive resources are essential in ensuring that all young people, regardless of their background, feel recognized, supported and encouraged to seek the help they need.

With students heading back to school, it's vital to prioritize mental health discussions, especially as 67% of young adults with mental health symptoms won't receive the care they need.

2024 Chicago Tribune. Distributed by Tribune Content Agency, LLC.

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Doc-Stud-Ukraine: Supporting PhD students as a significant element of strengthening the health system in deoccupied territories in Ukraine

Project information.

The aim of the project is to build the capacity of PhD students and young researchers so that they effectively can contribute to strengthen the health systems, especially for children and adolescents in deoccupied territories in Ukraine.   

The war in Ukraine has created an unprecedented pressure on the health system. Parts of the health system has been destroyed during the war and special needs have arisen that the health system was not originally built to handle. PhD students and young researchers can contribute to health systems strengthening if their capacity is built in an adequate way. However, during the war there are limited possibilities for PhD students to access training and to further develop as researchers.   

A core group of Ukrainian PhD students and their supervisors will take active part in seminars and workshops arranged, some on site in Sweden and others online. They will be part of planning executing and evaluating all activities and are also the beneficiaries of the activities together with a larger group of PhD students and young researchers who participate in certain activities online. Among the activities are study visits and meetings with WHO Kiev office.    

Classroom Strategies to Improve the Mental and Academic Well-Being of Latinx Students

Carlos Mendieta

National Hispanic Heritage Month is observed from September 15 – October 15.

Latinx students are struggling.

Recent studies suggest Latinx students face higher school dropout rates compared to their white and black peers. The dropout rate for Hispanic students in 2021 was 90.24% higher than that of white students and 32.2% higher than that of black students, according to the National Center for Education Statistics.

These jarring statistics pose an important question: How can educators better support Latinx students in the classroom?

Much like a plant needs water and sunlight to flourish, students need a solid foundation to excel. As educators, we play a vital role in nurturing this foundation for Latinx students.

To start, it is important to understand the context behind some of the challenges Latinx students may face in the classroom. Well-being plays a critical role in student success, directly influencing academic performance and dropout rates. Broadly, socioeconomic disparities and language barriers are major factors that may affect Latinx students’ well-being. However, identifying obstacles that educators can address on a daily basis is equally important.

Here are three challenges often faced by Latinx students and ways educators can help to address each of them:

The topic of mental health often carries a heavy stigma within Latinx communities. This stigma stems from cultural beliefs, fear of discrimination, and a strong emphasis on independence, which can discourage individuals from seeking help or acknowledging their concerns. Compared to their white peers, Latinx students are less likely to seek support for their mental well-being and less likely to acknowledge mental health concerns. (CITATION: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568160/   & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081153/ )

What can educators do?

• K eep mental health on your students’ radar! Take intentional steps to reduce the taboo associated with the subject of mental health in your classroom. Simply referring to the importance of maintaining a healthy mind as a crucial factor in overall well-being and academic success can be an effective, regular contribution toward stigma reduction.
• Provide resources. Make information about mental health services and resources readily available and easily accessible. Visual aids (e.g., posters and pictures about mental health) in your classroom can also help to make the topic more approachable by signaling to your students that mental health is an important and accepted part of their overall well-being. The Scanlan Center for School Mental Health also has mindfulness coloring sheets, activity pages, and audio-guided mediations for use in your classroom or to send home in parent/caregiver newsletters.

2. Microaggressions versus Cultural Opportunities

Microaggressions

Microaggressions are subtle, often unintentional, discriminatory remarks or actions that communicate assumptions or stereotypes about a person’s race, ethnicity, gender, or other social identities. These comments or behaviors may be brief and intentionally harmless , but they can have a cumulative and harmful impact on the receiving end, contributing toward a hostile or unwelcoming environment for diverse students.

Common microaggressions toward Latinx students involve making assumptions about their nationality or heritage based on stereotypes.

• “You’re from Mexico, right? Do you celebrate [specific cultural event]?”
• “Your English is so good. Have you been in the U.S. for a long time?”
• “I love your traditional clothing! It must be so fun to dress like that.”

Although the intention behind these questions and remarks may appear harmless on the surface, they are often over-simplistic and perpetuate stereotypes about nationality, language, or culture. Check out this Tedx Youth Talk about microaggressions .

Students are quick to emulate the behaviors and norms established by their teacher, so educators must model awareness and understanding. This approach is crucial in reducing the occurrence of microaggressions and cultivating a more inclusive and respectful environment for all students.

Cultural Opportunities

Although we should work to avoid microaggressions and perpetuating stereotypes, it is important that these concerns do not intimidate us from seeking cultural opportunities. The reason so many stereotypes and hateful behaviors exist in the first place is due to a lack of understanding. Fundamentally, we are afraid of what we do no know. This fear can often lead to discrimination or avoidance.

• Understand, reflect, include. First, educators should understand what microaggressions are and how they can manifest. Regular self- reflection and professional development can be beneficial to acknowledge and address unconscious biases. You should also attempt to use inclusive language whenever possible to avoid language that may be exclusionary or stereotypical.
• Seek cultural opportunities. Fostering a safe, welcoming environment is crucial so that students can feel encouraged to share the cultures or identities important to them. Without making assumptions or pressing students to share, simply being aware of and acknowledging significant cultural events (e.g., Dia de los Muertos, Cinco de Mayo, Hispanic Heritage Month) can go a long way toward inviting healthy, productive conversation.
• Maintain transparency with your intentions. Being transparent about intentions while recognizing the assumptive nature of microaggressive follow-ups can transform a negative interaction into a positive, growth-based interaction (e.g., “I really don’t want to single you out or assume that you represent all Latinx people, but would you be willing to share a bit more about [culturally relevant topic they mentioned]? Followed by appreciating and validating your students for their engagement.)

3. Low Expectations

A growing body of research suggests teacher expectations are strongly connected to student outcomes. Essentially, high expectations are linked with high outcomes, while low expectations are linked with low outcomes. Unfortunately, research indicates that educators hold lower expectations for Latinx students compared to white students.

• Reflect on biases. Addressing the negative effects of low expectations requires self-reflection and a willingness to engage with our own biases. Take some time to understand your own biases you may have about Latinx students. Try out the Project Implicit tool from psychologists at the University of Virginia, the University of Washington, and Harvard University.
• Provide equitable expectations and equitable support. As the research suggests, you should believe in the potential of every student and communicate your high expectations consistently. Finally, become aware of the amount of time spent helping students of different races or ethnicities. Reflect on how you engage with different students and encourage and reinforce them consistently, regardless of prior beliefs or experiences.

By embracing these strategies and cultivating an inclusive, supportive environment, you can make a profound difference in the lives of your Latinx students. Let’s commit to creating classrooms where all students feel valued, understood, and capable of greatness.

Carlos A. Mendieta is currently a student in the University of Iowa College of Education’s Counseling Psychology Doctoral Program .

Photo credit: Canva