thesis about depression among students

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An Exploratory Study of Students with Depression in Undergraduate Research Experiences

• Katelyn M. Cooper
• Logan E. Gin
• M. Elizabeth Barnes
• Sara E. Brownell

*Address correspondence to: Katelyn M. Cooper ( E-mail Address: [email protected] ).

Department of Biology, University of Central Florida, Orlando, FL, 32816

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Biology Education Research Lab, Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ 85281

Depression is a top mental health concern among undergraduates and has been shown to disproportionately affect individuals who are underserved and underrepresented in science. As we aim to create a more inclusive scientific community, we argue that we need to examine the relationship between depression and scientific research. While studies have identified aspects of research that affect graduate student depression, we know of no studies that have explored the relationship between depression and undergraduate research. In this study, we sought to understand how undergraduates’ symptoms of depression affect their research experiences and how research affects undergraduates’ feelings of depression. We interviewed 35 undergraduate researchers majoring in the life sciences from 12 research-intensive public universities across the United States who identify with having depression. Using inductive and deductive coding, we identified that students’ depression affected their motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing in undergraduate research experiences. We found that students’ social connections, experiencing failure in research, getting help, receiving feedback, and the demands of research affected students’ depression. Based on this work, we articulate an initial set of evidence-based recommendations for research mentors to consider in promoting an inclusive research experience for students with depression.

INTRODUCTION

Depression is described as a common and serious mood disorder that results in persistent feelings of sadness and hopelessness, as well as a loss of interest in activities that one once enjoyed ( American Psychiatric Association [APA], 2013 ). Additional symptoms of depression include weight changes, difficulty sleeping, loss of energy, difficulty thinking or concentrating, feelings of worthlessness or excessive guilt, and suicidality ( APA, 2013 ). While depression results from a complex interaction of psychological, social, and biological factors ( World Health Organization, 2018 ), studies have shown that increased stress caused by college can be a significant contributor to student depression ( Dyson and Renk, 2006 ).

Depression is one of the top undergraduate mental health concerns, and the rate of depression among undergraduates continues to rise ( Center for Collegiate Mental Health, 2017 ). While we cannot discern whether these increasing rates of depression are due to increased awareness or increased incidence, it is clear that is a serious problem on college campuses. The percent of U.S. college students who self-reported a diagnosis with depression was recently estimated to be about 25% ( American College Health Association, 2019 ). However, higher rates have been reported, with one study estimating that up to 84% of undergraduates experience some level of depression ( Garlow et al. , 2008 ). Depression rates are typically higher among university students compared with the general population, despite being a more socially privileged group ( Ibrahim et al. , 2013 ). Prior studies have found that depression is negatively correlated with overall undergraduate academic performance ( Hysenbegasi et al. , 2005 ; Deroma et al. , 2009 ; American College Health Association, 2019 ). Specifically, diagnosed depression is associated with half a letter grade decrease in students’ grade point average ( Hysenbegasi et al. , 2005 ), and 21.6% of undergraduates reported that depression negatively affected their academic performance within the last year ( American College Health Association, 2019 ). Provided with a list of academic factors that may be affected by depression, students reported that depression contributed to lower exam grades, lower course grades, and not completing or dropping a course.

Students in the natural sciences may be particularly at risk for depression, given that such majors are noted to be particularly stressful due to their competitive nature and course work that is often perceived to “weed students out”( Everson et al. , 1993 ; Strenta et al. , 1994 ; American College Health Association, 2019 ; Seymour and Hunter, 2019 ). Science course instruction has also been described to be boring, repetitive, difficult, and math-intensive; these factors can create an environment that can trigger depression ( Seymour and Hewitt, 1997 ; Osborne and Collins, 2001 ; Armbruster et al ., 2009 ; Ceci and Williams, 2010 ). What also distinguishes science degree programs from other degree programs is that, increasingly, undergraduate research experiences are being proposed as an essential element of a science degree ( American Association for the Advancement of Science, 2011 ; President’s Council of Advisors on Science and Technology, 2012 ; National Academies of Sciences, Engineering, and Medicine [NASEM], 2017 ). However, there is some evidence that undergraduate research experiences can add to the stress of college for some students ( Cooper et al. , 2019c ). Students can garner multiple benefits from undergraduate research, including enhanced abilities to think critically ( Ishiyama, 2002 ; Bauer and Bennett, 2003 ; Brownell et al. , 2015 ), improved student learning ( Rauckhorst et al. , 2001 ; Brownell et al. , 2015 ), and increased student persistence in undergraduate science degree programs ( Jones et al. , 2010 ; Hernandez et al. , 2018 ). Notably, undergraduate research experiences are increasingly becoming a prerequisite for entry into medical and graduate programs in science, particularly elite programs ( Cooper et al. , 2019d ). Although some research experiences are embedded into formal lab courses as course-based undergraduate research experiences (CUREs; Auchincloss et al. , 2014 ; Brownell and Kloser, 2015 ), the majority likely entail working with faculty in their research labs. These undergraduate research experiences in faculty labs are often added on top of a student’s normal course work, so they essentially become an extracurricular activity that they have to juggle with course work, working, and/or personal obligations ( Cooper et al. , 2019c ). While the majority of the literature surrounding undergraduate research highlights undergraduate research as a positive experience ( NASEM, 2017 ), studies have demonstrated that undergraduate research experiences can be academically and emotionally challenging for students ( Mabrouk and Peters, 2000 ; Seymour et al. , 2004 ; Cooper et al. , 2019c ; Limeri et al. , 2019 ). In fact, 50% of students sampled nationally from public R1 institutions consider leaving their undergraduate research experience prematurely, and about half of those students, or 25% of all students, ultimately leave their undergraduate research experience ( Cooper et al. , 2019c ). Notably, 33.8% of these individuals cited a negative lab environment and 33.3% cited negative relationships with their mentors as factors that influenced their decision about whether to leave ( Cooper et al. , 2019c ). Therefore, students’ depression may be exacerbated in challenging undergraduate research experiences, because studies have shown that depression is positively correlated with student stress ( Hish et al. , 2019 ).

While depression has not been explored in the context of undergraduate research experiences, depression has become a prominent concern surrounding graduate students conducting scientific research. A recent study that examined the “graduate student mental health crisis” ( Flaherty, 2018 ) found that work–life balance and graduate students’ relationships with their research advisors may be contributing to their depression ( Evans et al. , 2018 ). Specifically, this survey of 2279 PhD and master’s students from diverse fields of study, including the biological/physical sciences, showed that 39% of graduate students have experienced moderate to severe depression. Fifty-five percent of the graduate students with depression who were surveyed disagreed with the statement “I have good work life balance,” compared to only 21% of students with depression who agreed. Additionally, the study highlighted that more students with depression disagreed than agreed with the following statements: their advisors provided “real” mentorship, their advisors provided ample support, their advisors positively impacted their emotional or mental well-being, their advisors were assets to their careers, and they felt valued by their mentors. Another recent study identified that depression severity in biomedical doctoral students was significantly associated with graduate program climate, a perceived lack of employment opportunities, and the quality of students’ research training environment ( Nagy et al. , 2019 ). Environmental stress, academic stress, and family and monetary stress have also been shown to be predictive of depression severity in biomedical doctoral students ( Hish et al. , 2019 ). Further, one study found that self-esteem is negatively correlated and stress is positively correlated with graduate student depression; presumably research environments that challenge students’ self-esteem and induce stress are likely contributing to depressive symptoms among graduate students ( Kreger, 1995 ). While these studies have focused on graduate students, and there are certainly notable distinctions between graduate and undergraduate research, the research-related factors that affect graduate student depression, including work–life balance, relationships with mentors, research environment, stress, and self-esteem, may also be relevant to depression among undergraduates conducting research. Importantly, undergraduates in the United States have reported identical levels of depression as graduate students but are often less likely to seek mental health care services ( Wyatt and Oswalt, 2013 ), which is concerning if undergraduate research experiences exacerbate depression.

Based on the literature on the stressors of undergraduate research experiences and the literature identifying some potential causes of graduate student depression, we identified three aspects of undergraduate research that may exacerbate undergraduates’ depression. Mentoring: Mentors can be an integral part of a students’ research experience, bolstering their connections with others in the science community, scholarly productivity, and science identity, as well as providing many other benefits ( Thiry and Laursen, 2011 ; Prunuske et al. , 2013 ; Byars-Winston et al. , 2015 ; Aikens et al. , 2016 , 2017 ; Thompson et al. , 2016 ; Estrada et al. , 2018 ). However, recent literature has highlighted that poor mentoring can negatively affect undergraduate researchers ( Cooper et al. , 2019c ; Limeri et al. , 2019 ). Specifically, one study of 33 undergraduate researchers who had conducted research at 10 institutions identified seven major ways that they experienced negative mentoring, which included absenteeism, abuse of power, interpersonal mismatch, lack of career support, lack of psychosocial support, misaligned expectations, and unequal treatment ( Limeri et al. , 2019 ). We hypothesize negative mentoring experiences may be particularly harmful for students with depression, because support, particularly social support, has been shown to be important for helping individuals with depression cope with difficult circumstances ( Aneshensel and Stone, 1982 ; Grav et al. , 2012 ). Failure: Experiencing failure has been hypothesized to be an important aspect of undergraduate research experiences that may help students develop some the most distinguishing abilities of outstanding scientists, such as coping with failure, navigating challenges, and persevering ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, experiencing failure and the stress and fatigue that often accompany it may be particularly tough for students with depression ( Aldwin and Greenberger, 1987 ; Mongrain and Blackburn, 2005 ). Lab environment: Fairness, inclusion/exclusion, and social support within one’s organizational environment have been shown to be key factors that cause people to either want to remain in the work place and be productive or to want to leave ( Barak et al. , 2006 ; Cooper et al. , 2019c ). We hypothesize that dealing with exclusion or a lack of social support may exacerbate depression for some students; patients with clinical depression react to social exclusion with more pronounced negative emotions than do individuals without clinical depression ( Jobst et al. , 2015 ). While there are likely other aspects of undergraduate research that affect student depression, we hypothesize that these factors have the potential to exacerbate negative research experiences for students with depression.

Depression has been shown to disproportionately affect many populations that are underrepresented or underserved within the scientific community, including females ( American College Health Association, 2018 ; Evans et al. , 2018 ), first-generation college students ( Jenkins et al. , 2013 ), individuals from low socioeconomic backgrounds ( Eisenberg et al. , 2007 ), members of the LGBTQ+ community ( Eisenberg et al. , 2007 ; Evans et al. , 2018 ), and people with disabilities ( Turner and Noh, 1988 ). Therefore, as the science community strives to be more diverse and inclusive ( Intemann, 2009 ), it is important that we understand more about the relationship between depression and scientific research, because negative experiences with depression in scientific research may be contributing to the underrepresentation of these groups. Specifically, more information is needed about how the research process and environment of research experiences may affect depression.

Given the high rate of depression among undergraduates, the links between depression and graduate research, the potentially challenging environment of undergraduate research, and how depression could disproportionately impact students from underserved communities, it is imperative to begin to explore the relationship between scientific research and depression among undergraduates to create research experiences that could maximize student success. In this exploratory interview study, we aimed to 1) describe how undergraduates’ symptoms of depression affect their research experiences, 2) understand how undergraduate research affects students’ feelings of depression, and 3) identify recommendations based on the literature and undergraduates’ reported experiences to promote a positive research experience for students with depression.

This study was done with an approved Arizona State University Institutional Review Board protocol #7247.

In Fall 2018, we surveyed undergraduate researchers majoring in the life sciences across 25 research-intensive (R1) public institutions across the United States (specific details about the recruitment of the students who completed the survey can be found in Cooper et al. (2019c) ). The survey asked students for their opinions about their undergraduate research experiences and their demographic information and whether they would be interested in participating in a follow-up interview related to their research experiences. For the purpose of this study, we exclusively interviewed students about their undergraduate research experiences in faculty member labs; we did not consider students’ experiences in CUREs. Of the 768 undergraduate researchers who completed the survey, 65% ( n = 496) indicated that they would be interested in participating in a follow-up interview. In Spring 2019, we emailed the 496 students, explaining that we were interested in interviewing students with depression about their experiences in undergraduate research. Our specific prompt was: “If you identify as having depression, we would be interested in hearing about your experience in undergraduate research in a 30–60 minute online interview.” We did not define depression in our email recruitment because we conducted think-aloud interviews with four undergraduates who all correctly interpreted what we meant by depression ( APA, 2013 ). We had 35 students agree to participate in the interview study. The interview participants represented 12 of the 25 R1 public institutions that were represented in the initial survey.

Student Interviews

We developed an interview script to explore our research questions. Specifically, we were interested in how students’ symptoms of depression affect their research experiences, how undergraduate research negatively affects student depression, and how undergraduate research positively affects student depression.

We recognized that mental health, and specifically depression, can be a sensitive topic to discuss with undergraduates, and therefore we tried to minimize any discomfort that the interviewees might experience during the interview. Specifically, we conducted think-aloud interviews with three graduate students who self-identified with having depression at the time of the interview. We asked them to note whether any interview questions made them uncomfortable. We also sought their feedback on questions given their experiences as persons with depression who had once engaged in undergraduate research. We revised the interview protocol after each think-aloud interview. Next, we conducted four additional think-aloud interviews with undergraduates conducting basic science or biology education research who identified with having depression to establish cognitive validity of the questions and to elicit additional feedback about any questions that might make someone uncomfortable. The questions were revised after each think-aloud interview until no question was unclear or misinterpreted by the students and we were confident that the questions minimized students’ potential discomfort ( Trenor et al. , 2011 ). A copy of the final interview script can be found in the Supplemental Material.

All interviews were individually conducted by one of two researchers (K.M.C. and L.E.G.) who conducted the think-aloud interviews together to ensure that their interviewing practices were as similar as possible. The interviews were approximately an hour long, and students received a $15 gift card for their participation.

Personal, Research, and Depression Demographics

All student demographics and information about students’ research experiences were collected using the survey distributed to students in Fall 2018. We collected personal demographics, including the participants’ gender, race/ethnicity, college generation status, transfer status, financial stability, year in college, major, and age. We also collected information about the students’ research experiences, including the length of their first research experiences, the average number of hours they spend in research per week, how they were compensated for research, who their primary mentors were, and the focus areas of their research.

In the United States, mental healthcare is disproportionately unavailable to Black and Latinx individuals, as well as those who come from low socioeconomic backgrounds ( Kataoka et al. , 2002 ; Howell and McFeeters, 2008 ; Santiago et al. , 2013 ). Therefore, to minimize a biased sample, we invited anyone who identified with having depression to participate in our study; we did not require students to be diagnosed with depression or to be treated for depression in order to participate. However, we did collect information about whether students had been formally diagnosed with depression and whether they had been treated for depression. After the interview, all participants were sent a link to a short survey that asked them if they had ever been diagnosed with depression and how, if at all, they had ever been treated for depression. A copy of these survey questions can be found in the Supplemental Material. The combined demographic information of the participants is in Table 1 . The demographics for each individual student can be found in the Supplemental Material.

a Students reported the time they had spent in research 6 months before being interviewed and only reported on the length of time of their first research experiences.

b Students were invited to report multiple ways in which they were treated for their depression; other treatments included lifestyle changes and meditation.

c Students were invited to report multiple means of compensation for their research if they had been compensated for their time in different ways.

d Students were asked whether they felt financially stable, particularly during the undergraduate research experience.

e Students reported who they work/worked with most closely during their research experiences.

f Staff members included lab coordinators or lab managers.

g Other focus areas of research included sociology, linguistics, psychology, and public health.

Interview Analysis

The initial interview analysis aimed to explore each idea that a participant expressed ( Charmaz, 2006 ) and to identify reoccurring ideas throughout the interviews. First, three authors (K.M.C., L.E.G., and S.E.B.) individually reviewed a different set of 10 interviews and took detailed analytic notes ( Birks and Mills, 2015 ). Afterward, the authors compared their notes and identified reoccurring themes throughout the interviews using open coding methods ( Saldaña, 2015 ).

Once an initial set of themes was established, two researchers (K.M.C. and L.E.G.) individually reviewed the same set of 15 randomly selected interviews to validate the themes identified in the initial analysis and to screen for any additional themes that the initial analysis may have missed. Each researcher took detailed analytic notes throughout the review of an interview, which they discussed after reviewing each interview. The researchers compared what quotes from each interview they categorized into each theme. Using constant comparison methods, they assigned quotes to each theme and constantly compared the quotes to ensure that each quote fit within the description of the theme ( Glesne and Peshkin, 1992 ). In cases in which quotes were too different from other quotes, a new theme was created. This approach allowed for multiple revisions of the themes and allowed the authors to define a final set of codes; the researchers created a final codebook with refined definitions of emergent themes (the final coding rubric can be found in the Supplemental Material). Once the final codebook was established, the researchers (K.M.C. and L.E.G.) individually coded seven additional interviews (20% of all interviews) using the coding rubric. The researchers compared their codes, and their Cohen’s κ interrater score for these seven interviews was at an acceptable level (κ  =  0.88; Landis and Koch, 1977 ). One researcher (L.E.G.) coded the remaining 28 out of 35 interviews. The researchers determined that data saturation had been reached with the current sample and no further recruitment was needed ( Guest et al. , 2006 ). We report on themes that were mentioned by at least 20% of students in the interview study. In the Supplemental Material, we provide the final coding rubric with the number of participants whose interview reflected each theme ( Hannah and Lautsch, 2011 ). Reporting the number of individuals who reported themes within qualitative data can lead to inaccurate conclusions about the generalizability of the results to a broader population. These qualitative data are meant to characterize a landscape of experiences that students with depression have in undergraduate research rather than to make claims about the prevalence of these experiences ( Glesne and Peshkin, 1992 ). Because inferences about the importance of these themes cannot be drawn from these counts, they are not included in the results of the paper ( Maxwell, 2010 ). Further, the limited number of interviewees made it not possible to examine whether there were trends based on students’ demographics or characteristics of their research experiences (e.g., their specific area of study). Quotes were lightly edited for clarity by inserting clarification brackets and using ellipses to indicate excluded text. Pseudonyms were given to all students to protect their privacy.

The Effect of Depressive Symptoms on Undergraduate Research

We asked students to describe the symptoms associated with their depression. Students described experiencing anxiety that is associated with their depression; this could be anxiety that precedes their depression or anxiety that results from a depressive episode or a period of time when an individual has depression symptoms. Further, students described difficulty getting out of bed or leaving the house, feeling tired, a lack of motivation, being overly self-critical, feeling apathetic, and having difficulty concentrating. We were particularly interested in how students’ symptoms of depression affected their experiences in undergraduate research. During the think-aloud interviews that were conducted before the interview study, graduate and undergraduate students consistently described that their depression affected their motivation in research, their creativity in research, and their productivity in research. Therefore, we explicitly asked undergraduate researchers how, if at all, their depression affected these three factors. We also asked students to describe any additional ways in which their depression affected their research experiences. Undergraduate researchers commonly described five additional ways in which their depression affected their research; for a detailed description of each way students’ research was affected and for example quotes, see Table 2 . Students described that their depression negatively affected their productivity in the lab. Commonly, students described that their productivity was directly affected by a lack of motivation or because they felt less creative, which hindered the research process. Additionally, students highlighted that they were sometimes less productive because their depression sometimes caused them to struggle to engage intellectually with their research or caused them to have difficulty remembering or concentrating; students described that they could do mundane or routine tasks when they felt depressed, but that they had difficulty with more complex and intellectually demanding tasks. However, students sometimes described that even mundane tasks could be difficult when they were required to remember specific steps; for example, some students struggled recalling a protocol from memory when their depression was particularly severe. Additionally, students noted that their depression made them more self-conscious, which sometimes held them back from sharing research ideas with their mentors or from taking risks such as applying to competitive programs. In addition to being self-conscious, students highlighted that their depression caused them to be overly self-critical, and some described experiencing imposter phenomenon ( Clance and Imes, 1978 ) or feeling like they were not talented enough to be in research and were accepted into a lab by a fluke or through luck. Finally, students described that depression often made them feel less social, and they struggled to socially engage with other members of the lab when they were feeling down.

The Effect of Undergraduate Research Experiences on Student Depression

We also wanted to explore how research impacted students’ feelings of depression. Undergraduates described how research both positively and negatively affected their depression. In the following sections, we present aspects of undergraduate research and examine how each positively and/or negatively affected students’ depression using embedded student quotes to highlight the relationships between related ideas.

Lab Environment: Relationships with Others in the Lab.

Some aspects of the lab environment, which we define as students’ physical, social, or psychological research space, could be particularly beneficial for students with depression.

Specifically, undergraduate researchers perceived that comfortable and positive social interactions with others in the lab helped their depression. Students acknowledged how beneficial their relationships with graduate students and postdocs could be.

Marta: “I think always checking in on undergrads is important. It’s really easy [for us] to go a whole day without talking to anybody in the lab. But our grad students are like ‘Hey, what’s up? How’s school? What’s going on?’ (…) What helps me the most is having that strong support system. Sometimes just talking makes you feel better, but also having people that believe in you can really help you get out of that negative spiral. I think that can really help with depression.”

Kelley: “I know that anytime I need to talk to [my postdoc mentors] about something they’re always there for me. Over time we’ve developed a relationship where I know that outside of work and outside of the lab if I did want to talk to them about something I could talk to them. Even just talking to someone about hobbies and having that relationship alone is really helpful [for depression].”

In addition to highlighting the importance of developing relationships with graduate students or postdocs in the lab, students described that forming relationships with other undergraduates in the lab also helped their depression. Particularly, students described that other undergraduate researchers often validated their feelings about research, which in turn helped them realize that what they are thinking or feeling is normal, which tended to alleviate their negative thoughts. Interestingly, other undergraduates experiencing the same issues could sometimes help buffer them from perceiving that a mentor did not like them or that they were uniquely bad at research. In this article, we use the term “mentor” to refer to anyone who students referred to in the interviews as being their mentors or managing their research experiences; this includes graduate students, postdoctoral scholars, lab managers, and primary investigators (PIs).

Abby: “One of my best friends is in the lab with me.  A lot of that friendship just comes from complaining about our stress with the lab and our annoyance with people in the lab. Like when we both agree like, ‘Yeah, the grad students were really off today, it wasn’t us,’ that helps. ‘It wasn’t me, it wasn’t my fault that we were having a rough day in lab; it was the grad students.’ Just being able to realize, ‘Hey, this isn’t all caused by us,’ you know? (…) We understand the stresses in the lab. We understand the details of what each other are doing in the lab, so when something doesn’t work out, we understand that it took them like eight hours to do that and it didn’t work. We provide empathy on a different level.”

Meleana: “It’s great to have solidarity in being confused about something, and it’s just that is a form of validation for me too. When we leave a lab meeting and I look at [another undergrad] I’m like, ‘Did you understand anything that they were just saying?’ And they’re like, ‘Oh, no.’ (…) It’s just really validating to hear from the other undergrads that we all seem to be struggling with the same things.”

Developing positive relationships with faculty mentors or PIs also helped alleviate some students’ depressive feelings, particularly when PIs shared their own struggles with students. This also seemed to normalize students’ concerns about their own experiences.

Alexandra: “[Talking with my PI] is helpful because he would talk about his struggles, and what he faced. A lot of it was very similar to my struggles.  For example, he would say, ‘Oh, yeah, I failed this exam that I studied so hard for. I failed the GRE and I paid so much money to prepare for it.’ It just makes [my depression] better, like okay, this is normal for students to go through this. It’s not an out of this world thing where if you fail, you’re a failure and you can’t move on from it.”

Students’ relationships with others in the lab did not always positively impact their depression. Students described instances when the negative moods of the graduate students and PIs would often set the tone of the lab, which in turn worsened the mood of the undergraduate researchers.

Abby: “Sometimes [the grad students] are not in a good mood. The entire vibe of the lab is just off, and if you make a joke and it hits somebody wrong, they get all mad. It really depends on the grad students and the leadership and the mood that they’re in.”

Interviewer: “How does it affect your depression when the grad students are in a bad mood?”

Abby: “It definitely makes me feel worse. It feels like, again, that I really shouldn’t go ask them for help because they’re just not in the mood to help out. It makes me have more pressure on myself, and I have deadlines I need to meet, but I have a question for them, but they’re in a bad mood so I can’t ask. That’s another day wasted for me and it just puts more stress, which just adds to the depression.”

Additionally, some students described even more concerning behavior from research mentors, which negatively affected their depression.

Julie: “I had a primary investigator who is notorious in the department for screaming at people, being emotionally abusive, unreasonable, et cetera. (…) [He was] kind of harassing people, demeaning them, lying to them, et cetera, et cetera. (…) Being yelled at and constantly demeaned and harassed at all hours of the day and night, that was probably pretty bad for me.”

While the relationships between undergraduates and graduate, postdoc, and faculty mentors seemed to either alleviate or worsen students’ depressive symptoms, depending on the quality of the relationship, students in this study exclusively described their relationships with other undergraduates as positive for their depression. However, students did note that undergraduate research puts some of the best and brightest undergraduates in the same environment, which can result in students comparing themselves with their peers. Students described that this comparison would often lead them to feel badly about themselves, even though they would describe their personal relationship with a person to be good.

Meleana: “In just the research field in general, just feeling like I don’t really measure up to the people around me [can affect my depression]. A lot of the times it’s the beginning of a little spiral, mental spiral. There are some past undergrads that are talked about as they’re on this pedestal of being the ideal undergrads and that they were just so smart and contributed so much to the lab. I can never stop myself from wondering like, ‘Oh, I wonder if I’m having a contribution to the lab that’s similar or if I’m just another one of the undergrads that does the bare minimum and passes through and is just there.’”

Natasha: “But, on the other hand, [having another undergrad in the lab] also reminded me constantly that some people are invested in this and meant to do this and it’s not me. And that some people know a lot more than I do and will go further in this than I will.”

While students primarily expressed that their relationships with others in the lab affected their depression, some students explained that they struggled most with depression when the lab was empty; they described that they did not like being alone in the lab, because a lack of stimulation allowed their minds to be filled with negative thoughts.

Mia: “Those late nights definitely didn’t help [my depression]. I am alone, in the entire building.  I’m left alone to think about my thoughts more, so not distracted by talking to people or interacting with people. I think more about how I’m feeling and the lack of progress I’m making, and the hopelessness I’m feeling. That kind of dragged things on, and I guess deepened my depression.”

Freddy: “Often times when I go to my office in the evening, that is when I would [ sic ] be prone to be more depressed. It’s being alone. I think about myself or mistakes or trying to correct mistakes or whatever’s going on in my life at the time. I become very introspective. I think I’m way too self-evaluating, way too self-deprecating and it’s when I’m alone when those things are really, really triggered. When I’m talking with somebody else, I forget about those things.”

In sum, students with depression highlighted that a lab environment full of positive and encouraging individuals was helpful for their depression, whereas isolating or competitive environments and negative interactions with others often resulted in more depressive feelings.

Doing Science: Experiencing Failure in Research, Getting Help, Receiving Feedback, Time Demands, and Important Contributions.

In addition to the lab environment, students also described that the process of doing science could affect their depression. Specifically, students explained that a large contributor to their depression was experiencing failure in research.

Interviewer: “Considering your experience in undergraduate research, what tends to trigger your feelings of depression?”

Heather: “Probably just not getting things right. Having to do an experiment over and over again. You don’t get the results you want. (…) The work is pretty meticulous and it’s frustrating when I do all this work, I do a whole experiment, and then I don’t get any results that I can use. That can be really frustrating. It adds to the stress. (…) It’s hard because you did all this other stuff before so you can plan for the research, and then something happens and all the stuff you did was worthless basically.”

Julie: “I felt very negatively about myself [when a project failed] and pretty panicked whenever something didn’t work because I felt like it was a direct reflection on my effort and/or intelligence, and then it was a big glaring personal failure.”

Students explained that their depression related to failing in research was exacerbated if they felt as though they could not seek help from their research mentors. Perceived insufficient mentor guidance has been shown to be a factor influencing student intention to leave undergraduate research ( Cooper et al. , 2019c ). Sometimes students talked about their research mentors being unavailable or unapproachable.

Michelle: “It just feels like [the graduate students] are not approachable. I feel like I can’t approach them to ask for their understanding in a certain situation. It makes [my depression] worse because I feel like I’m stuck, and that I’m being limited, and like there’s nothing I can do. So then I kind of feel like it’s my fault that I can’t do anything.”

Other times, students described that they did not seek help in fear that they would be negatively evaluated in research, which is a fear of being judged by others ( Watson and Friend, 1969 ; Weeks et al. , 2005 ; Cooper et al. , 2018 ). That is, students fear that their mentor would think negatively about them or judge them if they were to ask questions that their mentor thought they should know the answer to.

Meleana: “I would say [my depression] tends to come out more in being more reserved in asking questions because I think that comes more like a fear-based thing where I’m like, ‘Oh, I don’t feel like I’m good enough and so I don’t want to ask these questions because then my mentors will, I don’t know, think that I’m dumb or something.’”

Conversely, students described that mentors who were willing to help them alleviated their depressive feelings.

Crystal: “Yeah [my grad student] is always like, ‘Hey, I can check in on things in the lab because you’re allowed to ask me for that, you’re not totally alone in this,’ because he knows that I tend to take on all this responsibility and I don’t always know how to ask for help. He’s like, ‘You know, this is my lab too and I am here to help you as well,’ and just reminds me that I’m not shouldering this burden by myself.”

Ashlyn: “The graduate student who I work with is very kind and has a lot of patience and he really understands a lot of things and provides simple explanations. He does remind me about things and he will keep on me about certain tasks that I need to do in an understanding way, and it’s just because he’s patient and he listens.”

In addition to experiencing failure in science, students described that making mistakes when doing science also negatively affected their depression.

Abby: “I guess not making mistakes on experiments [is important in avoiding my depression]. Not necessarily that your experiment didn’t turn out to produce the data that you wanted, but just adding the wrong enzyme or messing something up like that. It’s like, ‘Oh, man,’ you know? You can get really down on yourself about that because it can be embarrassing.”

Commonly, students described that the potential for making mistakes increased their stress and anxiety regarding research; however, they explained that how other people responded to a potential mistake was what ultimately affected their depression.

Briana: “Sometimes if I made a mistake in correctly identifying an eye color [of a fly], [my PI] would just ridicule me in front of the other students. He corrected me but his method of correcting was very discouraging because it was a ridicule. It made the others laugh and I didn’t like that.”

Julie: “[My PI] explicitly [asked] if I had the dedication for science. A lot of times he said I had terrible judgment. A lot of times he said I couldn’t be trusted. Once I went to a conference with him, and, unfortunately, in front of another professor, he called me a klutz several times and there was another comment about how I never learn from my mistakes.”

When students did do things correctly, they described how important it could be for them to receive praise from their mentors. They explained that hearing praise and validation can be particularly helpful for students with depression, because their thoughts are often very negative and/or because they have low self-esteem.

Crystal: “[Something that helps my depression is] I have text messages from [my graduate student mentor] thanking me [and another undergraduate researcher] for all of the work that we’ve put in, that he would not be able to be as on track to finish as he is if he didn’t have our help.”

Interviewer: “Why is hearing praise from your mentor helpful?”

Crystal: “Because a lot of my depression focuses on everybody secretly hates you, nobody likes you, you’re going to die alone. So having that validation [from my graduate mentor] is important, because it flies in the face of what my depression tells me.”

Brian: “It reminds you that you exist outside of this negative world that you’ve created for yourself, and people don’t see you how you see yourself sometimes.”

Students also highlighted how research could be overwhelming, which negatively affected their depression. Particularly, students described that research demanded a lot of their time and that their mentors did not always seem to be aware that they were juggling school and other commitments in addition to their research. This stress exacerbated their depression.

Rose: “I feel like sometimes [my grad mentors] are not very understanding because grad students don’t take as many classes as [undergrads] do. I think sometimes they don’t understand when I say I can’t come in at all this week because I have finals and they’re like, ‘Why though?’”

Abby: “I just think being more understanding of student life would be great. We have classes as well as the lab, and classes are the priority. They forget what it’s like to be a student. You feel like they don’t understand and they could never understand when you say like, ‘I have three exams this week,’ and they’re like, ‘I don’t care. You need to finish this.’”

Conversely, some students reported that their research labs were very understanding of students’ schedules. Interestingly, these students talked most about how helpful it was to be able to take a mental health day and not do research on days when they felt down or depressed.

Marta: “My lab tech is very open, so she’ll tell us, ‘I can’t come in today. I have to take a mental health day.’ So she’s a really big advocate for that. And I think I won’t personally tell her that I’m taking a mental health day, but I’ll say, ‘I can’t come in today, but I’ll come in Friday and do those extra hours.’ And she’s like, ‘OK great, I’ll see you then.’  And it makes me feel good, because it helps me take care of myself first and then I can take care of everything else I need to do, which is amazing.”

Meleana: “Knowing that [my mentors] would be flexible if I told them that I’m crazy busy and can’t come into work nearly as much this week [helps my depression]. There is flexibility in allowing me to then care for myself.”

Interviewer: “Why is the flexibility helpful given the depression?”

Meleana: “Because sometimes for me things just take a little bit longer when I’m feeling down. I’m just less efficient to be honest, and so it’s helpful if I feel like I can only go into work for 10 hours in a week. It declutters my brain a little bit to not have to worry about all the things I have to do in work in addition the things that I need to do for school or clubs, or family or whatever.”

Despite the demanding nature of research, a subset of students highlighted that their research and research lab provided a sense of stability or familiarity that distracted them from their depression.

Freddy: “I’ll [do research] to run away from those [depressive] feelings or whatever. (…) I find sadly, I hate to admit it, but I do kind of run to [my lab]. I throw myself into work to distract myself from the feelings of depression and sadness.”

Rose: “When you’re sad or when you’re stressed you want to go to things you’re familiar with. So because lab has always been in my life, it’s this thing where it’s going to be there for me I guess. It’s like a good book that you always go back to and it’s familiar and it makes you feel good. So that’s how lab is. It’s not like the greatest thing in the world but it’s something that I’m used to, which is what I feel like a lot of people need when they’re sad and life is not going well.”

Many students also explained that research positively affects their depression because they perceive their research contribution to be important.

Ashlyn: “I feel like I’m dedicating myself to something that’s worthy and something that I believe in. It’s really important because it contextualizes those times when I am feeling depressed. It’s like, no, I do have these better things that I’m working on. Even when I don’t like myself and I don’t like who I am, which is again, depression brain, I can at least say, ‘Well, I have all these other people relying on me in research and in this area and that’s super important.’”

Jessica: “I mean, it just felt like the work that I was doing had meaning and when I feel like what I’m doing is actually going to contribute to the world, that usually really helps with [depression] because it’s like not every day you can feel like you’re doing something impactful.”

In sum, students highlighted that experiencing failure in research and making mistakes negatively contributed to depression, especially when help was unavailable or research mentors had a negative reaction. Additionally, students acknowledged that the research could be time-consuming, but that research mentors who were flexible helped assuage depressive feelings that were associated with feeling overwhelmed. Finally, research helped some students’ depression, because it felt familiar, provided a distraction from depression, and reminded students that they were contributing to a greater cause.

We believe that creating more inclusive research environments for students with depression is an important step toward broadening participation in science, not only to ensure that we are not discouraging students with depression from persisting in science, but also because depression has been shown to disproportionately affect underserved and underrepresented groups in science ( Turner and Noh, 1988 ; Eisenberg et al. , 2007 ; Jenkins et al. , 2013 ; American College Health Association, 2018 ). We initially hypothesized that three features of undergraduate research—research mentors, the lab environment, and failure—may have the potential to exacerbate student depression. We found this to be true; students highlighted that their relationships with their mentors as well as the overall lab environment could negatively affect their depression, but could also positively affect their research experiences. Students also noted that they struggled with failure, which is likely true of most students, but is known to be particularly difficult for students with depression ( Elliott et al. , 1997 ). We expand upon our findings by integrating literature on depression with the information that students provided in the interviews about how research mentors can best support students. We provide a set of evidence-based recommendations focused on mentoring, the lab environment, and failure for research mentors wanting to create more inclusive research environments for students with depression. Notably, only the first recommendation is specific to students with depression; the others reflect recommendations that have previously been described as “best practices” for research mentors ( NASEM, 2017 , 2019 ; Sorkness et al. , 2017 ) and likely would benefit most students. However, we examine how these recommendations may be particularly important for students with depression. As we hypothesized, these recommendations directly address three aspects of research: mentors, lab environment, and failure. A caveat of these recommendations is that more research needs to be done to explore the experiences of students with depression and how these practices actually impact students with depression, but our national sample of undergraduate researchers with depression can provide an initial starting point for a discussion about how to improve research experiences for these students.

Recommendations to Make Undergraduate Research Experiences More Inclusive for Students with Depression

Recognize student depression as a valid illness..

Allow students with depression to take time off of research by simply saying that they are sick and provide appropriate time for students to recover from depressive episodes. Also, make an effort to destigmatize mental health issues.

Undergraduate researchers described both psychological and physical symptoms that manifested as a result of their depression and highlighted how such symptoms prevented them from performing to their full potential in undergraduate research. For example, students described how their depression would cause them to feel unmotivated, which would often negatively affect their research productivity. In cases in which students were motivated enough to come in and do their research, they described having difficulty concentrating or engaging in the work. Further, when doing research, students felt less creative and less willing to take risks, which may alter the quality of their work. Students also sometimes struggled to socialize in the lab. They described feeling less social and feeling overly self-critical. In sum, students described that, when they experienced a depressive episode, they were not able to perform to the best of their ability, and it sometimes took a toll on them to try to act like nothing was wrong, when they were internally struggling with depression. We recommend that research mentors treat depression like any other physical illness; allowing students the chance to recover when they are experiencing a depressive episode can be extremely important to students and can allow them to maximize their productivity upon returning to research ( Judd et al. , 2000 ). Students explained that if they are not able to take the time to focus on recovering during a depressive episode, then they typically continue to struggle with depression, which negatively affects their research. This sentiment is echoed by researchers in psychiatry who have found that patients who do not fully recover from a depressive episode are more likely to relapse and to experience chronic depression ( Judd et al. , 2000 ). Students described not doing tasks or not showing up to research because of their depression but struggling with how to share that information with their research mentors. Often, students would not say anything, which caused them anxiety because they were worried about what others in the lab would say to them when they returned. Admittedly, many students understood why this behavior would cause their research mentors to be angry or frustrated, but they weighed the consequences of their research mentors’ displeasure against the consequences of revealing their depression and decided it was not worth admitting to being depressed. This aligns with literature that suggests that when individuals have concealable stigmatized identities, or identities that can be hidden and that carry negative stereotypes, such as depression, they will often keep them concealed to avoid negative judgment or criticism ( Link and Phelan, 2001 ; Quinn and Earnshaw, 2011 ; Jones and King, 2014 ; Cooper and Brownell, 2016 ; Cooper et al. , 2019b ; Cooper et al ., unpublished data ). Therefore, it is important for research mentors to be explicit with students that 1) they recognize mental illness as a valid sickness and 2) that students with mental illness can simply explain that they are sick if they need to take time off. This may be useful to overtly state on a research website or in a research syllabus, contract, or agreement if mentors use such documents when mentoring undergraduates in their lab. Further, research mentors can purposefully work to destigmatize mental health issues by explicitly stating that struggling with mental health issues, such as depression and anxiety, is common. While we do not recommend that mentors ask students directly about depression, because this can force students to share when they are not comfortable sharing, we do recommend providing opportunities for students to reveal their depression ( Chaudoir and Fisher, 2010 ). Mentors can regularly check in with students about how they’re doing, and talk openly about the importance of mental health, which may increase the chance that students may feel comfortable revealing their depression ( Chaudoir and Quinn, 2010 ; Cooper et al ., unpublished data ).

Foster a Positive Lab Environment.

Encourage positivity in the research lab, promote working in shared spaces to enhance social support among lab members, and alleviate competition among undergraduates.

Students in this study highlighted that the “leadership” of the lab, meaning graduate students, postdocs, lab managers, and PIs, were often responsible for establishing the tone of the lab; that is, if they were in a bad mood it would trickle down and negatively affect the moods of the undergraduates. Explicitly reminding lab leadership that their moods can both positively and negatively affect undergraduates may be important in establishing a positive lab environment. Further, students highlighted how they were most likely to experience negative thoughts when they were alone in the lab. Therefore, it may be helpful to encourage all lab members to work in a shared space to enhance social interactions among students and to maximize the likelihood that undergraduates have access to help when needed. A review of 51 studies in psychiatry supported our undergraduate researchers’ perceptions that social relationships positively impacted their depression; the study found that perceived emotional support (e.g., someone available to listen or give advice), perceived instrumental support (e.g., someone available to help with tasks), and large diverse social networks (e.g., being socially connected to a large number of people) were significantly protective against depression ( Santini et al. , 2015 ). Additionally, despite forming positive relationships with other undergraduates in the lab, many undergraduate researchers admitted to constantly comparing themselves with other undergraduates, which led them to feel inferior, negatively affecting their depression. Some students talked about mentors favoring current undergraduates or talking positively about past undergraduates, which further exacerbated their feelings of inferiority. A recent study of students in undergraduate research experiences highlighted that inequitable distribution of praise to undergraduates can create negative perceptions of lab environments for students (Cooper et al. , 2019). Further, the psychology literature has demonstrated that when people feel insecure in their social environments, it can cause them to focus on a hierarchical view of themselves and others, which can foster feelings of inferiority and increase their vulnerability to depression ( Gilbert et al. , 2009 ). Thus, we recommend that mentors be conscious of their behaviors so that they do not unintentionally promote competition among undergraduates or express favoritism toward current or past undergraduates. Praise is likely best used without comparison with others and not done in a public way, although more research on the impact of praise on undergraduate researchers needs to be done. While significant research has been done on mentoring and mentoring relationships in the context of undergraduate research ( Byars-Winston et al. , 2015 ; Aikens et al. , 2017 ; Estrada et al. , 2018 ; Limeri et al. , 2019 ; NASEM, 2019 ), much less has been done on the influence of the lab environment broadly and how people in nonmentoring roles can influence one another. Yet, this study indicates the potential influence of many different members of the lab, not only their mentors, on students with depression.

Develop More Personal Relationships with Undergraduate Researchers and Provide Sufficient Guidance.

Make an effort to establish more personal relationships with undergraduates and ensure that they perceive that they have access to sufficient help and guidance with regard to their research.

When we asked students explicitly how research mentors could help create more inclusive environments for undergraduate researchers with depression, students overwhelmingly said that building mentor–student relationships would be extremely helpful. Students suggested that mentors could get to know students on a more personal level by asking about their career interests or interests outside of academia. Students also remarked that establishing a more personal relationship could help build the trust needed in order for undergraduates to confide in their research mentors about their depression, which they perceived would strengthen their relationships further because they could be honest about when they were not feeling well or their mentors might even “check in” with them in times where they were acting differently than normal. This aligns with studies showing that undergraduates are most likely to reveal a stigmatized identity, such as depression, when they form a close relationship with someone ( Chaudoir and Quinn, 2010 ). Many were intimidated to ask for research-related help from their mentors and expressed that they wished they had established a better relationship so that they would feel more comfortable. Therefore, we recommend that research mentors try to establish relationships with their undergraduates and explicitly invite them to ask questions or seek help when needed. These recommendations are supported by national recommendations for mentoring ( NASEM, 2019 ) and by literature that demonstrates that both social support (listening and talking with students) and instrumental support (providing students with help) have been shown to be protective against depression ( Santini et al. , 2015 ).

Treat Undergraduates with Respect and Remember to Praise Them.

Avoid providing harsh criticism and remember to praise undergraduates. Students with depression often have low self-esteem and are especially self-critical. Therefore, praise can help calibrate their overly negative self-perceptions.

Students in this study described that receiving criticism from others, especially harsh criticism, was particularly difficult for them given their depression. Multiple studies have demonstrated that people with depression can have an abnormal or maladaptive response to negative feedback; scientists hypothesize that perceived failure on a particular task can trigger failure-related thoughts that interfere with subsequent performance ( Eshel and Roiser, 2010 ). Thus, it is important for research mentors to remember to make sure to avoid unnecessarily harsh criticisms that make students feel like they have failed (more about failure is described in the next recommendation). Further, students with depression often have low self-esteem or low “personal judgment of the worthiness that is expressed in the attitudes the individual holds towards oneself” ( Heatherton et al. , 2003 , p. 220; Sowislo and Orth, 2013 ). Specifically, a meta-analysis of longitudinal studies found that low self-esteem is predictive of depression ( Sowislo and Orth, 2013 ), and depression has also been shown to be highly related to self-criticism ( Luyten et al. , 2007 ). Indeed, nearly all of the students in our study described thinking that they are “not good enough,” “worthless,” or “inadequate,” which is consistent with literature showing that people with depression are self-critical ( Blatt et al. , 1982 ; Gilbert et al. , 2006 ) and can be less optimistic of their performance on future tasks and rate their overall performance on tasks less favorably than their peers without depression ( Cane and Gotlib, 1985 ). When we asked students what aspects of undergraduate research helped their depression, students described that praise from their mentors was especially impactful, because they thought so poorly of themselves and they needed to hear something positive from someone else in order to believe it could be true. Praise has been highlighted as an important aspect of mentoring in research for many years ( Ashford, 1996 ; Gelso and Lent, 2000 ; Brown et al. , 2009 ) and may be particularly important for students with depression. In fact, praise has been shown to enhance individuals’ motivation and subsequent productivity ( Hancock, 2002 ; Henderlong and Lepper, 2002 ), factors highlighted by students as negatively affecting their depression. However, something to keep in mind is that a student with depression and a student without depression may process praise differently. For a student with depression, a small comment that praises the student’s work may not be sufficient for the student to process that comment as praise. People with depression are hyposensitive to reward or have reward-processing deficits ( Eshel and Roiser, 2010 ); therefore, praise may affect students without depression more positively than it would affect students with depression. Research mentors should be mindful that students with depression often have a negative view of themselves, and while students report that praise is extremely important, they may have trouble processing such positive feedback.

Normalize Failure and Be Explicit about the Importance of Research Contributions.

Explicitly remind students that experiencing failure is expected in research. Also explain to students how their individual work relates to the overall project so that they can understand how their contributions are important. It can also be helpful to explain to students why the research project as a whole is important in the context of the greater scientific community.

Experiencing failure has been thought to be a potentially important aspect of undergraduate research, because it may provide students with the potential to develop integral scientific skills such as the ability to navigate challenges and persevere ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, in the interviews, students described that when their science experiments failed, it was particularly tough for their depression. Students’ negative reaction to experiencing failure in research is unsurprising, given recent literature that has predicted that students may be inadequately prepared to approach failure in science ( Henry et al. , 2019 ). However, the literature suggests that students with depression may find experiencing failure in research to be especially difficult ( Elliott et al. , 1997 ; Mongrain and Blackburn, 2005 ; Jones et al. , 2009 ). One potential hypothesis is that students with depression may be more likely to have fixed mindsets or more likely to believe that their intelligence and capacity for specific abilities are unchangeable traits ( Schleider and Weisz, 2018 ); students with a fixed mindset have been hypothesized to have particularly negative responses to experiencing failure in research, because they are prone to quitting easily in the face of challenges and becoming defensive when criticized ( Forsythe and Johnson, 2017 ; Dweck, 2008 ). A study of life sciences undergraduates enrolled in CUREs identified three strategies of students who adopted adaptive coping mechanisms, or mechanisms that help an individual maintain well-being and/or move beyond the stressor when faced with failure in undergraduate research: 1) problem solving or engaging in strategic planning and decision making, 2) support seeking or finding comfort and help with research, and 3) cognitive restructuring or reframing a problem from negative to positive and engaging in self encouragement ( Gin et al. , 2018 ). We recommend that, when undergraduates experience failure in science, their mentors be proactive in helping them problem solve, providing help and support, and encouraging them. Students also explained that mentors sharing their own struggles as undergraduate and graduate students was helpful, because it normalized failure. Sharing personal failures in research has been recommended as an important way to provide students with psychosocial support during research ( NASEM, 2019 ). We also suggest that research mentors take time to explain to students why their tasks in the lab, no matter how small, contribute to the greater research project ( Cooper et al. , 2019a ). Additionally, it is important to make sure that students can explain how the research project as a whole is contributing to the scientific community ( Gin et al. , 2018 ). Students highlighted that contributing to something important was really helpful for their depression, which is unsurprising, given that studies have shown that meaning in life or people’s comprehension of their life experiences along with a sense of overarching purpose one is working toward has been shown to be inversely related to depression ( Steger, 2013 ).

Limitations and Future Directions

This work was a qualitative interview study intended to document a previously unstudied phenomenon: depression in the context of undergraduate research experiences. We chose to conduct semistructured interviews rather than a survey because of the need for initial exploration of this area, given the paucity of prior research. A strength of this study is the sampling approach. We recruited a national sample of 35 undergraduates engaged in undergraduate research at 12 different public R1 institutions. Despite our representative sample from R1 institutions, these findings may not be generalizable to students at other types of institutions; lab environments, mentoring structures, and interactions between faculty and undergraduate researchers may be different at other institution types (e.g., private R1 institutions, R2 institutions, master’s-granting institutions, primarily undergraduate institutions, and community colleges), so we caution against making generalizations about this work to all undergraduate research experiences. Future work could assess whether students with depression at other types of institutions have similar experiences to students at research-intensive institutions. Additionally, we intentionally did not explore the experiences of students with specific identities owing to our sample size and the small number of students in any particular group (e.g., students of a particular race, students with a graduate mentor as the primary mentor). We intend to conduct future quantitative studies to further explore how students’ identities and aspects of their research affect their experiences with depression in undergraduate research.

The students who participated in the study volunteered to be interviewed about their depression; therefore, it is possible that depression is a more salient part of these students’ identities and/or that they are more comfortable talking about their depression than the average population of students with depression. It is also important to acknowledge the personal nature of the topic and that some students may not have fully shared their experiences ( Krumpal, 2013 ), particularly those experiences that may be emotional or traumatizing ( Kahn and Garrison, 2009 ). Additionally, our sample was skewed toward females (77%). While females do make up approximately 60% of students in biology programs on average ( Eddy et al. , 2014 ), they are also more likely to report experiencing depression ( American College Health Association, 2018 ; Evans et al. , 2018 ). However, this could be because women have higher rates of depression or because males are less likely to report having depression; clinical bias, or practitioners’ subconscious tendencies to overlook male distress, may underestimate depression rates in men ( Smith et al. , 2018 ). Further, females are also more likely to volunteer to participate in studies ( Porter and Whitcomb, 2005 ); therefore, many interview studies have disproportionately more females in the data set (e.g., Cooper et al. , 2017 ). If we had been able to interview more male students, we might have identified different findings. Additionally, we limited our sample to life sciences students engaged in undergraduate research at public R1 institutions. It is possible that students in other majors may have different challenges and opportunities for students with depression, as well as different disciplinary stigmas associated with mental health.

In this exploratory interview study, we identified a variety of ways in which depression in undergraduates negatively affected their undergraduate research experiences. Specifically, we found that depression interfered with students’ motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing. We also identified that research can negatively affect depression in undergraduates. Experiencing failure in research can exacerbate student depression, especially when students do not have access to adequate guidance. Additionally, being alone or having negative interactions with others in the lab worsened students’ depression. However, we also found that undergraduate research can positively affect students’ depression. Research can provide a familiar space where students can feel as though they are contributing to something meaningful. Additionally, students reported that having access to adequate guidance and a social support network within the research lab also positively affected their depression. We hope that this work can spark conversations about how to make undergraduate research experiences more inclusive of students with depression and that it can stimulate additional research that more broadly explores the experiences of undergraduate researchers with depression.

Important note

If you or a student experience symptoms of depression and want help, there are resources available to you. Many campuses provide counseling centers equipped to provide students, staff, and faculty with treatment for depression, as well as university-dedicated crisis hotlines. Additionally, there are free 24/7 services such as Crisis Text Line, which allows you to text a trained live crisis counselor (Text “CONNECT” to 741741; Text Depression Hotline , 2019 ), and phone hotlines such as the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can also learn more about depression and where to find help near you through the Anxiety and Depression Association of American website: https://adaa.org ( Anxiety and Depression Association of America, 2019 ) and the Depression and Biopolar Support Alliance: http://dbsalliance.org ( Depression and Biopolar Support Alliance, 2019 ).

ACKNOWLEDGMENTS

We are extremely grateful to the undergraduate researchers who shared their thoughts and experiences about depression with us. We acknowledge the ASU LEAP Scholars for helping us create the original survey and Rachel Scott for her helpful feedback on earlier drafts of this article. L.E.G. was supported by a National Science Foundation (NSF) Graduate Fellowship (DGE-1311230) and K.M.C. was partially supported by a Howard Hughes Medical Institute (HHMI) Inclusive Excellence grant (no. 11046) and an NSF grant (no. 1644236). Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF or HHMI.

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Submitted: 4 November 2019 Revised: 24 February 2020 Accepted: 6 March 2020

© 2020 K. M. Cooper, L. E. Gin, et al. CBE—Life Sciences Education © 2020 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

COLLEGE STUDENT DEPRESSION, ANXIETY DISORDER, AND SUICIDE: INSTITUTIONAL TRENDS, ASSOCIATIONS, AND MITIGATION INTERVENTIONS

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• Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
• This study sought to identify trends and incidence levels of college student depression, anxiety disorder, and suicide at United States colleges and universities. A public health approach was employed to ascertain if institutional and social determinants of mental illness are acting upon students. Once specific underlying factors were identified, a set of institutional interventions were developed to inform colleges and universities about strategies that can be implemented to mitigate student mental illness. This work has determined that there are numerous initiatives that institutions of higher education can implement to mitigate student mental illness. A one-person systematic review was undertaken to assess and determine the current state of scholarship within this topic area. Scholarship on this topic has primarily been focused on individual pathology and access to care. The reviewed research relates to access to campus counseling resources, counseling center models of care, risk identification, risk stratification, and intervention modalities. However, there is a dearth of literature on how institutional factors may be affecting student mental health. College students are at significant risk of mental illness, with 46.2% of college students reporting debilitating depression and 66.4% of college students feeling overwhelming anxiety in the 2018 to 2019 academic year (ACHA-NCHA). Of significant concern is the fact that 36.9% of students reported serious suicidal ideation and 10.9% of students attempted suicide in the 2018 to 2019 academic year (CCMH). Approximately 1,100 students die by suicide each year (Fernández Rodríguez and Huertas, 2013). A concurrent triangulation mixed methods approach was employed. Quantitative research included the collection and analysis of secondary data from valid sources. Qualitative research factors were explored through Key Informant interviews of Counseling Center Directors and Deans of Students to explore hypothesized underlying factors. Results were utilized to develop an institutional plan of action that can be implemented on a college-by-college basis. A modified sequential intercept model will be employed to inform implementation. Action plan steps include pedagogical modifications, policy changes related to FERPA, eliminating barriers to help-seeking behavior, and creating collaborative campus cultures, among others. The end goal is to create supportive and transparent campus communities where students can thrive.
• Mental health
• Higher education
• Public health
• https://doi.org/10.17615/n1y4-tz44
• Dissertation
• In Copyright - Educational Use Permitted
• Helm-Murtagh, Susan
• Frerichs, Leah
• Maurer Smith, Kathleen
• Naumann, Rebecca
• Volmar, Karen
• Doctor of Public Health
• University of North Carolina at Chapel Hill Graduate School

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• Published: 13 July 2021

Systematic review and meta-analysis of depression, anxiety, and suicidal ideation among Ph.D. students

• Emily N. Satinsky 1 ,
• Tomoki Kimura 2 ,
• Mathew V. Kiang 3 , 4 ,
• Rediet Abebe 5 , 6 ,
• Scott Cunningham 7 ,
• Hedwig Lee 8 ,
• Xiaofei Lin 9 ,
• Cindy H. Liu 10 , 11 ,
• Igor Rudan 12 ,
• Srijan Sen 13 ,
• Mark Tomlinson 14 , 15 ,
• Miranda Yaver 16 &
• Alexander C. Tsai 1 , 11 , 17  

Scientific Reports volume  11 , Article number:  14370 ( 2021 ) Cite this article

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• Epidemiology
• Health policy
• Quality of life

University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I 2  = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I 2  = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.

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Introduction.

Mental health problems among graduate students in doctoral degree programs have received increasing attention 1 , 2 , 3 , 4 . Ph.D. students (and students completing equivalent degrees, such as the Sc.D.) face training periods of unpredictable duration, financial insecurity and food insecurity, competitive markets for tenure-track positions, and unsparing publishing and funding models 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 —all of which may have greater adverse impacts on students from marginalized and underrepresented populations 13 , 14 , 15 . Ph.D. students’ mental health problems may negatively affect their physical health 16 , interpersonal relationships 17 , academic output, and work performance 18 , 19 , and may also contribute to program attrition 20 , 21 , 22 . As many as 30 to 50% of Ph.D. students drop out of their programs, depending on the country and discipline 23 , 24 , 25 , 26 , 27 . Further, while mental health problems among Ph.D. students raise concerns for the wellbeing of the individuals themselves and their personal networks, they also have broader repercussions for their institutions and academia as a whole 22 .

Despite the potential public health significance of this problem, most evidence syntheses on student mental health have focused on undergraduate students 28 , 29 or graduate students in professional degree programs (e.g., medical students) 30 . In non-systematic summaries, estimates of the prevalence of clinically significant depressive symptoms among Ph.D. students vary considerably 31 , 32 , 33 . Reliable estimates of depression and other mental health problems among Ph.D. students are needed to inform preventive, screening, or treatment efforts. To address this gap in the literature, we conducted a systematic review and meta-analysis to explore patterns of depression, anxiety, and suicidal ideation among Ph.D. students.

Flowchart of included articles.

The evidence search yielded 886 articles, of which 286 were excluded as duplicates (Fig.  1 ). An additional nine articles were identified through reference lists or grey literature reports published on university websites. Following a title/abstract review and subsequent full-text review, 520 additional articles were excluded.

Of the 89 remaining articles, 74 were unclear about their definition of graduate students or grouped Ph.D. and non-Ph.D. students without disaggregating the estimates by degree level. We obtained contact information for the authors of most of these articles (69 [93%]), requesting additional data. Three authors clarified that their study samples only included Ph.D. students 34 , 35 , 36 . Fourteen authors confirmed that their study samples included both Ph.D. and non-Ph.D. students but provided us with data on the subsample of Ph.D. students 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 . Where authors clarified that the sample was limited to graduate students in non-doctoral degree programs, did not provide additional data on the subsample of Ph.D. students, or did not reply to our information requests, we excluded the studies due to insufficient information (Supplementary Table S1 ).

Ultimately, 32 articles describing the findings of 29 unique studies were identified and included in the review 16 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 (Table 1 ). Overall, 26 studies measured depression, 19 studies measured anxiety, and six studies measured suicidal ideation. Three pairs of articles reported data on the same sample of Ph.D. students 33 , 38 , 45 , 51 , 53 , 56 and were therefore grouped in Table 1 and reported as three studies. Publication dates ranged from 1979 to 2019, but most articles (22/32 [69%]) were published after 2015. Most studies were conducted in the United States (20/29 [69%]), with additional studies conducted in Australia, Belgium, China, Iran, Mexico, and South Korea. Two studies were conducted in cross-national settings representing 48 additional countries. None were conducted in sub-Saharan Africa or South America. Most studies included students completing their degrees in a mix of disciplines (17/29 [59%]), while 12 studies were limited to students in a specific field (e.g., biomedicine, education). The median sample size was 172 students (interquartile range [IQR], 68–654; range, 6–6405). Seven studies focused on mental health outcomes in demographic subgroups, including ethnic or racialized minority students 37 , 41 , 43 , international students 47 , 50 , and sexual and gender minority students 42 , 54 .

In all, 16 studies reported the prevalence of depression among a total of 23,469 Ph.D. students (Fig.  2 ; range, 10–47%). Of these, the most widely used depression scales were the PHQ-9 (9 studies) and variants of the Center for Epidemiologic Studies-Depression scale (CES-D, 4 studies) 63 , and all studies assessed clinically significant symptoms of depression over the past one to two weeks. Three of these studies reported findings based on data from different survey years of the same parent study (the Healthy Minds Study) 40 , 42 , 43 , but due to overlap in the survey years reported across articles, these data were pooled. Most of these studies were based on data collected through online surveys (13/16 [81%]). Ten studies (63%) used random or systematic sampling, four studies (25%) used convenience sampling, and two studies (13%) used multiple sampling techniques.

Pooled estimate of the proportion of Ph.D. students with clinically significant symptoms of depression.

The estimated proportion of Ph.D. students assessed as having clinically significant symptoms of depression was 0.24 (95% confidence interval [CI], 0.18–0.31; 95% predictive interval [PI], 0.04–0.54), with significant evidence of between-study heterogeneity (I 2  = 98.75%). A subgroup analysis restricted to the twelve studies conducted in the United States yielded similar findings (pooled estimate [ES] = 0.23; 95% CI, 0.15–0.32; 95% PI, 0.01–0.60), with no appreciable difference in heterogeneity (I 2  = 98.91%). A subgroup analysis restricted to the studies that used the PHQ-9 to assess depression yielded a slightly lower prevalence estimate and a slight reduction in heterogeneity (ES = 0.18; 95% CI, 0.14–0.22; 95% PI, 0.07–0.34; I 2  = 90.59%).

Nine studies reported the prevalence of clinically significant symptoms of anxiety among a total of 15,626 Ph.D. students (Fig.  3 ; range 4–49%). Of these, the most widely used anxiety scale was the 7-item Generalized Anxiety Disorder scale (GAD-7, 5 studies) 64 . Data from three of the Healthy Minds Study articles were pooled into two estimates, because the scale used to measure anxiety changed midway through the parent study (i.e., the Patient Health Questionnaire-Generalized Anxiety Disorder [PHQ-GAD] scale was used from 2007 to 2012 and then switched to the GAD-7 in 2013 40 ). Most studies (8/9 [89%]) assessed clinically significant symptoms of anxiety over the past two to four weeks, with the one remaining study measuring anxiety over the past year. Again, most of these studies were based on data collected through online surveys (7/9 [78%]). Five studies (56%) used random or systematic sampling, two studies (22%) used convenience sampling, and two studies (22%) used multiple sampling techniques.

Pooled estimate of the proportion of Ph.D. students with clinically significant symptoms of anxiety.

The estimated proportion of Ph.D. students assessed as having anxiety was 0.17 (95% CI, 0.12–0.23; 95% PI, 0.02–0.41), with significant evidence of between-study heterogeneity (I 2  = 98.05%). The subgroup analysis restricted to the five studies conducted in the United States yielded a slightly lower proportion of students assessed as having anxiety (ES = 0.14; 95% CI, 0.08–0.20; 95% PI, 0.00–0.43), with no appreciable difference in heterogeneity (I 2  = 98.54%).

Six studies reported the prevalence of suicidal ideation (range, 2–12%), but the recall windows varied greatly (e.g., ideation within the past 2 weeks vs. past year), precluding pooled estimation.

Additional stratified pooled estimates could not be obtained. One study of Ph.D. students across 54 countries found that phase of study was a significant moderator of mental health, with students in the comprehensive examination and dissertation phases more likely to experience distress compared with students primarily engaged in coursework 59 . Other studies identified a higher prevalence of mental ill-health among women 54 ; lesbian, gay, bisexual, transgender, and queer (LGBTQ) students 42 , 54 , 60 ; and students with multiple intersecting identities 54 .

Several studies identified correlates of mental health problems including: project- and supervisor-related issues, stress about productivity, and self-doubt 53 , 62 ; uncertain career prospects, poor living conditions, financial stressors, lack of sleep, feeling devalued, social isolation, and advisor relationships 61 ; financial challenges 38 ; difficulties with work-life balance 58 ; and feelings of isolation and loneliness 52 . Despite these challenges, help-seeking appeared to be limited, with only about one-quarter of Ph.D. students reporting mental health problems also reporting that they were receiving treatment 40 , 52 .

Risk of bias

Twenty-one of 32 articles were assessed as having low risk of bias (Supplementary Table S2 ). Five articles received one point for all five categories on the risk of bias assessment (lowest risk of bias), and one article received no points (highest risk). The mean risk of bias score was 3.22 (standard deviation, 1.34; median, 4; IQR, 2–4). Restricting the estimation sample to 12 studies assessed as having low risk of bias, the estimated proportion of Ph.D. students with depression was 0.25 (95% CI, 0.18–0.33; 95% PI, 0.04–0.57; I 2  = 99.11%), nearly identical to the primary estimate, with no reduction in heterogeneity. The estimated proportion of Ph.D. students with anxiety, among the 7 studies assessed as having low risk of bias, was 0.12 (95% CI, 0.07–0.17; 95% PI, 0.01–0.34; I 2  = 98.17%), again with no appreciable reduction in heterogeneity.

In our meta-analysis of 16 studies representing 23,469 Ph.D. students, we estimated that the pooled prevalence of clinically significant symptoms of depression was 24%. This estimate is consistent with estimated prevalence rates in other high-stress biomedical trainee populations, including medical students (27%) 30 , resident physicians (29%) 65 , and postdoctoral research fellows (29%) 66 . In the sample of nine studies representing 15,626 Ph.D. students, we estimated that the pooled prevalence of clinically significant symptoms of anxiety was 17%. While validated screening instruments tend to over-identify cases of depression (relative to structured clinical interviews) by approximately a factor of two 67 , 68 , our findings nonetheless point to a major public health problem among Ph.D. students. Available data suggest that the prevalence of depressive and anxiety disorders in the general population ranges from 5 to 7% worldwide 69 , 70 . In contrast, prevalence estimates of major depressive disorder among young adults have ranged from 13% (for young adults between the ages of 18 and 29 years in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions III 71 ) to 15% (for young adults between the ages of 18 and 25 in the 2019 U.S. National Survey on Drug Use and Health 72 ). Likewise, the prevalence of generalized anxiety disorder was estimated at 4% among young adults between the ages of 18 and 29 in the 2001–03 U.S. National Comorbidity Survey Replication 73 . Thus, even accounting for potential upward bias inherent in these studies’ use of screening instruments, our estimates suggest that the rates of recent clinically significant symptoms of depression and anxiety are greater among Ph.D. students compared with young adults in the general population.

Further underscoring the importance of this public health issue, Ph.D. students face unique stressors and uncertainties that may put them at increased risk for mental health and substance use problems. Students grapple with competing responsibilities, including coursework, teaching, and research, while also managing interpersonal relationships, social isolation, caregiving, and financial insecurity 3 , 10 . Increasing enrollment in doctoral degree programs has not been matched with a commensurate increase in tenure-track academic job opportunities, intensifying competition and pressure to find employment post-graduation 5 . Advisor-student power relations rarely offer options for recourse if and when such relationships become strained, particularly in the setting of sexual harassment, unwanted sexual attention, sexual coercion, and rape 74 , 75 , 76 , 77 , 78 . All of these stressors may be magnified—and compounded by stressors unrelated to graduate school—for subgroups of students who are underrepresented in doctoral degree programs and among whom mental health problems are either more prevalent and/or undertreated compared with the general population, including Black, indigenous, and other people of color 13 , 79 , 80 ; women 81 , 82 ; first-generation students 14 , 15 ; people who identify as LGBTQ 83 , 84 , 85 ; people with disabilities; and people with multiple intersecting identities.

Structural- and individual-level interventions will be needed to reduce the burden of mental ill-health among Ph.D. students worldwide 31 , 86 . Despite the high prevalence of mental health and substance use problems 87 , Ph.D. students demonstrate low rates of help-seeking 40 , 52 , 88 . Common barriers to help-seeking include fears of harming one’s academic career, financial insecurity, lack of time, and lack of awareness 89 , 90 , 91 , as well as health care systems-related barriers, including insufficient numbers of culturally competent counseling staff, limited access to psychological services beyond time-limited psychotherapies, and lack of programs that address the specific needs either of Ph.D. students in general 92 or of Ph.D. students belonging to marginalized groups 93 , 94 . Structural interventions focused solely on enhancing student resilience might include programs aimed at reducing stigma, fostering social cohesion, and reducing social isolation, while changing norms around help-seeking behavior 95 , 96 . However, structural interventions focused on changing stressogenic aspects of the graduate student environment itself are also needed 97 , beyond any enhancements to Ph.D. student resilience, including: undercutting power differentials between graduate students and individual faculty advisors, e.g., by diffusing power among multiple faculty advisors; eliminating racist, sexist, and other discriminatory behaviors by faculty advisors 74 , 75 , 98 ; valuing mentorship and other aspects of “invisible work” that are often disproportionately borne by women faculty and faculty of color 99 , 100 ; and training faculty members to emphasize the dignity of, and adequately prepare Ph.D. students for, non-academic careers 101 , 102 .

Our findings should be interpreted with several limitations in mind. First, the pooled estimates are characterized by a high degree of heterogeneity, similar to meta-analyses of depression prevalence in other populations 30 , 65 , 103 , 104 , 105 . Second, we were only able to aggregate depression prevalence across 16 studies and anxiety prevalence across nine studies (the majority of which were conducted in the U.S.) – far fewer than the 183 studies included in a meta-analysis of depression prevalence among medical students 30 and the 54 studies included in a meta-analysis of resident physicians 65 . These differences underscore the need for more rigorous study in this critical area. Many articles were either excluded from the review or from the meta-analyses for not meeting inclusion criteria or not reporting relevant statistics. Future research in this area should ensure the systematic collection of high-quality, clinically relevant data from a comprehensive set of institutions, across disciplines and countries, and disaggregated by graduate student type. As part of conducting research and addressing student mental health and wellbeing, university deans, provosts, and chancellors should partner with national survey and program institutions (e.g., Graduate Student Experience in the Research University [gradSERU] 106 , the American College Health Association National College Health Assessment [ACHA-NCHA], and HealthyMinds). Furthermore, federal agencies that oversee health and higher education should provide resources for these efforts, and accreditation agencies should require monitoring of mental health and programmatic responses to stressors among Ph.D. students.

Third, heterogeneity in reporting precluded a meta-analysis of the suicidality outcomes among the few studies that reported such data. While reducing the burden of mental health problems among graduate students is an important public health aim in itself, more research into understanding non-suicidal self-injurious behavior, suicide attempts, and completed suicide among Ph.D. students is warranted. Fourth, it is possible that the grey literature reports included in our meta-analysis are more likely to be undertaken at research-intensive institutions 52 , 60 , 61 . However, the direction of bias is unpredictable: mental health problems among Ph.D. students in research-intensive environments may be more prevalent due to detection bias, but such institutions may also have more resources devoted to preventive, screening, or treatment efforts 92 . Fifth, inclusion in this meta-analysis and systematic review was limited to those based on community samples. Inclusion of clinic-based samples, or of studies conducted before or after specific milestones (e.g., the qualifying examination or dissertation prospectus defense), likely would have yielded even higher pooled prevalence estimates of mental health problems. And finally, few studies provided disaggregated data according to sociodemographic factors, stage of training (e.g., first year, pre-prospectus defense, all-but-dissertation), or discipline of study. These factors might be investigated further for differences in mental health outcomes.

Clinically significant symptoms of depression and anxiety are pervasive among graduate students in doctoral degree programs, but these are understudied relative to other trainee populations. Structural and clinical interventions to systematically monitor and promote the mental health and wellbeing of Ph.D. students are urgently needed.

This systematic review and meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach (Supplementary Table S3 ) 107 . This study was based on data collected from publicly available bibliometric databases and did not require ethical approval from our institutional review boards.

Eligibility criteria

Studies were included if they provided data on either: (a) the number or proportion of Ph.D. students with clinically significant symptoms of depression or anxiety, ascertained using a validated scale; or (b) the mean depression or anxiety symptom severity score and its standard deviation among Ph.D. students. Suicidal ideation was examined as a secondary outcome.

We excluded studies that focused on graduate students in non-doctoral degree programs (e.g., Master of Public Health) or professional degree programs (e.g., Doctor of Medicine, Juris Doctor) because more is known about mental health problems in these populations 30 , 108 , 109 , 110 and because Ph.D. students face unique uncertainties. To minimize the potential for upward bias in our pooled prevalence estimates, we excluded studies that recruited students from campus counseling centers or other clinic-based settings. Studies that measured affective states, or state anxiety, before or after specific events (e.g., terrorist attacks, qualifying examinations) were also excluded.

If articles described the study sample in general terms (i.e., without clarifying the degree level of the participants), we contacted the authors by email for clarification. Similarly, if articles pooled results across graduate students in doctoral and non-doctoral degree programs (e.g., reporting a single estimate for a mixed sample of graduate students), we contacted the authors by email to request disaggregated data on the subsample of Ph.D. students. If authors did not reply after two contact attempts spaced over 2 months, or were unable to provide these data, we excluded these studies from further consideration.

Search strategy and data extraction

PubMed, Embase, PsycINFO, ERIC, and Business Source Complete were searched from inception of each database to November 5, 2019. The search strategy included terms related to mental health symptoms (e.g., depression, anxiety, suicide), the study population (e.g., graduate, doctoral), and measurement category (e.g., depression, Columbia-Suicide Severity Rating Scale) (Supplementary Table S4 ). In addition, we searched the reference lists and the grey literature.

After duplicates were removed, we screened the remaining titles and abstracts, followed by a full-text review. We excluded articles following the eligibility criteria listed above (i.e., those that were not focused on Ph.D. students; those that did not assess depression and/or anxiety using a validated screening tool; those that did not report relevant statistics of depression and/or anxiety; and those that recruited students from clinic-based settings). Reasons for exclusion were tracked at each stage. Following selection of included articles, two members of the research team extracted data and conducted risk of bias assessments. Discrepancies were discussed with a third member of the research team. Key extraction variables included: study design, geographic region, sample size, response rate, demographic characteristics of the sample, screening instrument(s) used for assessment, mean depression or anxiety symptom severity score (and its standard deviation), and the number (or proportion) of students experiencing clinically significant symptoms of depression or anxiety.

Risk of bias assessment

Following prior work 30 , 65 , the Newcastle–Ottawa Scale 111 was adapted and used to assess risk of bias in the included studies. Each study was assessed across 5 categories: sample representativeness, sample size, non-respondents, ascertainment of outcomes, and quality of descriptive statistics reporting (Supplementary Information S5 ). Studies were judged as having either low risk of bias (≥ 3 points) or high risk of bias (< 3 points).

Analysis and synthesis

Before pooling the estimated prevalence rates across studies, we first transformed the proportions using a variance-stabilizing double arcsine transformation 112 . We then computed pooled estimates of prevalence using a random effects model 113 . Study specific confidence intervals were estimated using the score method 114 , 115 . We estimated between-study heterogeneity using the I 2 statistic 116 . In an attempt to reduce the extent of heterogeneity, we re-estimated pooled prevalence restricting the analysis to studies conducted in the United States and to studies in which depression assessment was based on the 9-item Patient Health Questionnaire (PHQ-9) 117 . All analyses were conducted using Stata (version 16; StataCorp LP, College Station, Tex.). Where heterogeneity limited our ability to summarize the findings using meta-analysis, we synthesized the data using narrative review.

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Acknowledgements

We thank the following investigators for generously sharing their time and/or data: Gordon J. G. Asmundson, Ph.D., Amy J. L. Baker, Ph.D., Hillel W. Cohen, Dr.P.H., Alcir L. Dafre, Ph.D., Deborah Danoff, M.D., Daniel Eisenberg, Ph.D., Lou Farrer, Ph.D., Christy B. Fraenza, Ph.D., Patricia A. Frazier, Ph.D., Nadia Corral-Frías, Ph.D., Hanga Galfalvy, Ph.D., Edward E. Goldenberg, Ph.D., Robert K. Hindman, Ph.D., Jürgen Hoyer, Ph.D., Ayako Isato, Ph.D., Azharul Islam, Ph.D., Shanna E. Smith Jaggars, Ph.D., Bumseok Jeong, M.D., Ph.D., Ju R. Joeng, Nadine J. Kaslow, Ph.D., Rukhsana Kausar, Ph.D., Flavius R. W. Lilly, Ph.D., Sarah K. Lipson, Ph.D., Frances Meeten, D.Phil., D.Clin.Psy., Dhara T. Meghani, Ph.D., Sterett H. Mercer, Ph.D., Masaki Mori, Ph.D., Arif Musa, M.D., Shizar Nahidi, M.D., Ph.D., Arthur M. Nezu, Ph.D., D.H.L., Angelo Picardi, M.D., Nicole E. Rossi, Ph.D., Denise M. Saint Arnault, Ph.D., Sagar Sharma, Ph.D., Bryony Sheaves, D.Clin.Psy., Kennon M. Sheldon, Ph.D., Daniel Shepherd, Ph.D., Keisuke Takano, Ph.D., Sara Tement, Ph.D., Sherri Turner, Ph.D., Shawn O. Utsey, Ph.D., Ron Valle, Ph.D., Caleb Wang, B.S., Pengju Wang, Katsuyuki Yamasaki, Ph.D.

A.C.T. acknowledges funding from the Sullivan Family Foundation. This paper does not reflect an official statement or opinion from the County of San Mateo.  

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A.C.T. conceptualized the study and provided supervision. T.K. conducted the search. E.N.S. contacted authors for additional information not reported in published articles. E.N.S. and T.K. extracted data and performed the quality assessment appraisal. E.N.S. and A.C.T. conducted the statistical analysis and drafted the manuscript. T.K., M.V.K., R.A., S.C., H.L., X.L., C.H.L., I.R., S.S., M.T. and M.Y. contributed to the interpretation of the results. All authors provided critical feedback on drafts and approved the final manuscript.

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Research Article

Depression, anxiety and stress among high school students: A cross-sectional study in an urban municipality of Kathmandu, Nepal

Contributed equally to this work with: Anita Karki, Bipin Thapa

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

* E-mail: [email protected] (PB); [email protected] (AK)

Affiliation Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

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

Affiliation Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China

Roles Writing – review & editing

Affiliation Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

Roles Conceptualization, Methodology, Supervision, Writing – review & editing

• Anita Karki, 
• Bipin Thapa, 
• Pranil Man Singh Pradhan, 

• Published: May 31, 2022
• https://doi.org/10.1371/journal.pgph.0000516
• Peer Review
• Reader Comments

Depression and anxiety are the most widely recognized mental issues affecting youths. It is extremely important to investigate the burden and associated risk factors of these common mental disorders to combat them. Therefore, this study was undertaken with the aim to estimate the prevalence and identify factors associated with depression, anxiety, and stress among high school students in an urban municipality of Kathmandu, Nepal. A cross-sectional study was conducted among 453 students of five randomly selected high schools in Tokha Municipality of Kathmandu. Previously validated Nepali version of depression, anxiety, and stress scale (DASS-21) was used to assess the level of symptoms of depression, anxiety and stress (DAS). Multivariable logistic regression was carried out to decide statistically significant variables of symptoms of DAS at p-value<0.05. The overall prevalence of DAS was found to be 56.5% (95% CI: 51.8%, 61.1%), 55.6% (95%CI: 50.9%, 60.2%) and 32.9% (95%CI: 28.6%, 37.4%) respectively. In the multivariable model, nuclear family type, students from science or humanities faculty, presence of perceived academic stress, and being electronically bullied were found to be significantly associated with depression. Female sex, having mother with no formal education, students from science or humanities faculty and presence of perceived academic stress were significantly associated with anxiety. Likewise, female sex, currently living without parents, and presence of perceived academic stress were significantly associated with stress. Prevention and control activities such as school-based counseling services focusing to reduce and manage academic stress and electronic bullying are recommended in considering the findings of this research.

Citation: Karki A, Thapa B, Pradhan PMS, Basel P (2022) Depression, anxiety and stress among high school students: A cross-sectional study in an urban municipality of Kathmandu, Nepal. PLOS Glob Public Health 2(5): e0000516. https://doi.org/10.1371/journal.pgph.0000516

Editor: Khameer Kidia, Brigham and Women’s Hospital, UNITED STATES

Received: February 22, 2022; Accepted: May 2, 2022; Published: May 31, 2022

Copyright: © 2022 Karki 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 data that support the findings of descriptive analysis of this study are available in Figshare with the identifier given below: https://doi.org/10.6084/m9.figshare.19203512 The data that support the findings of inferential analysis of this study are available in Figshare with the identifier given below: https://doi.org/10.6084/m9.figshare.19203491 .

Funding: The authors received no specific funding for this work.

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

Introduction

Mental disorders contribute to a huge proportion of disease burden across all societies [ 1 ]. Among them, depression, anxiety and stress are the leading causes of illness and disability among adolescents [ 2 ]. The physical, psychological, and behavioral changes that occur throughout adolescence predispose them to a variety of mental health issues [ 3 ]. Despite this, mental health and mental disorders are largely ignored and not given the same importance as physical health [ 4 ].

The existing community-based studies conducted among high school students of various parts of Nepal have reported a wide range of prevalence of symptoms of depression and anxiety. The prevalence of depressive symptoms has been reported to range from 27% to 76% [ 5 – 7 ]. Likewise, the limited studies conducted in Nepal have estimated the proportion of symptoms of anxiety to range from 10% to 57% [ 7 – 9 ]. A nationwide survey conducted in Nepal revealed the prevalence of mental distress among adolescents (13-17years) to be 5.2% [ 10 ]. The Global School Health Survey which was a nationwide survey conducted in 2015 reported anxiety among 4.6% of the students [ 11 ].

Previous studies have revealed that sex [ 12 – 16 ], staying away from home [ 17 ], grade [ 12 , 14 , 16 ], stream of study [ 18 ], academic performance and examination related issues [ 7 , 19 ], cyber bullying [ 20 ] were linked with depression. Likewise, sex [ 8 , 21 ], grade of students and type of school i.e., public or private [ 8 ], family type [ 17 ], not living with parents, educational level of parents [ 21 ] and high educational stress [ 22 ] had been the determinants of anxiety as per previous studies.

High school education is an important turning point in the life of academic students in Nepal [ 23 ]. As the educational system becomes more specialized and tough in high school, the students become more likely to experience stress at this level. This might put them at risk of developing common mental disorders such as depression, anxiety and stress (DAS). However, there is a paucity of research studies that have assessed DAS among high school students in Nepal.

Exploring the magnitude and risk factors of symptoms of DAS are very crucial to combat the burden of adolescent mental health issues [ 24 ]. However, due to limited access to psychological and psychiatric services as well as the significant social stigma associated with mental health issues, anxiety and depression in early adolescence frequently go undiagnosed and untreated, particularly in developing countries such as Nepal. Therefore, this study aimed to estimate the prevalence and identify factors associated with the symptoms of DAS among high school students in an urban municipality of Kathmandu, Nepal.

Materials and methods

Study setting, design, and population.

This was a cross-sectional survey conducted in randomly selected high schools of Tokha Municipality, Kathmandu District in province no. 3 of Nepal. The data collection period was from 27 th August to 11 th September 2019. This municipality was formed on 7 December 2014 by merging five previous villages. It has an area of 16.2 sq.km. and comprises 11 wards [ 25 , 26 ]. The municipality is rich in cultural and ethnic diversity [ 25 ]. According to Nepal government records as of 2017, there were total 218,554 students in Tokha municipality in 82 schools. High school students were the study population for this study [ 26 ]. In Nepal, high school students comprise of grade 11 and grade 12 students. The high school differs from lower schooling level since the students have the opportunity to enroll in specialized areas such as science, management, humanities and education. High school are also popularly known as 10+2 [ 27 ].

Sample size calculation and sampling technique

Sample size was estimated using the formula for cross-sectional survey [ 28 ], n = Z 2 p(1-p)/ e 2 considering the following assumptions; proportion (p) = 0.24 [ 12 ], 95% confidence level, the margin of error of 5%. The estimated proportion used for sample size calculation was based on proportion of symptoms of anxiety i.e., 24%, as reported by a similar study conducted in Manipur, India [ 12 ].

After calculation, the minimum sample size required was 280. After adjusting for design effect of 1.5 to adjust variance from cluster design and assuming non-response rate of 10%, final sample of 467 was calculated. Two-stage cluster sampling was used. A list of all high schools of Tokha municipality was obtained from the education division of the municipality. Out of twelve high schools (8 private schools and 4 public schools), five schools were randomly selected. Within each selected high school further two sections each of grades 11 and 12 were randomly selected. A total of 20 sections were selected, 4 from each selected school, and all the students from the selected sections were included in the study.

Data collection tools

A structured questionnaire was prepared based on our study objectives which was divided into three sections. The first section included information about socio-demographic, familial and academic characteristics of the students. The second section included two item question to assess socializing among the students which was based on a previous study by Vankim and Nelson [ 29 ], two questions to assess bullying among the students based on 2019 Youth Risk Behavior Survey [ 30 ] and one item question to assess perceived academic stress. The third section consisted of Depression, Anxiety and Stress Scale (DASS-21) used to assess level of symptoms of depression, anxiety and stress among the students.

DASS-21 is a psychological screening instrument capable of differentiating symptoms of DAS. Depression, anxiety, and stress are three subscales and there are 7 items in each subscale. Each item is scored on a 4-point Likert scale which ranges from 0 i.e., did not apply to me at all to 3 i.e., applied to me very much. Scores for DAS were calculated by summing the scores for the relevant items. and multiplying by two [ 31 ]. A previously validated Nepali version of DASS-21 was obtained and used for data collection. Nepali version of the DASS-21 has demonstrated adequate internal consistency and validity. However, in the validation paper, the construct validity of the tool was evaluated against life satisfaction scale and not a systematic diagnostic tool [ 32 ]. Reliability for the symptoms of DAS was tested by Cronbach alpha. Cronbach alpha values for DAS were 0.74, 0.77, and 0.74 respectively.

Data collection procedure and technique

Data was collected after obtaining permission from the municipality’s education division as well as individual high schools. The questionnaire was in both English and Nepali language and had been pre-tested among 45 high school students of neighboring municipality. Self-administered anonymous questionnaires were distributed to students in their respective classrooms and requested for participation. An orientation session was conducted for the filling the questionnaire before distribution. Written informed consent was taken from all students prior to data collection whereas additional written parental consent was obtained from students below 18 years of age. One of the investigators herself collected the data from students. After data collection, a session on depression, anxiety, and stress along with the importance of discussing it with the guardians/ teachers and asking for help was conducted.

Study variables

The study variables are described in Table 1 .

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Data analysis

Compilation of data was done in EpiData 3.1 and then exported to IBM SPSS Statistics version 20 (IBM Corp., Armonk, NY) for cleaning and analysis. Descriptive analysis was performed. Frequency tables with percentages were generated for categorical variables, while mean and standard deviation (SD) were calculated for continuous variables.

Binary logistic regression was performed to identify associated factors of symptoms of DAS. Firstly, we performed univariate analysis in which each co-variate was modeled separately to determine the odds of DAS. Those variables with p-value <0.15 in univariate analysis were identified as candidate variables for multivariable logistic regression. In multivariable logistic regression, a p-value of < .05 was considered to be statistically significant and strength of association was measured using adjusted odds ratio (AOR) at 95% confidence interval.

Multicollinearity of variables was tested before entering them in the regression analysis. No problem of multicollinearity was seen among the variables (the highest observed VIF was 1.25,1.10 and 1.13 for symptoms of DAS respectively. The goodness of fit of the regression model was tested by the application of the Hosmer and Lemeshow test; the model was found to be a good fit (P >.05).

The regression model was explained by the equation:

Log [Y/ (1-Y)] = b 0 + b 1 X 1 + b 2 X 2 + b 3 X 3 … ..b n X n + e

Where Y is the expected probability for the outcome variable to occur, b 0 is the constant/intercept, b 1 through b n are the regression coefficients and the X 1 through X n are distinct independent variables and e is the error term.

Ethical approval and consent

The study protocol was approved by the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University (Reference no. 23/ (6–11) 76/077). Approval to conduct this study was also obtained from the education division of Tokha Municipality (Ref: 076/077-23) and respective school authorities. A written informed consent (in the Nepali language) was obtained from the students before the data collection to assure their willingness to participate and no identifiers were listed in the questionnaire to make it anonymous and confidential. Parental consent was obtained for students who were under the age of 18. No incentives were provided.

Sociodemographic, academic and contextual characteristics of the students

The research questionnaire was distributed to a sample of 468 high school students, one of whom refused to participate in this study, with a response rate of 99.78%. Responses from 14 students were excluded due to incompleteness. This study presents the analysis on a total of 453 students.

The mean age of the students was 16.99 years (SD = ±1.12), ranging from 14 to 22 years. The proportion of female students (54.1%) was higher than male students (45.9%). Majority of the students were found to be currently living with their parents i.e., 65.8%. Around 70% of the students were from nuclear family. Regarding parent’s educational level, majority of the students responded that their father as well as mother had attained secondary level of education i.e., 31.6% and 33.3% respectively.

With regards to academic characteristics, more than two- third of students i.e., 69.5% were from private high schools while the remaining 30.5% were studying in a government or public high school. More than half i.e. (53.4%) of the students studied in grade eleven. About half of the students i.e., 50.6% were from management faculty. Only 3.8% students reported to have failed in the previous examination.

It was noted that about 60% of students perceived themselves to be stressed due to their studies. Most students were low socializing i.e., 60.9%. Around one-tenth students reported being bullied electronically in the past 12 months (10.2%). Similar proportion of students i.e., 10.4% also reported being bullied on school property in the past 12 months ( Table 2 ).

https://doi.org/10.1371/journal.pgph.0000516.t002

Level of symptoms of DAS among the students

The prevalence of symptoms of DAS was found to be 56.5% (51.8%, 61.1%), 55.6% (50.9%, 60.2%) and 32.9% (28.6%, 37.4%) respectively. About a quarter of students showed moderate level of symptoms of depression and anxiety i.e., 25.8% and 24.5% respectively. On the other hand, symptoms of mild stress were most prevalent among the students. i.e., 14.8% ( Table 3 ).

https://doi.org/10.1371/journal.pgph.0000516.t003

Factors associated with symptoms of depression

The results from multivariable logistic regression analyses for correlates of symptoms of depression are shown in Table 4 . The variables that remain in the final model were age, type of family, father’s education, mother’s education, type of school, grade, faculty, perceived academic stress, and bullied electronically as these variables had p-value less than 0.15 in the univariate model. In the final model, nuclear family type (AOR: 1.64, 95% CI: 1.06–2.52), students from science/humanities faculty (AOR: 1.58, 95% CI: 1.05–2.40), presence of perceived academic stress (AOR: 1.62, 95% CI: 1.08–2.44) and bullied electronically in past 12 months (AOR: 2.84, 95% CI: 1.34–5.99) were significantly associated with symptoms of depression.

https://doi.org/10.1371/journal.pgph.0000516.t004

Factors associated with symptoms of anxiety

The results from multivariable logistic regression analyses for correlates of symptoms of anxiety are shown in Table 5 . The variables that remained in the final model were age, sex, mother’s education, stream/ faculty, perceived academic stress, bullied electronically, and bullied on school property (p<0.15). Female sex (AOR: 1.82, 95% CI: 1.23–2.71), no formal education attained by the mother (AOR: 1.63, 95% CI: 1.08–2.47), students from science or humanities faculties (AOR: 1.50, 95% CI: 1.01–2.21), and presence of perceived academic stress (AOR: 1.93, 95% CI: 1.30–2.87), and were significantly associated with symptoms of anxiety.

https://doi.org/10.1371/journal.pgph.0000516.t005

Factors associated with symptoms of stress

The results from multivariable logistic regression analyses for main correlates of symptoms of stress are shown in Table 6 . The variables that remained in the final model were sex, current living status, grade, stream / faculty, perceived academic stress, bullied electronically and bullied on school property. In the final model, female sex (AOR: 1.54, 95% CI: 1.01–2.34), currently living without parents, (AOR: 1.70, 95% CI: 1.11–2.61), and presence of perceived academic stress (AOR: 2.11, 95% CI: 1.36–3.26) were significantly associated with stress symptoms.

https://doi.org/10.1371/journal.pgph.0000516.t006

In our study, the prevalence of depressive symptoms among high school students was found to be 56.5%. The existing community-based studies conducted among high school students of various parts of Nepal have reported a wide range of prevalence of depressive symptoms. A study by Gautam et al. reported that more than one quarter i.e., 27% of high school students in a rural setting of Nepal showed depressive symptoms [ 6 ]. Similarly, in a study conducted by Bhattarai et. al. in four schools of a metropolitan city in Nepal, it was found that more than 2/5 th i.e., 44.2% students exhibited depressive symptoms [ 5 ]. Similar proportion of depressive symptoms i.e., 41.6% was also reported by Sharma et. al in a study conducted among adolescent students of public schools of Kathmandu [ 9 ]. The prevalence estimated by these studies are lower than the findings of our study [ 5 , 6 , 9 ]. On contrary, a single high school study by Bhandari et al reported depressive symptoms among 76% students [ 7 ]. In our study, the proportion of students showing symptoms of anxiety were 55.6%. A study by Sharma et al. revealed that more than half i.e. 56.9% of public high school students showed symptoms of anxiety [ 9 ]. Another study by Bhandari et. al, also found out that nearly one out of two students i.e., 46.5% suffered from anxiety [ 8 ].These findings are in line with the findings of our study. On contrary, a study by Bhandari reported that only 10% students had mild anxiety [ 7 ]. In our study, the prevalence of stress symptoms among students was 32.9%. A study by Sharma et. al reported that more than 1/4 th students i.e., 27.5% showed symptoms of stress which corroborates with the findings of our study.

While the prevalence of symptoms of DAS reported by our study corroborates with the existing literatures in Nepal, it is exceptionally high. One possible explanation for this could be that the data was collected at the beginning of academic session. The students in the eleventh grade were undergoing sudden transition from secondary school life to high school life with regards to new friends, teachers, school environment, and change in daily schedules whereas the students in 12 th grade were awaiting results of previous board exam. This anticipation and the tremendous pressure faced by 12 th grade students for tertiary education might have contributed to the high prevalence of symptoms of DAS among 12 th grade students whereas the higher prevalence of symptoms of DAS among 11 th grade students could be possibly explained by the inability to cope with the adjustment of sudden transition from secondary to high school life. Moreover, the wide range in prevalence of DAS symptoms among these community-based studies could be attributed to the difference in the setting (rural or urban) and difference in methodology used.

Among South Asian countries, the prevalence of depression reported by our study is in line with the studies conducted in India, and Bangladesh, but slightly higher than one conducted in China and [ 13 , 17 , 33 , 34 ]. On contrary, our study has shown higher prevalence of anxiety among students as compared to study conducted in India, Sri Lanka, Vietnam and China [ 12 , 19 , 22 , 34 ].The prevalence of symptoms of stress in this study is comparable to the study from Chandigarh but higher than similar study from Manipur, India [ 12 , 17 ]. Hence, it can be suggested that there is a huge burden of DAS among high school students in South Asia. In context of Nepal, there is no standalone mental health policy. Further, there is inadequate funding allocated for mental health services along with shortage of qualified mental health professionals. In addition, there is much stigma that surrounds mental illness which acts as a barrier to seek and utilize mental health care services [ 35 ]. Due to these reasons, mental health illnesses are likely to remain untreated and continue to persist in the society. This may explain the high prevalence of DAS in our setting.

Socio-demographic characteristics and association with symptoms of DAS (depression, anxiety and stress)

In current study, it was found that females were more likely to suffer from symptoms of anxiety and stress than their male counterparts. This finding corroborates with the findings from previous studies [ 19 , 21 , 36 – 39 ]. On the contrary, a study conducted in Dang, Nepal reported that males were 1.5 times more likely to become anxious [ 8 ].One possible explanation for this is adolescent stage in girls is marked by hormonal changes as a result of various reproductive events which may have a role in the etiology of anxiety disorders [ 40 ]. Furthermore, when compared to boys, girls are more likely to be subjected to stressful situations such as sexual and domestic violence, which may make them more prone to anxiety and stress problems [ 41 ].

This study revealed that the students who live in nuclear families were more likely to exhibit depressive symptoms compared to students from joint or extended families. There are more members in a joint family system, which may provide better opportunities for adolescents to share their emotions and issues, hence providing a strong support system that may serve as a protective factor against depression which may be lacking in nuclear families [ 42 ]. Moreover, this study also found out that risks of stress symptoms was higher among students who were staying far from their parents. A similar finding was reported by Arif et al., 2019 in Uttar Pradesh, India [ 43 ]. One of the possible explanations might be that students who live without their parents may spend a substantial amount of time alone after school, which does not encourage familial intimacy [ 44 ]. As a result, they may feel alone and disconnected from their parents [ 45 ]. These adolescents may miss out on the opportunity to internalize the support they would otherwise get, leading to increased stress.

In our study, the students who reported no formal mother’s education were at greater risk of showing symptoms of anxiety. This was in accordance with other similar studies [ 38 , 46 ]. The attachment theory provides a robust foundation for understanding how parental behavior affects a child’s ability to recognize and manage stressful events throughout their lives [ 47 ]. The theory supports that the educated mother plays a stronger parenting role in the development of emotional skills and mental health outcomes in teenagers which might be protective for anxiety.

Academic characteristics and association with symptoms of DAS

In our study, the students from science or humanities faculties were more likely to have depression and anxiety as compared to management students. This was in line with other studies which showed higher proportion of depressive symptoms among science students. [ 48 ]. Generally, science students have to compete more, study longer hours and have a higher level of curriculum difficulty than management students which explains the finding. Likewise, it is believed that the humanities students have a poorer past academic performance in the secondary school, and may have chosen this stream / faculty as a secondary choice [ 49 ]. This combined with the uncertainty regarding future work prospects among humanities students may likely explain the higher prevalence of depression among humanities students.

In our study, the students who reported to be stressed due to their studies were more likely to suffer from symptoms of DAS. Several studies have documented similar findings [ 7 , 22 ]. A possible explanation might be that high school is an important stage in an individual’s academic life. However, the inability to meet the expectation of parents, teachers, and oneself in terms of academic performance can lead to overburden of stress [ 50 ]. This persistent academic related stress might accelerate the development of mood disorders such as depression, anxiety and stress among the adolescents [ 51 ].

Contextual factors and association with symptoms of DAS

In our study, the risk of depressive symptoms was higher among those students who were bullied via electronic means. Literature suggests that higher the level of cyberbullying/electronic bullying leads to higher the level of depressive symptoms among adolescents [ 52 ]. A similar study by Perren et. al demonstrated that depression was significantly associated with cyberbullying even after controlling for traditional forms of bullying [ 20 ]. The victims of cyberbullying may experience anonymous verbal or visual threats via electronic means. These repeated incidents can cause the victims to feel powerless which exacerbates the feeling of fear. This can cause significant emotional distress among victims and contribute to development of depressive symptoms [ 53 ].

Even though widely utilized in both clinical as well as research setting, DASS scales are screening tools for symptoms of depression, anxiety, and stress. Hence, they cannot be used as a modality for diagnosis. This limitation should be considered when interpreting the findings of this study. Due to its cross-sectional design, this study was unable to establish causal relationship of depression, anxiety, and stress with associated factors. Since the study tools used in this study investigate the habits and activities of the high school students in the past, recall and reporting bias are likely; however, the effect due to potential confounders have been controlled. As Nepal is a culturally diverse country, the findings of only one municipality may not be generalized to the whole country. Therefore, future studies covering a larger population of high school students employing more robust study designs such as interventional studies are recommended to get the real scenario of common mental disorders.

In conclusion, more than half of the students had depression and anxiety symptoms and nearly one third of the students had stress symptoms. Nuclear family type, students from humanities/science faculty, presence of perceived academic stress, and being bullied electronically were found to be significantly associated with symptoms of depression. Female sex, no formal mother education, students from humanities/science faculty, and presence of perceived academic stress were significantly associated with symptoms of anxiety. Likewise, symptoms of stress were significantly associated with female sex, currently living without parents, and presence of perceived academic stress.

Therefore, prevention and control activities such as school-based counseling services focusing to reduce and manage academic stress and electronic bullying faced by the students are recommended considering findings of this research.

Supporting information

S1 file. questionnaire form used in data collection..

https://doi.org/10.1371/journal.pgph.0000516.s001

Acknowledgments

We are grateful to Tokha municipality for granting permission to conduct the study. Special thank goes to the school management and teachers for their co-ordination during data collection. Lastly, we would like to thank all the study participants for their co-operation and support during the study.

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Mercyhurst's new approach: Moving beyond depression screenings to foster hope and connection among students

Positivity is a concept not typically aligned with depression, but it is the driver for a new initiative of the Mercyhurst University Counseling Center.  

Since 2007, the Counseling Center has performed annual depression screenings to serve as a barometer of students’ mental health and offer support as appropriate. Basically, the day included the screenings, feedback, literature, and connecting students with support services. 

Today, studies show that rates of depression and anxiety among college students have been rising. In the throes of COVID-19 and its aftermath, students faced increased isolation, disruptions to their education, and heightened stress, all of which contributed to a rise in mental health struggles, according to the American College Health Association.

This past spring, thanks to a mini-grant from the Pennsylvania Higher Education Suicide Prevention Coalition, the depression screenings of the past saw their demise. In their place, Mercyhurst chose a more participative, uplifting event.

“We recognized that in addition to increasing students’ individual awareness of personal depression, we wanted them to experience an event that would bring them together in a way that lifts the spirit, supports hope, fosters interaction, and builds social connections,” explained Dr. Judy Smith, executive director, Wellness.

The grant enabled the center to host three such events at different times and sites across campus that included games, food, competitions, and other activities that would appeal to students. As always, the events were complemented by visits from the ever-popular canines of Therapy Dogs United.  

In all, 205 students participated in the three sessions. Some just participated in the activities – Jenga contests were a big draw – while others also completed screenings. All students who were screened received results and recommendations; those with more severe indicators of stress and depression were notified immediately with the offer of counseling and other resources. An additional 100 students completed the depression screening surveys at the Counseling Center office.

“It was an entirely different feel,” Smith said. “One image that stuck with me was our Active Minds club showing students how to weave friendship bracelets. At first, there were two young women in the room; a half hour later, there were 20, even some men. The area became filled with conversation and laughter. It exemplified the positive social interactions that can spring from working together on something.”

The connections, she hopes, will help to free up young people to talk more openly about mental health. “It’s OK to talk about your moods,” Smith said. “There’s no shame in it. We can talk about our cholesterol; why not our emotional health?”

Although the mini-grant was just shy of $750, Smith said she had money left over and intends to continue the new program into the 2024-25 academic year.

FILE PHOTO: Therapy dogs are frequent visitors on campus. 

Depression In College Students: How Mental Health Concerns Can Impact Young Adults

You may have heard about the college student mental health crisis. Statistics suggest that rates of anxiety, depression, and suicidal ideation have never been higher among student populations than they are today. Here, we’ll look specifically at depression in college students: what causes it and suggestions for addressing symptoms.

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Mental health concerns common among college students

According to the National Education Association, the following are some of the most common mental health concerns among college students today.

Depression is a mental health condition characterized by a pervasive sense of hopelessness and sadness. Physically, it can result in symptoms like fatigue, weight gain or loss, a lack of appetite, disrupted sleeping patterns, insomnia, and/or unexplained aches and pains. Mentally, it can lead to symptoms like a lack of motivation, a sense of self-loathing, a desire to isolate oneself from loved ones, and difficulty concentrating. For a college student, these could show up in the form of a decreased interest in social activities and reduced academic performance. Treatment for depression is available and usually consists of some form of talk therapy, sometimes in combination with medication.

Anxiety disorders

Anxiety disorders are the most common mental health condition seen in college counseling centers , according to research conducted by Penn State’s Center for Collegiate Mental Health. Anxiety disorders that are highly prevalent among college students include social anxiety disorder and generalized anxiety disorder. Treatment for anxiety disorders is available and usually consists of some form of talk therapy, sometimes in combination with medication.

Other common mental health concerns among college students

According to the Center for Collegiate Mental Health, two other common mental health diagnoses among college students are substance use disorder (sometimes incorrectly referred to as “substance abuse disorder”) and post-traumatic stress disorder (PTSD).

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

In addition, many college students may need emotional support from a therapist or counselor even though they don’t meet the criteria for any specific diagnosis, which is okay. College can be a time of intense growth, change, and stress, and a mental health provider can help you through it.

Common factors that can affect mental health in college

Why exactly are mental health challenges so common in college students? There are many potential reasons. First, for many traditional-aged college students, this may be the first time in their lives that they have left their hometown or are living away from their families, which can lead to homesickness and a sense of isolation. 

College can also be a much more demanding time in one’s life than ever experienced before, with higher levels of academic pressure as well as the financial stress of juggling the cost of tuition, books, and living expenses. Additionally, for many people, college is a highly social time, which can result in a healthy emotional support system but can also lead to stress if there is tension or conflict in romantic or platonic relationships. Also note that those who have a family history of mental health conditions may be at greater risk of developing a condition themselves, especially if other risk factors apply to them as well.

College student mental health statistics

A recent study suggests that almost half of college students report symptoms of depression , with female students being slightly more likely to meet the criteria for depression than male students. Per this study, other risk factors for depression in college students include:

• Being an older student
• Being closer to graduation
• Having higher grades
• Pursuing medical school or another health-related career path
• Having poor physical health
• Experiencing high levels of academic pressure

In addition, the annual Healthy Minds survey assessing mental health on college campuses suggests that 36% of college students met the criteria for generalized anxiety disorder , 17% have an eating disorder, and 10% have a trauma- and stressor-related disorder like PTSD. These statistics point to the urgent need to address mental health among student populations.

How to cope with depression as a college student 

The recommended course of action for those experiencing signs of depression or another mental health challenge is typically to meet with a mental health professional. Counselors and therapists can help you identify what may be going on with your mental health and develop a plan to address it. They may also be able to refer you to a doctor or psychiatrist who can prescribe mental health medication, if needed. 

In addition, keeping up with self-care is typically important for mental health. Some examples of self-care tips for college students include:

• Get enough sleep each night
• Stick to routines
• Get regular social interaction
• Exercise often
• Eat nutrient-dense foods whenever possible
• Find healthy ways to manage stress
• Set boundaries
• Stay hydrated
• Practice meditation

Resources for student support

If you are experiencing depression or another mental health concern in college, you might look into some of the following resources:

• On-campus mental health services. Many colleges have an on-campus counseling center where students can get free or low-cost mental health care like counseling or therapy.
• National organizations. For example, the National Alliance for Mental Illness (NAMI) has online resources specifically for students and hosts many local chapters on college campuses. 
• Crisis help lines. If you are in need of immediate support, the Crisis Text Line (text HOME to 741741) and the National Suicide Prevention Lifeline (dial 988) are available. 
• Online therapy. Sometimes, on-campus mental health services have significant wait lists. If you’d like to speak with a care provider sooner or would simply prefer to engage in therapy virtually, you might consider online therapy. With a platform like BetterHelp , you can get matched and meet with a licensed therapist from anywhere with an internet connection.

Benefits of online therapy for students

If your campus counseling center is fully booked but your depression symptoms are significantly impacting your studies or your mental well-being, you may not prefer to wait for an appointment to become available. Online therapy can help bridge the mental health care gap in these scenarios.

Research suggests that online therapy and traditional in-person therapy may not have significant differences in outcomes when it comes to alleviating mental health symptoms. For example, one study specifically examined the impact of online therapy on symptoms of depression and anxiety, two conditions common among college students. Its findings suggest that online therapy was as effective at symptom reduction as in-person therapy . 

Living with depression in college can be challenging, but it doesn’t have to define your college experience. Speaking to a therapist on campus or online may help you better understand your mental state and start taking steps toward feeling better.                     

• What Is A First-Generation College Student, And What Unique Challenges Do They Face? Medically reviewed by Julie Dodson , MA
• Practical Solutions For Managing School Anxiety Medically reviewed by Julie Dodson , MA
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PhDepression: Examining How Graduate Research and Teaching Affect Depression in Life Sciences PhD Students

Logan e. gin.

† Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ 85281

Nicholas J. Wiesenthal

§ Department of Biology, University of Central Florida, Orlando, FL 32816

Katelyn M. Cooper

Graduate students are more than six times as likely to experience depression compared with the general population. However, few studies have examined how graduate school specifically affects depression. In this qualitative interview study of 50 life sciences PhD students from 28 institutions, we examined how research and teaching affect depression in PhD students and how depression in turn affects students’ experiences teaching and researching. Using inductive coding, we identified factors that either positively or negatively affected student depression. Graduate students more commonly mentioned factors related to research that negatively affected their depression and factors related to teaching that positively affected their depression. We identified four overarching aspects of graduate school that influenced student depression: the amount of structure in teaching and research, positive and negative reinforcement, success and failure, and social support and isolation. Graduate students reported that depression had an exclusively negative effect on their research, primarily hindering their motivation and self-confidence, but that it helped them to be more compassionate teachers. This work pinpoints specific aspects of graduate school that PhD programs can target to improve mental health among life sciences graduate students.

INTRODUCTION

In 2018, researchers found that graduate students were more than six times as likely to report experiencing depression and anxiety compared with the general population and subsequently declared a “graduate student mental health crisis” ( Evans et al. , 2018 ; Flaherty, 2018 ). Calls to identify which factors exacerbate graduate student mental health problems followed (“The Mental Health of PhD Researchers,” 2019; Woolston, 2019a ). However, few studies have taken an inductive approach to identifying what aspects of graduate school in particular affect student mental health. More commonly, large quantitative studies propose a limited number of factors that may affect student mental health that participants select from, few of which directly relate to graduate research or teaching ( Peluso et al. , 2011 ; Levecque et al. , 2017 ; Evans et al. , 2018 ; Liu et al. , 2019 ). In this interview study, we focus on depression in life sciences PhD students and examine which specific aspects of research and teaching graduate students report as affecting their depression. We also explore how depression affects students’ experiences in graduate school.

The American Psychiatric Association defines depression as a common and serious medical illness that negatively affects how one feels, the way one thinks, and how one acts ( American Psychiatric Association, 2020 ). Depression is characterized by nine symptoms: depressed mood; markedly diminished interest or pleasure in activities; reduced ability to think or concentrate, or indecisiveness; feelings of worthlessness, or excessive or inappropriate guilt; recurrent thoughts of death or suicidal ideation, or suicide attempts or plans; insomnia or hypersomnia; significant change in appetite or weight; psychomotor agitation or retardation; and fatigue or loss of energy ( American Psychiatric Association, 2013 ; Schmidt and Tolentino, 2018 ). For depression to be diagnosed, the presence of at least five of the symptoms is required most of the day, nearly every day, for at least 2 weeks in addition to the occurrence of either depressed mood or diminished interest or pleasure ( American Psychiatric Association, 2013 ). In the general U.S. population, depression affects approximately 6.7% of individuals and is estimated to affect 16.6% of individuals at some point in their lifetime.

Graduate students are far more likely to report experiencing depression compared with the general population ( Evans et al. , 2018 ; Barreira et al. , 2020 ). Specifically, a recent study of master’s and PhD students in programs across the world, spanning a variety of disciplines, found that 39% of graduate students reported having moderate to severe depression ( Evans et al. , 2018 ). Similar studies have demonstrated high rates of depression in graduate students in specific disciplines such as economics ( Barreira et al. , 2020 ), biochemistry ( Helmers et al. , 1997 ), pharmacology ( Helmers et al. , 1997 ), and physiology ( Helmers et al. , 1997 ). Depression rates have surged in recent years among graduate students ( American College Health Association, 2014 , 2019 ). Talking about depression has become more socially acceptable, particularly among younger adults ( Anxiety and Depression Association of America, 2015 ; Lipson et al. , 2019 ), which may have contributed to the number of students willing to reveal that they are struggling with mental health. Additionally, depression is highly related to burnout, defined as a work-related chronic stress syndrome involving emotional exhaustion, depersonalization, and reduced personal accomplishment ( Maslach et al. , 2001 ; Bianchi et al. , 2014 ). Graduate work environments appear to be increasingly characterized as stressful and demanding ( American College Health Association, 2014 , 2019 ; Woolston, 2017 ), which may also be contributing to the increase in graduate depression rates.

Increasingly, scientists, psychologists, and education researchers are recognizing graduate student mental health as a concern and calling for further investigation of graduate student mental health in hopes of identifying interventions to improve graduate student quality of life (“The Mental Health of PhD Researchers,” 2019; Woolston, 2019a , b ). For example, in 2019, Nature added a question to its annual survey of PhD students asking students from around the world whether they had sought help for anxiety or depression, and more than one-third (36%) confirmed they had ( Woolston, 2019b ). Additionally, notable publication outlets such as Nature (“The Mental Health of PhD Researchers,” 2019), Scientific American ( Puri, 2019 ), and Science ( Pain, 2018 ) have published blogs or editorials spotlighting the need to improve graduate student mental health.

Some recent studies have sought to uncover the factors affecting depression in graduate students. Primarily, survey studies with predetermined factors that researchers hypothesized impact student mental health have identified poor mentor–mentee relationships ( Peluso et al. , 2011 ; Evans et al. , 2018 ; Hish et al. , 2019 ; Liu et al. , 2019 ; Charles et al. , 2021 ), financial stress ( Hish et al. , 2019 ; Jones-White et al. , 2020 ; Charles et al. , 2021 ), and lack of work–life balance ( Evans et al. , 2018 ; Liu et al. , 2019 ) to be associated with depression or depressive symptoms among graduate students in various disciplines. Other variables shown to be predictive of depression include low research self-efficacy, defined as low confidence in one’s ability to do research ( Liu et al. , 2019 ), difficulty publishing papers ( Liu et al. , 2019 ), hours worked per week ( Peluso et al. , 2011 ), and perceived institutional discrimination ( Charles et al. , 2021 ). Factors that appear to be protective of depressive symptoms include social support ( Charles et al. , 2021 ), mastery, defined as the extent to which individuals perceive themselves to be in control of the forces that impact their lives ( Hish et al. , 2019 ), positive departmental social climate ( Charles et al. , 2021 ), optimism about career prospects ( Charles et al. , 2021 ), and sense of belonging to one’s graduate program ( Jones-White et al. , 2020 ). While these studies have identified some depression-related factors associated with graduate school broadly and emphasize the importance of positive mentor–mentee relationships, few studies have explored factors specifically associated with research and teaching, the two activities that graduate students engage in most frequently during their time in a program. Additionally, the extant literature has primarily focused on surface causes of graduate student depression, yet understanding the underlying causes may be key to developing meaningful interventions. For example, while it is well established that student perception of poor mentorship is related to student depression ( Evans et al. , 2018 ; Hish et al. , 2019 ; Liu et al. , 2019 ; Charles et al. , 2021 ), it is less well understood what specific behaviors mentors exhibit and how such behaviors negatively affect the cognitive and behavioral underpinnings of graduate student depression. Without this knowledge, it is difficult to develop strategies to help mentors be more inclusive of students.

Theories of depression seek to explain the causes of depression. No theoretical model is widely accepted as an overarching framework for depression within the psychological and psychiatric communities ( Mcleod, 2015 ; Ramnerö et al. , 2016 ); instead, there are a number of models addressing how different aspects of depression are associated with the disorder. Arguably, the three most prominent models are cognitive ( Beck et al. , 1979 ), behavioral ( Martell et al. , 2001 ), and psychodynamic ( Busch et al. , 2016 ). In brief, cognitive theories focus on an individual’s beliefs and propose that changes in thinking precede depressive symptoms; for example, negative views of oneself, the world, and the future are thought to be common for individuals with depression ( Beck et al. , 1979 ; Leahy, 2002 ). Behavioral theories emphasize that depression is a result of one’s interaction with the environment; depressive symptoms are thought to be the result of decreased reward, lack of positive reinforcement, encouragement of depressive or passive behaviors, and discouragement of healthy behaviors ( Lewinsohn, 1974 ; Martell et al. , 2001 ; Carvalho et al. , 2011 ). Psychodynamic theories of depression consider the role of feelings and behaviors in the etiology and persistence of depressive symptoms; these theories often focus on 1) one’s biology and temperamental vulnerabilities, 2) earliest attachment relationships, and 3) childhood experiences associated with frustration, helplessness, loss, guilty, or loneliness ( Busch et al. , 2016 ). While each group of theories has been critiqued and no one theory fully explains one’s experience with depression ( Mcleod, 2015 ; Ramnerö et al. , 2016 ), we propose that each may be helpful in understanding how aspects of graduate school may affect depression among PhD students.

The thoughts and behaviors associated with depression may in turn affect students’ experiences in graduate school, particularly their experiences with research and teaching. While no studies have examined how depression explicitly affects graduate students’ research experiences, studies have identified ways in which depression can affect students’ experiences in undergraduate research ( Cooper et al. , 2020a , b ). Undergraduate researchers report that their depression negatively affected their motivation, ability to concentrate and remember, intellectual engagement, and creativity in research ( Cooper et al. , 2020b ). Undergraduates described that their depression also caused them to be overly self-critical, less social, and ultimately negatively affected their research productivity. Additionally, undergraduates have been reluctant to share their depression with others in the lab, because they fear that they will be judged ( Cooper et al. , 2020b ). While these studies provide some insight into how depression may affect graduate students’ experience in research, there is much less information about how depression may affect graduate teaching.

In this study, we interviewed 50 PhD students in the life sciences who self-identified with having depression with the intent of answering two research questions that address gaps in the literature: 1) What specific aspects of graduate research and teaching affect PhD student depression? 2) How does PhD students’ depression affect their experience in research and teaching?

Student Interviews

This study was done under an approved Arizona State University Institutional Review Board protocol (no. 00011040).

In Fall 2019, we surveyed graduate students by sending an email out to program administrators of all life sciences graduate programs in the United States that are listed in U.S. News & World Report (2019) . Of the 259 graduate programs that we contacted, 75 (29.0%) program administrators agreed to forward our survey to students enrolled in their graduate programs. Of the 840 graduate students who participated in the survey, 459 (54.6%) self-identified as having depression based on general demographic questions on the survey. Of the 459 students who identified as having depression, 327 (71.2%) agreed to be contacted for a follow-up interview. In Summer 2020, we sent a recruitment email out to the 327 students who identified as having depression, asking to interview them about their experiences with depression in a PhD program. We specifically did not require that students be diagnosed with depression in order to participate in the interview study. We did not want to bias our sample, as mental health care is disproportionately unavailable to Black and Latinx individuals, as well as to those who come from low socioeconomic backgrounds ( Howell and McFeeters, 2008 ; Kataoka et al. , 2002 ; Santiago et al. , 2013 ). Of the students who were contacted, 50 PhD students (15.3%) enrolled across 28 life sciences PhD programs completed an interview.

The interview script was based on a previous interview script that we had developed, which successfully elicited what aspects of research affect depression in undergraduates and how depression affects their research ( Cooper et al. , 2020a ). Our previous work has shown that research experiences do not exclusively worsen depression, but that aspects of research can also help students manage their depression ( Cooper et al. , 2020a ). As such, our interview questions explored what aspects of research helped students manage their depression (positively affecting depression), and what aspects worsened students’ depression (negatively affecting depression). Additionally, we hypothesized that other prominent aspects of graduate school, such as teaching, would also affect PhD student depression and revised the interview script to include questions focused on examining the relationship between depression and teaching. We asked students what aspects of graduate research and teaching made their depression worse and what aspects helped them manage their depression. Participants were invited to come up with as many aspects as possible. We also asked how students perceived their depression affected their research and teaching. With the knowledge that we would be conducting interviews during summer of 2020 in the midst of the COVID-19 pandemic, and that the pandemic had likely exacerbated graduate student depression ( Chirikov et al. , 2020 ), we directed students to not reference aspects of research and teaching that were uniquely related to the pandemic (e.g., teaching remotely or halted research) when discussing the relationship between research, teaching, and depression. We were specifically interested in aspects of teaching and research that affected student depression before the pandemic and would presumably affect student depression afterward. We conducted think-aloud interviews with four graduate students who identified as having depression to ensure that our questions would not offend anyone with depression and to establish cognitive validity of the interview script by ensuring that each student understood what each question was asking. The interview script was iteratively revised after each think-aloud interview ( Trenor et al. , 2011 ). A final copy of the interview script can be found in the Supplemental Material.

All interviews were conducted using Zoom by one of two researchers (L.E.G. or K.M.C.). The average interview time was about 45 minutes. After the interview, all participants were sent a short survey to collect their demographics and additional information about their depression (a copy of the survey can be found in the Supplemental Material). Participants were provided a small monetary gift card in exchange for their time. All interviews were deidentified and transcribed before analysis.

Interview Analysis

Three researchers (L.E.G., N.J.W., and K.M.C.) independently reviewed 12 of the same randomly selected interviews to explore each idea that a participant expressed and to identify recurring themes ( Charmaz, 2006 ). Each researcher took detailed analytic notes during the review. After, the three researchers met to discuss their notes and to identify an initial set of recurring themes that occurred throughout the interviews ( Saldaña, 2015 ). The authors created an initial codebook outlining each theme and the related description. Together, the authors then reviewed the same set of five additional interviews to validate the themes outlined in the codebook and to identify any themes that may have been missed during the initial review. The researchers used constant comparison methods to compare quotes from the interviews to each theme and to establish whether any quotes were different enough from a particular theme to warrant an additional code ( Glesne and Peshkin, 1992 ). Together, the three researchers revised the codebook until they were confident that it captured the most common themes and that no new themes were emerging. A final copy of the codebook can be found in the Supplemental Material. Two authors (L.E.G. and N.J.W.) used the final codebook to code five randomly selected interviews (10% of all interviews) and their Cohen’s κ interrater score was at an acceptable level (κ = 0.94; Landis and Koch, 1977 ). Then, one researcher (N.J.W.) coded the remaining 45 interviews. In the text, we present themes mentioned by at least 10% of interviewees and use quotes to highlight themes. Some quotes were lightly edited for clarity.

Author Positionality

Some of the authors identify as having depression and some do not. One author had completed a PhD program (K.M.C.), one author was in the process of completing a PhD program (L.E.G.), and two authors were undergraduates (N.J.W. and I.F.) at the time when the interviews and analyses took place.

Interview Participants

Fifty PhD students agreed to participate in the study. Students were primarily women (58%), white (74%), and continuing-generation college students (78%). Twelve percent of students were international students, and the average age of the participants was 28 years old. While 20% of students were unsure of their career goals, 32% of students planned to pursue a career in academia, and 24% were planning to pursue a career in industry. Students reported how severe they perceived their depression to be, on average, during the time they had spent in their PhD programs. Most students reported their depression as either moderate (50%) or severe (28%). Eighty percent of students reported being diagnosed with depression, and 74% reported receiving treatment for depression. Participants were at different stages in their PhD programs ranging from first year to sixth year or more. Three students had graduated between the time they completed the initial survey and when they participated in the interview in Summer 2020. Students self-reported their main research areas and represented a broad range, with ecology and evolutionary biology (26%), animal science (14%), molecular biology (14%), and neurobiology (10%) being the most common. Eighty-six percent of students had experience teaching undergraduates, primarily as teaching assistants (TAs), at the time of the interviews. All student demographics are summarized in Table 1 .

Participant demographics

The Effect of Research on Graduate Student Depression

Students more commonly identified ways that research negatively affected their depression than ways research positively affected their depression. Considering all factors that students listed and not just those that were most common, students on average listed two ways in which an aspect of research negatively affected their depression and one way in which an aspect of research positively affected their depression.

The most commonly reported aspect of research that worsened students’ depression was experiencing failures, obstacles, or setbacks in research. Specifically, students cited that failed experiments, failed research projects, and the rejection of manuscripts and grants was particularly difficult for their depression. Conversely, students highlighted that their depression was positively affected when they were able to make substantial progress on their research projects; for example, if they wrote part of a manuscript or if an experiment worked. Students also explained that accomplishing smaller or mundane research tasks was helpful for their depression, both because they felt as though they were checking off a box and also because it allowed them to focus on something other than the negative thoughts often associated with depression.

Students also highlighted that the unstructured nature of graduate research worsened their depression. Specifically, students described that, in graduate research, there are often no clear directions, sets of guidelines, or deadlines to help structure their day-to-day activities. Without this structure, students need to rely on their own motivation to outline goals, accomplish tasks, or seek help, which participants described can be difficult when one is experiencing a depressive episode. However, students also felt as though the unstructured nature of research benefited their depression, because it allowed for flexibility. Those who did not have frequent deadlines or strict schedules were able to not conduct research on days when they needed to recover from a depressive episode or schedule research around therapy or other activities that had a positive impact on their depression. Finally, students highlighted that their passion for their research was protective against depression. Their love for the subject of their research or thinking about how their work may have a positive impact on others could positively affect their motivation or mood.

Students described that their relationships with others in the lab also affected their depression. Specifically, if their mentors or others in their lab had unreasonable or overwhelming expectations of them, it could make them feel as though they would never be able to meet such expectations. Research also provides an environment for students to constantly compare themselves with others, both those in supervisory roles as well as peers. Notably, when students mentioned comparing themselves with others, this comparison never made them feel good about themselves, but was exclusively detrimental to their depression; they felt as though they would never be able to accomplish what others had already accomplished. Students’ relationships with their mentors also seemed to have a notable impact on their depression. Having a positive relationship with their mentors or a mentor who provided psychosocial support positively affected their depression, whereas perceiving a negative relationship with their mentors, particularly a mentor who provided consistently harsh or negative feedback, was detrimental. Students who had absent mentors or mentors who provided infrequent technical support and guidance also felt as though this situation worsened their depression, because it prevented or prolonged their success in research. Finally, students highlighted that conducting graduate research can be isolating, because you are often working on something different from those in the lab or because those outside graduate school cannot relate to the stress and struggles associated with research. However, in instances in which students were able to collaborate with others, this could be protective against depression, because it gave students a sense of comradery or validated their feelings about specific aspects of research. The most common research-related factors that students reported negatively and positively affected their depression and example student quotes of each factor are reported in Tables 2 and ​ and3, 3 , respectively.

Research-related factors that PhD students reported negatively affected their depression

Research-related factors that PhD students reported positively affected their depression

The Effect of Teaching on Graduate Student Depression

We asked all graduate students who had teaching experience ( n = 43) how teaching affected their depression. Graduate students more commonly identified ways that teaching positively affected their depression than ways teaching negatively affected their depression. On average, considering all factors that graduate students listed and not just those that were most common, participants listed two ways in which teaching positively affected their depression and one way in which teaching negatively affected their depression.

Graduate students most commonly highlighted that teaching provided positive reinforcement from undergraduates, which helped them manage their depression. This positive reinforcement came in multiple forms ranging from formal teaching evaluations to positive verbal comments from undergraduates about how good a graduate student was at teaching to watching undergraduates accomplish academic goals or grasp complex concepts. A subset of graduate students highlighted that teaching was good for their depression, because it was something they were passionate about or that they genuinely enjoyed. As such, it was a source of happiness, as was being able to collaborate and form friendships with other TAs or instructors. Some graduate students also acknowledged that they felt confident teaching, often because they had mastered content that undergraduates had not. However, this was not always the case; some graduate students highlighted that a lack of teaching training and preparation negatively affected their self-efficacy as instructors, which in turn exacerbated their depression. This was further exacerbated by the pressure that graduate students put on themselves to perform well as instructors. The potential to have a negative impact on undergraduates and their learning experiences could worsen students’ depression by increasing the stress surrounding their performance as a teacher. Additionally, some graduate students received negative reinforcement from undergraduates, in the form of negative comments on formal teaching evaluations or disrespectful behavior from undergraduates such as groans or eye rolls, which graduate students explained negatively affected their self-efficacy, further worsening their depression.

Students also highlighted that teaching could negatively affect their depression because it interfered with the time they felt they needed to be spending on research or added to the large number of responsibilities they had as graduate students. However, some students welcomed time away from research; teaching sometimes served as a distraction from research-related stressors. Students also highlighted that teaching is structured, which positively affected their depression. That is, there are concrete tasks, such as grading, that need to be accomplished or places that the graduate student needs to be during a specific time. This structure helped motivate them to accomplish teaching goals, even if they were feeling a lack of motivation because of their depression. The most common teaching-related factors that graduate students reported negatively and positively affected their depression and example student quotes for each factor are reported in Tables 4 and ​ and5, 5 , respectively.

Teaching-related factors that PhD students reported negatively affected their depression

a Forty-three out of the 50 students who participated in the study had experience teaching undergraduates either as a TA or as an instructor of record. We only considered the responses from the TAs with teaching experiences when calculating the percent of students who reported each factor.

Teaching-related factors that PhD students reported positively affected their depression

The Effect of Depression on Graduate Research

In the interviews, we asked graduate students how their depression affected their graduate research, if at all. They identified three primary ways in which depression could affect research, all of which were negative. The most common way depression affected research was interfering with students’ motivation, which in turn affected their productivity. Students described that their productivity was affected immediately, for example, struggling to execute daily tasks like collecting or analyzing data. However, graduate students described that their lack of motivation ultimately resulted in larger consequences, such as delays in getting papers submitted and published. In fact, some graduate students explicitly stated that they felt as though they would have been able to graduate earlier if they had not had depression. The second way in which depression affected graduate students’ research is that it interfered with their ability to focus or concentrate. Students primarily explained that the lack of focus did not delay their research but caused their research to be less enjoyable or made them frustrated because they had to expend additional mental energy to execute tasks. Depression also caused students to be less confident or overly critical of themselves. Specifically, if an experiment did not go right or they experienced rejection of a manuscript, they tended to internalize it and blame themselves. This lack of confidence often inhibited students’ abilities to make decisions about research or take risks in research. They described frequently second-guessing themselves, which made decisions and taking risks in research more difficult. The most common ways students reported that their depression affected their research and example student quotes are reported in Table 6 .

Self-reported ways that depression affected PhD students’ research or the student as a researcher

The Effect of Depression on Teaching

Graduate students described one positive way and two negative ways that depression affected their teaching. Students explained that, because they had experienced depression, they were more compassionate and empathetic toward the undergraduates in their courses. Specifically, they felt they could better understand some of the struggles that undergraduates experience and were sometimes more likely to be flexible or lenient about course requirements and deadlines if an undergraduate was struggling. However, graduate students reported that depression also negatively affected their teaching. Specifically, depression could cause graduate students to feel disconnected or disengaged from undergraduates. It could also cause graduate students to feel as though they had a lack of energy or felt down when teaching. The common self-reported ways that depression affected PhD students’ teaching and example quotes are reported in Table 7 .

Self-reported ways that depression affected PhD students’ teaching or the graduate student as an instructor

a Forty-three out of the 50 students who participated in the study had experience teaching undergraduates either as a TA or as an instructor of record. We only considered the responses from the TAs with teaching experiences when calculating the percent of students who reported each theme.

Despite the increasing concern about graduate student mental health among those in the scientific community ( Pain, 2018 ; “The Mental Health of PhD Researchers,” 2019; Puri, 2019 ), there is a lack of information about how specific aspects of science PhD programs affect students with depression. This is the first study to explicitly investigate which particular aspects of research and teaching affect depression among life sciences PhD students and how depression, in turn, affects graduate students’ experiences in research and teaching. Overall, graduate students highlighted factors related to teaching and research that both alleviated and exacerbated their symptoms of depression. Graduate students more commonly brought up ways that research negatively affected their depression, than ways that it positively affected their depression. Conversely, graduate students more commonly mentioned ways that teaching had a positive effect on their depression compared with a negative effect. The requirement and opportunity to teach differs among life sciences graduate programs ( Schussler et al. , 2015 ; Shortlidge and Eddy, 2018 ). As such, future research should investigate whether the amount of teaching one engages in during graduate school is related to levels of graduate student depression. Despite differences in how teaching and research affect student depression, this study unveiled factors that protect against or worsen depressive symptoms. Specifically, four overarching factors affecting graduate student depression emerged from the interviews: 1) Structure; 2) Positive and Negative Reinforcement; 3) Failure and Success; 4) Social Support and Isolation. We discuss here how each of these factors may positively and negatively affect graduate student depression.

One stark contrast between research and teaching is the amount of structure in each activity. That is, students expressed that research goals are often amorphous, that there are not concrete instructions for what needs to be accomplished, and that there is often no set schedule for when particular tasks need to be accomplished. Conversely, with teaching, graduate students often knew what the goals were (e.g., to help students learn), exactly what they needed to accomplish each week (e.g., what to grade, what to teach), and when and where they needed to show up to teach (e.g., a class meets at a particular time). Graduate students highlighted that a lack of structure, particularly in research, was detrimental for their depression. Their depression often made it difficult for them to feel motivated when there was not a concrete task to accomplish. Major depression can interfere with executive function and cognition, making goal setting and goal achievement particularly difficult ( Elliott, 1998 ; Watkins and Brown, 2002 ). In fact, research has documented that individuals with depression generate less specific goals and less specific explanations for approaching a goal than individuals who do not have depression ( Dickson and Moberly, 2013 ). As such, it may be particularly helpful for students with depression when an activity is structured, relieving the student from the need to articulate specific goals and steps to achieve goals. Students noted that the lack of structure or the flexibility in research was helpful for their depression in one way: It allowed them to better treat their depression. Specifically, students highlighted that they were able to take time to go to therapy or to not go into the lab or to avoid stressful tasks, which may be important for successful recovery from a depressive episode ( Judd et al. , 2000 ).

Compared with conducting research, many participants reported that the concrete tasks associated with teaching undergraduates were helpful for their depression. This is supported by literature that illustrates that concrete thinking, as opposed to abstract thinking, can reduce difficulty making decisions in individuals with depression ( Dey et al. , 2018 ), presuming that teaching often requires more concrete thinking compared with research, which can be more abstract. Additionally, cognitive-behavioral treatments for depression have demonstrated that developing concrete goals for completing tasks is helpful for individuals with depression ( Detweiler-Bedell and Whisman, 2005 ), which aligns with graduate students’ perceptions that having concrete goals for completing teaching tasks was particularly helpful for their depression.

Positive and Negative Reinforcement

Graduate students reported that the negative reinforcement experienced in research and teaching had a significant negative effect on their depression, while the positive reinforcement students experienced only in teaching had a positive effect. Notably, students did not mention how positive reinforcement affected their depression in the context of research. Based on student interviews, we predict that this is not because they were unaffected by positive reinforcement in research, but because they experienced it so infrequently. Drawing from behavioral theories of depression, the concept of response-contingent positive reinforcement (RCPR; Lewinsohn, 1974 ; Kanter et al. , 2004 ) helps explain this finding. As summarized by Kanter and colleagues (2004) , RCPR describes someone seeking a response and being positively reinforced; for example, graduate students seeking feedback on their research are told that what they have accomplished is impressive. Infrequent RCPR may lead to cognitive symptoms of depression, such as low self-esteem or guilt, resulting in somatic symptoms of depression, such as fatigue and dysphoria ( Lewinsohn, 1974 ; Martell et al. , 2001 ; Manos et al. , 2010 ). RCPR is determined by three factors. 1) How many potential events may be positively reinforcing to an individual. For example, some people may find an undergraduate scoring highly on an exam in a class they are teaching to be reinforcing and others may find that they only feel reinforced when an undergraduate explicitly compliments their teaching. 2) The availability of reinforcing events in the environment. If graduate students’ mentors have the ability to provide them with RCPR but are never able to meet with them, these reinforcing events are unavailable to them. 3) The instrumental behavior of an individual. Does the individual exhibit the behavior required to obtain RCPR? If graduate students do not accomplish their research-related tasks on time, they may not receive RCPR from their mentor. If individuals are not positively reinforced for a particular behavior, they may stop exhibiting it, further exacerbating the depressive cycle ( Manos et al. , 2010 ). Therefore, the lack of positive reinforcement in research may be particularly damaging to graduate students, because it may discourage them from completing tasks, leading to additional depressive symptoms. Conversely, teaching presents many opportunities for positive reinforcement. Every time graduate students teach, they have the opportunity to receive positive reinforcement from their students or to witness a student’s academic accomplishment, such as an undergraduate expressing excitement when they understand a concept. As such, it is not surprising that positive reinforcement was the primary teaching-related factor that graduate students reported helped with their depression. Despite the positive reinforcement of teaching for graduate students with depression, we are not suggesting that graduate students should take on additional teaching loads or that teaching should be viewed as the sole respite for graduate students with depression. Overwhelming students with increased responsibilities may counteract any positive impact that teaching could have on students’ depression.

Failure and Success

Failure and success affected student depression, but only in the context of research; contrary to research, students rarely mentioned concrete metrics for success and failure in teaching. While graduate students highlighted receiving positive or negative reinforcement from undergraduates, they did not relate this to being a “successful” instructor. It is unsurprising that graduate students did not mention failing or succeeding at teaching, given that experts in teaching agree that it is difficult to objectively evaluate quality teaching ( d’Apollonia and Abrami, 1997 ; Kember et al. , 2002 ; Gormally et al. , 2014 ). In fact, the lack of teacher training and knowledge about how to teach effectively negatively affected student depression, because it could cause students to feel unprepared as an instructor. Integrating teacher training into graduate programs has been championed for decades ( Torvi, 1994 ; Tanner and Allen, 2006 ; Schussler et al. , 2015 ); however, the potential for such training to bolster graduate student mental health is new and should be considered in future research. With regard to graduate students’ research, the concept of success and failure was far more concrete; students mentioned failing in terms of failed experiments, research projects, and rejected manuscripts and grant proposals. Successes included accepted manuscripts, funded grant proposals, and concrete progress on significant tasks, such as writing or conducting an experiment that yielded usable data. Failure has been shown to negatively affect depression among undergraduate researchers ( Cooper et al. , 2020a ), who are hypothesized to be inadequately prepared to experience failure in science ( Henry et al. , 2019 ). However, it is less clear how well prepared graduate students are to experience failure ( Simpson and Maltese, 2017 ). Drawing from cognitive theories of depression, depression is associated with dysfunctional cognitive schemas or dysfunctional thinking that can lead individuals with depression to have negative thoughts about the world, themselves, and the future and to interpret information more negatively than is actually the case (called negative information-processing biases; Beck, 1967 ; Beck et al. , 1979 ; Gotlib and Krasnoperova, 1998 ; Maj et al. , 2020 ). Related to failure, individuals with dysfunctional cognitive schemas may harbor beliefs such as if something fails at work (or in graduate research), they are a failure as a person or that a small failure can be as detrimental as a larger failure ( Weissman, 1979 ; Miranda and Persons, 1988 ). As such, setbacks in research may be particularly difficult for PhD students with depression. Graduate students in our study also mentioned how failing in research was often out of their control, particularly failure related to experiments and research projects. The extent to which one feels they can control their environment is important for mental health, and lower estimates of control have been hypothesized to be an important factor for depression ( Grahek et al. , 2019 ). Therefore, this feeling of being unable to control success in research may further exacerbate student depression, but this would need to be tested. Importantly, these findings do not imply that individuals with depression are unable to cope with failure; they only suggest that individuals perceive that failure in science can exacerbate their depression.

Social Support and Isolation

Graduate students reported that feelings of isolation in research could worsen their depression. Specifically, they highlighted that it can be difficult for their mental health when their friends outside graduate school cannot relate to their struggles in research and when others in their research group are not working on similar projects. One study of more than 1400 graduate students at a single university found that feeling isolated from fellow graduate students and faculty positively predicted imposter phenomenon ( Cohen and McConnell, 2019 ), defined as the worry that they were fooling others about their abilities and that their fraudulence would be exposed ( Clance and Imes, 1978 ), which is positively correlated with depression among college students ( McGregor et al. , 2008 ). Developing a positive lab environment, where undergraduates, graduate students, and postgraduates develop positive relationships, has been shown to positively affect undergraduates ( Cooper et al. , 2019 ) and may also positively affect graduate students who experience such feelings of isolation. Graduate students in this study described that both teaching and research had the potential to be a source for relationship development and social support. Students who described positive collaborative relationships in research and teaching felt this had a positive impact on their depression, which aligns with a review of studies in psychiatry concluding that being connected to a large number of people and having individuals who are able to provide emotional support by listening or giving advice is protective against depression ( Santini et al. , 2015 ), as well as a study that found that social support is protective against depression, specifically among the graduate population ( Charles et al. , 2021 ).

These four factors provide clear targets for graduate programs looking to improve the experiences of students with depression. For example, increasing structure in research could be particularly helpful for graduate students with depression. Ensuring that students have concrete plans to accomplish each week may not only positively impact depression by increasing structure, but ultimately by increasing a student’s success in research. Research mentors can also emphasize the role of failure in science, helping students realize that failure is more common than they may perceive. Increasing opportunities for positive reinforcement in teaching and research may be another avenue to improving student mental health. Providing students with appropriate teacher training is a first step to enhancing their teaching skills and potential for positive reinforcement from undergraduate students ( Schussler et al. , 2015 ). Additionally, teaching evaluations, a common form of both positive and negative reinforcement, are known to be biased and disadvantage women, People of Color, and those with non–English speaking backgrounds ( Fan et al. , 2019 ; Chávez and Mitchell, 2020 ) and arguably should not be used to assess teaching. In research, mentors can make an effort to provide positive feedback or praise in meetings in addition to critiques. Finally, to provide social support to graduate students with depression, graduate programs could consider creating specific initiatives that are related to supporting the mental health of graduate students in their departments, such as a support group for students to meet and discuss their experiences in graduate school and how those experience pertain to their mental health.

Limitations and Directions for Future Research

In this study, we chose to only interview students with the identity of interest (depression), as is common with exploratory studies of individuals with underserved, underrepresented, or marginalized identities (e.g. Carlone and Johnson, 2007 ; Cooper and Brownell, 2016 ; Barnes et al. , 2017 , 2021 ; Downing et al. , 2020 ; Gin et al. , 2021 ; Pfeifer et al. , 2021 ). However, in future studies, it would be beneficial to also examine the experiences of individuals who do not have depression. This would provide information about the extent to which specific aspects of graduate research and teaching are disproportionately beneficial or challenging for students with depression. In this study, we did not explicitly examine whether there was a relationship between students’ identities and depression because of the small number of students in particular demographic groups. However, a theme that occurred rather infrequently (but is included in the Supplemental Material) is that discrimination or prejudice in the lab or academia could affect depression, which was reported exclusively by women and People of Color. As such, disaggregating whether gender and race/ethnicity predicts unique factors that exacerbate student depression is an important next step in understanding how to create more equitable and inclusive research and teaching environments for graduate students. Moreover, our sample included a significant number of students from ecology and evolutionary biology PhD programs, which may limit the generalizability of some findings. It is important to acknowledge potential subdisciplinary differences when considering how research may affect depression. Additionally, some of the factors that affect student depression, such as lack of teaching training and confidence in teaching, may be correlated with time spent in a graduate program. Future quantitative studies would benefit from examining whether the factors that affect student depression depend on the student’s subdiscipline and time spent in the graduate program. The primary focus of this study was the relationship between depression and graduate teaching/research. Many of the factors that emerged from the interviews are also associated with burnout ( Bianchi et al. , 2014 ; Maslach et al. , 2001 ). Burnout and depression are known to be highly related and often difficult to disaggregate ( Bianchi et al. , 2014 ). It was beyond the scope and design of this study to disaggregate which factors relate exclusively to the condition of burnout. Additionally, the interviews in this study were collected at a single time point. Thus, we are unable to differentiate between students who had depression before starting graduate school and students who experienced depression after starting graduate school. Future longitudinal studies could explore the effects of students’ experiences in research and teaching on their depression over time as well as on long-term outcomes such as persistence in graduate programs, length of time for degree completion, and career trajectory. This study identified a number of factors that graduate programs can address to benefit graduate student mental health, and we hope that future studies design and test interventions designed to improve the experiences of graduate students in teaching and research.

In this interview study of 50 life sciences PhD students with depression, we examined how graduate research and teaching affect students’ depressive symptoms. We also explored how depression affected graduate students’ teaching and research. We found that graduate students more commonly highlighted ways that research negatively affected their depression and ways that teaching positively affected their depression. Four overarching factors, three of which were related to both teaching and research, were commonly associated with student depression, including the amount of structure provided in research and teaching, failure and success, positive and negative reinforcement, and social connections and isolation. Additionally, graduate students identified depression as having an exclusively negative effect on their research, often hindering motivation, concentration, and self-esteem. However, they did note that depression made them more compassionate teachers, but also could cause them to have low energy or feel disconnected when teaching. This study provides concrete factors that graduate programs can target in hopes of improving the experiences of life sciences PhD students with depression.

Important Note

There are resources available if you or someone you know is experiencing depression and want help. Colleges and universities often have crisis hotlines and counseling services designed to provide students, staff, and faculty with treatment for depression. These can often be found by searching the university website. Additionally, there are free 24/7 services such as Crisis Text Line, which allows you to text a trained live crisis counselor (text “CONNECT” to 741741; Text Depression Hotline, 2019 ), and phone hotlines such as the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). If you would like to learn more about depression or depression help and resources near you, visit the Anxiety and Depression Association of American website: https://adaa.org ( Anxiety and Depression Association of America, 2019 ) and the Depression and Bipolar Support Alliance: http://dbsalliance.org ( Depression and Bipolar Support Alliance, 2019 ).

Acknowledgments

We are incredibly grateful to the 50 graduate students who were willing to share their personal experiences with us. We thank Sara Brownell, Tasneem Mohammed, Carly Busch, Maddie Ostwald, Lauren Neel, and Rachel Scott for their helpful feedback on earlier drafts of this work. L.E.G. was supported by an NSF Graduate Fellowship (DGE-1311230). Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF.

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Teen mental health improving, CDC reports. But the kids are far from all right.

Young people are faring better in their mental health in the past few years after a period of increased sadness and hopelessness during the COVID-19 pandemic, a report by the Centers for Disease Control and Prevention found.

The data released last week showed a 2% decrease from 2021 to 2023 in high school students reporting they felt sad or hopeless. The total dropped from 42% to 40% of students who reported having these feelings, marking the first time the annual Youth Risk Behavior Survey didn’t report an increase in over a decade.

But mental and behavioral health experts aren’t celebrating a victory just yet. This is because reported rates of kids feeling sad or hopeless remain high, especially teenage girls who showed a decrease, from 57% to 53% cases, over those two years.

“We’ve made some progress tackling these issues in recent years, which proves that they are not insurmountable,” said Kathleen Ethier, director of the CDC’s adolescent and school health division. “However, there’s still much work ahead.”

What’s getting better

The new report also found small but meaningful improvements among students in marginalized groups.

Four percent fewer Hispanic teens over those two years felt persistently sad or hopeless, experienced poor mental health and seriously considered attempting suicide, and 3% fewer made a suicide plan.

Black teens also saw a 4% decrease in students who reported they'd attempted suicide and a 2% decrease in people injured in a suicide attempt.

Ariana Hoet, a pediatric psychologist and executive clinical director of The Kids Mental Health Foundation, said increased awareness, government funding and school programs can partially explain why youth mental health has improved over the past few years.

“The pandemic opened our eyes (to the fact) that children’s mental health was a concern,” she said. “People are looking for resources and accessing resources more frequently.”

There has also been a concerted effort to highlight the causes of despair in young adults.

Last year, U.S. Surgeon General Dr. Vivek Murthy issued a health advisory that highlighted the impact of social media on young people's mental health. The White House also awarded hundreds of millions of dollars to mental and behavioral health care programs in schools and at-risk communities.

Dr. Elizabeth Ortiz-Schwartz, a child psychiatrist at Silver Hill Hospital in Connecticut, said the return to in-class learning and extracurricular activities may have also helped improve students' mental health.

“There’s more opportunities to integrate (and) socialize with peers,” she said. “The normalization of activities was probably very helpful.”

What’s getting worse

Returning to classrooms also meant going back to stressors like academic pressure, bullying and in-school violence, Ortiz-Schwartz said.

The CDC report found increases in students being threatened or injured with a weapon at school, being bullied at school or missing school due to safety concerns at school or en route to school.

The percentage of female students who missed school increased from 10% to 16% in those two years, and nearly 20% of females experienced sexual violence in 2023, according to the survey. Almost 30% of LGBTQ+ students said they were bullied and 20% missed school due to safety concerns.

The rise in violence may be a natural consequence of returning to in-person classes where there are more opportunities for physical encounters, experts said. But they said there may be more at play.

Ortiz-Schwartz has noticed that some of her patients after quarantine seemed developmentally stunted, exhibiting social-emotional behaviors she normally sees in younger kids.

The increase in violence and bullying in the data may also be a product of social media normalizing aggressive language and behaviors, leading to less self-censoring and more bullying when kids are together in person.

Another area that adults should note, said Hoet, from The Kids Mental Health Foundation, is how the behavior manifests itself so they can teach teens to cope.

“Children tend to show depression with irritability,” Hoet said. “We have to teach emotional regulation… being angry is okay, being angry is normal but we have to find a way to cope with that anger.”

Parents protecting mental health

Not all students were hard hit by COVID-19.

A report published by the Springtide Research Institute in July found that 13-year-olds had positive outcomes during the pandemic. Out of the 1,000 kids surveyed, nearly 50% said the COVID-19 pandemic had a positive impact on their family relationships.

While the results appear hopeful, researchers noted that the survey answers heavily varied based on a teen's household income. Among kids with an above-average household income, 64% said the pandemic had a positive impact on family relationships. However, only 34% of kids with a below-average household income experienced a positive impact on their family relations.

“Some kids probably loved (staying at home) and really thrived and then some kids didn’t and it’s because each environment is different,” Hoet said.

The report emphasizes that students have unique needs, said Dr. Laura Erickson-Schroth, chief medical officer at The Jed Foundation, a nonprofit focused on emotional health and suicide prevention for teens and young adults.

“We really need to pay attention to the reasons why young people are in the situations (and) the reasons why young people are having trouble seeking out help when they need it,” she said.

Educators should continue to improve on programs and curriculum at school, however, the best protector of mental health is child-adult relationships and that starts at home with parents and guardians, Hoet said.

The CDC also says increasing health education, connecting young people to health services and making school environments safer and more supportive are key to improving mental health.

“This work is far from complete,” said Dr. Debra Houry, CDC’s chief medical officer and deputy director for program and science “Every child should feel safe and supported, and CDC will continue its work to turn this data into action until we reach that goal.”

Adrianna Rodriguez can be reached at [email protected].

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High schoolers’ mental health shows small improvement in a US government survey

FILE - Students gather in a common area as they head to classes in Oregon, May 4, 2017. (AP Photo/Don Ryan, File)

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There are small signs of improvement in the mental health of U.S. teenagers, a government survey released Tuesday said, but the share of students — particularly girls — feeling sad and hopeless remained high.

From 2021 to 2023, the portion of high school students who reported feelings of persistent sadness or hopelessness declined from 42% to 40%, according to the Centers for Disease Control and Prevention report . More than 20,000 students were surveyed at school in the spring of 2023.

Among girls, the percentage reporting persistent sadness or hopelessness fell from 57% to 53%. The share of girls reporting they had seriously considered attempting suicide edged downward from 30% to 27%.

The COVID-19 pandemic disrupted many school activities, increased isolation among youth and may have contributed to the 2021 findings on mental health. But long-term trends also reflect a worsening of mental health among teenagers, particularly girls .

EDITOR’S NOTE: This story includes discussions of mental health. If you or someone you know needs help, reach out to the national suicide and crisis lifeline at 988, or the National Alliance on Mental Illness by calling 1-800-950-6264 or texting “NAMI” to 741741.

Social media’s emphasis on appearance and body image contributes to the pressures on girls’ mental health, said Dr. Anisha Abraham of Children’s National Hospital in Washington, D.C., and a spokesperson for the American Academy of Pediatrics.

In 2023, 77% of students said they used social media several times a day, with girls more likely than boys to use social media that often. Sixteen percent of high school students said they’d been electronically bullied during the past year through texting, Instagram, Facebook or other social media. Girls and LGBTQ+ students were more likely to report electronic bullying.

“Open conversations at home with caregivers and parents are really important,” Abraham said. Parents who notice teens feeling hopeless or pulling away from normal activities should take those signals seriously and make sure they “get in for counseling or further screening.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.