There is a growing body of research that indicates that doing a doctoral dissertation can be taxing on the mental health of PhD students, with depression, anxiety, or burnout as potential pitfalls. Is this problem real and, if so, how bad is it? In this post, I review several recent studies, some of which also offer insights about potential risk factors. This also kickstarts the whole idea of this blog, as a way to increase awareness about these difficulties, and offer practical tips and tricks to survive such a difficult period.
The other day I encountered a colleague at the university. When I first met her, more than two years ago, she seemed a very active, positive person, with an iron will and lots of initiative, a true go-getter. Now, when I talked to her, she still smiled, but a light inquiry into how things were going quickly revealed her many struggles, from unhelpful supervisors to problems with some of the software she has to use on a daily basis. Subsequent times we’ve met recently have led to similar exchanges: “everything is a problem”, is one of her most frequent sentences now.
Of course, many things may have happened for this person to change her attitude so starkly, but there is one thing I know for sure about her: she has been doing a PhD for the last two years. And I have been around PhD students long enough now, in different labs and different countries (including my own PhD) to know that this is not an isolated case. Interestingly, when I was a knowledge worker in the industry, such emotional downturns were relatively uncommon, so… what’s going on here?
Well, doing a PhD is hard. Anyone will tell you that, from the university professor, to the baker whose cousin is a lab rat. However, we often understand that as: oh, you have to be really smart to do it. But maybe it is not the smarts (or lack thereof) that makes it difficult.
I recently crossed this problem again in the generalist press, and apparently this topic appears in the news from time to time. It just seems to be largely ignored, or thought to be “the way things are”. But the first link above referenced a couple of concrete, recent research studies, so I decided to start digging… is there more to this than my subjective perceptions?
the some research says
Apparently, some researchers must be getting worried about this, because I found quite a few interesting studies done in the last couple of years. For instance, a recent study on more than 2,000 graduate students from 26 countries1 found that about 39% of them had moderate or severe depression symptoms (and 41% of them had moderate/severe anxiety symptoms). This does not mean much (who is not depressed these days with all the fake news and stuff?) until you read that the prevalence of depression symptoms in the general population is less than 6%2! Another study done in Belgium last year3 found similar rates of mental health symptoms (30%-50% depending on the severity) in more than 3,600 PhD students. There, they also do a comparison to understand how high that is: the prevalence of the same symptoms in “highly educated” general population is around 14%-27% 4. In a study in Brazil, about 21% seemed to be the prevalence of major depression symptoms in graduate students 5. Going a bit back in time, and to other countries, we find different numbers: 8.9% (France, 2010 6), 27% (Turkey, 2008 7), 13% (US, 2007 8), or 5% (Brazil again, in 1995 9)… It is interesting how data varies quite a lot from country to country (but also for the general population, symptoms for depression in Brazil are 22% in the latest study, vs. the 6% of Germany), and over time (in the Brazilian 1995 study they mention a general population prevalence of 2%!). On top of that, other factors can be at play, like selection bias (not all studies are from cross-sectional or representative samples).
The studies also point out some factors that seem to correlate with such symptoms: gender, having children or a partner, perceived work-life balance, or quality of the student’s supervision. Some of these vary from study to study, but many seem to be common. There is quite a lot to be said about this topic of what seems to correlate with depression in doctorate students, so I will cover that separately in an upcoming post.
Then, the question remains: are you at a greater risk of depression if you do a PhD? It seems that it depends a lot on where you are in the world: in a country where people may have already other reasons for depression generally (like Brazil?), the number is quite close to the general population; but in a relatively “happy” country like Germany, the chances of being depressed seems to multiply by 5 or more if you are a PhD student!
In absolute terms, across studies, the most recent numbers seem to be that around 25-50% of students show moderate or severe depression symptoms. That’s one in four, up to one in every two students! Certainly something to watch out for.
In practice - a call to action
And how is this useful, what can you do now that you know this?
- If you are a PhD student and you’re feeling a bit down (and chances are you have felt this in the past, or will in the future), at least know that you are not alone. This is not to say: “yeah, this is normal, so buckle up and go on”. Mental wellbeing is just as important as physical health (but we talk much less about it, and it is a well-known taboo in many societies). If we start coughing and feeling dizzy, we try to self-diagnose (e.g., with a thermometer), and if it seems serious, we go to the doctor. Well, there are questionnaires like the PHQ-9 (used in many of the studies above), which you can take in order to get an idea of how bad it is. At the very least, talk to somebody, anybody you trust - and if it’s bad, go to your doctor, or an specialist!
- If you are friends or family with a PhD student, you can just keep a friendly eye on them, check in with them from time to time, maybe point them to this blog if you think this information can be useful for them. And if they mention many of the symptoms that appear in these self-tests, maybe suggest them to self-diagnose or see a doctor.
- If you are a supervisor, you can periodically interest yourself in your students’ morale and again suggest self-diagnosis or seeing a doctor if you think something is going on. If you think all this talk of depression is nonsense (“nobody cared about my depression when I did my PhD!“), think again: will anyone benefit if your student drops out (or worse) tomorrow? Your research won’t, for sure. In a later post I will also write about the whole students dropping out issue.
- If you are considering to do a PhD, think about this carefully, and consider yourself warned. True, thousands of people do PhDs successfully every year, but that does not mean there is no suffering on the way; a PhD can also be one of the happiest, most fulfilling episodes of your life (at least mine was so for the most part). Just be aware of the risks (see a later post for more about the risk factors and correlates). Be prepared.
- For me, personally, as a novice PhD supervisor, this has motivated me to learn more about these mental wellbeing issues, and other techniques and tools to help my students be more productive and (why not) happier during the PhD. I want to be prepared to help others. I will be documenting my discoveries in this blog, and I hope you will find them useful.
Learning about this is going to be a fun journey, feel free to come along!
- In Nature, no less: Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature Biotechnology, 36(3), 282–284. [return]
- Although this number comes from a study done in Germany only: Kocalevent, R.-D., Hinz, A., & Brähler, E. (2013). Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 35(5), 551–555. https://doi.org/10.1016/j.genhosppsych.2013.04.006 [return]
- Levecque, K., Anseel, F., Beuckelaer, A. D., Heyden, J. V. der, & Gisle, L. (2017). Work organization and mental health problems in PhD students. Research Policy, 46(4), 868–879. https://doi.org/10.1016/j.respol.2017.02.008 [return]
- How come highly-educated people are more depressed? A case of “ignorance is bliss”? Maybe we are not educating people in the right things? Interestingly, highly-educated employees (i.e., not working in universities) have lower prevalence (12%-25%). What is the university doing to people? That is the topic of a whole another post. [return]
- Oliveira, Y. B. C., O., R. C. (preprint). Depression and University: The effect of studying on mental health in Brazilian students. Preprint retrieved November 24, 2018, from here. [return]
- Verger, P., Guagliardo, V., Gilbert, F., Rouillon, F., & Kovess-Masfety, V. (2010). Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking. Social Psychiatry and Psychiatric Epidemiology, 45(2), 189–199. https://doi.org/10.1007/s00127-009-0055-z [return]
- Bayram, N., & Bilgel, N. (2008). The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology, 43(8), 667–672. https://doi.org/10.1007/s00127-008-0345-x [return]
- Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and Correlates of Depression, Anxiety, and Suicidality Among University Students. American Journal of Orthopsychiatry, 77(4), 534–542. https://doi.org/10.1037/0002-94126.96.36.1994 [return]
- Gorenstein, C., Pompéia, S., & Andrade, L. (1995). Scores of Brazilian University Students on the Beck Depression and the State-Trait Anxiety Inventories. Psychological Reports, 77(2), 635–641. https://doi.org/10.2466/pr0.19188.8.131.525 [return]