phd thesis on stress

Management of Stress and Anxiety Among PhD Students During Thesis Writing: A Qualitative Study

Affiliation.

• 1 Author Affiliations: Department of Medical Education, Medical Education Research Center, University of Medical Sciences, Isfahan (Drs Bazrafkan, Yousefi, and Yamani); and Applied Linguistics, Shiraz University of Medical Sciences (Dr Shokrpour), Shiraz, Iran.
• PMID: 27455365
• DOI: 10.1097/HCM.0000000000000120

Today, postgraduate students experience a variety of stresses and anxiety in different situations of academic cycle. Stress and anxiety have been defined as a syndrome shown by emotional exhaustion and reduced personal goal achievement. This article addresses the causes and different strategies of coping with this phenomena by PhD students at Iranian Universities of Medical Sciences. The study was conducted by a qualitative method using conventional content analysis approach. Through purposive sampling, 16 postgraduate medical sciences PhD students were selected on the basis of theoretical sampling. Data were gathered through semistructured interviews and field observations. Six hundred fifty-four initial codes were summarized and classified into 4 main categories and 11 subcategories on the thematic coding stage dependent on conceptual similarities and differences. The obtained codes were categorized under 4 themes including "thesis as a major source of stress," "supervisor relationship," "socioeconomic problem," and "coping with stress and anxiety." It was concluded that PhD students experience stress and anxiety from a variety of sources and apply different methods of coping in effective and ineffective ways. Purposeful supervision and guidance can reduce the cause of stress and anxiety; in addition, coping strategy must be in a thoughtful approach, as recommended in this study.

• Academic Dissertations as Topic*
• Adaptation, Psychological
• Anxiety / psychology*
• Education, Graduate
• Interviews as Topic
• Qualitative Research
• Stress, Psychological / psychology*
• Students, Medical / psychology*

• 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.

The present project was supported by the Office for Students Catalyst Award. The funder had no involvement in the design of the study, the collection, analysis or interpretation of the data, nor the writing of this manuscript.

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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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“How is your thesis going?”–Ph.D. students’ perspectives on mental health and stress in academia

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Eberhard Karls Universität Tübingen, Tübingen, Germany, sustainAbility Ph.D. Initiative at the Eberhard Karls Universität, Tübingen, Germany

Roles Conceptualization, Data curation, Writing – original draft, Writing – review & editing

Roles Conceptualization, Data curation, Writing – review & editing

Roles Conceptualization, Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Roles Writing – review & editing

Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Writing – original draft, Writing – review & editing

• Julian Friedrich, 
• Anna Bareis, 
• Moritz Bross, 
• Zoé Bürger, 
• Álvaro Cortés Rodríguez, 
• Nina Effenberger, 
• Markus Kleinhansl, 
• Fabienne Kremer, 
• Cornelius Schröder

• Published: July 3, 2023
• https://doi.org/10.1371/journal.pone.0288103
• Peer Review
• Reader Comments

Mental health issues among Ph.D. students are prevalent and on the rise, with multiple studies showing that Ph.D. students are more likely to experience symptoms of mental health-related issues than the general population. However, the data is still sparse. This study aims to investigate the mental health of 589 Ph.D. students at a public university in Germany using a mixed quantitative and qualitative approach. We administered a web-based self-report questionnaire to gather data on the mental health status, investigated mental illnesses such as depression and anxiety, and potential areas for improvement of the mental health and well-being of Ph.D. students. Our results revealed that one-third of the participants were above the cut-off for depression and that factors such as perceived stress and self-doubt were prominent predictors of the mental health status of Ph.D. students. Additionally, we found job insecurity and low job satisfaction to be predictors of stress and anxiety. Many participants in our study reported working more than full-time while being employed part-time. Importantly, deficient supervision was found to have a negative effect on Ph.D. students’ mental health. The study’s results are in line with those of earlier investigations of mental health in academia, which likewise reveal significant levels of depression and anxiety among Ph.D. students. Overall, the findings provide a greater knowledge of the underlying reasons and potential interventions required for advancing the mental health problems experienced by Ph.D. students. The results of this research can guide the development of effective strategies to support the mental health of Ph.D. students.

Citation: Friedrich J, Bareis A, Bross M, Bürger Z, Cortés Rodríguez Á, Effenberger N, et al. (2023) “How is your thesis going?”–Ph.D. students’ perspectives on mental health and stress in academia. PLoS ONE 18(7): e0288103. https://doi.org/10.1371/journal.pone.0288103

Editor: Khader Ahmad Almhdawi, Jordan University of Science and Technology Faculty of Applied Medical Science, JORDAN

Received: March 23, 2023; Accepted: June 20, 2023; Published: July 3, 2023

Copyright: © 2023 Friedrich et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The anonymized data set is available at https://doi.org/10.23668/psycharchives.12914 . All code for the analysis can be found at https://github.com/coschroeder/mental_health_analysis .

Funding: We acknowledge support by the Open Access Publishing Fund of University of Tübingen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Work situations can be demanding and have a profound influence on employees’ mental health and well-being across different sectors and disciplines [ 1 ]. Multiple studies show that the mental health status of people working in academia and especially that of Ph.D. students seems to be particularly detrimental when compared to the public [e.g., 2 , 3 ]. Disorders such as anxiety and depression are on the rise in the general population [ 4 , 5 ]. Multiple studies show that this is even more severe in academia [ 6 – 10 ] and in particular Ph.D. students are affected by mental health problems [ 11 , 12 ]. Worldwide surveys grant support for Ph.D. students’ suboptimal and alarming mental health situations [ 13 , 14 ].

A comprehensive study with more than 2000 participants (90% Ph.D. students, 10% Master students) from over 200 institutions across different countries showed that graduate students were more than six times more likely to experience symptoms of depression and anxiety than the general public [ 2 ]. Furthermore, a global-scale meta-analysis [ 3 ] and several other studies concerned with the mental health of Ph.D. students in different countries, e.g., the United States [ 7 , 9 ], the United Kingdom [ 6 ], France [ 15 ], Poland [ 8 ], Belgium [ 16 ] or Germany [ 11 , 12 ] voice concerns about the mental health situation of Ph.D. students. Recent research conducted in Belgium has consistently found a higher prevalence of mental health problems among Ph.D. students compared to different groups of other highly educated individuals [ 16 ]. In the same study, 50% of the Ph.D. students reported that they suffer from some form of mental health problem, and every third is at risk of a common psychiatric disorder [ 16 ]. A similar picture is forming in Germany. For example, the prevalence of at least moderate depression among doctoral researchers at the Max Planck Society, one of the biggest academic societies in Germany, was between 9.6% and 11.6% higher than in the age-related general population [ 11 ].

Increasing numbers of anxiety and depression among Ph.D. students

Recent studies describe not only a high prevalence but also a rising tendency of mental health issues among Ph.D. students. In a study from 2017, 12% of the respondents reported seeking help for depression or anxiety related to their Ph.D. [ 13 ], while in 2019, the result was even more drastic, as 36% of the respondents reported that having searched for help for those same reasons [ 14 ]. Several studies among doctoral researchers within the Max Planck Society show similar results. For instance, a survey in 2019 showed that the average of the Ph.D. students were at risk for an anxiety disorder and another sample from 2020 provided even more robust support for this claim [ 11 , 12 ]. Furthermore, the mean depression score increased from 2019 to 2020 in both samples [ 11 ].

Risk factors and resources

Given these alarming statistics, several studies addressed risks and resources for increased mental health issues. Other studies have revealed that gender, perceived work-life balance, and mentorship quality are correlated with mental health issues [ 2 , 17 ]. Specifically, female gender [ 17 ] and transgender/gender-nonconforming Ph.D. students are, on average, more likely to suffer from mental health issues [ 2 ]. In contrast, a positive and supportive mentoring relationship or a supervisor’s leadership style, and a good work-life balance are positively associated with better mental health [ 2 , 16 ]. While some authors [ 18 ] reported a negative correlation between the Ph.D. stage and mental health, with students at later stages disclosing greater levels of distress, others [ 16 ] did not find significant differences in this regard. Moreover, another report identified that Ph.D. students’ satisfaction levels strongly correlate with their relationship with their supervisors, number of publications, hours worked, and received guidance from advisors [ 19 ]. Furthermore, several studies showed a positive correlation between job satisfaction [ 20 , 21 ] as well as a negative correlation between job insecurity [ 22 ] and mental health or perceived stress, also in Ph.D. students.

Aim and research questions

Taken together, the alarming findings on the psychological status of Ph.D. students around the globe cannot be denied. However, data on the situation of Ph.D. students in Germany are scarce [ 11 , 12 , 23 ]; thus, comparisons of different universities within a country can hardly be made. However, addressing those differences is particularly relevant since the working conditions, concerning contract types, financial situations or supervision vary strongly among different countries, geographical regions and universities or institutions [ 24 ]. Furthermore, little is known about the reasons for this precarious situation and where exactly the need for action lies [ 25 ]. Therefore, the aim of this study was to conduct a survey among Ph.D. students at a university in the southwest of Germany to assess Ph.D. students’ mental health status. Additionally, the present study also reveals information on the extent of the need for additional support services and pinpoints the specific areas where these services ought to be emphasized. In order to help identify relevant indicators, this investigation provides empirically sound findings on the mental health situation of Ph.D. students in Germany.

Materials and methods

Sample and procedure.

Overall, 589 participants (60.3% female, 0.8% of diverse gender, M Age = 28.8, SD Age = 3.48, range 17–48 years) out of a total of enrolled 2552 Ph.D. students (response rate: 23.1%; actual numbers of Ph.D. students at the University of Tübingen higher as some Ph.D. students are not enrolled) took part in an online survey from October to December 2021. Instructions, items, and scales were all presented in English. Participants could answer the open questions in German or English and were comprised of Ph.D. students across various stages of their Ph.D. at the University of Tübingen without further exclusion criteria. The online questionnaire was sent to Ph.D. students’ email addresses via mailing distribution lists in cooperation with the central institution for strategic researcher development (Graduate Academy) of the University of Tübingen and with Ph.D. representatives of different faculties. Ethics approval was obtained by the “Ethics Committee of the Faculty of Economics and Social Science of the University of Tübingen” and written informed consent was given by the participants.

The distribution of faculty affiliation of the participants was heterogeneous with shares of 61.8% Science, 12.4% Humanities, 11.7% Economics and Social Sciences. These numbers reflect the different sizes of faculties and are roughly aligned with the relative numbers of students (41.7% Science, 24.8% Medicine, 16.2% Humanities, 7.5% Economics and Social Sciences), with a clear underrepresentation of the Medical Faculty. Faculties with less than 20 participants or participants with multiple answers were grouped into one category for further analysis (Others 14.1%, see S1 Table ). 67.9% of the participants were German and in total, 82.9% came from European countries. During data collection, the participants were at different stages of their Ph.D. ranging from 0 to over 130 months with a mean time of two and a half years (30.0 months) of Ph.D. progress.

First, demographic data and background information on the current Ph.D. situation were collected. In a second part, to get a differentiated view, we included different measures to operationalize the mental health status of Ph.D. students. The quantitative questionnaire assessed 1) general health, generalized anxiety disorder, as well as internally reviewed self-generated questions, 2) life and job satisfaction, and quantitative job insecurity, and 3) stressors (institutional and systemic), causes of stress and potential solutions. This study also collected information regarding the degree of participants’ familiarity with the mental health resources available at the university, e.g., points of contacts for counseling, in order to evaluate whether Ph.D. students make use of these services. Moreover, participants were asked to name additional services that they may consider necessary.

General health and stressors.

General health was assessed by two items of the Perceived Health Questionnaire (PHQ-2) [ 26 ]. Participants were asked to indicate how frequently they had experienced depressed moods and anhedonia over the past four weeks on a scale from 1 (not at all) to 4 (nearly every day). Additionally, they were presented with seven items of the Generalized Anxiety Disorder scale (GAD-7) [ 27 ] capturing the severity of various anxiety signs like nervousness, restlessness, and easy irritation on a scale from 1 (not at all) to 4 (nearly every day). Both scales were used in this combination in a previous study in German higher education [ 28 ]. Furthermore, we included two binary questions on whether the participants are currently in psychotherapy and if they have ever been diagnosed with a mental disorder.

The condensed version of the Perceived Stress Scale (PSS) [ 29 ] was used to get the degree of stressful situations in life in the last twelve months or since the start of the Ph.D. [ 30 ]. The response scale ranged from 0 (never) to 4 (very often), the following being a sample item: “… how often have you felt that you were unable to control the important things in your life?” To check the internal consistency of the four items, we calculated Cronbach’s alpha which was .79.

Job satisfaction and life satisfaction.

Three items on a scale from 1 (strongly disagree) to 5 (strongly agree) were used to measure job satisfaction [ 31 ], where a higher mean score indicated higher job satisfaction. A sample item is: “I am satisfied with my job.” Cronbach’s alpha was .86. Additionally, we added one item concerning general life satisfaction [adapted from 32 ] with the same response categories to get a more holistic insight.

Job insecurity.

To assess the fear of losing the job itself, quantitative job insecurity was measured with three items (e.g., “I am worried about having to leave my job before I would like to.”) [ 33 ] on a scale from 1 (strongly disagree) to 5 (strongly agree). We calculated a mean score with higher scores indicating higher job insecurity. Cronbach’s alpha was .80.

Institutional and systemic stressors.

For institutional stressors, we focused mainly on the role of supervision and included eight questions, four were framed using positive wording and four with negative wording, each with a scale from 1 (not at all) to 5 (all of the time). We summarized these questions in two constructs (positive support/negative support) which had Cronbach’s alphas of .85 and .76, respectively. As for systemic stressors, we included two questions on long-term contracts and on future perspectives, again using a scale from 1 (strongly disagree) to 5 (strongly agree).

To cover the potential impacts of the COVID-19 pandemic and the implemented regulations, we included two questions to evaluate whether the pandemic affected the students’ general situation. On the one hand, participants were asked to pick the statement that best describes the effects of the pandemic in general (“yes, it improved my general situation”, “yes, it worsened my general situation”, “yes, but it neither worsened nor improved my general situation”, “no”), and on the other hand, they were asked to evaluate whether the particular answers provided in this survey had been affected by the pandemic from 1 (very likely) to 5 (very unlikely).

Rating procedure and open answers

Causes of stress and potential solutions..

We included three open-ended questions in the questionnaire to get a deeper understanding of the perceived causes of stress, potential ways to improve mental health, and ways to improve the overall situation of Ph.D. students. The questions were: (1) “What is/are the cause(s) of your stress?” (2) “What would need to change to improve your mental health status?” (3) “What could be done to improve your situation?” Participants could mention as many points as they wanted (without any word limit). To analyze these questions, we built categories by following the model of inductive category development [ 34 ]. Two raters screened the first and last 20 responses in the data set and created categories for reoccurring topics (for a list containing all categories see S5 – S7 Tables). In the next steps, two new raters rated all open answers with the developed categories and added additional categories if needed. Applicable categories were rated with 1 (“category was mentioned”) or 0 (“category was not mentioned”). For example, the following response to question (1) “[My] supervisor is on maternity leave with open end, i.e. I have no one to talk to about my topic and have almost nothing so far […] I feel like I’m not good enough at this, not sure I will be able to succeed–everyone else has other projects and publications except me–no topic-related network” was rated with 1 in the following four categories: supervision (quality & quantity), social integration & interactions (private & professional), self-perception (internal factors), and perceived lack of relevant competences & experience–(sense) of progress and success. The full list of categories and inter-rater reliability as measured by Krippendorf’s Alpha is reported in Table 3 [ 35 ].

Descriptive statistics of work environment and workload

The largest part of the participants (65.5%) was temporarily employed, 12.1% got a scholarship, 7.6% were permanently employed, and 6.5% were not employed at all. The mean for total contract length was 34.3 months, with a range between two and 72 months. About 10.5% of the participants had a contract for only 12 months or shorter. A similar large variation was found in the percentage of employment with a mean of 63%, ranging from 10% to 100% of employment. For workload, we found a mean of 36.0 hours of Ph.D.-related work per week with a standard deviation of 15.6 hours. After taking a closer look at high workloads, we found that 31.3% of the participants work 45 hours or more (21.5% work 50 hours and more) per week. On top of their Ph.D. work, many Ph.D. students work in other jobs, which combined with the hours spent for Ph.D.-related work, summed up to the mean of 44.1 overall working hours per week. A detailed description can be found in S1 Table .

Faculty-wise comparison

In an explorative manner, we compared the mean differences of the most important variables between different faculties. Most of the analyzed variables did not show significant differences. Still, we want to stress that the highly imbalanced sample sizes (see S3 Table ) could lead to false negative outcomes due to the small numbers of participants in some groups. However, we found that the mean job insecurity was significantly different between faculties ( p < .001, Kruskal-Wallis rank sum test) with comparable low job insecurity in the faculties of law ( M = 2.10, SD = 1.22) and theology ( M = 2.38, SD = 1.19) and high insecurity in the faculty of humanities ( M = 3.32, SD = 0.91).

In total, 41.9% of the participants stated that their general situation worsened due to the pandemic, while 28.5% stated that the pandemic affected but it neither worsened nor improved their general situation. 33.5% of the participants stated that their responses in this study were “very likely” or “likely” to be affected by the pandemic, with a mean of 2.97 ( SD = 1.26).

General health and stressors

The mean of the sum score for PHQ-2 in our study was 2.32 which is below the cut-off of three for major depression [ 26 ]. Yet, 33.1% of the participants were above the cut-off. For the GAD-7, the sum score for the study’s sample was 8.49. Cut points of 5 might be interpreted as mild, cut points of 10 as moderate and 15 as severe levels of anxiety [ 27 ], which implies a mild risk level for generalized anxiety with the suggestion of a follow-up examination in this sample. When asking for mental disorders, we found that 19.9% of the participants ( n = 99) have already been diagnosed with a mental disorder and 15.5% ( n = 77) are currently in psychotherapy. The sum score for the Perceived Stress Scale (PSS) of 7.79 (with Min = 0, Max = 15) was above the total sum score compared to a representative British sample (6.11) [ 36 ] and a representative German community sample (4.79 for PSS-4) [ 37 ]. Job satisfaction of our participants with a total sum score of 10.06 was lower compared to a sum score of 12.79 in a German sample of workers in small- and medium sized enterprises [ 38 ]. The mean score for job satisfaction was 3.35, also lower than in a sample of Ph.D. students in Belgium (3.9) [ 39 ]. Job insecurity was with a total sum score of 8.76 higher compared to the German small- and medium sized enterprises sample (5.67) [ 38 ]. Consistently, more than 80% of the Ph.D. students in our study were worried about the lack of permanent or long-term contracts in academia ( M = 4.25, SD = 1.09; 5 indicating a strong agreement). Nevertheless, around half of the participants (54.5%) believed that having a Ph.D. would help them find a good job ( M = 3.49, SD = 0.97). We found a mean score of 3.48 ( SD = 0.98) for the positive support questions which is above average over response levels. Around 57.1% of the Ph.D. students felt supported by their supervisor “most” or “all of the time”. Around 55.7% felt comfortable when contacting the supervisor for support. The negative support construct was with a mean score of 2.18 below average: 46.7% of the participants had never felt looked down, and 62.6% had never felt mistreated by their supervisor. Nevertheless, 28.6% of the Ph.D. students answered feelings of degradation and 19.1% felt mistreated more than “some of the time”. When it comes to the frequency of the meetings with the supervisor, the mean reported a value of 2.4 laying somewhere between having meetings once a month (2) and at least every three months (3). However, 18.2% reported meeting their supervisor only once every six months or less. For sample items and detailed values see S2 Table .

When we analyzed the relationship between the studied outcomes, we found that all major constructs correlated significantly (see Table 1 ). High correlations occurred between the items of the related PHQ-2 and GAD-7 as well as their connections to the PSS. Understandably, the two institutional support dimensions were highly correlated ( r = -.69).

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https://doi.org/10.1371/journal.pone.0288103.t001

Regression for perceived stress, depression, and anxiety

To predict potential driving factors for the two more direct mental health measurements, namely depression and anxiety, and for perceived stress, we employed linear regression models with these three constructs as response variables controlling for age and gender. We included relevant risk factors and stressors such as job insecurity, perceived stress, negative support and resources such as job and life satisfaction, and positive support to get a comprehensible overview over predictors. All analyses were carried out in R statistics version 4.1.3.

For depression, significant predictors were job satisfaction (β = -0.1, SE = 0.04, p < .05), life satisfaction (β = -0.3, SE = 0.04, p < .001), perceived stress (β = 0.4, SE = 0.05, p < .001) and negative institutional support (β = 0.11, SE = 0.05, p < .05, see Table 2 ). The model explained 46.7% of the variance, F (8, 482) = 54.5, p < .01.

https://doi.org/10.1371/journal.pone.0288103.t002

For anxiety, all studied variables except job satisfaction and positive support were significant predictors with a variance explanation of 36.0%, F (8, 392) = 29.5, p < .01 (see Table 2 ). Noticeable was the strong influence of perceived stress on anxiety. Specifically, we observed that with an increase of one unit in perceived stress, the level of GAD-7 increased by 2.02 units and was in line with the high correlation ( r = .52, p < .01, Table 2 ).

For perceived stress, we found that job insecurity (β = 0.15, SE = 0.02, p < .01), life satisfaction (β = -0.32, SE = 0.03, p < .01) as well as negative institutional support (β = 0.13, SE = 0.04, p < .01) were significant predictors with a model variance explanation of 42.7%, F (4, 486) = 53.5, p < .01. The detailed results for this regression analysis can be found in S4 Table .

Qualitative answers

In the following, we report the main categories with short sample quotes as well as the mean frequency of the two raters (see Table 3 ; details in S5 – S7 Tables). The inter-rater reliability as indicated by Krippendorff’s alpha for the top five categories of all questions was above α ≥ .67, except for the category Manageable Workload for question MH06_1 (see Table 3 ) with α = .62; CI [0.50; 0.74]. A threshold of .67 is commonly considered as the lower conceivable limit that still allows tentative conclusions [ 40 ].

https://doi.org/10.1371/journal.pone.0288103.t003

Causes of stress.

The question “What is/are the cause(s) of your stress?” was answered by n = 446 participants. To cover the breadth of the responses, we built 18 categories. The most frequently mentioned categories were Workload & Time Pressure (mean rating frequency = 211), Self-Perception ( M = 132.5), Job-Insecurity ( M = 93), Social Integration & Interactions ( M = 91), and Supervision Quality & Quantity ( M = 88.5). The category Workload & Time Pressure includes all responses referring to the amount of work and/or deadlines. The category Self-Perception includes responses that indicate a perceived lack of competences or other personal doubts, concerns, and worries (e.g., “Since I started my Ph.D. I have almost constantly felt stupid”, “feeling like not belonging in academia, lack of self-confidence, feeling of making too little progress”). The category Job Insecurity reflects responses regarding contract length and general uncertainty about future employment (e.g., “scholarship is to be ended”, “Not knowing how things will work out after the PhD”, “Hopelessness of scientific career because there are too few full-time positions”). The category Social Integration & Interactions covers responses regarding the integration and sense of belonging in the work environment (e.g., “not valued by colleagues”, “being socially isolated at work”) as well as social issues in the private life (e.g., “Mostly my personal life, or often the lack thereof”, “problems with parents”). The category Supervision Quality & Quantity was used to capture all supervision-related responses including comments about the lack of support, feedback, frequency of meetings, or supervisors’ interest in the topics (e.g., “no clear communication with supervisor”, “lack of support from supervisor, even gossiping about me behind my back”).

Potential ways to improve the mental health status.

When asked “What would need to change to improve your mental health status?”, the Ph.D. students’ responses ( n = 307) included various topics, some addressing compensation and income-related aspects, others highlighting supportive supervision. Overall, the responses lead to twelve different categories. Most answers referred to Supportive Supervision ( M = 98.5), followed by Job Security/Contract ( M = 59). Sample quotes with respect to supervision are e.g., “more feedback from supervisor or even more interest in my topic” or “more regular support by supervisor”. The category Job Security/Contract contains comments with respect to contract length and aspects for future employment (e.g., “no more worries about not being able to get my contract renewed”). The category Manageable Workload ( M = 56.5) includes all responses around work-life balance (e.g., “having also activities beside work”, “clear work hours”). The fourth category was Compensation & Financial Security ( M = 35) and included all income- and compensation-related aspects of the job (e.g., “Be paid 100% would be a start”, “Get paid for all the time at work”). The category Less Additional Tasks ( M = 27.5) was used to specifically cover responses mentioning the number of additional tasks within the job (“Less work in teaching/work unrelated to PhD”).

Ways to improve the personal situation.

In addition to the previous question, which focused on general ways to improve the mental health status, we asked the Ph.D. students the following question: “What could be done to improve your situation?” Based on the themes and topics mentioned in the responses ( n = 281) we built eleven categories. The categories mentioned the most were Job-Security & Compensation ( M = 85.5), followed by Supportive Supervision ( M = 68), Services and Support System ( M = 39.5), Decrease Pressure to Perform ( M = 39.5), and Manageable Workload ( M = 36). The category Job-Security & Compensation includes responses like “chances of getting a long-term job in academia, not just the three-year programs” or “Fair payment (half of students get 50% others 65% even at the same institute)”. For the category Supportive Supervision “Regular meetings with people who are supportive & have an expertise in my research topic” can serve as a sample quote. The category Services and Support System was built to cover the responses named a solution outside the working group and team, such as “it would be helpful to see a university-based psychologist outside of the regular working hours” or “more courses (or better communications about them) about stress management”. The next category was labeled Decrease Pressure to Perform and included all responses that highlighted a high level of perceived pressure, such as “the performance pressure (every talk at a seminar is a job talk) is a big problem” or “Instead of pressuring academics to publish as much as possible, there should be more focus on the quality instead of the quantity of their articles/publication”. The last category, Manageable Workload , contained answers with respect to the amount of work (e.g., “Normal working hours, having really free-time without having the feeling that I should be working, it should be normal to take all vacation days”).

Summary of the qualitative answers.

With respect to the open answers, it can be summarized that the factors named as causes for stress and the possible solutions cover a wide range of topics. However, there are reoccurring topics across all three questions, such as supervision, workload, and job security. The role of supervision is a reemerging motif in the qualitative content analysis. While the quality and quantity of supervision were seen as a cause of stress, supportive supervision has a positive impact on the mental health status as well as the whole situation of the Ph.D. students. Furthermore, job insecurity was mentioned as an important stressor, while stable contracts and appropriate compensation for the work and fewer extra tasks were also added for improvement. Workload and time pressure were the most often stated causes of stress, followed by self-doubts and worries about not having enough competencies for the job. A manageable workload, fewer additional tasks, and a lower pressure to perform were indicated by the participants as valuable improvements.

Summary of the main findings

The conducted survey investigates the mental health of Ph.D. students at a university in the southwest of Germany and gives insights into what causes stress and mental health disorders and where there is a need for further support services. Our qualitative and quantitative analyses revealed interesting and consistent results on the alarming situation of the mental health of Ph.D. students.

First, our quantitative results revealed that one-third of the participants were above the cut-off for depression which is an indicator of a high risk of depression that should be checked by a health professional. On average, the surveyed Ph.D. students were at a mild risk level for an anxiety disorder. While our study design does not allow us to diagnose mental illnesses, it identifies problems that need to be pursued further. It reveals some unhealthy working conditions and increased risks for mental illnesses. Our qualitative and quantitative results showed consistently that many of the most prominent issues for our study’s participants are personal factors such as perceived stress, life satisfaction and self-doubt, but modulated by structural deficits such as financial and job security as well as workload and time pressure. The quantitative analyses revealed that life satisfaction, perceived stress and negative support are the main predictors for anxiety disorders as well as depression. Additionally, low job satisfaction was a significant predictor of depression and job insecurity for anxiety. Furthermore, we identified job insecurity, life satisfaction as well as negative institutional support as predictors for perceived stress.

Second and besides mental health problems, our quantitative analyses showed how supervision and the work environment played a role in the mental health and general well-being of Ph.D. students. Deficient supervision could affect Ph.D. students’ perceived job insecurity and job dissatisfaction. Although good supervision was not a predictor for satisfaction, being comfortable with contacting the supervisor could lower the perceived stress. This shows the importance of the supervisor-student relationship and highlights the importance of the social work environment, which was also mentioned by study participants in the open-end questions. While the categories in the qualitative analyses mainly served to find recurring themes, they can also be used to distinguish between different levels. Some participants reflected causes of stress on a personal level (e.g., self-perception). In contrast, others set the focus on the supervisor level or working group level, or even on the more structural abstract level of the academic system.

Third, our study does not only investigate the mental health situation of Ph.D. students, but we also analyze how the situation and mental health status could be improved. Many suggestions were straightforward given the results of the causes of stress, i.e., bad supervision should be improved, and a secure income should be guaranteed. However, we were also able to show that Ph.D. students wish to make use of services and support systems that could be provided by the university. Furthermore, less pressure to perform and a manageable workload with fewer additional tasks besides the Ph.D. project might decrease the stress level and improve mental health status.

Overall, detrimental mental health is a known problem in academia, and we show another example of its extent as well as opportunities for improvement at a German university.

Comparison to other studies

Data on Ph.D. students’ situation in Germany are scarce, and we, therefore, perform a broader comparison with Ph.D. students around the world. However, the results of this comparison should be taken with caution as our questionnaire and time of survey conduction are unique. We focus mainly on PHQ-2 [ 26 ] and GAD-7 [ 27 ], for which other studies in Germany during the pandemic showed that–compared to pre-COVID-19 reference values–these measurements were significantly increased [ 41 ]. Two studies conducted during the COVID-19 pandemic include the same scales [ 41 , 42 ] and reveal similar results for the general population in Germany, while in our later study from October to December 2021, the risk for anxiety and depression is slightly higher. In our study, one-third of the participants (33.1%) was above the cut-off for major depression, compared to the studies in a 1.5-year earlier timeframe, where 14.1% (March to May 2020; n = 15704, 70.7% female gender; 42.6% university education) [ 42 ] and 21.4% (March to July 2020; n = 16918; 69.7% female gender; 42.4% university education [ 41 ] of the participants with diverse occupations were above the cut-off. Furthermore, in our study, 39.2% of the participants were at the mild risk level for anxiety compared to 27.4% of the participants in an earlier study [ 41 ]. This shows the increase in depression and anxiety during the pandemic and even higher numbers in our study compared with the German general population. Nevertheless, compared to a survey at public research universities in the United States from May to July 2020, the number of doctoral students screened for major depressive disorder symptoms with the same measurements PHQ-2 was higher with 36% [ 43 ], indicating high numbers of mental issues in academia in several countries.

While using the same scales and items for job satisfaction and job insecurity, our study showed worse sum scores compared to a sample of employers and employees in small- and medium sized enterprises in Germany (December 2020 to May 2021; n = 828; 53.7% female gender, M = 41.5 years; 38.8% higher education entrance qualification) [ 38 ]. It seems that Ph.D. students have higher job insecurity and job dissatisfaction compared to workers in diverse branches and occupations. This may result from different contract types, as workers, especially in industrial sectors, have long-term contracts. The recurrent factor of time pressure and workload, also mentioned in the open-end questions, is backed up by the raw numbers of the contract types and working hours, which may also lead to job dissatisfaction. Although the mean contract type in our study is 63%, the mean number of hours dedicated to Ph.D. work ( M = 36.0, SD = 15.6 hours) is almost in the range of a full-time position. What is more, the participants reported a total weekly workload ( M = 44.1, SD = 11.4 hours) that exceeds a typical full-time position in Germany [ 44 ]. The discrepancy between Ph.D. work and corresponding contract types results in a mean of 12.1 hours of overwork per week (based on a 38.5-hour full-time contract, which is the standard contract for Ph.D. students in Germany). This is in line with previous studies where the authors found a mean of 12.6 hours of overwork per week for Ph.D. students in Science, Technology, Engineering, and Mathematics disciplines in Germany [ 45 ]. However, the authors did not include any further work obligations and corrected for contract types with low percentages, and thus the results are difficult to compare directly. Furthermore, we used gender as a control variable, which turned out to be statistically significant for anxiety and stress. This is in line with related work where the female gender was reported to be higher correlated with mental disorders [ 2 , 17 , 46 , 47 ].

Strengths and limitations

Generalization..

While we aimed for our study to reflect the current situation for Ph.D. students as best as possible, there are points that are limiting the generalization of the results or are beyond the scope of this survey. First, we collected the data between October and December 2021, a time at which the ordinance on protection against risks of infection with the SARS-CoV-2 virus (“Coronavirus-Schutzverordnung”) [ 48 ] was still in place in Germany and influenced private and working life. About one-third (33.5%) of our study population stated that it is very likely or likely that the pandemic affected their answers. Nonetheless, a pandemic is a situation that can reoccur and is only one more reason to proactively set up a resilient Ph.D. graduation system. Another research group [ 49 ] investigated how mental health care should change as a consequence of the COVID-19 pandemic and concluded that the pandemic could even be seen as a chance to improve mental health services [ 49 ]. Nevertheless, we would like to point out that generalizing from a mental health study conducted during a pandemic may be difficult.

Overall, around 23% of all Ph.D. students at the University of Tübingen [ 50 ] participated in our study, which is slightly below the response rate in other similar studies [e.g., 16 ]. Considering that university students are very frequently invited to various questionnaires and studies, and given that our survey lasted approximately 20 minutes, it can be argued that the participants were motivated to invest time into their responses. However, our study population remains small compared to the total number of Ph.D. students in Germany. Moreover, we want to emphasize the likely sample bias in our data. We recruited participants mainly via mailing lists and our project therefore probably has especially appealed to people who are already interested in health or aware of mental health issues. However, given our relatively large coverage of almost a quarter of all Ph.D. students at the University of Tübingen, even a selective sample can give us insights into overall tendencies. The transferability of our results to other German universities or even universities in other countries is also not guaranteed as the academic systems can largely differ. Additionally, the results of this study are influenced by the overall living conditions the Ph.D. students experience. As Tübingen is a small town in the southwest of Germany, a comparison to larger cities or other countries might not be viable as the conditions probably differ largely.

Finally, even within one university, the generalization of our results is further limited by the uneven distribution of the participants across faculties. Most participants (61.8%) were from the Science Faculty, which is also the largest department (in terms of the highest total number of students) at the University of Tübingen. This skewness limits the faculty-wise comparisons, and we would expect to find interesting insights into the different graduate programs by conducting detailed comparisons. These differences could not only arise from different academic traditions but also from the highly varying expectations on the scope of a Ph.D. thesis. It follows that more detailed and systematic monitoring and data collection in national and international surveys are needed.

Methodology.

In a cross-sectional study, we investigate the current situation of Ph.D. students. While this is a valid and important instrument to access the current state, it cannot give us information about the dynamic changes in the transition phase between undergraduate studies and the Ph.D. as well as across the Ph.D. [ 51 ]. To track these changes or make comparisons over time, a longitudinal study design or propensity score matching procedures [ 52 ] could give further insights. It is therefore desirable to establish regular surveys and monitoring systems either on a university level or in a national survey to provide information on the impact of undertaken actions and implemented changes. We used a mixed quantitative and qualitative research approach. While this provides information on distinct levels, there are some pitfalls. For example, the open answer categories were defined post-hoc. While this gives the possibility for the participants to express their thoughts freely, it makes a systematic analysis more difficult, and the analysis might be biased by the evaluators. Overall, it is important to summarize and statistically analyze our study results on an overall level, but it must not be forgotten that every person and Ph.D. project is individual.

Implications for research and practice

The overall scarce data, paired with worrisome flashlights on the mental health situation of Ph.D. students in different countries, highlights the need for more systematic monitoring of mental health in academia. For this purpose, standardized as well as domain-specific scales for Ph.D. students need to be established and longitudinal data needs to be collected. This would enable researchers to measure the effect of larger environmental changes (such as the COVID-19 pandemic or economic developments) and to measure the impact of interventions targeted to improve the situation. At the same time, we propose including qualitative measurements to assess unknown variables and the unique situation each Ph.D. student faces. These could also inform the development of additional quantitative measurable constructs to reflect the dynamic situation in academia. Such monitoring systems can either be implemented at the university level to give detailed insights into the situation at a specific university or on a national level to get an overall impression of Ph.D. students’ health issues. Optimally, a survey should be promoted from an independent self-governing institution dedicated to advancing science and research. While the demands for a better mental health situation for Ph.D. students are obvious, systematical and political changes need to be addressed in the research community and in academia.

Our mixed methods research approach allows us not only to find out more about the issues of Ph.D. students but also to draw conclusions about what is needed to improve their situation. However, finding solutions to a recognized problem is not a straightforward task, and complex problems often require a step-by-step solution. Therefore, we assume that more practical implications, which could be indicated by an established monitoring system, will be necessary once the first steps have been taken.

In general, we can group interventions into at least four levels that can influence each other: the Ph.D. students themselves, the supervisors, the universities or research institutions, and the greater political context and academic culture. Building on the responses about potential improvements and additional services, we identified the following practical implications:

On an individual level, the main interventions could happen in capacity building (e.g., in time/project management, self-reflection or mental health awareness) but also by being more proactive about changing working modes (e.g., establishing collaborations or a peer counseling system) or by improving the social environment. This could additionally lead to a change in self-perception, for which direct interventions might be more difficult. At this point, we want to highlight that changes on the individual level aim to prevent the development of mental health problems and strengthen the resilience of Ph.D. students. They can at no point replace professional support once such problems have been manifested.

The level of supervision seems to be the most urgent and promising target for an improvement of Ph.D. students’ situation. As supervisors are usually defining a project and its goals, but also additional teaching or other tasks, they are responsible for setting the workload and time constraints. Not only the hard constraints of the working conditions but also the quality of supervision was often mentioned to be highly deficient. Possible interventions could target improving the skills in personnel management of supervisors. But also, clear supervision requirements and guidelines could be imposed by the university. Such agreements (including expectations on the thesis, supervision times and conciliation mechanisms) might be an option to enhance the agreements in a supervisor-student relationship. While these suggestions are not new, and some of them are theoretically established in some university departments, our study results suggest that they are often ignored or not properly implemented, and more binding agreements and control mechanisms need to be made. Establishing additional external supervision, where for example the personnel management is reflected, might also give new perspectives and enhance demanding situations. At this point, it has to be considered that there are strong dependencies between Ph.D. students and their supervisors since, in many cases, it is the supervisors who have a major impact on the outcome of a Ph.D. thesis, such as the final grade. It remains challenging how Ph.D. students can criticize the supervising situation without negatively impacting the personal relationship with their supervisors.

Further interventions on the level of universities and research institutions might include support in bureaucratic processes and providing more information on different contact points (e.g., for mental health services). It is obvious that the aforementioned interventions (such as capacity building courses for Ph.D. students and supervisors) are dependent on the support of the central facilities of the research institution. Furthermore, highlighting the high prevalence of mental health problems, for example, at mandatory introductory sessions for Ph.D. students, might help to raise awareness about this topic. This could help unexperienced young researchers to notice signs of anxiety and depression early on before these mental disorders manifest. Finally, public events on this topic could reduce the stigma associated with it, making it easier for affected Ph.D. students to seek help. Such events might also be used to remind the students that it is important to take care not only of their physical but also mental health, for instance, by strengthening social relationships and pursuing hobbies which are not work-related.

Lastly, there are also changes in the political setting and academic culture needed. This includes a fair payment system, reasonable control of contract lengths and extensions, and more perspectives for long-term positions in academia. Considering that the vast majority of Ph.D. students will end up in positions outside of academia, it could be beneficial to better prepare students for careers in alternative job markets, such as industry. Such interventions might directly influence the job insecurity and job dissatisfaction of Ph.D. students. In Germany, the current regulations for temporary academic employment are being evaluated [ 53 ], but even propositions from the conference of university rectors [ 54 ] seem not to be sufficient for fundamental changes. These changes would also need a shift in the academic culture [ 55 ], in which “publish or perish” is still a guiding theme leading to high pressure to perform. Working on a cultural shift is a task for all scientists. This will lead to a more sustainable work culture from which all stakeholders might benefit.

All in all, there is an interplay and dependence of all mentioned levels. Importantly, most problems mentioned in the survey can result from shortcomings on multiple levels, and therefore interventions on more than one level are needed for a satisfying solution. For example, changes to improve the mental health situation on an individual level can be dependent on the consent of the supervisor and can also be negatively impacted by already existing mental health issues. In addition to individual responsibility for health, it is important to systematically target prevention and change the system on the aforementioned levels so that Ph.D. students are better and more quickly supported when mental health problems arise.

This study shows once again the detrimental mental health situation of Ph.D. students in academia. By analyzing the mental health of Ph.D. students at a German university, we found alarming hints of depressive and anxious tendencies that are in line with other comparable studies. Furthermore, we have identified main stressors, such as perceived stress or self-doubts, and resources, such as a positive student-supervisor relationship. Understanding conditional factors and being able to improve the situation depend on such identifications. With our study, we provide first insights of the status quo for the University chair, the Graduate Academy, and other stakeholders in the academic system. We invite them to inspect the results and suggestions responsibly so that actions to assess and improve the conditions for Ph.D. students’ mental health and well-being can be taken in the future. Based on our data, additional offers for Ph.D. students, as well as their supervisors, should be created and existing ones sustainably modified. Positive conditions and resources for mental health and well-being will not restrict to academia but will affect all areas of life. While an increased mental health state is an indispensable value on its own, additional benefits can be created for research, teaching, practice, and society. As such, mental health is a big part of sustainable living and should have a high priority for all people. While this is already acknowledged in the sustainable development goals, further steps need to be taken to raise awareness and provide support throughout society.

Supporting information

S1 table. sample items and descriptives of ph.d. students ( n = 589): percentage (%), mean ( m ), standard deviation ( sd ), minimum and maximum ( min - max )..

https://doi.org/10.1371/journal.pone.0288103.s001

S2 Table. Used scales and items with percentage (%), mean ( M ), standard deviation ( SD ), minimum and maximum ( Min - Max ), median , Cronbach’s alpha .

https://doi.org/10.1371/journal.pone.0288103.s002

S3 Table. Faculty wise mean comparison on the job insecurity scale.

https://doi.org/10.1371/journal.pone.0288103.s003

S4 Table. Linear regression model for perceived stress and the predictors.

https://doi.org/10.1371/journal.pone.0288103.s004

S5 Table. Categories and ratings for the causes of stress.

https://doi.org/10.1371/journal.pone.0288103.s005

S6 Table. Categories and ratings for an improvement of mental health.

https://doi.org/10.1371/journal.pone.0288103.s006

S7 Table. Categories and ratings for an improvement of the situation.

https://doi.org/10.1371/journal.pone.0288103.s007

Acknowledgments

We would like to express our gratitude to all participants of the survey as well to the sustainAbility Ph.D. initiative at the University of Tübingen. We thank Dr. Stephanie Rosenstiel for support with the ethics approval and Prof. Dr. Birgit Derntl and Prof. Dr. Andreas Fallgatter for their helpful feedback on the conception of the questionnaire. We thank Mumina Javed and Monja Neuser for their support in the early phase of the project.

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Home > Student Research, Creative Works, and Publications > Masters Theses and Doctoral Dissertations > 512

Masters Theses and Doctoral Dissertations

The role of resilience, emotion regulation, and perceived stress on college academic performance.

Katherine A. Pendergast , University of Tennessee at Chattanooga Follow

Committee Chair

Ozbek, Irene Nichols, 1947-

Committee Member

Clark, Amanda J.; Rogers, Katherine H.

Dept. of Psychology

College of Arts and Sciences

University of Tennessee at Chattanooga

Place of Publication

Chattanooga (Tenn.)

Stress is a common problem for college students. The goal of this thesis was to examine the relationships between protective and risk factors to experiencing stress and how these factors may predict academic performance in college students. 125 college students were surveyed twice over the course of a semester on emotion regulation strategies, trait resilience, and perceived stress. The relationships between these variables and semester GPA were analyzed using correlational, multiple regression, and hierarchical regression analyses. It was determined that trait resilience scores do predict use of emotion regulation strategies but change in stress and trait resilience do not significantly predict variation in academic performance during the semester. Limitations and future directions are further discussed.

Acknowledgments

Thanks to my advisor, Dr. Ozbek, and committee members, Dr. Clark and Dr. Rogers, for invaluable feedback and support. Additional thanks to Dr. Jonathan Davidson, M.D., for his permission to use the CD-RISC to better understand resilience in the college population. Also, I would like to extend thanks to Linda Orth, Sandy Zitkus, and the entire records office staff of the University of Tennessee at Chattanooga for their willingness to collaborate and assist with this project. Lastly, I would like to thank the faculty and students of the Psychology Department for their overall support.

M. S.; A thesis submitted to the faculty of the University of Tennessee at Chattanooga in partial fulfillment of the requirements of the degree of Master of Science.

Stress (Psychology); Academic achievement -- Education (Higher)

Stress; Resilience; Emotion regulation; Academic performance

Document Type

Masters theses

xi, 72 leaves

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Recommended Citation

Pendergast, Katherine A., "The role of resilience, emotion regulation, and perceived stress on college academic performance" (2017). Masters Theses and Doctoral Dissertations. https://scholar.utc.edu/theses/512

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The Savvy Scientist

Experiences of a London PhD student and beyond

PhD Burnout: Managing Energy, Stress, Anxiety & Your Mental Health

PhDs are renowned for being stressful and when you add a global pandemic into the mix it’s no surprise that many students are struggling with their mental health. Unfortunately this can often lead to PhD fatigue which may eventually lead to burnout.

In this post we’ll explore what academic burnout is and how it comes about, then discuss some tips I picked up for managing mental health during my own PhD.

Please note that I am by no means an expert in this area. I’ve worked in seven different labs before, during and after my PhD so I have a fair idea of research stress but even so, I don’t have all the answers.

If you’re feeling burnt out or depressed and finding the pressure too much, please reach out to friends and family or give the Samaritans a call to talk things through.

Note – This post, and its follow on about maintaining PhD motivation were inspired by a reader who asked for recommendations on dealing with PhD fatigue. I love hearing from all of you, so if you have any ideas for topics which you, or others, could find useful please do let me know either in the comments section below or by getting in contact . Or just pop me a message to say hi. 🙂

This post is part of my PhD mindset series, you can check out the full series below:

• PhD Burnout: Managing Energy, Stress, Anxiety & Your Mental Health (this part!)
• PhD Motivation: How to Stay Driven From Cover Letter to Completion
• How to Stop Procrastinating and Start Studying

What is PhD Burnout?

Whenever I’ve gone anywhere near social media relating to PhDs I see overwhelmed PhD students who are some combination of overwhelmed, de-energised or depressed.

Specifically I often see Americans talking about the importance of talking through their PhD difficulties with a therapist, which I find a little alarming. It’s great to seek help but even better to avoid the need in the first place.

Sadly, none of this is unusual. As this survey shows, depression is common for PhD students and of note: at higher levels than for working professionals.

All of these feelings can be connected to academic burnout.

The World Health Organisation classifies burnout as a syndrome with symptoms of:

– Feelings of energy depletion or exhaustion; – Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; – Reduced professional efficacy. Symptoms of burnout as classified by the WHO. Source .

This often leads to students falling completely out of love with the topic they decided to spend years of their life researching!

The pandemic has added extra pressures and constraints which can make it even more difficult to have a well balanced and positive PhD experience. Therefore it is more important than ever to take care of yourself, so that not only can you continue to make progress in your project but also ensure you stay healthy.

What are the Stages of Burnout?

Psychologists Herbert Freudenberger and Gail North developed a 12 stage model of burnout. The following graphic by The Present Psychologist does a great job at conveying each of these.

I don’t know about you, but I can personally identify with several of the stages and it’s scary to see how they can potentially lead down a path to complete mental and physical burnout. I also think it’s interesting that neglecting needs (stage 3) happens so early on. If you check in with yourself regularly you can hopefully halt your burnout journey at that point.

PhDs can be tough but burnout isn’t an inevitability. Here are a few suggestions for how you can look after your mental health and avoid academic burnout.

Overcoming PhD Burnout

Manage your energy levels, maintaining energy levels day to day.

• Eat well and eat regularly. Try to avoid nutritionless high sugar foods which can play havoc with your energy levels. Instead aim for low GI food . Maybe I’m just getting old but I really do recommend eating some fruit and veg. My favourite book of 2021, How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reduce Disease , is well worth a read. Not a fan of veggies? Either disguise them or at least eat some fruit such as apples and bananas. Sliced apple with some peanut butter is a delicious and nutritious low GI snack. Check out my series of posts on cooking nutritious meals on a budget.
• Get enough sleep. It doesn’t take PhD-level research to realise that you need to rest properly if you want to avoid becoming exhausted! How much sleep someone needs to feel well-rested varies person to person, so I won’t prescribe that you get a specific amount, but 6-9 hours is the range typically recommended. Personally, I take getting enough sleep very seriously and try to get a minimum of 8 hours.

A side note on caffeine consumption: Do PhD students need caffeine to survive?

In a word, no!

Although a culture of caffeine consumption goes hand in hand with intense work, PhD students certainly don’t need caffeine to survive. How do I know? I didn’t have any at all during my own PhD. In fact, I wrote a whole post about it .

By all means consume as much caffeine as you want, just know that it doesn’t have to be a prerequisite for successfully completing a PhD.

Maintaining energy throughout your whole PhD

• Pace yourself. As I mention later in the post I strongly recommend treating your PhD like a normal full-time job. This means only working 40 hours per week, Monday to Friday. Doing so could help realign your stress, anxiety and depression levels with comparatively less-depressed professional workers . There will of course be times when this isn’t possible and you’ll need to work longer hours to make a certain deadline. But working long hours should not be the norm. It’s good to try and balance the workload as best you can across the whole of your PhD. For instance, I often encourage people to start writing papers earlier than they think as these can later become chapters in your thesis. It’s things like this that can help you avoid excess stress in your final year.
• Take time off to recharge. All work and no play makes for an exhausted PhD student! Make the most of opportunities to get involved with extracurricular activities (often at a discount!). I wrote a whole post about making the most of opportunities during your PhD . PhD students should have time for a social life, again I’ve written about that . Also give yourself permission to take time-off day to day for self care, whether that’s to go for a walk in nature, meet friends or binge-watch a show on Netflix. Even within a single working day I often find I’m far more efficient when I break up my work into chunks and allow myself to take time off in-between. This is also a good way to avoid procrastination!

Reduce Stress and Anxiety

During your PhD there will inevitably be times of stress. Your experiments may not be going as planned, deadlines may be coming up fast or you may find yourself pushed too far outside of your comfort zone. But if you manage your response well you’ll hopefully be able to avoid PhD burnout. I’ll say it again: stress does not need to lead to burnout!

Everyone is unique in terms of what works for them so I’d recommend writing down a list of what you find helpful when you feel stressed, anxious or sad and then you can refer to it when you next experience that feeling.

I’ve created a mental health reminders print-out to refer to when times get tough. It’s available now in the resources library (subscribe for free to get the password!).

Below are a few general suggestions to avoid PhD burnout which work for me and you may find helpful.

• Exercise. When you’re feeling down it can be tough to motivate yourself to go and exercise but I always feel much better for it afterwards. When we exercise it helps our body to adapt at dealing with stress, so getting into a good habit can work wonders for both your mental and physical health. Why not see if your uni has any unusual sports or activities you could try? I tried scuba diving and surfing while at Imperial! But remember, exercise doesn’t need to be difficult. It could just involve going for a walk around the block at lunch or taking the stairs rather than the lift.
• Cook / Bake. I appreciate that for many people cooking can be anything but relaxing, so if you don’t enjoy the pressure of cooking an actual meal perhaps give baking a go. Personally I really enjoy putting a podcast on and making food. Pinterest and Youtube can be great visual places to find new recipes.
• Let your mind relax. Switching off is a skill and I’ve found meditation a great way to help clear my mind. It’s amazing how noticeably different I can feel afterwards, having not previously been aware of how many thoughts were buzzing around! Yoga can also be another good way to relax and be present in the moment. My partner and I have been working our way through 30 Days of Yoga with Adriene on Youtube and I’d recommend it as a good way to ease yourself in. As well as being great for your mind, yoga also ticks the box for exercise!
• Read a book. I’ve previously written about the benefits of reading fiction * and I still believe it’s one of the best ways to relax. Reading allows you to immerse yourself in a different world and it’s a great way to entertain yourself during a commute.

* Wondering how I got something published in Science ? Read my guide here .

Talk It Through

• Meet with your supervisor. Don’t suffer in silence, if you’re finding yourself struggling or burned out raise this with your supervisor and they should be able to work with you to find ways to reduce the pressure. This may involve you taking some time off, delegating some of your workload, suggesting an alternative course of action or signposting you to services your university offers.

Also remember that facing PhD-related challenges can be common. I wrote a whole post about mine in case you want to cheer yourself up! We can’t control everything we encounter, but we can control our response.

A free self-care checklist is also now available in the resources library , providing ideas to stay healthy and avoid PhD burnout.

Top Tips for Avoiding PhD Burnout

On top of everything we’ve covered in the sections above, here are a few overarching tips which I think could help you to avoid PhD burnout:

• Work sensible hours . You shouldn’t feel under pressure from your supervisor or anyone else to be pulling crazy hours on a regular basis. Even if you adore your project it isn’t healthy to be forfeiting other aspects of your life such as food, sleep and friends. As a starting point I suggest treating your PhD as a 9-5 job. About a year into my PhD I shared how many hours I was working .
• Reduce your use of social media. If you feel like social media could be having a negative impact on your mental health, why not try having a break from it?
• Do things outside of your PhD . Bonus points if this includes spending time outdoors, getting exercise or spending time with friends. Basically, make sure the PhD isn’t the only thing occupying both your mental and physical ife.
• Regularly check in on how you’re feeling. If you wait until you’re truly burnt out before seeking help, it is likely to take you a long time to recover and you may even feel that dropping out is your only option. While that can be a completely valid choice I would strongly suggest to check in with yourself on a regular basis and speak to someone early on (be that your supervisor, or a friend or family member) if you find yourself struggling.

I really hope that this post has been useful for you. Nothing is more important than your mental health and PhD burnout can really disrupt that. If you’ve got any comments or suggestions which you think other PhD scholars could find useful please feel free to share them in the comments section below.

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Dealing With Stress and Anxiety as a PhD Student

Pursuing a PhD can be both interesting and overwhelming. In the beginning, a majority of the PhD students feel energised to conduct extra-ordinary research and submit a PhD research proposal which is unique and innovative. However, with time the task to balance both personal and academic life becomes difficult. As a result, the students try to isolate themselves to focus on their PhD thesis writing. This isolation often makes students stressed and anxious and even leads them to confusion. So, before you try to isolate yourself to introduce the whole mankind to cutting-edge research, read the below tips which will help you to deal with stress and anxiety as a research student.

Be organised

One of the major sources of stress is the inability to control a situation. As PhD proposal writing or PhD dissertation writing are inevitable parts of a PhD academic life, try to manage your time wisely. To keep control over the deadlines, ensure that you do not leave any academic writing task for the last minute. Experts suggest that breaking a major task into smaller goals is the best way to remain organised and stay on top of your PhD work.

Identify and address your dysfunctional emotions

As a number of thoughts run through a PhD student’s mind, to retain the health of your emotions it is important to stay away from any irrational thoughts. Identifying your dysfunctional feelings is a great way to deal with stress and anxiety. Instead of procrastinating your work due to irrational feelings or feeling embarrassed about your research related problems, try to get professional PhD thesis help . Professional help with PhD thesis writing will guide you in completing your work which might otherwise get affected due to negative feelings.

Being mindful means paying more attention to yourself and your surroundings. This is one of the proven methods of reducing the stress level as the people who practice mindfulness can easily notice any early signs of stress. It is also the best way to reduce any kind of distress in students during examination periods. To practice mindfulness, just sit quietly and pay attention to your body and surroundings. Do some breathing exercises to relax and reduce any negative thoughts.

The PhD students need to spend hours either standing for conducting a research or continuously sitting for reading and writing PhD dissertation. This adds to the physical and mental stress which you might go through. Taking part in any exercise such as walking, running, aerobics or swimming before starting your PhD work will help you improve your mental and physical health.

Look after yourself

Stress and anxiety can either lead to developing habits such as poor eating, emotional eating, drinking or smoking. Although these habits might reduce your stress temporarily, when continued for a long time, these habits can affect your body and immune system. So, be watchful and never fall prey to any habits which might lead you to nowhere. Additionally, get enough sleep to charge yourself up before doing any intellectual activity.

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5 Ways to Combat PhD Stress

• By Nicholas R.
• January 8, 2024

When you’re starting your research career as an academic researcher, there will be many things that overwhelm you when you start out. As someone who has been through this myself, I have put together 5 ways of dealing with overwhelming feelings during your PhD journey.

These strategies may not work every time, but they’ve helped me get through my own struggles so far and hopefully can help you too!

1. Know What’s Going On

Before you dive into trying to solve any problem or figure anything out, take care of yourself mentally by knowing what exactly overwhelms you at the moment. One way to do this is to journal about what stresses you right now. When you feel more able to cope, try exploring solutions for those issues.

For example, if you find yourself struggling with managing workload, then it might be helpful to know that this type of stress often occurs at the very beginning and very end of a PhD, at least for myself and others I’ve spoken to.

Knowing the sources of your stress is the first step to addressing it.

2. Take Care of Yourself

Once you understand why you’re feeling overwhelmed, the next thing to consider is taking care of yourself physically. Stress from work, school, relationships etc., all contribute to poor health decisions such as skipping meals, engaging in unhealthy eating habits, drinking or smoking excessively, reducing sleep and exercise etc. All of which impact negatively on our physical and mental well-being.

In addition, one study showed that people under extreme levels of pressure (such as doctoral candidates) were more prone to developing heart problems compared to other groups. So while taking care of yourself should always be a priority, it’s especially important to prioritise it even further when we’re stressed.

It can seem difficult to balance personal needs and researcher responsibilities, but doing so requires prioritising self-care over everything else. In order to achieve this, set aside dedicated blocks of time each day where you avoid distractions, focus solely on activities related to your wellbeing, and allow yourself to fully engage in whatever activity brings peace to your mind and body.

3. Talk About It With Friends and Family

One thing that you learn early in a PhD is that there’s no such thing as a free lunch. While the rewards of doing your PhD are many, there is a significant cost, and it comes in the form of stress.

You’ve probably heard the expression “ PhD students are walking time bombs ” – which is basically just a polite way of saying that PhD students are walking around with a serious short-fuse, and it’s only a matter of time before that fuse goes off.

Seek support from others before that happens…

Talking to close friends and family members helps us to process emotions better. Research shows that talking to others provides relief by releasing negative thoughts and worries, so we don’t need to carry them around inside ourselves throughout the rest of the day. Having supportive individuals in our lives makes it easier to handle both small tasks and large ones.

If you live alone, however, having someone available to discuss your concerns with can provide valuable insight into whether or not you’re handling stressful events properly. A friend or family member can offer perspective and guidance without judging you for your current situation.

4. Make Time For Fun Activities

We’ve all heard that it takes 10 years to make a really brilliant scientist. You might have trouble proving this, but it is a very long time, and many people struggle with sticking to a research plan that is longer than 3 months.

We also know that there are many distractions available in the ‘real world’, that are not available to researchers. A few months ago, for example, I went to a pub quiz night. While this may sound like a total waste of time, in fact it has become a huge amount of fun for me, and has helped me to get my research into the right place.

I also find that regular, non-research-related social events help keep things fresh and remind me that there are more important things than my research at the moment.

5. Accept That This Is Just Part Of The Process

The hardest part about completing a PhD program is simply surviving it. Many of the lessons learned along the way will come from overcoming obstacles and failures. Learning from setbacks and mistakes prepares us for future success. But sometimes, no matter how hard we try, we just won’t be successful at accomplishing certain milestones or reaching our desired outcome.

That doesn’t mean giving up though. Instead, accept that failure can happen and move onto bigger opportunities. Sometimes we learn more from our successes and achievements rather than focusing on our failures and shortcomings. Also, remember that setbacks aren’t permanent. Often, after a short period of mourning, we bounce back stronger than ever.

We shouldn’t beat ourselves up over failing. Rather, let it inspire us to become wiser and smarter for next time. After all, it takes countless attempts to master the skills required to succeed.

Regardless of how you’re feeling, remember that you are not alone. You are not alone on your PhD journey. You are not alone in your feelings. And you are not alone in your desire to succeed.

The answer is simple: there is no age limit for doing a PhD; in fact, the oldest known person to have gained a PhD in the UK was 95 years old.

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Jay is in the third year of his PhD at Savitribai Phule Pune University, researching the applications of mesenchymal stem cells and nanocarrier for bone tissue engineering.

Julia’s in her final year of her PhD at University College London. Her research is helping to better understand how Alzheimer’s disease arises, which could lead to new successful therapeutics.

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Four years ago, while I was writing a paper for my Master’s degree at Oxford, I came down with a stomach bug.

No, not a stomach bug, the mother of all stomach bugs. I had the worst stomach pain of my life; I had a fever; I couldn’t sleep, let alone eat. At one point it got so bad that I asked a neighbor to stand guard outside the toilet so I wouldn’t faint and suffocate on my own sick. Dignity be damned; that’s how bad it was.

After a week, it ended. Two months later, it returned.

Over the next three years, I would suffer from the mystery illness for roughly a week every other months. I did all the tests known to medicine and a few the doctors made up just to humor me. The conclusion: “it’s psychosomatic” or “it’s stress”.

But I wasn’t stressed. Once I started my PhD, I was mostly a shining ball of well-organized happiness – apart from those weeks were I was a searing ball of pain.

After three years, when I was just about to give up on ever having a normal, healthy life again, two things happened:

1) A friend convinced me to go running

2) Another friend made me try Mark Williams’s mindfulness meditation program

Initially, I hated both.

Mindfulness meditation is not, contrary to what my friend suggested, the solution to life, the universe, and everything. Neither is it, as I thought, attempting the impossible task to think nothing. It’s mostly lying around focusing on small things – breathing, the sensations of the body, the passage of thoughts.

All that annoying focusing made me notice a few things.

For one thing, the daily focus on how my abdomen feels while breathing made me realize that my stomach was not either fine or a burning ball of pain but that it was always in some degree of discomfort. And that I was really good at not noticing pain.

Then I discovered that when my stomach was worse, I’d usually also find a hand clenched without previously being aware of it.

How can you not be aware you’re clenching your fist? I don’t know; it’s possible.

Then, I realized that on some days, I would find focusing almost impossibly hard. Every time, I’d try focusing on my breathing, I’d remember that I needed to pay a bill, or I’d rerun disagreement I’d had in my mind, or I’d mentally write a paragraph.

I also seemed to notice a relationship between my inability to focus on the meditation and my stomach. The effect was not immediate but when I was unable to focus for a few days, I was sure to find my stomach increasingly painful.

While meditating you are encouraged to acknowledge your thoughts (“I’m worrying” or “I’m planning”) before you return to whatever you’re supposed to focus on.

This categorizing  acknowledgement made me realize that, sometimes, I’d be unable to focus on my meditation not because I was too worried but because I was too excited about my research to focus on anything else. At those times, I was ecstatic. I was definitely not stressed or anxious but I wasn’t calm either.

And here’s the shocker: My stomach does not care whether I am happy or sad.

It only cares whether I am calm.

This is why ‘psychosomatic’ never made sense to me. Yes, sometimes I got sick while I was stressed or anxious. But a lot of the time, I got sick after being happy about my work. A

better way of thinking about my stomach situation would be that it’s not only triggered by stress but when I am adrenalized or excited.

Finally, I noticed that whenever I meditated after going for a run, I would find it unusually easy to focus. I discovered that there were certain physical activities that do something to me akin to turning a computer off and on again.

So at the end of my three year odyssey, here is what I have learnt about managing physical and mental health in a high-stress environment:

1) If you suffer from physical symptoms, see a doctor .

Yes, most thought my symptoms were psychosomatic but one friend told me to seek a diagnosis. “I had similar symptoms and everyone thought it was psychosomatic,” she confided, “It was cancer”. Having a mystery illness checked out might make you a hypochondriac but it might just make you a cancer survivor.

2) If you’re sure you’re physically healthy, find a way to diagnose what precisely it is that triggers your symptoms .

“It’s psychosomatic” or “it’s stress” is hardly actionable. What exactly do your thoughts run to when you’re jittery? What exactly is it that you keep worrying about?

A lot of the time when you think you are anxious about everything, you are actually worried about a curiously specific thing (a paragraph, an unpaid bill). Once you know the specific problem, it becomes much easier to solve. Given the repetitive and specific focus, I think mindfulness meditation works as a diagnostic tool for different kinds of people and stress-related problems.

3) Find a way to deal with whatever is causing your symptoms.

This might be the specific problem but, sometimes, the overworked brain simply needs a reboot. For me the reboot is intense physical activity, preferably on my own, with music in nature.

The crucial thing is that you have to be honest with yourself. As much as I’d like the solution to be junkfood and netflix, these things (fantastic as they are) don’t do anything for my stomach or my stress-level.

4) Once you understand the problem and the solution, make a plan and stick to it.

Mostly, I don’t want to run. But knowing that running will make me relaxed and pain free and staying will make me hurt is infinitely more motivating than dreams of a “bikini body” ever could be. Once you really know what works, discipline becomes easier.

5) Don’t punish yourself for what your body does.

By far the biggest obstacle on my way to well-being was the word “psychosomatic” and my natural tendency to react to lagging productivity by pushing myself harder.

I would often stretch my unproductive, tired, pained days to the agonizing limit because I had not “deserved” a rest. If you do this, stop it. If you feel tired, or overworked, or in pain, take a break, treat yourself, and be kind to your body. If you’re feeling awesome, go work. Use the energy you have; running on empty does more harm than good.

My stomach and I have been fab friends for 6 months and counting.

Do you have physical stress symptoms? What are your tricks to staying healthy and happy in the PhD? What do you do to reboot?

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The Thesis Whisperer is written by Professor Inger Mewburn, director of researcher development at The Australian National University . New posts on the first Wednesday of the month. Subscribe by email below. Visit the About page to find out more about me, my podcasts and books. I'm on most social media platforms as @thesiswhisperer. The best places to talk to me are LinkedIn , Mastodon and Threads.

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