The high rate of mental health problems in postgraduates needs an urgent solution
Long working hours, short-term contracts and uncertainty affect all sections of society. In academia, they are taken as standard parts of life, only with an added fear of failure, isolation and a constant struggle for funding. It therefore comes as no surprise that many postgraduate researchers suffer from mental health conditions.
Thankfully, higher education institutions (HEIs) are beginning to acknowledge the problem and take steps to offer much-needed support. Last year, Universities UK published a framework for mental health, which proposes a whole university approach to looking after students and staff. The framework makes mental health a ‘strategic priority’ and calls for early intervention, with campaigns against stigma and mental health literacy training for staff and students.
UK learned societies are also coming together to offer support. The Royal Society of Chemistry (RSC) recently hosted an event in London on mental health in the research community, co-organised by the Institute of Physics, the Royal Academy of Engineering, the Royal Society (RS), Wellcome Trust and the Royal Society of Biology.
One postdoctoral researcher at the event, whose name has been withheld, spoke of the difficulties that many academics face. ‘You have to believe that your research is going to work, you have to believe in your research methods …You have to have that confidence and you have to have that commitment. If you have a mental health condition, it’s really hard.’
Felipe knew that his PhD would be tough. Originally from Brazil, he had moved to a research group in Europe. This meant adapting to a new country, learning a new language and switching from organic chemistry to biology.
Halfway through his studies, he realised he was struggling. ‘The new project was very ambitious, many students and postdocs previously assigned to it had failed,’ he explains.
Felipe started feeling under pressure. Unfortunately, his supervisor was not supportive or understanding. Felipe developed severe depression and lost all of his interest in research. ‘At first, when I woke up I felt thrilled to be able to work on something unique, even if the project was not working as it should have. Later, walking to work, I would get panic attacks just from getting closer to the building I was working in.’
Felipe felt scared of admitting his problems, especially to his professor. ‘Every time we talked, I ended up being insulted and shouted at for the project not progressing according to his standards.’ After one of the meetings, Felipe started having suicidal thoughts.
Realising the seriousness of his situation, he decided to take action. He stopped working on the project, and moved to another biomedical research institute. ‘During the first months in the new environment, I started feeling more motivated and enthusiastic about my work and science in general. I enjoyed my lab tasks, reading articles, writing reports, almost just as I had felt at the beginning.’
Unfortunately, Felipe’s mental health problems came back. As a result, he isolated himself. ‘Because of my lack of social life, I became addicted to pornography. Watching these videos started as a way to vent out stress, but later ended up as a problem.’ With increasing amount of stress in his life, the addiction turned into a habit, further limiting his self-confidence and the ability to form new relationships.
Felipe eventually finished his doctorate. He considered his mental health, burnout and addiction and decided to take a sabbatical on a farm. ‘After about five or six months spent as a farmer, I started to relax and feel better about myself. My image as a person and a scientist improved and I finally got my suicidal thoughts under control. My desire to return into chemistry is coming back.’
Felipe’s name has been changed to protect his anonymity
Factors of vulnerability
To make matters worse, the academic culture of ‘high achievement, expectations of high workloads and not displaying any weaknesses’ can prevent postgraduate researchers from talking openly about their wellbeing, according to a recent study by UK organisation Vitae, in partnership with the Institute for Employment Studies and the University of Ghent, Belgium. Funded by Research England, the study found that the culture can also trigger imposter syndrome, where academics are plagued by self-doubt and consider themselves unworthy of their positions (Chemistry World, June 2016, p68). A 2017 study by RAND Europe, a not-for-profit policy research organisation, found that over 40% of postgraduates report symptoms of depression, emotion or stress-related problems. The study, carried out at the request of the RS and the Wellcome Trust, found that the proportion of postgraduates with a mental health problem, based on self-reported evidence, is generally higher than for other working populations.
The findings ‘resonated strongly with the academic community,’ RAND’s Susan Guthrie told the learned society event. ‘Out of all of the studies that I have ever done, it’s the one that seems to have received the most interest and attention.’
A specific combination of factors appears to make academics vulnerable. These include short-term contracts; a culture of long working hours with pressure to deliver; and a need to balance commitments, including research, teaching and administration. Sara Shinton, head of researcher development at the IAD, adds that there are also personal factors rife in academic life: complex demands that fragment time; an increased burden of bureaucracy; bad behaviour from colleagues that causes stress to be pushed down an institution’s hierarchy; and a corrosive impact of career uncertainty – people are having to wait longer and longer until they obtain lectureships.
While none of the factors is unique to the academic environment, ‘the way they come together is very interesting,’ says Guthrie. ‘We start to see things like very high levels of job satisfaction co-existing with high levels of job stress.’
A diagnosis of dyslexia and bipolar disorder saw Jane forced to suspend her MChem at a UK university. Only now, after four years, does she feel ready to return.
Jane struggled with her MChem from the start. ‘I worked in the evenings and at weekends. Any time off was to wash my laundry or go to the supermarket,’ she recalls. After one term, she decided that she couldn’t face going back. But her college tutors reassured her that her experience was not uncommon and recommended antidepressants.
When she scraped through her exams, her tutors played down her concerns, telling her that everything would ‘click’ at some point. ‘Why does it never click?’ she thought in desperation.
A series of self-help guides on the university website all seemed to apply to her. When Jane emailed for guidance, the response alluded to a possible ‘learning difficulty’. She went for a diagnostic assessment and was shocked to discover that she was indeed seriously dyslexic. ‘I had spent years wondering what was wrong with me,’ she says. She vividly remembers sitting in the library and watching other people skim-read text. ‘I would read a paragraph and have no idea what it meant.’ The diagnosis sent Brown’s stress levels soaring and a college nurse accompanied her to the GP, who prescribed antidepressants. But she soon stopped taking them, after becoming ‘completely hyperactive’.
Her GP then referred her to a psychiatrist, who gave a ‘working diagnosis of type II bipolar disorder’. Having been ‘pretty chilled’, her college strongly recommended that she suspend her course or risk failing her exams. They gave her two weeks to leave college accommodation and she has heard little from them since. ‘I am not the only person this has happened to,’ she says.
Jane’s name has been changed to protect her anonymity
The RAND results are echoed by a 2018 survey by researchers from the universities of Texas and Kentucky, US. The ‘strikingly high’ rates of anxiety and depression should be a ‘call to action’ to establish and expand mental health and career development resources in universities, write the authors in Nature Biotechnology.
In particular, the US researchers highlight the vital role that academic supervisors play, with ‘strong and supportive’ relationships correlating with lower levels of anxiety and depression.
Supervisors are ideally placed to identify when post-graduate researchers are becoming stressed, suggests the Vitae study. Although some HEIs realise there is a lack of support for supervisors, several are now looking into providing more support and training in wellbeing and mental health.
Importantly, Vitae states that supervisors also need to feel that their own wellbeing and mental health is a priority for institutions. It encourages them to be role models for their postgraduate researchers in adopting healthy ways of working.
As a supervisor of dozens of students and staff, Reay recognises that ‘empathy is useful, listening is vital’. In his comment piece, he says: ‘We are mentors, not therapists, but our university communities are under enormous stress.’ He points to growing awareness of mental health conditions, with supervisor training, peer-support networks and counselling services now commonplace. ‘More importantly, the stigma of mental health issues is fading.’
Michelle Scire is an analytical chemist working in the US. Her life was happy and successful. Then, one morning as she was getting ready for her classes as a biology student, she found she could not move. Paralysed in bed, all she could do was to cry. Michelle had experienced her first anxiety attack. Soon, she began to experience panic attacks almost every day, and started ditching classes and calling in sick. ‘My work image, being an enthusiastic person who never called in, was out of the door. My grades started to suffer. I felt like I was failing in life, I wanted to jump out of my own body, I wanted it to end. I was never suicidal, but I thought that being dead would be better that enduring this.’
Realising the seriousness of her mental health issues, she sought help in the health clinic at her campus. ‘The doctor was not listening to my complaints. I was simply prescribed antidepressants. The longest anything helped was for two to three weeks.’
Instead, Michelle decided to change her lifestyle: she improved her nutrition, started exercising regularly and quit energy drinks. Her condition has now significantly improved and she has secured a job at an environmental lab. There, she realised that surrounding herself with positive people had a huge influence on both her results and mental health. ‘I have amazing managers that behave like curious kids. They get excited about everything, even a new instrument arriving into the lab. Being surrounded by people like that ignited the same curiosity and passion in me.’
Michelle was eventually diagnosed with general anxiety disorder, which causes her to get panic attacks without any obvious reason. After eight years, she has learned that her condition is guilt-driven, but manageable. ‘Even if I want to take an hour off to relax, I feel guilty because I should be working. The silver lining is that my anxiety keeps me incredibly productive.’
Michelle also runs a science communication blog and an Instagram profile, which has proven as beneficial even for her mental health. ‘It is a great source of reassurance; we connect with a lot of people suffering from the same issues. I know from my own experience that being able to read about similar stories is very comforting; it makes me feel understood and not alone.’
Although postgraduates at all career stages are at risk of developing mental health problems, PhD students are particularly vulnerable. The Vitae report suggests that institutions need to find ways to help them disconnect ‘healthy stress’ related to the intellectual challenge of undertaking a doctorate from other stresses that have a negative impact on wellbeing and mental health.
‘We are taking the best minds of a generation – the people who should be going out and changing the world – and we are breaking them because the PhD system is set up to be so stressful,’ comments Tom Price from the University of Liverpool’s Institute of Integrative Biology (IIB).
Price is involved in a pilot project looking at ways to help students in the early stages of their PhD, one of a series funded by Research England to support mental health and wellbeing for postgraduates. The project will target both PhD students and the people that support them, including supervisors. ‘Through the project we want to develop a range of training and development tools, and resources,’ says Kate Jones, head of operations at the IIB.
The first stage is just raising awareness, says Price. ‘Every PhD student should know what support is available and how much support there is.’
In some cases it’s as simple as letting PhD students know how many days’ holiday they are allowed. ‘If you can notice you are in the early stages of heading towards depression, taking a break can really make a difference,’ says Price. ‘We want students to be aware of these issues, so that they will hopefully be aware of how to detect them in themselves and potentially in each other so we can build up a support network. We are also trying to make sure that supervisors and other staff are aware of issues.’
Many factors are unlikely to change, says Price. ‘We can’t change the amount of money that PhD students get paid. And we can’t make research easy – research is going to be difficult and stressful.’
But there are a lot of things that can be improved. ‘The major things that cause poor mental health are things like not having clear goals, targets changing continuously, power dynamics and a lack of job security. All those things are known to cause poor mental health across any industry. And with all of those things you can see reasons why PhD students are going to be particularly vulnerable.’
Meanwhile, the University of Edinburgh’s Institute for Academic Development (IAD) will soon begin to compile a guide to passing a PhD viva or defence. The viva is ‘a really important crunch point,’ Shinton told the RSC meeting. ‘It’s the point where you have to be bombastic and confident and defend your position … For some of our students that is almost impossible to do,’ she said. ‘The issue is that the viva should not be a situation that breaks you. It should be a positive experience.’
Teresa Ambrosio is a PhD student at the University of Nottingham, UK. As a young student, Teresa was proactive and enthusiastic about life and chemistry. However, as she progressed with her PhD and her projects became harder to handle, she started feeling anxious, alone and overwhelmed. Unable to move forward with her career and life, she considered quitting her PhD. ‘I really struggled to stay focused on chemistry. During some days, I did not feel only mentally, but also physically sick. I eventually did not feel safe in the lab any more, considering the toxic character of reagents I was working with.’
Teresa went to a mental health counsellor, a free service provided by the university. Initially looking at her life as unproductive and messy, she was able to gain a new perspective. ‘Thanks to this service I got a different picture about my PhD, my research and my future career.’
Ultimately, she opened up to her friends, family and supervisor. ‘Before I went to talk to my supervisor, I was nervous, but I felt it was a moral obligation. He was amazing, full of support and empathy. He said that a clear mind is the most important feature of a scientist, and we needed to take good care of it. Because of the stigma surrounding mental health problems, I was afraid to talk to anyone. After opening up, the quality of my life has improved significantly. I feel more in control of both my personal life and research.’
Teresa has recently started taking medication to help her cope with depression. Since then, she has started going out, spending time with friends and feeling happier. Her research has also improved. ‘I am much more focused and feel enthusiastic about my project. I do not consider my work so heavy, my time and work is easier to manage. Taking advantage of the counselling service was the best decision I could have made, it made me realise that I indeed want to stay in science.’
Since rediscovering her passion for science, Teresa has been offering insights into her daily life as a researcher on her blog PhDtoSuccess. Her outreach work focuses on promoting female scientists, grad school advice and mental health. ‘I feel empowered to communicate my story via social media and my webpage. My followers can really relate to my story and feel supported.’
Acknowledge, facilitate, intervene
For many postgraduates, taking up a new position a long way from home means being uprooted from their support network. Aside from the logistical problems of having to register with a local medical practice and locate mental health support, being away from friends and family can be particularly challenging. The situation is not helped by ‘rhetoric about having to hit the ground running,’ says Shinton.
The IAD has published a guide on getting started and thriving as a postdoc. It also outlines three steps to support postgraduate researchers: acknowledge; facilitate, and intervene. ‘We try to acknowledge the fact that when you have a mental health condition, it creeps up on you. It’s very difficult for you to be objective. There might be a tiny window where you are both aware that there is a problem and willing to get help,’ says Shinton. ‘What we are trying to do is make it really easy so that, in that window, you know who to go to and what to do to find help.’
Shinton would like to see more kindness pervade science departments. ‘The environment that we are in rewards people for the things that we are able to count, like money and papers. It doesn’t reward anyone for being kind and supportive.’ She urges others to push back on things that erode wellbeing. ‘Push back on the expectation that you need to be mobile; push back on the expectation that the biggest, loudest, most confident voice in the room gets all the money.’
Ultimately, providing a safe, supportive, working environment for postgraduate researchers will require ‘systemic culture change and top-down commitment to promoting mental health,’ says the Vitae report. But steps to creating a safe working environment and removing isolation need not be complex or costly. For example, tea rooms in science departments, many of which have been removed during refurbishments, can play a vital role in helping people share their worries and research woes. Shinton sees departmental tea rooms as a ‘silver bullet’. ‘It’s my new mission – reinstatement of tea rooms in UK science departments.’
At the end of the RSC event, attendees split into discussion groups for a workshop. Themes to emerge included the importance of incentivising teamwork and normalising failure. Yet one particular phrase resonated strongly with attendees: that there should be a space for every kind of scientist. That includes those with mental health conditions who need our support.
Emma Davies is a science writer based in Bishop’s Stortford, UK. Additional reporting by Martina Hestericová