Correlation of search terms in Google. As more searches containing the words “graduate school” are entered so are more searches containing the word “problems”. I’m not putting much weight on this as support for my arguments here, but it is a metaphorically interesting result at least.

There is an abundance of comics and writings online that poke fun at the tortured graduate student, anxious and overwhelmed, complaining about grading and research and the next frightful meeting with their advisor (e.g. PhD comics and this recent buzzfeed post). Graduate students consume and propagate these memes because, oh! how we can relate, and oh! how easy it is to make fun of people with emotional problems. And those outside the graduate school loop seem confused why grad students are so sensitive and mentally unstable. As these ideas migrate across the Internet and across our hallways I worry our collective community is masking its real concerns about mental health behind laughter.

Undergraduate and graduate students alike often suffer from anxiety, depression, and other mental health issues (1, 2). Many students move to new cities or countries to start their degree and thus lack social connections and support, commonly to feel overwhelmed by teaching and research loads, and often have persistent fears of failure and inadequacy. These and other causes can lead to anxiety and depression that drain students’ creativity and motivation. In one study of over 3,000 international graduate students, 44% said they had mental health issues that “significantly affected their well-being or academic performance” (3). In addition, these can lead to graver health concerns, most dramatically suicide, which, among college students across 10 universities, was found to be highest among graduate students (4).

From these studies and my personal experiences and observations, I think that mental health issues are the biggest barriers to success among graduate students.

Graduate departments are supposed to provide resources to help their students succeed, but what do graduate programs offer to prevent or deal with mental health problems? It seems typically little to none. Most universities offer counseling programs that can be helpful but this is a reactionary solution, an approach that patches leaks in an already damaged vessel. What can graduate programs do to help create robust fleets that can successfully navigate the perilous waters of graduate school? There surely are many ways to work towards achieving this goal, but here are some suggestions:

Graduate departments need to openly acknowledge the problem. If mental health issues are barriers to success than this should be a prominent topic in grad student orientations, student handbooks, initial meetings with advisors, and other places. It needs to be clear that departments recognize this as an important concern. Mental health issues are often poorly understood and stigmatized, both of which can prevent people from seeking help when they desperately need it. For example, when someone is seriously physically injured they typically seek immediate help, but that same person suffering terribly from depression or anxiety may not seek any help because of denial that they have a serious issue or because they are ashamed. These are large and complicated problems that have roots in the way our societies as a whole perceive mental health, but the simplest first step to addressing them is making mental health part of the conversation in our academic communities.

Academic advisors should receive training on preventing, recognizing, and addressing mental health issues in their students (and themselves too!). Professors often don’t receive much, or any, training on being mentors or supervisors, which can leave them ill prepared in guiding their students towards success. The primary and most clearly articulated role of an advisor is to provide assistance and guidance in purely academic endeavors: understanding concepts, shaping ideas, teaching technical details of research, writing, etc. However, a greatly under-appreciated role of effective advisors is to provide psychological support, guidance, and assistance to students who are often working through some of the most difficult periods in their lives, both personally and professionally. The amount of involvement an advisor has in the personal lives of students is a matter of choice, but if they choose to not take an active role in helping students with mental health issues they at least need to know how to recognize problems and have resources to point students toward.

Graduate programs should offer (or even require) courses or workshops that teach yoga and mindfulness techniques. Yoga and mindfulness provide concrete techniques to promote mental health. This is not just a personal anecdote (although, it is that as well) but also rather something supported very robustly by decades of research. Take this study with 28 young men and women (mostly students) who were experiencing symptoms of anxiety and depression. Half of them took two one-hour yoga classes a week for five weeks. After five weeks the treatment group had a 70% reduction in symptoms of depression and a 20% reduction in anxiety. There were no clear changes in the control group (5). The physical health benefits of yoga are very robust and supported in a review of over 80 studies (6); the mental health benefits of yoga specifically are less studied but reviews on both depression (7) and anxiety (8) suggest general support for effectiveness of yoga as a treatment.

The positive effects of mindfulness (AKA meditation) on mental health are well studied and strongly supported. A meta-analysis of 20 studies found a positive effect size of around 0.5 for both mental and physical health (9). That means that groups partaking in mindfulness treatments had 0.5 standard deviation units higher scores for health metrics. Another meta-analysis of seven randomized controlled studies showed that mindfulness treatments reduced stress by 1.4 standard deviations (10). That’s quite large for a standardized effect size! (Yet another meta-analysis from 2010 found similar results (11)).

In most university environments there are already places where students can receive training in yoga and mindfulness, often on campus even. This is great. However, availability is not enough, departments need to commit to making these services available and actively encourage students to participate. Courses could be arranged that are offered to graduate students and could even be taken for credit. Workshops could also be arranged with invited instructors that are highly encouraged or even required. Finally, if only private courses and workshops (i.e. not free) are available then departments could offer full or partial compensation for students taking them.

These are just some suggestions and I am sure there are many other potentially promising options. Another that comes to mind is encouraging or requiring students to visits with a student counselor once or twice during the course of a graduate degree, just as a check in to see how they are doing and if they are potentially suffering any mental health issues that they themselves may not be aware of.

Alright, some final words: in academia, and throughout our societies, mental health issues drift around like a light fog, ever present, clearly a bit pesky, but easily ignored. The haze can become particularly thick for graduate students as we climb our way upwards in our research and our careers. But perhaps it is time for a stout breeze, leaving a fresh new atmosphere in its place. An air where we can openly acknowledge that mental health is an issue to be dealt with. Perhaps with this increased visibility we can see and be open to new solutions to old problems.

PS: I think this general argument applies to all levels of education, from elementary school through undergraduate level and beyond.

PPS: Here are two resources that offer free online guided mindfulness exercises, Headspace and UCLA Mindful Awareness Center.

HT to Marc Johnson for providing some very helpful comments on this post.

References

1. Bayram N, Bilgel N (2008) The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Social Psychiatry and Psychiatric Epidemiology.

2. Dyrbye LN, Thomas MR, Shanafelt TD (2006) Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine.

3. Hyun J, Quinn B, Madon T, Lustig S (2007) Mental health need, awareness, and use of counseling services among international graduate students. Journal of American College Health.

4. Silverman MM, Meyer PM, Sloane F (1997) The Big Ten Student Suicide Study: A 10‐Year Study of Suicides on Midwestern University Campuses. Suicide and Life-Threatening Behavior.

5. Woolery A, Myers H, Sternlieb B, Zeltzer L (2004) A yoga intervention for young adults with elevated symptoms of depression. Alternative therapies in health and medicine. 10:60–63.

6. Ross A, Thomas S (2010) The health benefits of yoga and exercise: a review of comparison studies. Journal Alternative Complement Medicine. 16:3–12.

7. Pilkington K, Kirkwood G, Rampes H (2005) Yoga for depression: the research evidence. Journal of affective disorders.

8. Kirkwood G, Rampes H, Tuffrey V (2005) Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine.

9. Grossman P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-based stress reduction and health benefits. Journal of Psychosomatic Research. 57:35–43.

10. Chiesa A, Serretti A (2009) Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Journal Alternative Complementary Medicine. 15:593–600.

11. Hofmann SG, Sawyer AT, Witt AA, Oh D (2010) The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology. 78:169–183.

20 thoughts on “Acknowledging and Addressing Mental Health Issues Among Graduate Students

  1. Nash, great post as I think this is a big problem. One thing to add, may be access to traditional means of coping with mental issues. Our coverage for seeing mental health professionals is pitiful and almost inaccessible on a graduate student stipend. So, those who really need the help, can’t get it. Also, what about bringing back the guidance counselor? Just a suggestion, if your argument applies to all levels of education, shouldn’t we pull upon things that work in other levels? Thanks for the post!

  2. Good post Nash, I agree with your suggestions and I would add socializing establishing connections among your peers/department has a big positive effect, which sometimes can be very difficult giving that everyone is in their “own little world” so maybe organizing student retreats would provide quality time for more effective social bounds

  3. Excellent post. I’m with Yessica regarding establishing connections in the department and the need for student retreats (what happened to grad movie nights?). I would also add that when I started as an international student at the university I found the assistance from the International Centre lacking, to say the least. At some point I just stopped contacting them when I had a problem. I think the issue was their focus on undergraduate students, while having no clue how to deal with grad students. For someone coming from a different background things can be a tad overwhelming and I believe international grad students are left out with no one to turn to for guidance.

  4. I agree wholeheartedly with you Nash, although I would go a bit farther and name some of the main syndromes graduate students suffer from, me included.  

    The main one is Imposter Syndrome – we feel so inadequate in one way or another  that we think that one day someone is going to realize we don’t belong in graduate school and kick us out.  I think the only real way to combat this is receiving consistent positive feedback when earned.  

    The second is what I like to call the “Vicious Guilt Cycle”.  We don’t accomplish as much as we think we should one day and feel guilty, and then again the next day, and the next, and then work piles up, and guilt piles up, until all we think about is research and how we aren’t accomplishing enough.  This can only be combatted through making realistic goals, but this is hard to do, especially for new graduate students or graduate students new to a field.  

    Meditation is hard, but it helps a great deal.  I am currently part of a dissertation support group, which is very helpful, knowing you are not alone in these feelings is about half the battle.  

    Having a great set of people in the lab to talk to when you have a problem also helps a great deal!!

    Just my thoughts….

  5. Great article. Only thing I’d add is that yoga is only one of many forms of physical exercise that greatly benefits mental health. Swimming, weightlifting, and many other sorts of intense exercise require the same mind-body connection and concentration that yoga does. Bottom line is you need to get moving doing something that you enjoy.

    That detail aside, this is a very important issue that needs to be considered in detail.

    • Thanks for this comment, I agree that many activities can be helpful and I certainly encourage people to do whatever works for them. However, because yoga is just as much about exercise and awareness of the mind as the body I suspect it will be more effective at dealing with mental issues than other forms of exercise, but I’m unaware of research that actually tests this supposition.

      • I can’t give you a citation off the top of my head, but I’m fairly certain that their is a body of research that suggests that exercise that breaks through the aerobic metabolism barrier and lasts on the order of an hour, does reams of good for depression and anxiety. Perhaps this is because of the shifts in autonomic function, reconnecting/realigning the ‘fight or flight’ mode to actual physical situations… although, there are lots of other things it could be as well.

  6. A great post on a very important topic Nash! There is definitely something unique about the grad school environment that brings out mental health issues. I struggled with depression and anxiety for several years and saw this happen to many of my peers. I think that when you put really motivated, normally high-functioning people in a position where they regularly fail (at least in science they do!), have only a few concrete markers of progress and few opportunities for positive feedback in a culture of “work all the time,” it’s unsurprising that people start to unravel. Support for mental health definitely should be addressed by graduate programs- it’s surprising that it isn’t given how prevalent these issues are. On the subject of exercise, I think there’s a lot of good data on the benefits many kinds of exercise in alleviating the symptoms of depression… and that people should be encouraged to do what works for them. I discovered that the mental benefits of running were a HUGE help in getting through my final few years of grad school.

  7. You’ve raised some incredibly important issues here. Poor mental health is definitely a massive obstacle, and we do need to ensure our workplaces are better organised to address this serious problem.

    However, I don’t agree with your prescription of compulsory yoga : a range of potential solutions needs to be available because people will differ in what works for them, and what they feel comfortable with. Pressuring people into an activity they just don’t want to do (whether that’s yoga, or whatever) is not exactly respectful of the individual, and I suspect that activities will work better if participants are there by consent rather than coercion. Better to make a number of solutions available, allow the individual to try them and make their free choice.

    • Yes, the idea of saying people ‘have to do this or that makes’ me uncomfortable too. But, an important part of the problem, as mentioned in other comments, is that many people won’t actually participate in helpful activities even if they are available and they are in need. I’m not sure what the solution is, but some level of coercion, at least just to give folks a taste of what is available, seems like a reasonable option.

  8. I loved your post! I am a professor at the National University of Mexico and always make an effort to teach my students the importance of mental health in all aspects of life. Congratulations!

  9. Great post, Nash. When I was the VP: Policy at the WLU Grad Student Association, we had some big choices to make with our healthcare plan because of the sheer volume of mental health related prescriptions started to outpace how much we could alot to them given what our students were paying for the plan. We knew mental health was a problem among grad students, but we were truly unnerved by the sheer volume prescriptions, but also the (conversely) poor attendance at our ‘escapes’ and ‘wellness’ events..

    The biggest challenge with mental health wellness is just how much people underestimate where they are at emotionally, and how much it is affecting their ability to work effectively. Generally speaking, services are not approached until its ‘too late’ for gentler interventions to be effective on their own.

    • “The biggest challenge with mental health wellness is just how much people underestimate where they are at emotionally, and how much it is affecting their ability to work effectively” I agree completely!

  10. As much as I agree with the fact that exercise can help alleviate symptoms of mild to severe depression and anxiety, I think the conversation has to go beyond that. Suggesting measures like supporting or offering social and physical extra-curricular programs and events for grad students is the main way mental health problems can be combated really doesn’t get to the root of a lot of mental health issues. For mild, temporary situational depression or anxiety issues (the sort of thing that PhD Comics, etc. poke fun at), yes, these can be effective countermeasures which relieve symptoms.

    However, this is not the case for grad students who suffer from more severe, long-term mental health conditions which are not necessarily related to grad school and require constant monitoring, care, and (often) medication. I would be interested in determining the percentage of grad students who have more severe and lasting diagnoses versus the population at large in the same age groups. From what I can tell, there is quite a large number of grad students and professional degree students who have such chronic conditions, and it isn’t simply caused by the high pressure schooling environment. BUT, the mentally unhealthy environment which often pervades these sorts of intensely competitive fields can exacerbate pre-existing issues or make treatment of them less effective.

    Ultimately, for students who aren’t just getting the run-of-the-mill grad school blues but have a chronic mental health problem which they must manage alongside their thesis work, teaching, etc., access to psychological and counselling services are of the utmost importance. Making students aware of the university programs and facilities that they can seek support through is critical. Improving grad student insurance coverage for talk therapy, psychiatric appointments, and medication is necessary (though U of T isn’t too bad for this, so long as you see the doctors and therapists at CAPS and find one who jives well with you — but outside referrals and monetary support for more intensive care needs are still lacking).

  11. This article is wonderful, that talk abut Acknowledging and Addressing Mental Health Issues Among Graduate Students, so all people should be think and follow. Thanks for this article,I love this article so much.

  12. Thanks for writing this Nash, and drawing my attention to it by tweeting it today! As someone who has struggled with anxiety and depression for a long time I agree with all your suggestions. Yoga and mindfulness are important tools. As Amanda indicated above, access to professional counselling is critical. Luckily, my current university offers free counselling to students. Unfortunately, their limited resources mean that their mandate is basically to “put a bandaid on it” or “patch the leaks” as you put it: each student gets a maximum of 6 sessions per year. They are then shunted into a group program, like mindfulness based stress reduction. While this is an excellent program (I’ve done it!) it’s not a replacement for one on one therapy when you’re struggling with serious mental health issues. More money needs to go into health and counselling services for all students, and grad students in particular.

    Another thing that is really great that others have already mentioned is a peer support group. I recently became a member of a group of people who felt they were lacking some of the support that they might regularly get from lab meetings, (e.g. because they are working from home, or not currently a member of a big lab) and decided to start our own weekly meeting. We aren’t all scientists, and while we do help each other with writing and giving practice talks and normal lab type things, we have also ended up being a support group for all kinds of issues, including mental health issues, that we don’t usually have the opportunity to talk about in our regular lives and labs or jobs. It’s a great solution for us, although I think it shouldn’t be the case in general that grad students end up needing going outside their departments to get this kind of support.

    • Thanks for you comments! I totally agree with your, and Amanda’s comments, that focused medical care (i.e. counselors & therapists) is incredibly important. Seeing a therapist at University of Toronto was a key part in getting out of a very bad place for me. In hindsight, I wished I made it more clear that I see yoga & meditation more as preventive tools. While they can certainly help in “treating” mental health issues, they are no substitute for professional help. Mental health is no less serious for your well being and quality of life than physical health. We wouldn’t avoid going to a doctor if we broke our arm, and we wouldn’t try to treat it with some do-it-yourself remedy. Serious mental health injuries should be no different. It is the disconnect between how we relate to, and respond to, a mental injury and a physical injury that is so absurd and damaging. This comic says it better than I can –> http://www.robot-hugs.com/helpful-advice/

      The lack of access to mental health treatment can be very serious problem for students. Long wait times, infrequent visits, limits on number of visits, can seriously hinder recovery. Universities take note, this is a place where you have the power to make your students lives better and increase their likelihood of academic success.

      • I hope someday mental health will just be part of “health”. And we’ll go see the doctor that helps us with the mental part (and it will be covered by the regular health insurance plan, no problem!) in just the same way as we go to the doctor that focuses on the physical part.