The mental health of university students in the United Kingdom is a topic that has drawn increasing attention in recent years. There have been influential thinktank reports, regular articles in the media, targeted Office for Students funding in 2018, and two national policy frameworks (Universities UK’s stepchange framework in 2017 and Student Minds’ University Mental Health Charter in 2019). There has also been a corresponding increase in research in the area, with studies often focusing particularly on medical students (Stavrou, 2020) and risk of suicide (Smit, 2019).

However, despite this, at present there is still a paucity of data, making evidence-based intervention difficult (Barkham, M. et al., 2019). Additionally, much of the existing research focuses on undergraduate students or the student body as a whole, with doctoral students (and their unique experiences and needs) largely overlooked.

Doing a PhD is often incredibly challenging, combining the stresses of undertaking a difficult qualification with the cultural and structural pitfalls of academia. Students may face long working hours, financial strain, pressure to succeed, career uncertainty and working in isolation. Perhaps as a result, some initial studies have suggested that this group may have a high prevalence of mental distress (Evans, T. M. et al., 2018).

This recent study (Byrom, N. et al., 2020) comprises a literature review identifying factors that may influence the wellbeing of PhD students, and a quantitative analysis of which factors predict students’ stress and wellbeing.

Literature review

The literature review identified the following factors as possible predictors of PhD students’ stress and wellbeing:

• Social support: Socialising within the academic community was identified as an important element of success both professionally and personally, but it can be difficult for PhD students to build a network, partly as they are often working independently and may be unsure of their place in the community (Janta, H. et al., 2014).
• Finances: The cost of living can be a strain on PhD students who may be self-funded or supported by relatively small stipends. Financial strain is known to be associated with mental health outcomes in students (McCloud, T. & Bann, D., 2019).
• Housing quality: Linked with the issue of finances, students whose housing is of poor quality may experience worse mental health as a result (Pevalin, D. J. et al., 2008).
• Physical health and sleep: Busy PhD students may neglect their physical health and get insufficient sleep, both of which are important for wellbeing (Rizzolo, S. et al., 2016).
• Supervisory relationship: Supervisors are the primary source of support for PhD students, and the quality of this relationship is central to students’ experience and wellbeing (Metcalfe, J. et al., 2018).

Methods

The researchers conducted an online survey with a convenience sample of PhD students from across the UK, recruited from social media and emails sent out at two universities. The survey took 25 minutes to complete and ran from August 2018 to March 2019. 431 students were recruited from 48 different universities and a range of subject areas (though the grouped area of ‘psychology, psychiatry and neuroscience’ was overrepresented).

The survey included validated measures on stress (the Perceived Stress Scale), mental wellbeing (the short version of the WEMWBS), social support, achievement orientation (motivation and readiness for academic work) and self-depreciation (also known as “imposter syndrome”). There were also questions on overall health, sleep and physical activity.

Additionally, the researchers worked with two panels of students to co-create 24 single items based on the factors identified in the literature review above and the students’ own experiences. These 24 items were statements such as “I am well-prepared for the work required to complete my program” and were measured on a 7-point Likert scale indicating level of agreement. Factor analysis was conducted to assess how these items clustered.

Multiple regression analysis was used to assess whether the various factors measured were associated with perceived stress and, separately, wellbeing. These analyses controlled first for the sociodemographic characteristics of the participants (gender, ethnicity, sexuality, age and whether home, international or EU student), next for their subject of study, then for contextual factors (support, career confidence, living conditions, etc) and finally for individual factors (feeling confidently prepared, self-depreciation, sleep and health, etc).

Results

Overall, the survey findings identified some areas of concern as well as some positive aspects of the PhD student experience. In particular, many students indicated that they had a positive relationship with their supervisor, felt on track and well prepared to complete, had a good academic support network, and felt safe where they lived. 54% indicated that they were exercising more than three times per week.

However, low levels of wellbeing were reported; the average score was lower than reports in existing age-matched data, and a quarter of participants had a score indicative of ‘probable depression or anxiety’. Less than 40% were confident about their career and career directions, 63% reported often feeling that they were ‘in over their heads’ and 75% often worried about failing. 59% also indicated that they had poor or very poor overall health.

In the factor analysis, the researchers found that a six-factor solution explained 53% of the variance, provided the simplest interpretable structure of factor groupings, and included 21 of the 24 items. These six factors were titled academic support network, financial confidence, living conditions, career confidence, supervisory relationship, and confidently prepared.

The regression analysis found:

• Better family support, sleep and overall health were associated with both lower stress and better wellbeing
• Higher self-depreciation was associated with lower wellbeing and increased stress
• Better support from supervisors and feeling confidently prepared were associated with lower stress (but not wellbeing)
• Achievement orientation and future career confidence were associated with better wellbeing (but not stress)

Conclusions

This study identified from the literature themes and factors which were then shown, in some cases, to be associated with wellbeing and stress in PhD students. Overall, the findings indicated that wellbeing was low in this population and some areas of real concern were identified. However, some other positive aspects of the PhD student experience were highlighted.

This study contributes data which helps to identify possible next steps for investigation and intervention in order to improve the mental health of PhD students in the UK: self-depreciation and imposter syndrome, career confidence and supervisory support, in particular.

Strengths and limitations

There is little existing data on the mental health of doctoral students and the factors that impact this and, writing as a PhD student, it is heartening to see more attention and research in this area. There are many ways in which PhD students could be better supported to succeed academically without sacrificing their mental health, and identifying potential avenues for this is extremely worthwhile. The fact that parts of this study were co-created with doctoral students is also cause for celebration.

A clear limitation is that this research was based on a convenience sample recruited primarily through social media. Considering the number of doctoral students in the UK, the sample size is small. The findings, and particularly the prevalence estimates, are therefore very vulnerable to bias. It is likely that students with bad doctoral experiences or mental health problems would be more likely to participate, potentially skewing the wellbeing data, for example.

The survey was also conducted cross-sectionally, so it is difficult to conclude that the relationships observed are causal, and also the direction of effect. For example, better wellbeing and less stress could cause better sleep and overall health, rather than the reverse.

The regression analyses also did not take into account socioeconomic status, which is likely to be an important factor in student mental health; for example, it may be a confounder in the relationship between future career confidence and wellbeing. Nevertheless, this paper provides a valuable contribution to the field and a starting point for future research to (hopefully) build upon.

Implications for practice

The researchers highlight the findings on self-depreciation in particular as being important, as this was found to be both negatively associated with wellbeing and positively associated with stress. They suggest that the so-called “imposter syndrome” may be influenced by contextual factors relating to the doctoral experience, and may therefore represent an avenue for improving students’ mental health.

In my experience of academia, imposter syndrome is often talked about as a common feature of academic life regardless of one’s position in the hierarchy, with structural barriers to addressing this such as competitive environments and job insecurity. Trying to temper this at the point of doctoral study could improve academics’ mental health throughout their career, and challenge the idea that this is an inevitable part of the job. For me, I feel that supportive, open environments and strong workplace support networks within universities, departments and lab groups are essential. I would not have got this far in my PhD without the support of the other PhD students in my Division. Additionally, as the researchers suggest, setting and clarifying realistic expectations and standards for work and achievement is important; it is difficult as a doctoral student (and beyond) to know when you have done ‘enough’ or ‘good enough’ work and receiving clear and encouraging feedback that that is the case can really help.

Statement of interests

Tayla McCloud is part of the Smarten student mental health research network, of which Nicola Byrom (the first author on this paper) is the leader. No other conflicts of interest.

Links

Byrom, N. C., Dinu, L., Kirkman, A., & Hughes, G. (2020). Predicting stress and mental wellbeing among doctoral researchers. Journal of Mental Health, 1-9.

Other references

Barkham, M., Broglia, E., Dufour, G., Fudge, M., Knowles, L., Percy, A., … & SCORE Consortium. (2019). Towards an evidence‐base for student wellbeing and mental health: Definitions, developmental transitions and data sets. Counselling and Psychotherapy Research, 19(4), 351-357.

Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature biotechnology, 36(3), 282.

Janta, H., Lugosi, P., & Brown, L. (2014). Coping with loneliness: A netnographic study of doctoral students. Journal of Further and Higher Education, 38(4), 553–571.

McCloud, T., & Bann, D. (2019). Financial stress and mental health among higher education students in the UK up to 2018: rapid review of evidence. J Epidemiol Community Health, 73(10), 977-984.

Metcalfe, J., Levecque, K., Wilson, S. (2018). Exploring wellbeing and mental health and associated support services for postgraduate researchers. Vitae.

Pevalin, D. J., Taylor, M. P., & Todd, J. (2008). The dynamics of unhealthy housing in the UK: A panel data analysis. Housing Studies, 23(5), 679–695.

Rizzolo, S., DeForest, A. R., DeCino, D. A., Strear, M., & Landram, S. (2016). Graduate student perceptions and experiences of professional development activities. Journal of Career Development, 43(3), 195-210.

Smit, J. (2019). Suicide in university students in England and Wales. The Mental Elf, December 2019.

Stavrou, P.Z. (2020). Mental health services for medical students: are specialist university-based student mental health services the answer? The Mental Elf, September 2020.

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