post thesis submission depression

Managing While and Post-PhD Depression And Anxiety: PhD Student Survival Guide

Embarking on a PhD journey can be as challenging mentally as it is academically. With rising concerns about depression among PhD students, it’s essential to proactively address this issue. How to you manage, and combat depression during and after your PhD journey?

In this post, we explore the practical strategies to combat depression while pursuing doctoral studies.

From engaging in enriching activities outside academia to finding supportive networks, we describe a variety of approaches to help maintain mental well-being, ensuring that the journey towards academic excellence doesn’t come at the cost of your mental health.

How To Manage While and Post-Phd Depression

Why phd students are more likely to experience depression than other students.

The journey of a PhD student is often romanticised as one of intellectual rigour and eventual triumph.

However, beneath this veneer lies a stark reality: PhD students are notably more susceptible to experiencing depression and anxiety.

This can be unfortunately, quite normal in many PhD students’ journey, for several reasons:

Grinding Away, Alone

Imagine being a graduate student, where your day-to-day life is deeply entrenched in research activities. The pressure to consistently produce results and maintain productivity can be overwhelming.

For many, this translates into long hours of isolation, chipping away at one’s sense of wellbeing. The lack of social support, coupled with the solitary nature of research, often leads to feelings of isolation.

Mentors Not Helping Much

The relationship with a mentor can significantly affect depression levels among doctoral researchers. An overly critical mentor or one lacking in supportive guidance can exacerbate feelings of imposter syndrome.

Students often find themselves questioning their capabilities, feeling like they don’t belong in their research areas despite their achievements.

Nature Of Research Itself

Another critical factor is the nature of the research itself. Students in life sciences, for example, may deal with additional stressors unique to their field.

Specific aspects of research, such as the unpredictability of experiments or the ethical dilemmas inherent in some studies, can further contribute to anxiety and depression among PhD students.

Competition Within Grad School

Grad school’s competitive environment also plays a role. PhD students are constantly comparing their progress with peers, which can lead to a mental health crisis if they perceive themselves as falling behind.

This sense of constant competition, coupled with the fear of failure and the stigma around mental health, makes many hesitant to seek help for anxiety or depression.

How To Know If You Are Suffering From Depression While Studying PhD?

If there is one thing about depression, you often do not realise it creeping in. The unique pressures of grad school can subtly transform normal stress into something more insidious.

As a PhD student in academia, you’re often expected to maintain high productivity and engage deeply in your research activities. However, this intense focus can lead to isolation, a key factor contributing to depression and anxiety among doctoral students.

Changes in Emotional And Mental State

You might start noticing changes in your emotional and mental state. Feelings of imposter syndrome, where you constantly doubt your abilities despite evident successes, become frequent.

This is especially true in competitive environments like the Ivy League universities, where the bar is set high. These feelings are often exacerbated by the lack of positive reinforcement from mentors, making you feel like you don’t quite belong, no matter how hard you work.

Lack Of Pleasure From Previously Enjoyable Activities

In doctoral programs, the stressor of overwork is common, but when it leads to a consistent lack of interest or pleasure in activities you once enjoyed, it’s a red flag. This decline in enjoyment extends beyond one’s research and can pervade all aspects of life.

The high rates of depression among PhD students are alarming, yet many continue to suffer in silence, afraid to ask for help or reveal their depression due to the stigma associated with mental health issues in academia.

Losing Social Connections

Another sign is the deterioration of social connections. Graduate student mental health is significantly affected by social support and isolation.

You may find yourself withdrawing from friends and activities, preferring the solitude that ironically feeds into your sense of isolation.

Changes In Appetite And Weight

Changes in appetite and weight can be a significant indicator of depression. As they navigate the demanding PhD study, students might experience fluctuations in their eating habits.

Some may find themselves overeating as a coping mechanism, leading to weight gain. Others might lose their appetite altogether, resulting in noticeable weight loss.

These changes are not just about food; they reflect deeper emotional and mental states.

Such shifts in appetite and weight, especially if sudden or severe, warrant attention as they may signal underlying depression, a common issue in the high-stress environment of PhD studies.

Unhealthy Coping Mechanisms

PhD students grappling with depression often feel immense pressure to excel academically while battling isolation and imposter syndrome. Lacking adequate mental health support, some turn to unhealthy coping mechanisms like substance abuse. These may include:

Overeating,
And many more.

These provide temporary relief from overwhelming stress and emotional turmoil. However, such methods can exacerbate their mental health issues, creating a vicious cycle of dependency and further detachment from healthier coping strategies and support systems.

It’s essential for PhD students experiencing depression to recognise these signs and seek professional help. Resources like the National Suicide Prevention Lifeline are very helpful in this regard.

Suicidal Thoughts Or Attempts

Suicidal thoughts or attempts may sound extreme, but they can happen in PhD studies. This is because of the high-pressure environment of PhD studies.

Doctoral students, often grappling with intense academic demands, social isolation, and imposter syndrome, can be susceptible to severe mental health crises.

When the burden becomes unbearable, some may experience thoughts of self-harm or suicide as a way to escape their distress. These thoughts are a stark indicator of deep psychological distress and should never be ignored.

It’s crucial for academic institutions and support networks to provide robust mental health resources and create an environment where students feel safe to seek help and discuss their struggles openly.

How To Prevent From Depression During And After Ph.D?

A PhD student’s experience is often marked by high rates of depression, a concern echoed in studies from universities like the University of California and Arizona State University. If you are embarking on a PhD journey, make sure you are aware of the issue, and develop strategies to cope with the stress, so you do not end up with depression.

Engage With Activities Outside Academia

One effective strategy is engaging in activities outside academia. Diverse interests serve as a lifeline, breaking the monotony and stress of grad school. Some activities you can consider include:

Social gatherings.

These activities provide a crucial balance. For instance, some students highlighted the positive impact of adopting a pet, which not only offered companionship but also a reason to step outside and engage with the world.

Seek A Supportive Mentor

The role of a supportive mentor cannot be overstated. A mentor who adopts a ‘yes and’ approach rather than being overly critical can significantly boost a doctoral researcher’s morale.

This positive reinforcement fosters a healthier research environment, essential for good mental health.

Stay Active Physically

Physical exercise is another key element. Regular exercise has been shown to help cope with symptoms of moderate to severe depression. It’s a natural stress reliever, improving mood and enhancing overall wellbeing. Any physical workout can work here, including:

Brisk walking
Swimming, or
Gym sessions.

Seek Positive Environment

Importantly, the graduate program environment plays a critical role. Creating a community where students feel comfortable to reveal their depression or seek help is vital.

Whether it’s through formal support groups or informal peer networks, building a sense of belonging and understanding can mitigate feelings of isolation and imposter syndrome.

This may be important, especially in the earlier stage when you look and apply to universities study PhD . When possible, talk to past students and see how are the environment, and how supportive the university is.

Choose the right university with the right support ensures you keep depression at bay, and graduate on time too.

Remember You Have The Power

Lastly, acknowledging the power of choice is empowering. Understanding that continuing with a PhD is a choice, not an obligation. If things become too bad, there is always an option to seek a deferment, pause. You can also quit your studies too.

Work on fixing your mental state, and recover from depression first, before deciding again if you want to take on Ph.D studies again. There is no point continuing to push yourself, only to expose yourself to self-harm, and even suicide.

Wrapping Up: PhD Does Not Need To Ruin You

Combating depression during PhD studies requires a holistic approach. Engaging in diverse activities, seeking supportive mentors, staying physically active, choosing positive environments, and recognising one’s power to make choices are all crucial.

These strategies collectively contribute to a healthier mental state, reducing the risk of depression. Remember, prioritising your mental well-being is just as important as academic success. This helps to ensure you having a more fulfilling and sustainable journey through your PhD studies.

Dr Andrew Stapleton has a Masters and PhD in Chemistry from the UK and Australia. He has many years of research experience and has worked as a Postdoctoral Fellow and Associate at a number of Universities. Although having secured funding for his own research, he left academia to help others with his YouTube channel all about the inner workings of academia and how to make it work for you.

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Epigrammetry

How to Academia - A blog on academic selfhelp

PhD and Postdoc Life / What's it like? / Work-Life Balance

Post PhD Submission Fatigue. Part 1

by Sarah Lang · Published 12/07/2021 · Updated 07/03/2022

As some of you might know, I submitted my PhD thesis a while ago. I knew about the supposed post-(PhD)-partum depression from stories, of course. I wasn’t sure how it was going to play out for myself. Now after more than a month, I’m definitely still in the deep of it and I’d like to share what I feel like and possibly discuss how others felt (if you’re willing to share). As of writing this article, I’m in a phase where I feel much better and get a little productive again and but then also fall back into a hole of being very tired (just for the record, so you know where I currently stand in the recovery process).

Having web-searched for the topic many times, I know that there are quite a few posts online but I found that most of them weren’t super helpful to me. I hope it might help someone to have my perspective as you’re going through it. In this post, I’m going to outline what Post-PhD-submission Fatigue is (according to me, my friends’ experiences and what I’ve found on the web), what I’ve heard about it and what people are saying about it. I will also set out to gather advice from “survivors”, so that we might even be able to provide some guidance if anybody comes across this post feeling lost. However, the personal experiences stories and the advice will probably mostly go into part two of this blog. Without further ado, let’s get into it…

What is Post PhD Submission Fatigue?

It’s a name (or even set of names) people have come up with to describe the feeling you get after the submission of your PhD thesis. Unlike what you’d think, most people do feel relieved but not in the happy-happy way they had imagined. Most people end up feeling extremely drained and like they’ve fallen into a void, lost perspective, don’t have that one big life goal to work towards, etc.

Some say it feels like burnout…

Some say it feels like burnout, some have even related it to symptoms of Post Traumatic Stress . In order to think through whether this classification makes sense, let me start with listing a few commonly mentioned symptoms of both (so you can check if you think any apply to you). If you feel that they do, don’t jump to conclusions. But if you very strongly related to them, make sure to reach out to a therapist or counselor as soon as possible. These issues can be quite serious and you shouldn’t feel “stupid” asking for help if you need it!

As symptoms for burnout, lots of web sources ( for example ) commonly list exhaustion (physical and mental), being annoyed at the world and your life (cynicism, feeling useless, feeling things don’t make sense or are pointless), lack of concentration, being easily irritated and missing more and more time from work due to sick days.

Watch out for common indicators of too much stress: Sleep, digestion, headaches

Additionally, common indicators of too much stress like issues with sleep, digestion or headaches can come with the package. These are all indicators you’re suffering from overwork and should see a doctor, therapist or at least dial down a little (reduce work, take a vacation, etc.) If the symptoms persist for a longer period of time that’s a sign that something’s off and you should seek help.

Personally, despite feeling super tired, I wouldn’t say that any of those common indicators of stress (or burnout) apply to how I’m feeling at all…

A further indicator you might be suffering from burnout – maybe most importantly -, is depression. For me personally, I can only relate to very few of those burnout symptoms but absolutely not depression (though I’m not a stranger to that, so I know how it feels). I have no indicators of too much stress.

I do have bursts of stress and anxiety but feel good and happy overall. Mostly I’m just very tired. The number of work hours I can reliably get in a day are about 3-4 maximum and notably, I get overwhelmed much more quickly than usual. I’ve been trying to conceptualize what it feels like over the last few weeks and I think the most obvious problem for me currently is being very “jumpy” when it comes to work. I get overwhelmed when to-dos pile up. I get stressed and panicked really quickly. But I can also shut work out much better than usual (maybe due to lack of energy or the overwhelm with it just being way too high).

I wouldn’t be surprised to find myself with symptoms of burnout because I have had tendencies of (seriously) working too much since my early youth. However, I also have always really enjoyed work and (over-?)used it as a coping mechanism to deal with other things. Despite the last weeks of the PhD pre-submission phase being very stressful with little room for myself, they coincided with some post-lockdown reopenings. I made the most of that. I worked at the university café, went to the reopened bouldering gym and met a few friends. Despite the stress, I have profoundly happy memories from that time. However, I feel that the past four weeks (ergo the first weeks post submission) have been somewhat of a blur. Time seemed to pass very fast.

Right after the submission, I had to prep getting to my US fellowship so it was quite busy. I was stressed but also still in the go-getter mindset from before the submission. I actually really like this mindset and I hope I can eventually re-cultivate it in the future. I wasted a lot less time on non-essentials and was very focused when I worked. Once I had arrived in the US, there was some jetlag and adjusting to the time zone change. Although, weirdly, even after more than four weeks, I still start yawning in the early evening. I’m starting to suspect this might be a problem of low blood sugar due to intermittent fasting (which I had been trying but will probably discontinue as I don’t really see the benefit).

When I first arrived in the US, I couldn’t look at any work at all in the beginning. I wouldn’t open my email or even go near anything work related. My memory has been horrible for weeks (getting much better now in month 2 post submission). I needed to write everything down and at the same time was continuously panicked I might have forgotten someting or missed a deadline. Despite the fact that I currently don’t even have all that many meetings or deadlines I could miss. So I feel that I was a bit too hyperfocused on what I had to get done.

Post Traumatic Stress versus Post Dissertation Stress?

Now let’s just take a quick look at symptoms of Post Traumatic Stress. Which some people have related to their own Post Dissertation Stress ( read more here ). These, however, are quite a bit more severe than what I have been experiencing, even though some people have drawn the parallel (and I can see why). Common symptoms of Post Traumatic Stress are being easily frightened or getting anxious, always on your guard for danger, possibly connected to self-destructive behaviour (like drinking too much, driving recklessly, etc.) Furthermore, trouble sleeping and concentrating, being irritable, angry or aggressive and feeling guilty.

I get why people would relate what they feel to Post Traumatic Stress because I also felt that I got disproportionately triggered by, say work, responsibilities, emails, totally normal to-dos (like taking the trash out). The smallest things put me in a “frenzy” if you want to call it that. This might have also been a reason for my extremely bad memory during the time because I overreacted so much to everything that my brain was constantly too busy stressing out and couldn’t focus (and commit stuff to memory, a process which is reduced during high-strss moments). The bad memory really got to an almost dysfunctional state. I had never experienced anything like that before. And then not being in full control of my brain stressed me even more (like a vicious cycle). But I guess I got through it alright and the memory part is really not an issue anymore now.

From what I hear, people are trying to move the concept of Post Traumatic Stress away from being reserved only to huge triggers (like having been in a war, victim of rape, etc.) – but I’m not sure I like it being applied to what I have felt. I think that I’m still in such a privileged situation. I’d say maybe it’s my body being confused at the stress dissipating after an extremely high-stress time. Maybe the symptoms are similar. I’m not sure I’d want to call this Post Traumatic Stress though (btw, in case you have been wondering… yes, it was known as PTSD, i.e. disorder but the “disorder” part was removed from many mental things which aren’t actually disorder.. like Autism etc.).

More practical advice is coming to you in the next post!

So yeah, that’s my story and my take on how to conceptualize it. This was a long post already, so I’ll save everything else I’ve written down for the next part. Maybe I even have enough material for two more posts, so remember to check this blog for more related content 🙂 What you can expect is, among others, further descriptions of possible symptoms and advice for how to deal with them. How long we’ve heard that it can take (or have experienced ourselves). Some experiences from others. What information we have found for making sense of your feelings (why are you feeling like this, what could cause it?).

That’s it for now. So long and thanks for all the fish!

Cite this blog post Sarah Lang (2021, July 12). Post PhD Submission Fatigue. Part 1. Epigrammetry . Retrieved May 2, 2024, from https://doi.org/10.58079/og7u

Tags: anxiety burnout depression fatigue feeling tired fellowship Post PhD Submission Fatigue Post Traumatic Stress

Book Review: Rest

by Sarah Lang · Published 23/06/2019 · Last modified 22/06/2019

Why “just focus on your thesis” is not entirely good advice

by Sarah Lang · Published 22/12/2019 · Last modified 23/02/2020

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The Research Whisperer

Just like the thesis whisperer – but with more money, post-phd depression.

The author of this post has chosen to remain anonymous and they hope that sharing their post-PhD challenges will be helpful for others who may be going through the same things, or who are supporting those who are.

For those who mentor or manage Early Career Researchers, especially new postdocs, it may be useful to have this post’s perspective in the contextual mix.

———————

When I submitted my thesis, I was hit by post-submission blues, which I was already aware of. What I didn’t expect was that the cloud didn’t lift with completion and graduation. I pretended otherwise, but the moments of genuine excitement and happiness were fleeting. I felt confused and ashamed, compounding my emotions.

Wondering if anyone else had ever felt this way, I Googled it. It turns out that I’m not alone in experiencing post-PhD depression and it is a lot more common than I thought.

Alarmingly, I had never heard of it.

This post shines some light on post-PhD depression so that we can better prepare PhD candidates for life during and after completion and provide the best support that we can to graduates.

The PhD journey changes people

Even if your experience was overwhelmingly positive, a PhD changes people by virtue of its length and nature. Completion can trigger reflection on your experience. It takes time to understand and accept how you’ve changed; this can be confronting and surface as an identity crisis.

Sacrifices made might be a source of pride, grief, or both. You may struggle with poorer mental and/or physical health. Catching up with ‘normal life’ can be nice but also a constant reminder of what you missed.

Processing the emotional and mental impact of a PhD can be particularly confronting for those who faced trauma during their PhD (whether coincidentally and/or because of it). Candidates might have turned to coping mechanisms that have become unhealth, in hindsight. When life suddenly changes due to completion, trauma can surface, as can the reality of the mechanisms used to cope.

There’s a lot of good-byes

For most people, the lifestyle, environment, and relationships that are part of the PhD journey change significantly or come to an end along with the PhD itself. The loss of things you loved can be intense and overwhelming. It can take time to grieve and let go.

The future is uncertain

PhD candidates who submit and graduate are often asked, ‘What next?’.

The post-doctoral job market is highly competitive, and non-academic career pathways can be difficult to establish. Graduates – even if they know what they want to do next – can struggle to find a suitable position, especially if they are part of a marginalised group and/or are primary caregivers.

There can be a range of internal and external pressures shaping decisions. Graduates might apply for particular roles purely because they feel that is what is expected of them. They might suffer from imposter syndrome, and question whether their success was deserved, and whether they are capable of continuing to succeed (‘maybe I just got lucky’). Others might feel trapped in a particular pathway due to their life circumstances.

What can help

It can really help to know you’re not alone! Acknowledge and accept what you feel: your feelings are valid.

Be gentle with yourself. Adjusting to life post-PhD takes time and that’s ok. It can help to do other things that you enjoy, like hobbies and making the most of relationships with family and friends. Engage in ways that feel safe and are less triggering. Set goals to help give you the buzz of completing things but be aware that it’s normal to be underwhelmed by these when compared to a PhD thesis.

When you can, reflect on what you enjoyed most throughout your PhD and investigate how you can continue to do that. Perhaps you loved data analysis, writing, interviewing participants, or tutoring students. These are all skills which are used in other career pathways, such as business analytics and teaching – the specifics might be different, but the process is the same.

There will be a range of opportunities that might be available to you which aren’t immediately obvious – so don’t be afraid to ask people, from your personal and academic circles, to point them out.

Of course, that can all be easier said than done. Consider talking about what you are going through with trusted family and friends and seeking professional help where appropriate. It’s ok to ask for support.

How to help someone else struggling with post-PhD depression

It’s nice to congratulate people when they submit and complete their degree but be mindful that they might not be feeling excited. Allow this to inform how you interact with people throughout their PhD journey.

For example, consider avoiding directly asking what they’re doing next, as this can be triggering (even if well-intentioned). Instead, consider asking, ‘What are you looking forward to next?’ – it gives space for the graduate to answer however they are comfortable. If you have a closer relationship with the graduate, you could also ask, ‘What were the highlights of your journey?’ and ‘How can we support you during this next stage?’.

Consider being open about your own post-PhD experience, too. Even a casual remark can help de-stigmatise post-PhD depression. Something like ‘I realised after I finished that I actually really missed working in the laboratory, so much so that I decided to volunteer to do outreach in high schools’, for example.

If possible, don’t cut off support immediately, whether it’s at a personal, professional, or institutional level.

Most importantly, prevention is better than a cure. It helps to encourage a strong identity for doctoral researchers beyond academia, including maintaining connections with their family, friends, and hobbies. Supervisors and other doctoral support teams can help by openly discussing work-life balance and encouraging it for their researchers.

Take the time to learn about mental health and the PhD journey, and implement best practice for yourself, your colleagues, and for PhD candidates more generally. The ‘Managing you mental health during your PhD: A survival guide’ by Dr Zoë Ayres is a fantastic resource for candidates and academics (and it’s available through many university libraries for free).

A PhD is a life-changing journey culminating in an extraordinary accomplishment. Everyone’s journey is different, including completion and what life after may bring – and that’s ok. We can all benefit from learning to better support each other regardless of what our journeys and futures look like.

News & Events

How to handle the post ph.d. blues.

November 28, 2016
Posted by: Mike Rucker
Category: Academic Life

For some of us the high that comes from a significant achievement can be followed by a period of feeling melancholy, or in some cases even malaise. It is not uncommon for new Ph.D. candidates to feel lost and empty. They struggle to find the motivation they once had after achieving such a herculean accomplishment. This has been well-documented in people completing marathons, for example. Months (or sometimes even years) of vigorous training leading up to a single athletic event… and then it is over leaving the runner feeling empty.

This phenomenon appears to be quite common among recent Ph.D. students as well. Some call it the post-dissertation slump; others refer to it more medically as post-dissertation stress disorder or post-dissertation depression. However, it is not our intent here to make the experience sound pathological; many students deal with some (unexpected) negative feelings after they have been hooded. One might describe it as being another part of the academic journey. Nonetheless, there is no harm in finding good ways to mitigate this down period, especially if it is effecting your well-being.

You have spent years on your coursework: managing your time, reading a barrage of articles (some of them interesting, while others… not so much), devoting all your energy to this worthy pursuit. Your sense of self can often become intertwined with the pursuit of a Ph.D. Accordingly, when that trajectory is no longer there, a sense of being lost is only natural. When you finally achieve your big goal, the feeling of ‘ so what now? ’ sneaks into your psyche.

Many students report experiencing a void after graduation. They can also feel insecure after graduation, especially if professional pursuits are not in the imminent future. The truth is academic life can sometimes be slightly removed from ‘reality’. Some struggle to make the transition out of academic life becoming somewhat paralyzed about what to do next. During your Ph.D. studies, the endgame is clear. Although some doubts would creep in occasionally, you usually feel dedicated and disciplined to see it through to the end. When the work is done, however, you are face with an entirely different road map. There is a lot of uncertainty and, sometimes, anxiety connected with a future unknown. The ‘unknown’ can pertain to different areas of life, such as future employment, finances, relocation, transforming the Ph.D. into something tangible, etc.

What should you do if you suddenly experience post dissertation depression and feel disheartened about things that used to excite you? Here are some things to keep in mind:

First of all, remember that what you are feeling is natural; it will pass.
You are not the only one experiencing a post dissertation low. Try to talk about it with other recent Ph.D. graduates or people working in academia. The likelihood is that they have experienced something similar at some point in their careers and will be able to relate/empathize.
Focus on the exciting new opportunities that are ahead of you. You might have been oblivious to some of them in the past because you were so occupied with finalizing your dissertation. Find joy in discovering them now that you have more time.
Revisit areas of your life you neglected while you were busy studying. This can may include engaging in some very un-academic activities/indulgences. Whatever works for you (as long as it is not inherently harmful) can bring some balance back into your life.
Try to plan out your future career path. Consider all possibilities, without prejudice, and decide if you will continue in academia or maybe move on to industry. Be creative when thinking about different work positions and be open about trying new things… a lot of doors just opened, but you need to find them. Enjoy the quest!
Even if you do not feel very motivated now, work on getting your Ph.D. material published, either in the form of journal articles or as a book. Publications can signal to your future employer (especially if you want a job in academia) that you will be an asset to their department.

Do not forget that you have just emerged from (likely) a very stressful period of your life. It is okay to allow some time to recover and recuperate, psychologically and physically. You have already showed what you are made of by graduating and there are other great things out there that will get you to engage with the same enthusiasm, if you simply take the time to seek and find them.

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Open access
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.

Adults who microdose psychedelics report health related motivations and lower levels of anxiety and depression compared to non-microdosers

Psilocybin microdosers demonstrate greater observed improvements in mood and mental health at one month relative to non-microdosing controls

Emotions and brain function are altered up to one month after a single high dose of psilocybin

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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Satinsky, E.N., Kimura, T., Kiang, M.V. et al. Systematic review and meta-analysis of depression, anxiety, and suicidal ideation among Ph.D. students. Sci Rep 11 , 14370 (2021). https://doi.org/10.1038/s41598-021-93687-7

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DOI : https://doi.org/10.1038/s41598-021-93687-7

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