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The Savvy Scientist

Experiences of a London PhD student and beyond

PhD Burnout: Managing Energy, Stress, Anxiety & Your Mental Health

PhDs are renowned for being stressful and when you add a global pandemic into the mix it’s no surprise that many students are struggling with their mental health. Unfortunately this can often lead to PhD fatigue which may eventually lead to burnout.

In this post we’ll explore what academic burnout is and how it comes about, then discuss some tips I picked up for managing mental health during my own PhD.

Please note that I am by no means an expert in this area. I’ve worked in seven different labs before, during and after my PhD so I have a fair idea of research stress but even so, I don’t have all the answers.

If you’re feeling burnt out or depressed and finding the pressure too much, please reach out to friends and family or give the Samaritans a call to talk things through.

Note – This post, and its follow on about maintaining PhD motivation were inspired by a reader who asked for recommendations on dealing with PhD fatigue. I love hearing from all of you, so if you have any ideas for topics which you, or others, could find useful please do let me know either in the comments section below or by getting in contact . Or just pop me a message to say hi. 🙂

This post is part of my PhD mindset series, you can check out the full series below:

• PhD Burnout: Managing Energy, Stress, Anxiety & Your Mental Health (this part!)
• PhD Motivation: How to Stay Driven From Cover Letter to Completion
• How to Stop Procrastinating and Start Studying

What is PhD Burnout?

Whenever I’ve gone anywhere near social media relating to PhDs I see overwhelmed PhD students who are some combination of overwhelmed, de-energised or depressed.

Specifically I often see Americans talking about the importance of talking through their PhD difficulties with a therapist, which I find a little alarming. It’s great to seek help but even better to avoid the need in the first place.

Sadly, none of this is unusual. As this survey shows, depression is common for PhD students and of note: at higher levels than for working professionals.

All of these feelings can be connected to academic burnout.

The World Health Organisation classifies burnout as a syndrome with symptoms of:

– Feelings of energy depletion or exhaustion; – Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; – Reduced professional efficacy. Symptoms of burnout as classified by the WHO. Source .

This often leads to students falling completely out of love with the topic they decided to spend years of their life researching!

The pandemic has added extra pressures and constraints which can make it even more difficult to have a well balanced and positive PhD experience. Therefore it is more important than ever to take care of yourself, so that not only can you continue to make progress in your project but also ensure you stay healthy.

What are the Stages of Burnout?

Psychologists Herbert Freudenberger and Gail North developed a 12 stage model of burnout. The following graphic by The Present Psychologist does a great job at conveying each of these.

I don’t know about you, but I can personally identify with several of the stages and it’s scary to see how they can potentially lead down a path to complete mental and physical burnout. I also think it’s interesting that neglecting needs (stage 3) happens so early on. If you check in with yourself regularly you can hopefully halt your burnout journey at that point.

PhDs can be tough but burnout isn’t an inevitability. Here are a few suggestions for how you can look after your mental health and avoid academic burnout.

Overcoming PhD Burnout

Manage your energy levels, maintaining energy levels day to day.

• Eat well and eat regularly. Try to avoid nutritionless high sugar foods which can play havoc with your energy levels. Instead aim for low GI food . Maybe I’m just getting old but I really do recommend eating some fruit and veg. My favourite book of 2021, How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reduce Disease , is well worth a read. Not a fan of veggies? Either disguise them or at least eat some fruit such as apples and bananas. Sliced apple with some peanut butter is a delicious and nutritious low GI snack. Check out my series of posts on cooking nutritious meals on a budget.
• Get enough sleep. It doesn’t take PhD-level research to realise that you need to rest properly if you want to avoid becoming exhausted! How much sleep someone needs to feel well-rested varies person to person, so I won’t prescribe that you get a specific amount, but 6-9 hours is the range typically recommended. Personally, I take getting enough sleep very seriously and try to get a minimum of 8 hours.

A side note on caffeine consumption: Do PhD students need caffeine to survive?

In a word, no!

Although a culture of caffeine consumption goes hand in hand with intense work, PhD students certainly don’t need caffeine to survive. How do I know? I didn’t have any at all during my own PhD. In fact, I wrote a whole post about it .

By all means consume as much caffeine as you want, just know that it doesn’t have to be a prerequisite for successfully completing a PhD.

Maintaining energy throughout your whole PhD

• Pace yourself. As I mention later in the post I strongly recommend treating your PhD like a normal full-time job. This means only working 40 hours per week, Monday to Friday. Doing so could help realign your stress, anxiety and depression levels with comparatively less-depressed professional workers . There will of course be times when this isn’t possible and you’ll need to work longer hours to make a certain deadline. But working long hours should not be the norm. It’s good to try and balance the workload as best you can across the whole of your PhD. For instance, I often encourage people to start writing papers earlier than they think as these can later become chapters in your thesis. It’s things like this that can help you avoid excess stress in your final year.
• Take time off to recharge. All work and no play makes for an exhausted PhD student! Make the most of opportunities to get involved with extracurricular activities (often at a discount!). I wrote a whole post about making the most of opportunities during your PhD . PhD students should have time for a social life, again I’ve written about that . Also give yourself permission to take time-off day to day for self care, whether that’s to go for a walk in nature, meet friends or binge-watch a show on Netflix. Even within a single working day I often find I’m far more efficient when I break up my work into chunks and allow myself to take time off in-between. This is also a good way to avoid procrastination!

Reduce Stress and Anxiety

During your PhD there will inevitably be times of stress. Your experiments may not be going as planned, deadlines may be coming up fast or you may find yourself pushed too far outside of your comfort zone. But if you manage your response well you’ll hopefully be able to avoid PhD burnout. I’ll say it again: stress does not need to lead to burnout!

Everyone is unique in terms of what works for them so I’d recommend writing down a list of what you find helpful when you feel stressed, anxious or sad and then you can refer to it when you next experience that feeling.

I’ve created a mental health reminders print-out to refer to when times get tough. It’s available now in the resources library (subscribe for free to get the password!).

Below are a few general suggestions to avoid PhD burnout which work for me and you may find helpful.

• Exercise. When you’re feeling down it can be tough to motivate yourself to go and exercise but I always feel much better for it afterwards. When we exercise it helps our body to adapt at dealing with stress, so getting into a good habit can work wonders for both your mental and physical health. Why not see if your uni has any unusual sports or activities you could try? I tried scuba diving and surfing while at Imperial! But remember, exercise doesn’t need to be difficult. It could just involve going for a walk around the block at lunch or taking the stairs rather than the lift.
• Cook / Bake. I appreciate that for many people cooking can be anything but relaxing, so if you don’t enjoy the pressure of cooking an actual meal perhaps give baking a go. Personally I really enjoy putting a podcast on and making food. Pinterest and Youtube can be great visual places to find new recipes.
• Let your mind relax. Switching off is a skill and I’ve found meditation a great way to help clear my mind. It’s amazing how noticeably different I can feel afterwards, having not previously been aware of how many thoughts were buzzing around! Yoga can also be another good way to relax and be present in the moment. My partner and I have been working our way through 30 Days of Yoga with Adriene on Youtube and I’d recommend it as a good way to ease yourself in. As well as being great for your mind, yoga also ticks the box for exercise!
• Read a book. I’ve previously written about the benefits of reading fiction * and I still believe it’s one of the best ways to relax. Reading allows you to immerse yourself in a different world and it’s a great way to entertain yourself during a commute.

* Wondering how I got something published in Science ? Read my guide here .

Talk It Through

• Meet with your supervisor. Don’t suffer in silence, if you’re finding yourself struggling or burned out raise this with your supervisor and they should be able to work with you to find ways to reduce the pressure. This may involve you taking some time off, delegating some of your workload, suggesting an alternative course of action or signposting you to services your university offers.

Also remember that facing PhD-related challenges can be common. I wrote a whole post about mine in case you want to cheer yourself up! We can’t control everything we encounter, but we can control our response.

A free self-care checklist is also now available in the resources library , providing ideas to stay healthy and avoid PhD burnout.

Top Tips for Avoiding PhD Burnout

On top of everything we’ve covered in the sections above, here are a few overarching tips which I think could help you to avoid PhD burnout:

• Work sensible hours . You shouldn’t feel under pressure from your supervisor or anyone else to be pulling crazy hours on a regular basis. Even if you adore your project it isn’t healthy to be forfeiting other aspects of your life such as food, sleep and friends. As a starting point I suggest treating your PhD as a 9-5 job. About a year into my PhD I shared how many hours I was working .
• Reduce your use of social media. If you feel like social media could be having a negative impact on your mental health, why not try having a break from it?
• Do things outside of your PhD . Bonus points if this includes spending time outdoors, getting exercise or spending time with friends. Basically, make sure the PhD isn’t the only thing occupying both your mental and physical ife.
• Regularly check in on how you’re feeling. If you wait until you’re truly burnt out before seeking help, it is likely to take you a long time to recover and you may even feel that dropping out is your only option. While that can be a completely valid choice I would strongly suggest to check in with yourself on a regular basis and speak to someone early on (be that your supervisor, or a friend or family member) if you find yourself struggling.

I really hope that this post has been useful for you. Nothing is more important than your mental health and PhD burnout can really disrupt that. If you’ve got any comments or suggestions which you think other PhD scholars could find useful please feel free to share them in the comments section below.

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5 Ways to Combat PhD Stress

• By Nicholas R.
• January 8, 2024

When you’re starting your research career as an academic researcher, there will be many things that overwhelm you when you start out. As someone who has been through this myself, I have put together 5 ways of dealing with overwhelming feelings during your PhD journey.

These strategies may not work every time, but they’ve helped me get through my own struggles so far and hopefully can help you too!

1. Know What’s Going On

Before you dive into trying to solve any problem or figure anything out, take care of yourself mentally by knowing what exactly overwhelms you at the moment. One way to do this is to journal about what stresses you right now. When you feel more able to cope, try exploring solutions for those issues.

For example, if you find yourself struggling with managing workload, then it might be helpful to know that this type of stress often occurs at the very beginning and very end of a PhD, at least for myself and others I’ve spoken to.

Knowing the sources of your stress is the first step to addressing it.

2. Take Care of Yourself

Once you understand why you’re feeling overwhelmed, the next thing to consider is taking care of yourself physically. Stress from work, school, relationships etc., all contribute to poor health decisions such as skipping meals, engaging in unhealthy eating habits, drinking or smoking excessively, reducing sleep and exercise etc. All of which impact negatively on our physical and mental well-being.

In addition, one study showed that people under extreme levels of pressure (such as doctoral candidates) were more prone to developing heart problems compared to other groups. So while taking care of yourself should always be a priority, it’s especially important to prioritise it even further when we’re stressed.

It can seem difficult to balance personal needs and researcher responsibilities, but doing so requires prioritising self-care over everything else. In order to achieve this, set aside dedicated blocks of time each day where you avoid distractions, focus solely on activities related to your wellbeing, and allow yourself to fully engage in whatever activity brings peace to your mind and body.

3. Talk About It With Friends and Family

One thing that you learn early in a PhD is that there’s no such thing as a free lunch. While the rewards of doing your PhD are many, there is a significant cost, and it comes in the form of stress.

You’ve probably heard the expression “ PhD students are walking time bombs ” – which is basically just a polite way of saying that PhD students are walking around with a serious short-fuse, and it’s only a matter of time before that fuse goes off.

Seek support from others before that happens…

Talking to close friends and family members helps us to process emotions better. Research shows that talking to others provides relief by releasing negative thoughts and worries, so we don’t need to carry them around inside ourselves throughout the rest of the day. Having supportive individuals in our lives makes it easier to handle both small tasks and large ones.

If you live alone, however, having someone available to discuss your concerns with can provide valuable insight into whether or not you’re handling stressful events properly. A friend or family member can offer perspective and guidance without judging you for your current situation.

4. Make Time For Fun Activities

We’ve all heard that it takes 10 years to make a really brilliant scientist. You might have trouble proving this, but it is a very long time, and many people struggle with sticking to a research plan that is longer than 3 months.

We also know that there are many distractions available in the ‘real world’, that are not available to researchers. A few months ago, for example, I went to a pub quiz night. While this may sound like a total waste of time, in fact it has become a huge amount of fun for me, and has helped me to get my research into the right place.

I also find that regular, non-research-related social events help keep things fresh and remind me that there are more important things than my research at the moment.

5. Accept That This Is Just Part Of The Process

The hardest part about completing a PhD program is simply surviving it. Many of the lessons learned along the way will come from overcoming obstacles and failures. Learning from setbacks and mistakes prepares us for future success. But sometimes, no matter how hard we try, we just won’t be successful at accomplishing certain milestones or reaching our desired outcome.

That doesn’t mean giving up though. Instead, accept that failure can happen and move onto bigger opportunities. Sometimes we learn more from our successes and achievements rather than focusing on our failures and shortcomings. Also, remember that setbacks aren’t permanent. Often, after a short period of mourning, we bounce back stronger than ever.

We shouldn’t beat ourselves up over failing. Rather, let it inspire us to become wiser and smarter for next time. After all, it takes countless attempts to master the skills required to succeed.

Regardless of how you’re feeling, remember that you are not alone. You are not alone on your PhD journey. You are not alone in your feelings. And you are not alone in your desire to succeed.

Stay up to date with current information being provided by the UK Government and Universities about the impact of the global pandemic on PhD research studies.

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Join thousands of other students and stay up to date with the latest PhD programmes, funding opportunities and advice.

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Scientific misconduct can be described as a deviation from the accepted standards of scientific research, study and publication ethics.

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Kat is in the second year of her PhD at the International Centre for Radio Astronomy Research (ICRAR) in Perth, Western Australia (WA). Her research involves studying supermassive black holes at the centres of distant galaxies.

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Experienced PhD stress in the world of academia

The academic world has changed a lot over the passed decade which has resulted in the deteriorating status of the researchers [2], a lot of work-related stress ( PhD stress ), and mental health issues for people working in academia [1],[3]. According to study [3], 47% of the PhD students in Berkeley reached the threshold for being depressed, and according to study [1], 40.81% of the PhD students in Flanders, Belgium felt under constant strain. Compared to highly educated professionals or students, people with a PhD or PhD students report much more mental health issues [1],[2]. Feelings of being powerless, helpless, stressed, depressed, unhappiness, and being unable to enjoy every day activities are common among people working in the academic field. On top of that, low self-esteem and perfectionism are common among academics [19]. Job insecurity, temporary contracts, too many PhD students and too little faculty positions, and changes in the funding policies are some of the contributing factors to more PhD stress [1],[2]. The biggest problem for most people working in the academic world is that they can’t do anything about these contributing factors: you join the rat race or you’re out!

Fortunately, PhD stress and the chance of developing mental health issues can be reduced to a minimum with the tips on this page. This article focuses on PhD stress , its causes and ways to reduce the experienced stress levels.    

PhD stress – Why do PhD students experience so much stress these days?

There are several contributing factors that add to the stress PhD students experience:

• Future perspective : poor promotion/job prospects; temporary contracts [1],[2].
• Personal life : work-family conflict & family-work conflict [1],[4],[5].
• Work context : supervisor’s leadership style; job demands; job control [1],[6],[7],[9],[10],[11].
• Personality and mental health [8].

Future perspective

PhD stress – Ratio between PhD students and faculty positions

Due to the economical crisis worldwide, many universities and research institutes are experiencing financial problems, because governments have been cutting in the funds for education for years now. Less funding leads to fewer (permanent) job positions or promotions, less money for research, and an increase in job insecurity and short-term contracts [1],[2]. Most research institutes and universities are forced to apply stricter criteria in the allocation of research funds. In some countries, research funds can only be obtained by universities and research institutes if research proposals are accepted by international funding commissions [2]. The cuts in funding can also be seen in the reducing amount of available job positions or promotions; people with a permanent job prefer the security the job gives them over the new challenges they face with a new (temporary) job. On top of that, the amount of PhD students has increased significantly over the past decade, whereas the amount of faculty positions has only slightly increased (see image) over the past decade [1]. More PhD students for few positions leads to more competition and PhD stress . The increasing amount of PhD students in combination with the poor job/promotion prospects has created a huge pool of unemployed people with a PhD. In short : less money for research and education has lead to more short term contracts , poor promotion/job prospects, more unemployment, more competition, and too many highly educated people (PhD students or higher) compared to the amount of positions available. Consequently, this leads to a lot of PhD stress .    

Personal life

Family to work: work to family by gender

A lot of PhD students or people with a PhD work in the evenings and weekends due to the high workload, which negatively affects their social life (missing out on family time, parties, and date nights with partner). This is a clear example of work-to-family interference. Both work-to-family and family-to-work conflicts are associated with psychological distress [1], job dissatisfaction, and burnout among employees in a range of occupations [5]. A possible reason could be the negative sanctions (at both personal and institutional levels) academic scientists face when family interferes with work [4]. Unsurprisingly, if the departmental climate becomes more competitive and stressful, the probability of work-to-family conflict increases significantly [4]. These circumstances will add to the PhD stress most academics experience, especially if nothing changes.    

Work context

8 bad leadership traits

Stress has a negative impact on leadership styles. When a supervisor experiences a lot of PhD stress , their leadership qualities deteriorate, which leads to higher levels of stress and burnout in their subordinates [6]. Also, destructive leadership is associated with counterproductive work behaviour and a negative attitude towards the organization in subordinates [7].

In other words: reducing PhD stress by applying changes on an organisational level can be effective if organisations focus on leadership styles and job demands and job control.  

Job demands and job control

There is a strong relationship between high job demands and emotional exhaustion and depressive feelings. Job demands are those physical, social or organizational aspects of the job that require sustained physical or mental effort [10]. High job demand and low job control is associated with increased PhD stress . Job control refers to control one experiences regarding the timing of breaks, usage of skills, and working pace [1]. High job demands, low job control, and certain leadership styles in combination with fewer (PhD/permanent) positions in academia creates a PhD stress cocktail so lethal that it’s almost impossible to sustain a health work-to-family life where weekends and evenings can be spend with family.    

Personality and mental health

Some people are more sensitive to stress than others. Certain personality traits such as neuroticism, disagreeableness, and tendency to perceive hostility can all lead individuals to be more reactive to stress as well as to perceive the behaviors of others in a hostile manner [8]. Also, suffering from PTSD, anxiety disorders or mood disorders can increase stress levels, because these mental disorders negatively affect daily life and work performance.    

What can you do to reduce PhD stress?

There are several things someone can do to reduce PhD stress and to stay as productive as before. For some people, small changes and adjustments are sufficient, whereas for others, it means they need to develop a whole new way of living and working. In some cases, the stressor will disappear, in other cases, however, coping skills will be offered to deal with them, because it’s difficult to control them (think of leadership style). Let’s have a closer look:  

Adopt a healthy day and night rhythm

An unhealthy day/night rhythm can cause all kinds of changes in peoples’ behaviour and mood. In general, sleep disturbance impairs quality of life. Compared to good sleepers, people with chronic sleep problems experience more psychological distress and impairments in daytime functioning [13]. People who experience sleep disturbances (or nightmares or insomnia), for instance, have significantly more suicidal thoughts and behaviours [12]. And right before people experience a manic or depressive episode, they report sleeping problems [13]. Therefore, it’s important to keep a healthy day/night rhythm: use the bed(room) only for sleeping; sleep a minimum of 6,5 and a maximum of eight hours a night [13]; switch off electronic devices one hour before you go to bed; develop a bedtime routine (brushing teeth, taking a shower, read for 10 minutes, turn off light); immediately leave the bed when you wake up (no snoozing).  

Adopt a healthy lifestyle

A healthy lifestyle both prevents and reduces the amount of stress one experiences [14]. People who’ve adopted a healthy lifestyle, pay attention to their nutrition, are more in touch with nature, exercise and relax regularly, and possess stress management skills and/or meditate [14]. Exercise and meditation do not only reduce the amount of stress one experiences, they also help reduce symptoms of anxiety and depression [14]. At the same time, both meditation and exercise force you to take a mental break from work/study related activities, and give you time to recharge mentally again. Paying attention to good nutrition indirectly affects the stress levels one experiences, because it prevents people from eating too many calories, and to eat healthy and varied. Obese people are at higher risk of developing depression; the odds increase for severely obese people [15]. Herbal and nutritional supplements such as kava, passionflower, Lysine, and Magnesium help reduce symptoms of anxiety [16], and thus add to the reduction of PhD stress . NOTE: Next to taking in anxiolytic ingredients, users of passionflower and kava may also consume ineffective of possibly toxic substances [16]. Therefore, it’s important to discuss the intake of herbal medication with your General Practitioner. Avoid (too much) coffee and alcohol. Although coffee has a stimulating effect on people, on the long run people can get dependent on caffeine with means that they need more caffeine to experience the same stimulating effect as before. Unfortunately, regular caffeine and alcohol intake leads to feelings of fatigue and tiredness.  

Visit a specialist

Visiting a therapist or counselor when someone feels emotionally or physically exhausted, also known as burnout, or depressed, suffers from symptoms of anxiety or has self-esteem issues is highly recommended. Sometimes, people cannot get better on their own and need a professional to treat or guide them through this process. It is possible that work or study is so demanding that it exhausts you mentally or physically, which increases the chance of developing a mental disorder or symptoms of mental disorders. Sometimes, (old/childhood) traumatic experiences resurface or get triggered, which can lead to sleeping problems, irritability, flashbacks, numbness, and eventually reduce the productivity levels needed to perform at work or for study. For others, low self-esteem may cause a lot of PhD stress , because they constantly question their own academic (writing) skills and are afraid to make mistakes. This may result in perfectionism and perfectionism leads to more worry and rumination about work [19]. Worry and rumination add to stress levels.  

Use a family calendar

People working in academia may experience a lot of work-to-family and family-to-work stress [1] due to job demands and family obligations. A lot of the problems within families are caused by self-centeredness: the intense desire to achieve desired goals and little tendency to satisfy the others’ needs [18]. Although there is no relationship between communication skill level and marriage satisfaction [17], there is a relationship between marriage satisfaction and conflict resolution: a domineering, authoritarian or autocratic control of the conflict leads to less marital satisfaction and longer lasting conflicts [18]. Due to this approach, partners are less likely to adjust to their partner’s needs and competition and feelings of jealousy between them grows [17]. Knowing in advance what someone’s schedule is, prevents surprises, conflicts, and increases the likelihood that the partner will adjust their schedule a little. A family calendar is very helpful for those who have a busy schedule and have children. People can plan events and deadlines way in advance and it reduces the experienced PhD stress significantly.  

Schedule breaks

It is common for people in academia to work on articles for hours at once, because they need to get into a flow (increases their productivity). Unfortunately, writing/working for hours without a proper break is exhausting on the long run, and makes people less emotionally available (which leads to more conflicts at home). Consequently, people become less productive which will lead to longer writing shifts. Therefore, it is important to have regular breaks of 10 minutes, and to have one big break of one hour around lunch time. Exercise, relax or socialize with friends in the evening. This will help you recharge your battery for the next day.  

Have a support network

Having a support network moderates the effects stress has on psychological distress and significantly improves quality of life [20]. Also, a support network is a strong predictor of a person’s physical health and wellbeing, and helps people cope with phd stress. Intimate social relationships, rather than family relationships, is the strongest predictor of overall life satisfaction [20].  

Have a back-up plan

Temporary contracts, less funding for research, too many people with at least a PhD (compared to the amount of positions available), and a strong competitive field, significantly reduce the chance that one will finds a PhD position or job in their desired field. Add the fact that switching careers is considered a failure (because you were not good enough), and it becomes clear that this may be the most difficult piece of advice to follow-up on. Unfortunately, it’s a fact that most people who do their PhD will not end up working in academia, or will have to live from temporary contract to temporary contract. Especially the latter adds to the experienced PhD stress . Make sure you have a back-up plan. Discuss with family or friends how long you will try to get (a) a PhD position or a permanent position in your desired field, before switching to plan B. Discuss what plan B will be and make sure that you like plan B, and that finding a job is easier with plan B.  

Schedule regular meeting with your supervisor/boss

Communicate with your supervisor/boss to know what he/she expects of you and to keep them updated about your progress. Depending on your boss’s leadership style and personality, it is likely that you boss will not ask too much of you when he/she knows how much you have to do still.    

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• Open access
• Published: 26 August 2020

Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis

• Cassie M. Hazell   ORCID: orcid.org/0000-0001-5868-9902 1 ,
• Laura Chapman 2 ,
• Sophie F. Valeix 3 ,
• Paul Roberts 4 ,
• Jeremy E. Niven 5 &
• Clio Berry 6  

Systematic Reviews volume  9 , Article number:  197 ( 2020 ) Cite this article

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Data from studies with undergraduate and postgraduate taught students suggest that they are at an increased risk of having mental health problems, compared to the general population. By contrast, the literature on doctoral researchers (DRs) is far more disparate and unclear. There is a need to bring together current findings and identify what questions still need to be answered.

We conducted a mixed methods systematic review to summarise the research on doctoral researchers’ (DRs) mental health. Our search revealed 52 articles that were included in this review.

The results of our meta-analysis found that DRs reported significantly higher stress levels compared with population norm data. Using meta-analyses and meta-synthesis techniques, we found the risk factors with the strongest evidence base were isolation and identifying as female. Social support, viewing the PhD as a process, a positive student-supervisor relationship and engaging in self-care were the most well-established protective factors.

Conclusions

We have identified a critical need for researchers to better coordinate data collection to aid future reviews and allow for clinically meaningful conclusions to be drawn.

Systematic review registration

PROSPERO registration CRD42018092867

Peer Review reports

Student mental health has become a regular feature across media outlets in the United Kingdom (UK), with frequent warnings in the media that the sector is facing a ‘mental health crisis’ [ 1 ]. These claims are largely based on the work of regulatory authorities and ‘grey’ literature. Such sources corroborate an increase in the prevalence of mental health difficulties amongst students. In 2013, 1 in 5 students reported having a mental health problem [ 2 ]. Only 3 years later, however, this figure increased to 1 in 4 [ 3 ]. In real terms, this equates to 21,435 students disclosing mental health problems in 2013 rising to 49,265 in 2017 [ 4 ]. Data from the Higher Education Statistics Agency (HESA) demonstrates a 210% increase in the number of students terminating their studies reportedly due to poor mental health [ 5 ], while the number of students dying by suicide has consistently increased in the past decade [ 6 ].

This issue is not isolated to the UK. In the United States (US), the prevalence of student mental health problems and use of counselling services has steadily risen over the past 6 years [ 7 ]. A large international survey of more than 14,000 students across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the United States) found that 35% of students met the diagnostic criteria for at least one common mental health condition, with highest rates found in Australia and Germany [ 8 ].

The above figures all pertain to undergraduate students. Finding equivalent information for postgraduate students is more difficult, and where available tends to combine data for postgraduate taught students and doctoral researchers (DRs; also known as PhD students or postgraduate researchers) (e.g. [ 4 ]). The latest trend analysis based on data from 36 countries suggests that approximately 2.3% of people will enrol in a PhD programme during their lifetime [ 9 ]. The countries with the highest number of DRs are the US, Germany and the UK [ 10 ]. At present, there are more than 281,360 DRs currently registered across these three countries alone [ 11 , 12 ], making them a significant part of the university population. The aim of this systematic review is to bring attention specifically to the mental health of DRs by summarising the available evidence on this issue.

Using a mixed methods approach, including meta-analysis and meta-synthesis, this review seeks to answer three research questions: (1) What is the prevalence of mental health difficulties amongst DRs? (2) What are the risk factors associated with poor mental health in DRs? And (3) what are the protective factors associated with good mental health in DRs?

Literature search

We conducted a search of the titles and abstracts of all article types within the following databases: AMED, BNI, CINAHL, Embase, HBE, HMIC, Medline, PsycInfo, PubMed, Scopus and Web of Science. The same search terms were used within all of the databases, and the search was completed on the 13th April 2018. Our search terms were selected to capture the variable terms used to describe DRs, as well as the terms used to describe mental health, mental health problems and related constructs. We also reviewed the reference lists of all the papers included in this review. Full details of the search strategy are provided in the supplementary material .

Inclusion criteria

Articles meeting the following criteria were considered eligible for inclusion: (1) the full text was available in English; (2) the article presented empirical data; (3) all study participants, or a clearly delineated sub-set, were studying at the doctoral level for a research degree (DRs or equivalent); and (4) the data collected related to mental health constructs. The last of these criteria was operationalised (a) for quantitative studies as having at least one mental health-related outcome measure, and (b) for qualitative studies as having a discussion guide that included questions related to mental health. We included university-published theses and dissertations as these are subjected to a minimum level of peer-review by examiners.

Exclusion criteria

In order to reduce heterogeneity and focus the review on doctoral research as opposed to practice-based training, we excluded articles where participants were studying at the doctoral level, but their training did not focus on research (e.g. PsyD doctorate in Clinical Psychology).

Screening articles

Papers were screened by one of the present authors at the level of title, then abstract, and finally at full text (Fig. 1 ). Duplicates were removed after screening at abstract. At each level of screening, a random 20% sub-set of articles were double screened by another author, and levels of agreement were calculated (Cohen’s kappa [ 13 ]). Where disagreements occurred between authors, a third author was consulted to decide whether the paper should or should not be included. All kappa values evidence at least moderate agreement between authors [ 14 ]—see Fig. 1 for exact kappa values.

PRISMA diagram of literature review process

Data extraction

This review reports on both quantitative and qualitative findings, and separate extraction methods were used for each. Data extraction was performed by authors CH, CB, SV and LC.

Quantitative data extraction

The articles in this review used varying methods and measures. To accommodate this heterogeneity, multiple approaches were used to extract quantitative data. Where available, we extracted (a) descriptive statistics, (b) correlations and (c) a list of key findings. For all mental health outcome measures, we extracted the means and standard deviations for the DR participants, and where available for the control group (descriptive statistics). For studies utilising a within-subjects study design, we extracted data where a mental health outcome measure was correlated with another construct (correlations). Finally, to ensure that we did not lose important findings that did not use descriptive statistics or correlations, we extracted the key findings from the results sections of each paper (list of key findings). Key findings were identified as any type of statistical analysis that included at least one mental health outcome.

Qualitative data extraction

In line with the meta-ethnographic method [ 15 ] and our interest in the empirical data as well as the authors’ interpretations thereof, i.e. the findings of each article [ 16 ], the data extracted from the articles comprised both results/findings and discussion/conclusion sections. For articles reporting qualitative findings, we extracted the results and discussion sections from articles verbatim. Where articles used mixed methods, only the qualitative section of the results was extracted. Methodological and setting details from each article were also extracted and provided (see Appendix A) in order to contextualise the studies.

Data analysis

Quantitative data analysis, descriptive statistics.

We present frequencies and percentages of the constructs measured, the tools used and whether basic descriptive statistics ( M and SD ) were reported. The full data file is available from the first author upon request.

Effect sizes

Where studies had a control group, we calculated a between-group effect size (Cohen’s d ) using the formula reported by Wilson [ 17 ], and interpreted using the standard criteria [ 13 ]. For all other studies, we sought to compare results with normative data where the following criteria were satisfied: (a) at least three studies reported data using the same mental health assessment tool; (b) empirical normative data were available; and (c) the scale mean/total had been calculated following original authors’ instructions. Only the Perceived Stress Scale (PSS) 10- [ 18 ] and 14-item versions [ 19 ] met these criteria. Normative data were available from a sample of adults living in the United States: collected in 2009 for the 10-item version ( n = 2000; M = 15.21; SD = 7.28) [ 20 ] and in 1983 for the 14-item version ( n = 2355; M = 19.62; SD = 7.49) [ 18 ].

The meta-analysis of PSS data was conducted using MedCalc [ 21 ], and based on a random effects model, as recommended by [ 22 ]. The between-group effect sizes (DRs versus US norms) were calculated comparing PSS means and standard deviations in the respective groups. The effect sizes were weighted using the variable variances [ 23 ].

Correlations

Where at least three studies reported data reflecting a bivariate association between a mental health and another variable, we summarised this data into a meta-analysis using the reported r coefficients and sample sizes. Again, we used MedCalc [ 21 ] to conduct the analysis using a random effects model, based on the procedure outlined by Borenstein, Hedges, Higgins and Rothstein [ 24 ]. This analysis approach involves converting correlation coefficients into Fisher’s z values [ 25 ], calculating the summary of Fisher’s z , and then converting this to a summary correlation coefficient ( r ). The effect sizes were weighted in line with the Hedges and Ollkin [ 23 ] method. Heterogeneity was assessed using the Q statistic, and I 2 value—both were interpreted according to the GRADE criteria [ 26 ]. Where correlations could not be summarised within a meta-analysis, we have reported these descriptively.

Due to the heterogenous nature of the studies, the above methods could not capture all of the quantitative data. Therefore, additional data (e.g. frequencies, statistical tests) reported in the identified articles was collated into a single document, coded as relating to prevalence, risk or protective factors and reported as a narrative review.

Qualitative data analysis

We used thematic analytic methods to analyse the qualitative data. We followed the thematic synthesis method [ 16 , 27 ] and were informed by a thematic analysis approach [ 28 , 29 ]. We took a critical realist epistemological stance [ 30 , 31 ] and aimed to bring together an analysis reflecting meaningful patterns amongst the data [ 29 ] or demi-regularities, and identifying potential social mechanisms that might influence the experience of such phenomena [ 31 ]. The focus of the meta-synthesis is interpretative rather than aggregative [ 32 ].

Coding was line by line, open and complete. Following line-by-line coding of all articles, a thematic map was created. Codes were entered on an article-by-article basis and then grouped and re-grouped into meaningful patterns. Comparisons were made across studies to attempt to identify demi-regularities or patterns and contradictions or points of departure. The thematic map was reviewed in consultation with other authors to inductively create and refine themes. Thematic summaries were created and brought together into a first draft of the thematic structure. At this point, each theme was compared against the line-by-line codes and the original articles in order to check its fit and to populate the written account with illustrative quotations.

Research rigour

The qualitative analysis was informed by independent coding by authors CB and SV, and analytic discussions with CH, SV and LC. Our objective was not to capture or achieve inter-rater reliability, rather the analysis was strengthened through involvement of authors from diverse backgrounds including past and recent PhD completion, experiences of mental health problems during PhD completion, PhD supervision experience, experience as employees in a UK university doctoral school and different nationalities. In order to enhance reflexivity, CB used a journal throughout the analytic process to help notice and bracket personal reflections on the data and the ways in which these personal reflections might impact on the interpretation [ 29 , 33 ]. The ENTREQ checklist [ 34 ] was consulted in the preparation of this report to improve the quality of reporting.

Quality assessment

Quantitative data.

The quality of the quantitative papers was assessed using the STROBE combined checklist [ 35 ]. A random 20% sub-sample of these studies were double-coded and inter-rater agreement was 0.70, indicating ‘substantial’ agreement [ 14 ]. The maximum possible quality score was 23, with a higher score indicating greater quality, with the mean average of 15.97, and a range from 0 to 22. The most frequently low-scoring criteria were incomplete reporting regarding the management of missing data, and lack of reported efforts to address potential causes of bias.

Qualitative data

There appeared to be no discernible pattern in the perceived quality of studies; the highest [ 36 , 37 , 38 , 39 , 40 ] and lowest scoring [ 41 , 42 , 43 , 44 , 45 , 46 ] studies reflected both theses and journal publications, a variety of locations and settings and different methodologies. The most frequent low-scoring criteria were relating to the authors’ positions and reflections thereof (i.e. ‘Qualitative approach and research paradigm’, ‘Researcher characteristics and reflexivity’, ‘Techniques to enhance trustworthiness’, ‘Limitations’, ‘Conflict of interest and Funding’). Discussions of ethical issues and approval processes was also frequently absent. We identified that we foregrounded higher quality studies in our synthesis in that these studies appeared to have greater contributions reflected in the shape and content of the themes developed and were more likely to be the sources of the selected illustrative quotes.

Mixed methods approach

The goal of this review is to answer the review questions by synthesising the findings from both quantitative and/or qualitative studies. To achieve our goal, we adopted an integrated approach [ 47 ], whereby we used both quantitative and qualitative methods to answer the same review question, and draw a synthesised conclusion. Different analysis approaches were used for the quantitative and qualitative data and are therefore initially reported separately within the methods. A separate synthesised summary of the findings is then provided.

Overview of literature

Of the 52 papers included in this review (Table 1 ), 7 were qualitative, 29 were quantitative and 16 mixed methods. Most articles (35) were peer-reviewed papers, and the minority were theses (17). Only four of the articles included a control group; in three instances comprising students (but not DRs) and in the other drawn from the general population.

Quantitative results

Thirty-five papers reported quantitative data, providing 52 reported sets of mental health related data (an average of 1.49 measures per study): 24 (68.57%) measured stress, 10 (28.57%) anxiety, 9 (25.71%) general wellbeing, 5 (14.29%) social support, 3 (8.57%) depression and 1 (2.86%) self-esteem. Five studies (9.62%) used an unvalidated scale created for the purposes of the study. Fifteen studies (28.85%) did not report descriptive statistics.

Of the four studies that included a control group, only two of these reported descriptive statistics for both groups on a mental health outcome [ 66 , 69 ]. There is a small (Cohen’s d = 0.27) and large between-group effect (Cohen’s d = 1.15) when DRs were compared to undergraduate and postgraduate clinical psychology students respectively in terms of self-reported stress.

The meta-analysis of DR scores on the PSS (both 10- and 14-item versions) compared to population normative data produced a large and significant between-group effect size ( d = 1.12, 95% CI [0.52, 1.73]) in favour of DRs scoring higher on the PSS than the general population (Fig. 2 ), suggesting DRs experience significantly elevated stress. However, these findings should be interpreted in light of the significant between-study heterogeneity that can be classified as ‘considerable’ [ 26 ].

A meta-analysis of between-group effect sizes (Cohen’s d ) comparing PSS scores (both 10- and 14-item versions) from DRs and normative population data. *Studies using the 14 item version of the PSS; a positive effect size indicates DRs had a higher score on the PSS; a negative effect size indicates that the normative data produced a higher score on the PSS; black diamond = total effect size (based on random effects model); d = Cohen’s d ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

To explore this heterogeneity, we re-ran the meta-analysis separately for the 10- and 14-item versions. The effect size remained large and significant when looking only at the studies using the 14-item version ( k = 6; d = 1.41, 95% CI [0.63, 2.19]), but was reduced and no longer significant when looking at the 10-item version only ( k = 3; d = 0.57, 95% CI [− 0.51, 1.64]). However, both effect sizes were still marred by significant heterogeneity between studies (10-item: Q = 232.02, p < .001; 14-item: Q = 356.76, p < .001).

Studies reported sufficient correlations for two separate meta-analyses; the first assessing the relationship between stress (PSS [ 18 , 19 ]) and perceived support, and the second between stress (PSS) and academic performance.

Stress x support

We included all measures related to support irrespective of whom that support came from (e.g. partner support, peer support, mentor support). The overall effect size suggests a small and significant negative correlation between stress and support ( r = − .24, 95% CI [− 0.34, − 0.13]) (see Fig. 3 ), meaning that low support is associated with greater perceived stress. However, the results should be interpreted in light of the significant heterogeneity between studies. The I 2 value quantifies this heterogeneity as almost 90% of the variance being explained by between-study heterogeneity, which is classified as ‘substantial’ (26).

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and perceived support. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Stress x performance

The overall effect size suggests that there is no relationship between stress and performance in their studies ( r = − .07, 95% CI [− 0.19, 0.05]) (see Fig. 4 ), meaning that DRs perception of their progress was not associated with their perceived stress This finding suggests that the amount of progress that DRs were making during their studies was not associated with stress levels.

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and performance. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Other correlations

Correlations reported in less than three studies are summarised in Fig. 5 . Again, stress was the most commonly tested mental health variable. Self-care and positive feelings towards the thesis were consistently found to negatively correlate with mental health constructs. Negative writing habits (e.g. perfectionism, blocks and procrastination) were consistently found to positively correlate with mental health constructs. The strongest correlations were found between stress, and health related quality of life ( r = − .62) or neuroticism ( r = .59), meaning that lower stress was associated with greater quality of life and reduced neuroticism. The weakest relationships ( r < .10) were found between mental health outcomes and: faculty concern, writing as knowledge transformation, innate writing ability (stress and anxiety), years married, locus of control, number of children and openness (stress only).

Correlation coefficients testing the relationship between a mental health outcome and other construct. Correlation coefficients are given in brackets ( r ); * p < .05; each correlation coefficient reflects the results from a single study

Several studies reported DR mental health problem prevalence and this ranged from 36.30% [ 54 ] to 55.9% [ 67 ]. Using clinical cut-offs, 32% were experiencing a common psychiatric disorder [ 64 ]; with another study finding that 53.7% met the questionnaire cut-off criteria for depression, and 41.9% for anxiety [ 67 ]. One study compared prevalence amongst DRs and the general population, employees and other higher education students; in all instances, DRs had higher levels of psychological distress (non-clinical), and met criteria for a clinical psychiatric disorder more frequently [ 64 ].

Risk factors

Demographics Two studies reported no significant difference between males and females in terms of reported stress [ 57 , 73 ], but the majority suggested female DRs report greater clinical [ 80 ], and non-clinical problems with their mental health [ 37 , 64 , 79 , 83 , 89 ].

Several studies explored how mental health difficulties differed in relation to demographic variables other than gender, suggesting that being single or not having children was associated with poorer mental health [ 64 ] as was a lower socioeconomic status [ 71 ]. One study found that mental health difficulties did not differ depending on DRs’ ethnicity [ 51 ], but another found that Black students attending ‘historically Black universities’ were significantly more anxious [ 87 ]. The majority of the studies were conducted in the US, but only one study tested for cross-cultural differences: reporting that DRs in France were more psychologically distressed than those studying in the UK [ 67 ].

Work-life balance Year of study did not appear to be associated with greater subjective stress in a study involving clinical psychology DRs (Platt and Schaefer [ 75 ]), although other studies suggested greater stress reported by those in the latter part of their studies [ 89 ], who viewed their studies as a burden [ 81 ], or had external contracts, i.e. not employed by their university [ 85 ]. Regression analyses revealed that a common predictor of poor mental health was uncertainty in DR studies; whether in relation to uncertain funding [ 64 ] or uncertain progress [ 80 ]. More than two-thirds of DRs reported general academic pressure as a cause of stress, and a lack of time as preventing them from looking after themselves [ 58 ]. Being isolated was also a strong predictor of stress [ 84 ].

Protective factors

DRs who more strongly endorsed all of the five-factor personality traits (openness, conscientiousness, extraversion, agreeableness and neuroticism) [ 66 ], self-reported higher academic achievement [ 40 ] and viewed their studies as a learning process (rather than a means to an end) [ 82 ] reported fewer mental health problems. DRs were able to mitigate poor mental health by engaging in self-care [ 72 ], having a supervisor with an inspirational leadership style [ 64 ] and building coping strategies [ 56 ]. The most frequently reported coping strategy was seeking support from other people [ 37 , 58 ].

Qualitative results

Meta-synthesis.

Four higher-order themes were identified: (1) Always alone in the struggle, (2) Death of personhood, (3) The system is sick and (4) Seeing, being and becoming. The first two themes reflect individual risk/vulnerability factors and the processes implicated in the experience of mental distress, the third represents systemic risk and vulnerability factors and the final theme reflects individual and systemic protective mechanisms and transformative influences. See Table 2 for details of the full thematic structure with illustrative quotes.

Always alone in the struggle

‘Always alone in the struggle’ reflects the isolated nature of the PhD experience. Two subthemes reflect different aspects of being alone; ‘Invisible, isolated and abandoned’ represents DRs’ sense of physical and psychological separation from others and ‘It’s not you, it’s me’ represents DRs’ sense of being solely responsible for their PhD process and experience.

Invisible, isolated and abandoned

Feeling invisible and isolated both within and outside of the academic environment appears a core DR experience [ 39 , 43 , 81 ]. Isolation from academic peers seemed especially salient for DRs with less of a physical presence on campus, e.g. part-time and distance students, those engaging in extensive fieldwork, outside employment and those with no peer research or lab group [ 36 , 52 , 68 ]. Where DRs reported relationships with DR peers, these were characterised as low quality or ‘not proper friendships’ and this appeared linked to a sense of essential and obvious competition amongst DRs with respect to current and future resources, support and opportunities [ 39 ], in which a minority of individuals were seen to receive the majority share [ 36 , 74 ]. Intimate sharing with peers thus appeared to feel unsafe. This reflected the competitive environment but also a sense of peer relationships being predicated on too shared an experience [ 39 ].

In addition to poor peer relations, a mismatch between the expected and observed depth of supervisor interest, engagement and was evident [ 40 , 81 ]. This mismatch was clearly associated with disappointment and anger, and a sense of abandonment, which appeared to impact negatively on DR mental health and wellbeing [ 42 ] (p. 182). Moreover, DRs perceived academic departments as complicit in their isolation; failing to offer adequate opportunities for academic and social belonging and connections [ 42 , 81 ] and including PGRs only in a fleeting or ‘hollow’ sense [ 37 ]. DRs identified this isolation as sending a broader message about academia as a solitary and unsupported pursuit; a message that could lead some DRs to self-select out of planning for future in academia [ 37 , 42 ]. DRs appeared to make sense of their lack of belonging in their department as related to their sense of being different, and that this difference might suggest they did not ‘fit in’ with academia more broadly [ 74 ]. In the short-term, DRs might expend more effort to try and achieve a social and/or professional connection and equitable access to support, opportunities and resources [ 74 ]. However, over the longer-term, the continuing perception of being professionally ‘other’ also seemed to undermine DRs’ sense of meaning and purpose [ 81 ] and could lead to opting out of an academic career [ 62 , 74 ].

Isolation within the PhD was compounded by isolation from one’s personal relationships. This personal isolation was first physical, in which the laborious nature of the PhD acted as a catalyst for the breakdown of pre-existing relationships [ 76 ]. Moreover, DRs also experienced a sense of psychological detachment [ 45 , 74 ]. Thus, the experience of isolation appeared to be extremely pervasive, with DRs feeling excluded and isolated physically and psychologically and across both their professional and personal lives.

It’s not you, it’s me

‘It’s not you, it’s me’ reflects DRs’ perfectionism as a central challenge of their PhD experience and a contributor to their sense of psychological isolation from other people. DRs’ perfectionism manifested in four key ways; firstly, in the overwhelming sense of responsibility experienced by DRs; secondly, in the tendency to position themselves as inadequate and inferior; thirdly, in cycles of perfectionist paralysis; and finally, in the tendency to find evidence which confirms their assumed inferiority.

DRs positioned themselves as solely responsible for their PhD and for the creation of a positive relationship with their supervisor [ 36 , 52 , 81 ]. DRs expressed a perceived need to capture their supervisors’ interest and attention [ 36 , 52 , 74 ], feeling that they needed to identify and sell to their supervisors some shared characteristic or interest in order to scaffold a meaningful relationship. DRs appeared to feel it necessary to assume sole responsibility for their personal lives and to prohibit any intrusion of the personal in to the professional, even in incredibly distressing circumstances [ 42 ].

DRs appeared to compare themselves against an ideal or archetypal DR and this comparison was typically unfavourable [ 37 ], with DRs contrasting the expected ideal self with their actual imperfect and fallible self [ 37 , 42 , 52 ]. DRs’ sense of inadequacy appeared acutely and frequently reflected back to them by supervisors in the form of negative or seemingly disdainful feedback and interactions [ 41 , 76 ]. DRs framed negative supervisor responses as a cue to work harder, meaning they were continually striving, but never reaching, the DR ideal [ 76 ]. This ideal-actual self-discrepancy was associated with a tendency towards punitive self-talk with clear negative valence [ 38 ].

DRs appear to commonly use self-castigation as a necessary (albeit insufficient) means to motivate themselves to improve their performance in line with perfectionistic standards [ 38 , 41 ]. The oscillation between expectation and actuality ultimately resulted in increased stress and anxiety and reduced enjoyment and motivation. Low motivation and enjoyment appeared to cause procrastination and avoidance, which lead to a greater discrepancy between the ideal and actual self; in turn, this caused more stress and anxiety and further reduced enjoyment and motivation leading to a sense of stuckness [ 76 ].

The internalisation of perceived failure was such that DRs appeared to make sense of their place, progress and possible futures through a lens of inferiority, for example, positioning themselves as less talented and successful compared to their peers [ 37 ]. Thus, instances such as not being offered a job, not receiving funding, not feeling connected to supervisors, feeling excluded by academics and peers were all made sense of in relation to DRs’ perceived relative inadequacy [ 36 ].

Death of personhood

The higher-order theme ‘Death of personhood’ reflects DRs’ identity conflict during the PhD process; a sense that DRs’ engage in a ‘Sacrifice of personal identity’ in which they feel they must give up their pre-existing self-identity, begin to conceive of themselves as purely ‘takers’ personally and professionally, thus experiencing the ‘Self as parasitic’, and ultimately experience a ‘Death of self-agency’ in relation to the thesis, the supervisor and other life roles and activities.

A sacrifice of personal identity

The sacrifice of personal identity first manifests as an enmeshment with the PhD and consequent diminishment of other roles, relationships and activities that once were integral to the DRs’ sense of self [ 59 , 76 ]. DRs tended to prioritise PhD activities to the extent that they engaged in behaviours that were potentially damaging to their personal relationships [ 76 ]. DRs reported a sense of never being truly free; almost physically burdened by the weight of their PhD and carrying with them a constant ambient guilt [ 37 , 38 , 44 , 76 ]. Time spent on non-PhD activities was positioned as selfish or indulgent, even very basic activities of living [ 76 ].

The seeming incompatibility of aspects of prior personal identity and the PhD appears to result in a sense of internal conflict or identity ‘collision’ [ 59 ]. Friends and relatives often provided an uncomfortable reflection of the DR’s changing identity, leaving DRs feeling hyper-visible and carrying the burden of intellect or trailblazer status [ 74 ]; providing further evidence for the incompatibility of their personal and current and future professional identities. Some DRs more purposefully pruned their relationships and social activities; to avoid identity dissonance, to conserve precious time and energy for their PhD work, or as an acceptance of total enmeshment with academic work as necessary (although not necessarily sufficient) for successful continuation in academia [ 40 , 52 , 77 ]. Nevertheless, the diminishment of the personal identity did not appear balanced by the development of a positive professional identity. The professional DR identity was perceived as unclear and confusing, and the adoption of an academic identity appeared to require DRs to have a greater degree of self-assurance or self-belief than was often the case [ 37 , 81 ].

Self as parasitic

Another change in identity manifested as DRs beginning to conceive of themselves as parasitic. DRs spoke of becoming ‘takers’, feeling that they were unable to provide or give anything to anyone. For some DRs, being ‘parasitic’ reflected them being on the bottom rung of the professional ladder or the ‘bottom of the pile’; thus, professionally only able to receive support and assistance rather than to provide for others. Other DRs reported more purposefully withdrawing from activities in which they were a ‘giver’, for example voluntary work, as providing or caring for others required time or energy that they no longer had [ 38 , 44 ]. Furthermore, DRs appeared to conceive of themselves as also causing difficulty or harm to others [ 81 ], as problems in relation to their PhD could lead them to unwillingly punishing close others, for example, through reducing the duration or quality of time spent together [ 38 ].

Feeling that close others were offering support appeared to heighten the awareness of the toll of the PhD on the individual and their close relationships, emphasising the huge undertaking and the often seemingly slow progress, and actually contributing to the sense of ambient guilt, shame, anger and failure [ 38 ]. Moreover, DRs spoke of feeling extreme guilt in perceiving that they had possibly sacrificed their own, and possibly family members’, current wellbeing and future financial security [ 49 ].

Death of self-agency

In addition to their sense of having to sacrifice their personal identity, DRs also expressed a loss of their sense of themselves as agentic beings. DRs expressed feeling powerless in various domains of their lives. First, DRs positioned the thesis as a powerful force able to overwhelm or swallow them [ 46 , 52 , 59 ]. Secondly, DRs expressed a sense of futility in trying to retain any sense of personal power in the climate of academia. An acute feeling of powerlessness especially in relation to supervisors was evident, with many examples provided of being treated as means to an end, as opposed to ends in themselves [ 39 , 42 , 62 ]. Supervisors did not interact with DRs in a holistic way that recognised their personhood and instead were perceived as prioritising their own will, or the will of other academics, above that of the DR [ 39 , 62 ].

Furthermore, DRs reported feeling as if they were used as a means for research production or furthering their supervisors’ reputations or careers [ 62 ]. DRs perceived that holding on to a sense of personal agency sometimes felt incompatible with having a positive supervisor relationship [ 42 ]. Thus whilst emotional distress, anger, disappointment, sadness, jealousy and resentment were clearly evident in relation to feeling excluded, used or over-powered by supervisors [ 37 , 42 , 52 , 62 ], DRs usually felt unable to change supervisor irrespective of how seriously this relationship had degraded [ 37 , 62 ]. Instead, DRs appeared to take on a position of resignation or defensive pessimism, in which they perceived their supervisors as thwarting their personhood, personal goals and preferences, but typically felt compelled to accept this as the status quo and focus on finishing their PhDs [ 42 ]. DRs resignation was such that they internalised this culture of silence and silenced themselves; tending to share litanies of problems with supervisors whilst prefacing or ending the statements with some contradictory or undermining phrase such as ‘but that’s okay’ [ 42 , 52 ].

The apparent lack of self-agency extended outward from the PhD into DRs not feeling able to curate positive life circumstances more generally [ 76 ]. A lack of time was perhaps the key struggle across both personal and professional domains, yet DRs paradoxically reported spending a lot of time procrastinating and rarely (if ever) mentioned time management as a necessary or desired coping strategy for the problem of having too little time [ 46 ]. The lack of self-agency was not only current but also felt in reference to a bleak and uncertain future; DRs lack of surety in a future in academia and the resultant sense of futility further undermined their motivation to engage currently with PhD tasks [ 38 , 40 ].

The system is sick

The higher-order theme ‘The system is sick’ represents systemic influences on DR mental health. First, ‘Most everyone’s mad here’ reflects the perceived ubiquity mental health problems amongst DRs. ‘Emperor’s new clothes’ reflects the DR experience of engaging in a performative piece in which they attempt to live in accordance with systemic rather than personal values. Finally, ‘Beware the invisible and visible walls’ reflects concerns with being caught between ephemeral but very real institutional divides.

Most everyone’s mad here

No studies focused explicitly on experiences of DRs who had been given diagnoses of mental health problems. Some study participants self-disclosed mental health problems and emphasised their pervasive impact [ 50 ]. Further lived experiences of mental distress in the absence of explicit disclosure were also clearly identifiable. The ‘typical’ presentation of DRs with respect to mental health appeared characterised as almost unanimous [ 39 ] accounts of chronic stress, anxiety and depression, emotional distress including frustration, anger and irritability, lack of mental and physical energy, somatic problems including appetite problems, headaches, physical pain, nausea and problems with drug and alcohol abuse [ 39 , 46 , 59 , 76 ]. Health anxiety, concerns regarding perceived new and unusual bodily sensations and perceived risks of developing stress-related illnesses were also common [ 46 , 59 , 76 ]. A PhD-specific numbness and hypervigilance was also reported, in which DRs might be less responsive to personal life stressors but develop an extreme sensitivity and reactivity to PhD-relevant stimuli [ 39 ].

An interplay of trait and state factors were suggested to underlie the perceived ubiquity of mental health problems amongst DRs. Etiological factors associated with undertaking a PhD specifically included the high workload, high academic standards, competing personal and professional demands, social isolation, poor resources in the university, poor living conditions and poverty, future and career uncertainty [ 36 , 41 , 43 , 46 , 49 , 76 ]. The ‘nexus’ of these factors was such that the PhD itself acted as a crucible; a process of such intensity that developing mental health problems was perhaps inevitable [ 39 ].

The perceived inevitability of mental health problems was such that DRs described people who did not experience mental health problems during a PhD as ‘lucky’ [ 39 ]. Supervisors and the wider academic system were seen to promote an expectation of suffering, for example, with academics reportedly normalising drug and alcohol problems and encouraging unhealthy working practices [ 39 ]. Furthermore, DRs felt that academics were uncaring with respect to the mental challenge of doing a PhD [ 39 ]. Nevertheless, academics were suggested to deny any culpability or accountability for mental health problems amongst DRs [ 39 , 59 , 74 ]. The cycle of indigenousness was further maintained by a lack of mental health literacy and issues with awareness, availability and access to help-seeking and treatment options amongst DRs and academics more widely [ 39 ]. Thus, DRs appeared to feel they were being let down by a system that was almost set up to cause mental distress, but within which there was a widespread denial of the size and scope of the problem and little effort put into identifying and providing solutions [ 39 , 59 ]. DRs ultimately felt that the systemic encouragement of unhealthy lifestyles in pursuit of academic success was tantamount to abuse [ 62 ].

A performance of optimum suffering

Against a backdrop of expected mental distress, DRs expressed their PhD as a performative piece. DRs first had to show just the right amount of struggle and difficulty; feeling that if they did not exhibit enough stress, distress and ill-health, their supervisors or the wider department might not believe they were taking their PhD seriously enough [ 40 ]. At the same time, DRs felt that their ‘researcher mettle’ was constantly being tested and they must rise to this challenge. This included first guarding against presenting oneself as intellectually inferior [ 36 ]. Yet it also seemed imperative not to show vulnerability more broadly [ 74 ]. Disclosing mental or physical health problems might lead not only to changed perceptions of the DR but to material disadvantage [ 74 ]. The poor response to mental health disclosures suggested to some DRs that universities might be purposefully trying to dissuade or discourage DRs with mental health problems or learning disabilities from continuing [ 74 ]. The performative piece is thus multi-layered, in that DRs must experience extreme internal psychological struggles, exhibit some lower-level signs of stress and fatigue for peer and faculty observance, yet avoid expressing any real academic or interpersonal weakness or the disclosure of any diagnosable disability or disease.

Emperor’s new clothes

DRs described feeling beholden to the prevailing culture in which it was expected to prioritise above all else developing into a competitive, self-promoting researcher in a high-performing research-active institution [ 39 , 42 ]. Supervisors often appeared the conduit for transmission of this academic ideal [ 74 ]. DRs felt reticent to act in any way which suggested that they did not personally value the pursuit of a leading research career above all else. For example, DRs felt that valuing teaching was non-conformist and could endanger their continuing success within their current institution [ 55 ]. Many DRs thus exhibited a sense of dissonance as their personal values often did not align with the institutional values they identified [ 74 ]. Yet DRs expressed a sense of powerlessness and a feeling of being ‘caught up’ in the values of the institution even when such values were personally incongruent [ 74 ]. The psychological toll of this sense of inauthenticity seemed high [ 55 ]. Where DRs acted in ways which ostensibly suggested values other than prioritising a research career, for example becoming pregnant, they sensed disapproval [ 76 ]. DRs also felt unable to challenge other ‘institutional myths’ for example, the perceived institutional denial of the duration of and financial struggle involved in completing a PhD [ 49 ]. There was a perceived tendency of academics to locate problems within DRs as opposed to acknowledging institutional or systemic inequalities [ 49 ]. DRs expressed strongly a sense in which there is inequity in support, resources and opportunities, yet universities were perceived as ignoring such inequity or labelling such divisions as based on meritocracy [ 36 , 74 ].

Beware the invisible and visible walls

DRs described the reality of working in academia as needing to negotiate a maze of invisible and visible walls. In the former case, ‘invisible walls’ reflect ephemeral norms and rules that govern academia. DRs felt that a big part of their continuing success rested upon being able to negotiate such rules [ 39 ]. Where rules were violated and explicit or implicit conflicts occurred, DRs were seen to be vulnerable to being caught in the ‘crossfire’ [ 36 ]. DRs identified academic groups and departments as being poor in explicitly identifying, discussing and resolving conflicts [ 37 ]. The intangibility of the ‘invisible walls’ gave rise to a sense of ambient anxiety about inadvertently transgressing norms and divides, such that some DRs reported behaving in ways that surprised even themselves [ 37 ].

Gendered and racial micropolitics of academic institutions were seen to manifest as more visible walls between people, with institutions privileging those with ‘insider’ status [ 36 ]. Women and people of colour typically felt excluded or disadvantaged in a myriad of observable and unobservable ways, with individuals able to experience both insider and outsider statuses simultaneously [ 36 , 37 ], for example when a male person of colour [ 36 ]. Female DRs suggested that not only must women prove themselves to a greater extent than men to receive equal access to resources, opportunities and acclaim but also are typically under additional pressure in both their professional and personal lives [ 37 , 52 , 76 ]. Women also felt that they had to take on more additional roles and responsibilities and encountered more conflicts in their personal lives compared to men [ 52 ]. Examples of professionally successful women in DRs’ departments were described as those who had crossed the divide and adopted a more traditionally male role [ 40 ]. Thus, being female or non-White were considered visible characteristics that would disadvantage people in the competitive academic environment and could give rise to a feeling of increased stress, pressure, role conflicts, and a feeling of being unsafe.

Seeing, being and becoming

The higher-order theme of ‘Seeing, being and becoming’ reflects protective and transformative influences on DR mental health. ‘De-programming’ refers to the DRs disentangling their personal beliefs and values from systemic values and also from their own tendency towards perfectionism. ‘The power of being seen’ reflects the positive impact on DR mental health afforded by feeling visible to personal and professional others. ‘Finding hope, meaning and authenticity’ refers to processes by which DRs can find or re-locate their own self-agency, purpose and re/establish a sense of living in accordance with their values. ‘The importance of multiple goals, roles and groups’ represents the beneficial aspects of accruing and sustaining multiple aspects to one’s identity and connections with others and activities outside the PhD. Finally, ‘The PhD as a process of transcendence’ reflects how the struggles involved in completing a PhD can be transformative and self-actualising.

De-programming

DRs reported being able to protect their mental health by ‘de-programming’ and disentangling their attitudes and practices from social and systemic values and norms. This disentangling helped negate DRs’ adopting unhealthy working practices and offered some protection against experiencing inauthenticity and dissonance between personal and systemic values.

First, DRs spoke of rejecting the belief that they should sacrifice or neglect personal relationships, outside interests and their self-identity in pursuit of academic achievement. DRs could opt-out entirely by choosing a ‘user-friendly’ programme [ 44 ] which encouraged balance between personal and professional goals, or else could psychologically reject the prevailing institutional discourse [ 40 ]. Rather than halting success, de-programming from the prioritisation of academia above all else was seen to be associated not only with reduced stress but greater confidence, career commitment and motivation [ 40 , 50 ]. It was also suggested possible to ‘de-programme’ in the sense of choosing not to be preoccupied by the ‘invisible walls’ of academia and psychologically ‘opt out’ of being concerned by potential conflicts, norms and rules governing academic workplace conduct [ 36 ]. Interaction with people outside of academia was seen to scaffold de-programming, by helping DRs to stay ‘grounded’ and offering a model what ‘normal’ life looks like. People outside of academia could also help DRs to see the truth by providing unbiased opinions regarding systemic practices [ 39 ].

A further way in which de-programming manifested was in DRs challenging their perfectionist beliefs. This include re-framing the goal as not trying to be the archetype of a perfect DR, and accepting that multiple demands placed on one individual invariably requires compromise [ 40 , 76 ]. DRs spoke of the need to conceptualise the PhD as a process, rather than just a product [ 46 , 82 ]. The process orientation facilitated framing of the PhD as just one-step in the broader process of becoming an academic as opposed to providing discrete evidence of worth [ 82 ]. Within this perspective, uncertainty itself could be conceived as a privilege [ 81 ]. The PhD was then seen as an opportunity rather than a test [ 37 , 46 ]. Moreover, the process orientation facilitated viewing the PhD as a means of growing into a contributing member of the research community, as opposed to needing to prove oneself to be accepted [ 82 ]. Remembering the temporary nature of the PhD was advised [ 45 ] as was holding on to a sense that not completing the PhD was also a viable life choice [ 76 ]. DRs also expressed, implicitly or explicitly, a decision to change their conceptualisation of themselves and their progress; choosing not to perceive themselves as stuck, but planning, learning and progressing [ 38 , 39 , 81 , 82 ]. This new perspective appeared to be helpful in reducing mental distress.

The power of being seen

DRs described powerful benefits to feeling seen by other people, including a sense of belonging and mattering, increased self-confidence and a sense of positive progress [ 37 ]. Being seen by others seems to provoke the genesis of an academic identity; it brings DRs into existence as academics. Being seen within the academic institution also supports mental health and can buffer emotional exhaustion [ 37 , 52 , 55 , 81 ]. DRs expressed a need to feel that supervisors, academics and peers were interested in them as people, their values, goals, struggles and successes; yet they also needed to feel that they and their research mattered and made a difference within and outside of the institution [ 42 , 52 , 81 ]. It was clear that DRs could find in their disciplinary communities the sense of belonging that often eluded them within their immediate departments [ 42 ]. Feeling a sense of belonging to the academic community seemed to buffer disengagement and amotivation during the PhD [ 81 ]. Positive engagement with the broader community was scaffolded by a sense of trust in the supervisor [ 81 ]. DRs often felt seen and supported by postdocs, especially where supervisors appeared absent or unsupportive [ 50 ].

Spending time with peers could be beneficial when there was a sense of shared experience and walking alongside each other [ 39 ]. Friendship was seen to buffer stress and protect against mental health problems through the provision of social and emotional support and help in identifying struggles [ 39 , 43 ]. In addition to relational aspects, the provision of designated physical spaces on campus or in university buildings also seemed important to being seen [ 37 ]. Peers in the university could provide DRs with further physical embodiments of being seen, for example, gift-giving in response to their birthdays or returning from leave [ 37 , 50 ]. Outside of the academic institution, DRs described how being seen by close others could support DRs to be their authentic selves, providing an antidote to the invisible walls of academia [ 50 ]. Good quality friendships within or outside academia could be life-changing, providing a visceral sense of connection, belonging and authenticity that can scaffold positive mental health outcomes during the PhD [ 39 ]. Pets could also serve to help DRs feel seen but without needing to extend too much energy into maintaining social relationships [ 50 ].

Finally, DRs also needed to see themselves, i.e. to begin to see themselves as burgeoning academics as opposed to ‘just students’ [ 81 ]. Feeling that the supervisor and broader academic community were supportive, developing one’s own network of process collaborators and successfully obtaining grant funding seemed tangible markers that helped DRs to see themselves as academics [ 37 , 81 ]. Seeing their own work published was also helpful in providing a boost in confidence and being a joyful experience [ 42 ]. Moreover, with sufficient self-agency, DRs can not only see themselves but render themselves visible to other people [ 37 ].

Multiple goals, roles and groups

In antidote to the diminished personal identity and enmeshment with the PhD, DRs benefitted from accruing and sustaining multiple goals, roles, occupations, activities and social group memberships. Although ‘costly’ in terms of increased stress and role conflicts, sustaining multiple roles and activities appeared essential for protecting against mental health problems [ 50 , 68 ].

Leisure activities appeared to support mental health through promoting physical health, buffering stress, providing an uplift to DRs’ mood and through the provision of another identity other than as an academic [ 44 , 50 , 76 ]. Furthermore, engagement in activities helped DRs to find a sense of freedom, allowing them to carve up leisure and work time and psychologically detach from their PhD [ 68 , 76 ]. Competing roles, especially family, forced DRs to distance themselves from the PhD physically which reinforced psychological separation [ 50 , 59 ]. Engaging in self-care and enjoyable activities provided a sense of balance and normalcy [ 39 , 44 , 68 ]. This normalcy was a needed antidote to abnormal pressure [ 59 ]. Even in the absence of fiercely competing roles and priorities, DRs still appeared to benefit from treating their PhD as if it is only one aspect of life [ 59 ]. Additional roles and activities reduced enmeshment with the PhD to the extent that considering not completing the PhD was less averse [ 40 ]. This position appeared to help DRs to be less overwhelmed and less sensitive to perceived and anticipated failures.

Finding hope, meaning and authenticity

Finding hopefulness and meaning within the PhD can scaffold a sense of living a purposeful, enjoyable, important and authentic life. Hopefulness is predicated on the ability to identify a goal, i.e. to visualise and focus on the desired outcome and to experience both self-agency and potential pathways towards the goal. Hopefulness was enhanced by the ability to break down tasks into smaller goals and progress in to ‘baby steps’ [ 38 , 59 ]. In addition, DRs benefitted from finding explicit milestones against which they can compare their progress [ 59 ], as this appeared to feed back into the cycle of hopeful thinking and spur further self-agency and goal pursuit.

The experience of meaning manifested in two main ways; first as the more immediate lived experience of passion in action [ 76 ]. Secondly, DRs found meaning in feeling that in their PhD and lives more broadly they were living in accordance with their values, for example, experiencing their own commitment in action through continuing to work on their PhD even when it was difficult to do so [ 76 ]. DRs who were able to locate their PhD within a broader sense of purpose appeared to derive wellbeing benefits. There was a need to ensure that values were in alignment, for example, finding homeostasis between emotional, intellectual, social and spiritual parts of the self [ 46 , 59 , 90 ].

The processes of finding hopefulness and meaning appear to be largely relational. Frequent contact with supervisors in person and social and academic contact with other DRs were basic scaffolds for hope and meaning [ 52 ]. DRs spoke of how a sense that their supervisors believed in them inspired their self-agency and motivation [ 42 , 62 , 76 ]. Partners, friends and family could also inspire motivation for continuing in PhD tasks [ 44 , 76 ]. Other people also could help instil a sense of motivation to progress and complete the PhD; a sense of being seen is to be beholden to finish [ 39 ]. Meaning appeared to be scaffolded by a sense of contribution, belonging and mattering [ 81 ] and could arise from the perception of putting something into the collective pot, inspiring hopefulness and helping others [ 39 , 42 ]. Moreover, hopefulness, meaning and authenticity also appeared mutually reinforcing [ 81 ]. Finding meaning and working on a project which is in accordance with personal values, preferences and interests is also helpful in completing the PhD and provides a feedback loop into hope, motivation and agentic thinking [ 39 , 81 ]. Furthermore, DRs could use agentic action to source a community of people who share their values, enabling them to engage in collective authenticity [ 39 ].

The PhD as a process of transcendence

The immense challenge of the PhD could be a catalyst for growth, change and self-actualisation, involving empowerment through knowledge, self-discovery, and developing increased confidence, maturity, capacity for self-direction and use of one’s own autonomy [ 44 , 82 ]. The PhD acted as a forge in which DRs were tested and became remoulded into something greater than they had been before [ 44 , 82 , 90 ]. The struggles endured during the PhD caused DRs to reconsider their sense of their own capacities, believing themselves to be more able than they previously would have thought [ 50 ]. The struggles endured added to the sense of accomplishment. A trusted and trusting supervisor appears to aid in the PhD being a process of transcendence [ 62 ].

More broadly, the PhD also helped DRs to transcend personal tragedy, allowing immersion in a meaningful activity which begins as a means of coping and becomes something completely [ 39 ]. The PhD could also serve as a transformative selection process for DRs’ social relationships, with some relationships cast aside and yet others formed anew [ 39 ]. Overall, therefore, the very aspects of the PhD which were challenging, and distressing could allow DRs to transcend their former selves and, through the struggle, become something more.

Summation of results

The findings regarding the risk and protective factors associated with DR mental health have been summarised in Table 3 in relation to (1) the type of research evidencing the factor (i.e. whether the evidence is quantitative only, part of the meta-synthesis only, or evident in both results sections); and (2) the volume of evidence (i.e. whether the factor was found in a single study or across multiple studies). The factors in the far-right column (i.e. the factors found across multiple research studies utilising both qualitative and quantitative methods) are the ones with the strongest evidence at present.

This systematic review summarises a heterogeneous research area, with the aim of understanding the mental health of DRs, including possible risk and protective factors. The qualitative and quantitative findings presented here suggest that poor mental health is a pertinent problem facing DRs; stress appears to be a key issue and significantly in excess of that experienced in the general population. Several risk and protective factors at the individual, interpersonal and systemic levels emerged as being important in determining the mental health of DRs. The factors with the strongest evidence-base (i.e. those supported by multiple studies using qualitative and quantitative findings) denote that being female and isolated increases the risk of the mental health problems, whereas seeing the PhD as a process, feeling socially supported, having a positive supervisor relationship and engaging in self-care is protective.

Results in context

Stress can be defined as (1) the extent to which a stimulus exerts pressure on an individual, and their propensity to bear the load; (2) the duration of the response to an aversive stimuli, from initial alert to exhaustion; or (3) a dynamic (im)balance between the demands and personal resource to manage those demands [ 91 ]. The Perceived Stress Scale (PSS) [ 18 , 19 ] used in our meta-analysis is aligned with the third of these definitions. As elaborated upon within the Transactional Model of Stress [ 92 ], stress is conceptualised as a persons’ appraisal of the internal and external demands put upon them, and whether these exceed their available resources. Thus, our results suggest that, when compared to the general population, PhD students experience a greater maladaptive imbalance between their available resources and the demands placed upon them. Stress in itself is not a diagnosable mental health problem, yet chronic stress is a common precipitant to mental health difficulties such as depression and posttraumatic stress disorder [ 93 , 94 ]. Therefore, interventions should seek to bolster DRs’ resources and limit demands placed on them to minimise the risks associated with acute stress and limit its chronicity.

Individual factors

Female DRs were identified as being at particular risk of developing mental health difficulties. This may result from additional hurdles when studying in a male-dominated profession [ 95 , 96 , 97 ], and the expectation that in addition to their doctoral studies, females should retain sole or majority responsibility for the domestic and/or caring duties within their family [ 52 , 76 ]. It may also be that females are more willing to disclose and seek help for mental health difficulties [ 98 ]. Nevertheless, the World Health Organisation (WHO) mental health survey results indicate that whilst anxiety and mood disorders are more prevalent amongst females, externalising disorders are more common in males [ 99 ]. As the vast majority of studies in this review focussed on internalising problems (e.g. stress, anxiety and depression) [ 37 , 64 , 79 , 80 , 83 , 89 ], this may explain the gender differences found in this review. Further research is needed to explore which perspective, if any, may explain gender gap in our results.

Perhaps unsurprisingly, self-care was associated with reduced mental health problems. The quantitative findings suggest that all types of self-care are likely to be protective of mental health (i.e. physical, emotional, professional and spiritual self-care). Self-care affords DRs the opportunity to take time away from their studies and nurture their non-PhD identities. However, the results from our meta-synthesis suggest that DRs are not attending to their most basic needs much less engaging in self-care behaviours that correspond to psychological and/or self-fulfilment needs [ 100 ]. Consequently, an important area for future enquiry will be identifying the barriers preventing DRs from engaging in self-care.

Interpersonal factors

Across both quantitative and qualitative studies, interpersonal factors emerged as the most salient correlate of DR mental health. That is, isolation was a risk factor, whereas connectedness to others was a protective factor. There was some variability in how these constructs were conceptualised across studies, i.e. (1) isolation: a lack of social support, having fewer social connections, feeling isolated or being physically separate from others; and (2) social connectedness: multiple group membership, academic relationships or non-academic relationships; but there was no indication that effects varied between concepts. The relationship between isolation and negative health consequences is well-established, for example both physical and mental health problems [ 101 ], and even increased mortality [ 102 ]. Conversely, social support is associated with reduced stress in the workplace [ 103 , 104 ]. Reducing isolation is therefore a promising interventional target for improving DRs’ mental health.

The findings regarding isolation are even more alarming when considered alongside the findings from several studies that PhD studies are consistently reported to dominate the lives of DRs, resulting in poor ‘work-life balance’ and losing non-PhD aspects of their identities. The negative impact of having fewer identities [ 105 ] can be mitigated by having a strong support network [ 106 ], and increasing multiple group memberships [ 107 ]. But for DRs, it is perhaps the absence of this social support, combined with identity impoverishment, which can explain the higher than average prevalence of stress found in our meta-analysis.

Systemic factors

DRs’ attitudes towards their studies may be a product of top-down systemic issues in academia more broadly. Experiencing mental health problems was reported as being the ‘norm’, but also appeared to be understood as a sign of weakness. The meta-synthesis results suggest that DRs believed their respective universities prioritise academic success over workplace wellbeing and encourage unhealthy working habits. Working in an unsupportive and pressured environment is strongly associated with negative psychological outcomes, including increased depression, anxiety and burnout [ 108 ]. The supervisory relationship appeared a particularly important aspect of the workplace environment. The quantitative analysis found a negative correlation between inspirational supervision and mental health problems. Meta-synthetic finding suggested toxic DR-supervisor relationships characterised by powerlessness and neglect, as well as relationships where DRs felt valued and respected—the former of these being associated with poor mental health, and the latter being protective. The association between DR-supervisor relationship characteristics needs to be verified using quantitative methods. Furthermore, DRs’ sense that they needed to exhibit ‘optimum suffering’, which appears to reflect a PhD-specific aspect of a broader academic performativity [ 109 ], is an important area for consideration. An accepted narrative around DRs needing to experience a certain level of dis/stress would likely contribute to poor mental health and as an impediment to the uptake and effectiveness of proffered interventions. Although further research is needed, it is apparent that individual interventions alone are not sufficient to improve DR mental health, and that a widespread culture shift is needed in order to prevent the transmission of unhealthy work attitudes and practices.

Limitations of the literature

Although we found a respectable number of articles in this area, the focus and measures used varied to the extent that typical review analysis procedures could not be used. That is, there was much heterogeneity in terms of how mental health was conceptualised and measured, as well as the range of risk and protective factors explored. Similarly, the quality of the studies was hugely variable. Common flaws amongst the literature include small sample sizes, the use of unvalidated tools and the incomplete reporting of results. Furthermore, for qualitative studies specifically, there appeared to be a focus on breadth instead of depth, particularly in relation to studies using mixed methods.

The generalisability of our findings is limited largely due to the lack of research conducted outside of the US, but also because we limited our review to papers written in English only. The nature of doctoral studies varies in important ways between studies. For example, in Europe, PhD studies usually apply for funding to complete their thesis within 3–4 years and must know their topic of interest at the application stage. Whereas in the US, PhD studies usually take between 5 and 6 years, involve taking classes and completing assignments, and the thesis topic evolves over the course of the PhD. These factors, as well as any differences in the academic culture, are likely to affect the prevalence of mental health problems amongst DRs and the associated risk and protective factors. More research is needed outside of the US.

‘Mental health’ in this review was largely conceptualised as a type of general wellbeing rather than a clinically meaningful construct. None of the studies were ostensibly focused on sampling DRs who were currently experiencing or had previously experienced mental health problems per se, meaning the relevance of the risk, vulnerability and protective factors identified in the meta-synthesis may be more limited in this group. Few studies used clinically meaningful measures. Where clinical measures were used, they captured data on common mental health problems only (i.e. anxiety and depression). Due to these limitations, we are unable to make any assertions about the prevalence of clinical-level mental health problems amongst DRs.

Limitations of this review

As a result of the heterogeneity in this research area, some of the results presented within this review are based on single studies (e.g. correlation data; see Fig. 5 ) rather than the amalgamation of several studies (e.g. meta-analysis/synthesis). To aid clarity when interpreting the results of this review, we have (Table 3 ) summarised the volume of evidence supporting risk and protective factors. Moreover, due to the small number of studies eligible for inclusion in this review, we were unable to test whether any of our findings are related to the study characteristics (e.g. year of publication, country of origin, methodology).

We were able to conduct three meta-analyses, one of which aimed to calculate the between-group effect size on the PSS [ 18 , 19 ] between DRs and normative population data. Comparing these data allowed us to draw some initial conclusions about the prevalence of stress amongst DRs, yet we were unable to control for other group differences which might moderate stress levels. For example, the population data was from people in the United States (US) in 1 year, whereas the DR data was multi-national at a variety of time points; and self-reported stress levels may vary with nationality [ 110 ] or by generation [ 111 , 112 ]. Moreover, two of the three meta-analyses showed significant heterogeneity. This heterogeneity could be explained by differences in the sample characteristics (e.g. demographics, country of origin), doctoral programme characteristics (e.g. area of study, funding status, duration of course) or research characteristics (e.g. study design, questionnaires used). However, due to the small number of studies included in these meta-analyses, we were unable to test any of these hypotheses and are therefore unable to determine the cause of this heterogeneity. As more research is conducted on the mental health of DRs, we will be able to conduct larger and more robust meta-analyses that have sufficient power and variance to statistically explore the causes of this heterogeneity. At present, our findings should be interpreted in light of this limitation.

Practice recommendations

Although further research is clearly needed, we assert that this review has identified sufficient evidence in support of several risk and protective factors to the extent that they could inform prevention and intervention strategies. Several studies have evidenced that isolation is toxic for DRs, and that social support can protect against poor mental health. Initiatives that provide DRs with the opportunity to network and socialise both in and outside of their studies are likely to be beneficial. Moreover, there is support for psychoeducation programmes that introduce DRs to a variety of self-care strategies, allow them to find the strategies that work for them and encourage DRs to make time to regularly enact their chosen strategies. Finally, the supervisory relationship was identified as an important correlate of DR mental health. Positive supervision was characterised as inspirational and inclusive, whereas negative supervision productised DRs or neglected them altogether. Supervisor training programmes should be reviewed in light of these findings to inform how institutions shape supervisory practices. Moreover, the initial findings reported here evidence a culture of normalising and even celebrating suffering in academia. It is imperative therefore that efforts to improve and protect the mental health of DRs are endorsed by the whole institution.

Research recommendations

First, we encourage further large-scale mental health prevalence studies that include a non-PhD comparison group and use validated clinical tools. None of the existing studies focused on the presence of serious mental health problems—this should be a priority for future studies in this area. Mixed-methods explorations of the experiences of DRs who have mental health problems, including serious problems, and in accessing mental health support services would be a welcome addition to the literature. More qualitative studies involving in-depth data collection, for example interview and focus group techniques, would be useful in further supplementing findings from qualitative surveys. Our review highlights a need for better communication and collaboration amongst researchers in this field with the goal of creating a level of consistency across studies to strengthen any future reviews on this subject.

The results from this systematic review, meta-analysis and meta-synthesis suggest that DRs reported greater levels of stress than the general population. Research regarding the risk and protective factors associated with the mental health of DRs is heterogenous and disparate. Based on available evidence, robust risk factors appear to include being isolated and being female, and robust protective factors include social support, viewing the PhD as a process, a positive DR-supervisor relationship and engaging in self-care. Further high-quality, controlled research is needed before any firm statements can be made regarding the prevalence of clinically relevant mental health problems in this population.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Confidence intervals

Doctoral researchers

Higher Education Statistics Agency

Perceived Stress Scale

Standard deviation

United Kingdom

United States

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Acknowledgements

Thank you to the Office for Students for their funding to support this work; and thank you to the University of Sussex Doctoral school and our steering group for championing and guiding the ‘Understanding the mental health of Doctoral Researchers (U-DOC)’ project.

The present project was supported by the Office for Students Catalyst Award. The funder had no involvement in the design of the study, the collection, analysis or interpretation of the data, nor the writing of this manuscript.

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CH contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. LC contributed to the data curation, investigation, project administration, validation and writing—review and editing of this paper. SV contributed to the data curation, formal analysis, investigation, project administration, validation and writing—review and editing of this paper. PR contributed to the funding acquisition, project administration, supervision and writing—review and editing of this paper. JN contributed to the conceptualisation, funding acquisition, methodology, project administration, supervision, validation, writing—original draft preparation and writing—review and editing of this paper. CB contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. The author(s) read and approved the final manuscript.

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Hazell, C.M., Chapman, L., Valeix, S.F. et al. Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis. Syst Rev 9 , 197 (2020). https://doi.org/10.1186/s13643-020-01443-1

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PhD students’ mental health is poor and the pandemic made it worse – but there are coping strategies that can help

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A pre-pandemic study on PhD students’ mental health showed that they often struggle with such issues. Financial insecurity and feelings of isolation can be among the factors affecting students’ wellbeing.

The pandemic made the situation worse. We carried out research that looked into the impact of the pandemic on PhD students, surveying 1,780 students in summer 2020. We asked them about their mental health, the methods they used to cope and their satisfaction with their progress in their doctoral study.

Unsurprisingly, the lockdown in summer 2020 affected the ability to study for many. We found that 86% of the UK PhD students we surveyed reported a negative impact on their research progress.

But, alarmingly, 75% reported experiencing moderate to severe depression. This is a rate significantly higher than that observed in the general population and pre-pandemic PhD student cohorts .

Risk of depression

Our findings suggested an increased risk of depression among those in the research-heavy stage of their PhD – for example during data collection or laboratory experiments. This was in contrast to those in the initial stages, or who were nearing the end of their PhD and writing up their research. The data collection stage was more likely to have been disrupted by the pandemic.

Our research also showed that PhD students with caring responsibilities faced a greatly increased risk of depression. In our our study , we found that PhD students with childcare responsibilities were 14 times more likely to develop depressive symptoms than PhD students without children.

This does align with findings on people in the general UK population with childcare responsibilities during the pandemic. Adults with childcare responsibilities were 1.4 times more likely to develop depression or anxiety compared to their counterparts without children or childcare duties.

It was also interesting to find that PhD students facing the disruption caused by the pandemic who did not receive an extension – extra financial support and time beyond the expected funding period – or were uncertain about whether they would receive an extension at the time of our study, were 5.4 times more likely to experience significant depression.

Our research also used a questionnaire designed to measure effective and ineffective ways to cope with stressful life events. We used this to look at which coping skills – strategies to deal with challenges and difficult situations — used by PhD students were associated with lower depression levels. These “good” strategies included “getting comfort and understanding from someone” and “taking action to try to make the situation better”.

Interestingly, female PhD students, who were slightly less likely than men to experience significant depression, showed a greater tendency to use good coping approaches compared to their counterparts. Specifically, they favoured the above two coping strategies that are associated with lower levels of depression.

On the other hand, certain coping strategies were associated with higher depression levels. Prominent among these were self-critical tendencies and the use of substances like alcohol or drugs to cope with challenging situations.

A supportive environment

Creating a supportive environment is not solely the responsibility of individual students or academic advisors. Universities and funding bodies must play a proactive role in mitigating the challenges faced by PhD students.

By taking proactive steps, universities could create a more supportive environment for their students and help to ensure their success.

Training in coping skills could be extremely beneficial for PhD students. For instance, the University of Cambridge includes this training as part of its building resilience course .

A focus on good strategies or positive reframing – focusing on positive aspects and potential opportunities – could be crucial. Additionally, encouraging PhD students to seek emotional support may also help reduce the risk of depression.

Another example is the establishment of PhD wellbeing support groups , an intervention funded by the Office for Students and Research England Catalyst Fund .

Groups like this serve as a platform for productive discussions and meaningful interactions among students, facilitated by the presence of a dedicated mental health advisor.

Our research showed how much financial insecurity and caring responsibilities had an effect on mental health. More practical examples of a supportive environment offered by universities could include funded extensions to PhD study and the availability of flexible childcare options.

By creating supportive environments, universities can invest in the success and wellbeing of the next generation of researchers.

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Emotional Phases of a Research Project: PhD and Postdoc Stress

Stress is a rather typical aspect of most research projects because every research project has five characteristic emotional phases: You start with naïve enthusiasm, become competent and disillusioned, you want to give up (the stress phase, slump or dip), you recover, and finally, you round up and exit. How do you survive PhD stress and postdoc stress?

Understanding the General Pattern of PhD Stress and Postdoc Stress Helps You Survive Difficult Times

I have supervised many PhD students and postdocs, and there seems to be a general pattern that appears repeatedly leading to PhD stress and postdoc stress.  Knowing these phases may help to survive the frustration and “The Dip,”  which generally occurs after half of the project is done.

In Year 1, You Start with Naïve Enthusiasm

You start with excitement and energy and learn all the new techniques. You get to know the environment and the key people (secretaries, technicians, collaboration partners, etc.).  You are unaware of the problems and obstacles. You give the best; you have to do a good job.

In Year 2, You Become Competent and Disillusioned, Leading to PhD or Postdoc Stress

In year 2,  you become pretty competent and know how the game is played.  You know the key people and have built important relationships. You also become aware of the limitations of your situation, you understand the technical, personal and political obstacles for your research.

After Two Years, Most Young Scientists Experience “The Dip” – Even More PhD stress or Postdoc Stress

At the end of year 2, you suddenly realize that you have not generated enough data to finish your project in time, many

experiments have failed, your results are fragmented, and only a fraction of your data can be published. After starting with fun and enthusiasm, there is a long slog between getting competent and publishing.

You may start to question the entire project , the study’s design, the validity of your incomplete results, or the competence of your supervisor. You may feel lonely because you are now the only expert on the subject, and even your supervisor knows less than you do about your specific topic.

Furthermore, you may even question your ability to pursue a successful research project (imposter syndrome) or become excellent in your field – read more here:  I am just an average scientist . This is a major internal reason for PhD stress and postdoc stress.

This may also be a difficult time for the relationship with your supervisor.

This is nearly inevitable. It is the classical dip when many young scientists consider quitting research, stopping their projects, or leaving their jobs. It is essential to know about this phase to survive and *not* give up.

In the Third Year, You Recover and Start to Harvest

If things go well, you learn to cope with the stress and recover from the frustration. Your supervisor may have coached or pulled you from “The Dip.” You learn to adapt, become self-sufficient, and be responsible for your success. 

You know the techniques, repeat many processes you have done before, develop efficient routines, and the work becomes manageable again. You create a certain degree of mastery in your field. Often, students finally generate conclusive data, which helps make sense of the previous data.

In the Last Year, You Round Up and Exit

In the last year, you are aware that the end of the project is getting nearer. If your project did not run well, you developed an exit strategy to make the best out of it, published your paper as well as possible, and/or created a nice thesis. 

If your project did run exceptionally well, you will try to increase the quality of the research even more to publish it even better. 

However, in many cases, the project, the funding, or your contract come to an end. You develop an exit strategy and start to think about your life *after* this project. 

You may consider the next project(s) and/or the next career move within or outside of academia.

The phases are not always linear

I have seen these five phases again and again when working with PhD students and postdocs. It’s important to note that these phases of stress and resolution might not always be as linear or universal as presented. Individual experiences can vary significantly based on personal circumstances, the nature of the research, and the environment of the academic institution.

However, knowing the general patterns will help you substantially handle your situation much more easily.

Postdocs Go Through the Cycle Faster – Repeated Postdoc Stress

If postdocs have a 2-year contract, they go through the cycle faster because, after one year, they realize that there is only one year left to finish the project and publish the paper. 

The considerable risk is to leave with one or several unfinished projects, which do not serve to find the next position because they are not published. 

The supervisor may help get additional funding to extend the contract, especially when the project is big, or there are several unfinished projects. 

This may restart the cycle of postdoc stress (naïve enthusiasm, disillusion, dip, recovery, and round-up) .

If You Are Frustrated for a Longer Period, Check Carefully Whether You Are in “The Dip”

If your research project sucks, you may be just in the classical dip. Discuss your concerns with your colleagues and your supervisor to ensure that your frustration is only a result of the emotional phase of your project and not a result of a poorly designed project, lousy working conditions, scientific misconduct, a colleague who is a bully, or  an abusive supervisor . 

Be aware that “The Dip” is also not easy for your supervisor because they must convince you that the project will probably be successful and that you must endure to finish it. However, there is always a chance that a research project ends with negative findings or, in rare cases, even fails altogether. 

If you realize that your project is not well-designed, you have an excellent opportunity to improve the design or make the difficult decision to find another or a complementary project.

The Psychological Effects of “The Dip”

Most young researchers experience the same dip, but everyone’s journey differs. They compare themselves to each other anyway. “The Dip” may increase the competitiveness. 

Therefore, young researchers must talk to and help each other as many experience similar struggles, even if they may be afraid to admit it due to competitiveness. 

You may be afraid that discussing your situation may make you appear weak. This is a heavy misconception. However, whining and complaining track you down emotionally and are indeed perceived as a weakness. 

In contrast, acknowledging that you are going through the classical dip and doing something about it (working hard to generate more data, finding alternative working hypotheses, improving or adding new techniques, discussing the study design, etc.) is a sign of strength, maturity, and professionalism.

The Role of the Supervisor in Handling Phd Stress and Postdoc Stress

The supervisor should help you to survive the emotional turmoil of “The Dip” by staying calm and focused. It is *not* the supervisor’s task to become your psychotherapist but to give you emotional and technical guidance. 

A good supervisor will help you to focus on the finish line (publishing your paper and finishing your thesis) and how to handle your concerns. Please do not forget:

• Most supervisors have not been educated on how to do that.
• Young supervisors may also experience “The Dip.”

Why are Phd students and postdocs so stressed?

Over the past decade, postdoctoral population growth has led to a pretty competitive atmosphere in the academic job market over the past decade. In addition, a postdoc salary often does not reflect the long hours and dedication required, leading to discussions about the academic system’s reliance on what some call cheap labor. 

The financial hardships faced by many PhD students are a major source of stress. Balancing a full-time job with PhD work can be overwhelming, leading to much stress and sometimes severe symptoms of mental health issues. Thus, it is essential to check out  free or fully funded PhD programs  before you make choices that lead to increasing debt.

Graduate students and postdoctoral scholars often face high levels of stress and pressure in academic institutions, which can lead to PhD burnout or postdoc burnout. You should be aware that certain  myths in science let you work too much  and still make you feel guilty about not doing enough.

In the current climate, national origin, sexual orientation, and gender identity may be targeted in the work environment, adding to the stress. If you are in a toxic environment, you might consider  quitting your current position  to protect your well-being.

Postdoctoral researchers may find that one deadline after the other, excessive reviewer requests of academic journals, and academic publishing requirements add to the pressure. Being a first author on publications can significantly impact your future career prospects, especially for those seeking a senior position. 

It’s a tangible result of hard work and has a positive impact on your career trajectory. However, publications are often seen as a benchmark for good scientists by young scientists. However, there are several other  qualifications and skills that are essential for an academic career . 

Lack of job security  is a significant  stressor  for many  postdocs under pressure , as the academic job market is notoriously competitive and the number of postdocs is increasing. Thus, postdocs aim for  tenure-track faculty positions  that provide more job security and retirement benefits than postdoc positions. 

How to Handle the Stress Phase, the Slump, the Dip?

Suppose you are frustrated for a more extended period (= several weeks or months), your general working conditions are fine, you get along well with your supervisor, and the project is, in principle, well-designed. 

In that case, you are probably in the “The Dip.”  

Typical characteristics of “The Dip” are doubt, frustration, low energy, and low productivity. Often, young scientists have generated a lot of results that are somehow not publishable yet. The results may be fragmented, and essential aspects must be investigated. 

Or the results may be inconclusive, and there is no clear answer to the questions addressed. 

Or the results may be all negative. You may wonder whether you should  publish a negative study .

Knowing this is a  classical phase  most young researchers go through is one key to enduring. 

Effective time management is a key skill for PhD candidates and postdocs. Balancing postdoc or PhD work and personal life is challenging but essential. Additionally, building a strong network of social support can significantly reduce the risk of developing mental disorders during the postdoc or PhD journey.

Engaging in social events and cultural and physical activities, and allowing free time for oneself are small but significant steps toward maintaining a healthy work-life balance.

Postdocs may find it additionally challenging to balance their daily tasks with the need to find a permanent position. In such a case, you need to check out the professional development opportunities of your institution and get advice on navigating the academic job market from experienced faculty members. 

However, if your postdoctoral training does not lead to any progress after two years, you might consider it a good thing for your career path to  quit your postdoc and find a better position .  

Preparing for Life After Postdoc Reduces the Stress

The best strategy to reduce your stress and build resilience is to  develop a solid vision of your life after your postdoc . Postdoctoral positions do not guarantee employment in the future – but your life experience as well as the technical and transferable skills gained during your postdoc, are invaluable for any future job.

As you near the transition call of your postdoctoral journey, consider your personal situation and all career options. Reflect well whether it’s pursuing academic positions and becoming an  independent academic  (group leader, professor) or seeking non-academic jobs (industry, policy, etc.). Therefore, you must carefully reflect whether being a professor is worth it.

To find clarity, you might enroll in my  course on finding your dream job in science .

For international scholars, this transition might involve additional considerations, such as visa status or opportunities in other countries. After clarifying the rules and regulations, you will feel much more secure.

Did You Consider Alternative Careers?

Only 3 % of PhD students and 10% of postdocs become professors . Thus, considering an alternative career makes a lot of sense. There is no reason to worry about a  stigma attached to leaving science. More than 90 % of all scientists find work outside academia.

Pursuing an academic career is not the only way to succeed in science; the real world offers a myriad of opportunities. Postdoctoral experience can be enriched by engaging in new projects that may lead to successful careers outside the traditional academic research path. 

Academic advisors and human resources at universities and or research institutes can provide guidance on alternative careers, including administrative or management roles in academia, positions in human resources, or as employment agency consultants.

Finally, industry positions can offer an alternative with potentially better health insurance and retirement plan options compared to the low pay and insecurity of  academic postdoc roles that do not necessarily lead to an academic career . 

However, be aware that academic faculty members are often  not the ideal mentors to give advice on transitioning to industry positions .

Get Professional Help for Phd and Postdoc Burnout

In some situations, it is not just a dip. Dealing with mental health issues is a reality for many in high-pressure working environments in academia. Even if you do not consider your workplace ‘toxic’ or ‘bad,’ the pressure may be overwhelming.

PhD or postdoc burnout is a serious issue. This detrimental stress can lead to depression and anxiety. Postdocs and PhD students need to recognize the warning signs and seek confidential help from mental health professionals. Asking for help and getting help is not a sign of weakness but of intelligence.

Especially when you experience some kind of  abuse by a supervisor .

Seeking professional mental health support is not just a last resort but can be a proactive and positive step at any stage.

Navigating a challenging research project can often lead to mental health problems due to the lot of stress involved. It’s crucial for doctoral students and postdocs to recognize the early signs of a mental health crisis and seek appropriate support. Incorporating regular exercise and maintaining a social life are effective strategies for managing stress levels – but sometimes, it is not enough.

A growing concern in higher education is the mental health crisis among young researchers. Nowadays, most supervisors know that addressing a PhD candidate’s mental health or a postdoc is as crucial as their academic success. Therefore, more and more universities offer comprehensive support services to address mental health symptoms and provide social support.

On-campus resources, like mental health services and staff assistance programs, often include psychologists and therapists trained to address the psychological distress associated with academic pressures and related traumatic experiences such as a toxic work environment.

Who can help with Phd burnout or postdoc burnout?

If you feel burnout as a young researcher, you might hesitate to reach out to mental health services and support groups because they might not understand the unique challenges of academic life. You might be ashamed that you ‘can not handle the pressure.’ However, most academic institutions have services that support PhD students and postdocs under challenging phases.

Often, it is enough to learn stress management techniques to maintain your well-being. Family members can be supportive by understanding the long hours and stressful nature of the work involved in graduate school and postdoctoral training.

However, if you are working in a toxic environment or you have to  handle an abusive supervisor , you must reach out for help and support from persons who are not part of the environment. Remember, taking care of your mental and physical health is not a luxury, but a necessity, especially in the long haul of an academic career.

What to Do Now to Handle PhD stress and Postdoc Stress

• Keep calm and carry on.
• Ask for technical help.  Often, a new perspective is very useful when you feel stuck.
• Ask for emotional support . Talk to your friends. Find a support group. Most universities provide psychological services for students. They are free and there for you to use, so take advantage!
• Discuss your concerns with your supervisor and colleagues, but remember that sometimes there is no easy solution.
• Learn to set boundaries.  If   there is too much work put on your shoulders, unrealistic expectations, and people request too much of your time or energy, you are allowed to set boundaries and say “No.” Stay firm but friendly; most people will respect your time and energy more.
• Limit complaining and whining  because complaining tracks you down emotionally. Keep a positive spirit to stay motivated and energetic. Your colleagues will appreciate it as well.
• Do not tell everybody a “victim story”   because this enforces your frustration.
• Be aware that the work is never “done,”  and the project could go on forever, but you have to wrap up sooner or later to publish your paper and/or finish your thesis. 
• Reduce or eliminate social media, alcohol   (or other drugs), and bad food , which may reduce your cognitive performance and your general fitness.
• Engage in physical exercise.  Make time to activate your body and mind and to release tension.
• Take time off! Do not work day and night.  Give yourself enough time to take care of your well-being by engaging in social activities.
• Get informed and prepare for your life after your PhD or postdoc.

If you are in “The Dip” right now, I wish you strength and good results! 

Frequently Asked Questions (FAQ)

Q: how do you manage stress during a short, two-year postdoctoral research project.

A: Focus on getting publishable results. Do not focus on a big multiyear project. Create a manageable to-do list, take regular breaks, and maintain open communication with coworkers and supervisors. Regular physical activity and good sleep habits can also help. Remember, going through emotional phases during your project is perfectly normal.

Q: How do I manage my relationship with my coworkers in a tense research environment?

A: Open communication, empathy, and a willingness to give and receive feedback are crucial. However, if others misbehave, discuss it first with trustworthy persons not part of the group. Develop a good strategy to address this behavior with your supervisor to avoid your complaint being seen as competitive behavior.  

Q: How does the overall environment affect my mental wellness during my PhD or postdoctoral period?

A: The environment, particularly if it’s ‘toxic,’ can significantly affect your sanity. Harassment, constant pressure, and a lack of support can result in significant stress. Do not hesitate to seek help if you notice a degradation in your mental health.

Q: How important is it to persist through difficult phases of my PhD or postdoc?

A: It is hugely important to persist. A research project is always an emotional rollercoaster, with high highs and low lows. Persistence helps you overcome obstacles and builds resilience for future challenges.

Q: How do I handle feeling like ‘I cannot even do this anymore’ during my PhD or postdoc?

A: If you constantly feel like ‘I cannot even do this anymore,’ it may be a sign of burnout. Talking to a therapist, taking time for self-care, or discussing your workload with your supervisor can be constructive steps forward.

Acknowledgments

I have used AI systems, including Grammarly, Google Bard, and ChatGPT, to enhance the English and comprehensiveness of this article. This post may contain affiliate links, meaning I get a small commission if you decide to purchase through my link. Thus, you support smartsciencecareer at no cost to you!

Recommended reading

The following articles may also interest you: 

• Is being a professor worth it?
• Four myths about scientists that let you work too much!
• How long does it take to complete a doctorate?
• For how long should I be a postdoc?
• Should I quit my postdoc?
• How to get over narcissistic abuse by a supervisor?
• Should I become a long-term postdoc?
• Should I publish negative results, or does this ruin my career in science?
• Why professors do not train you for the non-academic job market – and how to handle it!
• Pressure or pleasure – what produces better science?
• Should I Become A Professor? Success Rate 3 %!
• Career or contribution
• Am I good enough for a career in science?
• I have no idea where I will be in two years
• Will I find a job as a scientist?
• I am just an average scientist – what can I do?

Sven Hendrix is a Professor of Neuroanatomy at Medical School Hamburg (MSH) in Germany. He leads a research group dedicated to the neuroimmunology of brain repair and the development of xenofree organoid models as alternatives to animal experiments. Additionally, he serves as the speaker for CENE, a center focused on academic career development across MSH, Medical School Berlin (MSB), and the Health and Medical University (HMU) in Potsdam and Erfurt, Germany.

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Study Engagement and Burnout of the PhD Candidates in Medicine: A Person-Centered Approach

Lotta tikkanen.

1 Centre for University Teaching and Learning, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland

2 School of Applied Educational Science and Teacher Education, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland

Kirsi Pyhältö

3 Faculty of Education, University of Oulu, Oulu, Finland

Aleksandra Bujacz

4 Behavioral Informatics Team, Health Informatics Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden

Juha Nieminen

5 Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

This study focused on exploring individual variations in doctoral candidates’ well-being, in terms of experienced research engagement and burnout by using a person-centered approach. In addition, the associations between well-being profiles and gender, country of origin, study status (full-time or part-time), research group status and drop-out intentions were explored. The participants were 692 PhD candidates in the field of medicine. Latent profile analysis was employed to identify the well-being profiles. Four distinct profiles were identified: high engagement–low burnout, high engagement–moderate burnout, moderate engagement–moderate burnout , and moderate engagement–high burnout. Working in a clinical unit or hospital and working in a research group seemed to be related to increased engagement and reduced risk for suffering burnout, while the intentions to quit one’s doctoral studies were more frequently reported in profiles with moderate levels of engagement. The findings imply that although a significant number of PhD candidates in medicine had an increased risk for developing burnout, for most of the PhD candidates research education is an engaging experience.

Introduction

Undertaking a doctoral degree provides both highs and lows, potentially significantly reducing or increasing PhD candidates’ well-being (e.g., Stubb et al., 2011 ; Divaris et al., 2012 ; Caesens et al., 2014 ; Hunter and Devine, 2016 ; Swords and Ellis, 2017 ). Yet, previous research on the topic has focused heavily on the negative attributes such as stress (e.g., Oswalt and Riddock, 2007 ; Pappa et al., 2020 ), depression (e.g. Peluso et al., 2011 ; Levecque et al., 2017 ), anxiety (e.g., Barry et al., 2018 ; Liu et al., 2019 ), and exhaustion (e.g., Hunter and Devine, 2016 ), while positive aspects of PhD experience have been studied to a lesser extent ( Barnes and Randall, 2012 ; Sverdlik et al., 2018 ; Pyhältö et al., 2019 ). In particular, the number of studies exploring the combination or co-existence of positive and negative attributes of PhD candidates’ well-being is limited (for an exception, see Stubb et al., 2011 ), although PhD candidate’s well-being cannot be reduced simply to an absence of negative experiences ( Schmidt and Hansson, 2018 ).

A large body of research has indicated that the risk of burnout among physicians and other health care workers is high ( van Vendeloo et al., 2018 ; Dyrbye et al., 2020 ; Woo et al., 2020 ). The COVID-19-pandemic has further increased the risk of burnout among health care workers ( Chirico et al., 2021 ; Magnavita et al., 2021 ). In contrast, we know little about the well-being of research-active employees in the medical fields. Based on the literature on doctoral education, PhD candidates working in the medical context have rarely been studied. The medical research context is affected by the culture and hierarchy of the wider organizational culture of health care and hospital hierarchy, likely affecting PhD candidates’ well-being ( Kusurkar et al., 2021 ). Furthermore, there are at least two distinct subgroups of PhD students in these contexts ( Naylor et al., 2016 ): those who also work clinically and those working in the basic sciences. These two groups of PhD candidates often work under very different conditions, within the same medical university setting ( Naylor et al., 2016 ). More context-specific studies into PhD candidates in medical research education and the differing subgroups of PhD candidates in medicine have been called for ( Naylor et al., 2016 ; Kusurkar et al., 2021 ).

In this study, we aimed to explore the individual variation in well-being among PhD candidates in medicine by employing a person-centered approach. We focused on identifying burnout-engagement profiles employed by PhD candidates in the medical fields, and how they are related to working in a clinical unit or hospital, study status (full-time or part-time), research group status, and drop-out intentions. Also, differences between international and native (Swedish) PhDs candidates, and men and women were examined.

PhD Candidates’ Well-Being

PhD candidates’ study well-being is a multidimensional construct referring to a combination of positive mental states, such as satisfaction, self-efficacy or/and study engagement, and absence of extensive and severe negative ones such as burnout or strain related to doctoral studies, further contributing to a candidates ability to pursue their study goals ( Korhonen et al., 2014 ; Widlund et al., 2018 ). Study well-being is constructed in an interplay between demands and resources of the PhD. candidate and their doctoral study environment (see on study well-being among undergraduates Salmela-Aro and Upadyaya, 2014 ). In this study, we explore PhD. candidates’ study well-being in terms of study engagement and burnout. It has been suggested that s tudy engagement is a symbol of an optimal PhD experience, characterized by vigor, dedication, and absorption ( Schaufeli et al., 2002b ; Salmela-Aro and Upadyaya, 2012 ). Among PhD candidates, engagement is typically manifested as high levels of energy and mental resilience while working with one’s doctoral research, a strong willingness to invest effort in the doctorate, a sense of significance, enthusiasm, and inspiration, and being fully focused on one’s work, whereby time passes quickly ( Virtanen and Pyhältö, 2012 ; Vekkaila et al., 2013 , 2014 ). Engagement in doctoral study has been shown to be positively related to study progress and negatively to drop-out intentions ( Castelló et al., 2016 ).

Study burnout , in turn, refers to a negative study experience that is characterized by two core symptoms, exhaustion and cynicism, resulting from prolonged stress ( Schaufeli et al., 2002a ; Salmela-Aro et al., 2009 ). Exhaustion refers to lack of emotional energy and chronic fatigue ( Maslach and Jackson, 1981 ), and cynicism refers to alienation from one’s studying, perceiving them as meaningless and losing interest in them ( Maslach, 2003 ). Burnout during doctoral study has been shown to be related to delaying doctoral study and intending to quit them ( Pyhältö et al., 2012 ; Anttila et al., 2015 ; Hunter and Devine, 2016 ; Cornér et al., 2017 ; Barry et al., 2018 ).

In variable-based studies, study engagement and burnout have typically been found to be negatively related to each other ( Schaufeli et al., 2002a ; González-Romá et al., 2006 ; Salmela-Aro and Upadyaya, 2012 ; Swords and Ellis, 2017 ). This means that the PhD candidates experiencing high levels of study engagement are likely to experience low levels of study burnout and vice versa. However, various combinations of study engagement and burnout are also possible ( Tuominen-Soini and Salmela-Aro, 2014 ; Salmela-Aro and Read, 2017 ). For example, a PhD candidate can be highly engaged in their doctorate, but simultaneously experience high levels of exhaustion. A reason for this might the gradual development of burnout: burnout typically begins with exhaustion, and then, if working conditions remain the same, also the levels of cynicism increase ( Maslach and Leiter, 2016 ). Studies using a person-centered approach to explore PhD candidates’ study engagement and burnout simultaneously are scarce, resulting in a lack of knowledge about individual variations in the study well-being of PhD candidates in medicine. In addition, it is not known how different study well-being profiles are related to individual and contextual factors.

Antecedents of PhD Students’ Study Well-Being

Research has identified several individual and contextual antecedents of PhD candidates’ well-being. For instance, gender has been shown to be associated with study well-being, yet the evidence is mixed: although there is some evidence showing that female PhD students experience more stress and exhaustion than males ( Toews et al., 1997 ; McAlpine et al., 2020 ), there is also evidence of male postgraduates being more likely to experience increased levels of exhaustion than their female colleagues. Hunter and Devine (2016) , on the other hand, showed that PhD students’ gender was not associated with their experiences of exhaustion. The mixed findings imply that gendered impact may be dependent on the socio-cultural or disciplinary practices.

Some differences between international and native PhD candidates have also been reported. It has also been suggested that international PhD candidates are more career-oriented and more satisfied with their doctoral studies, which might make them more likely to experience research engagement compared to native PhD candidates ( Harman, 2003 ; Sakurai et al., 2017 ). However, international PhD candidates have also been shown to experience stress due to a lack of a supportive network ( Pappa et al., 2020 ), which increases their risk of burnout. Yet, evidence concerning the differences between domestic and international PhD candidates’ well-being is particularly limited.

Working conditions can be expected to have an impact on the well-being of PhD candidates in the medical fields. First, it has been suggested that the PhD candidates who are involved in clinical work experience high work strain due to constant balancing with their clinical or patient responsibilities and PhD research ( Kusurkar et al., 2021 ), which makes them prone to burnout experiences. On the other hand, there is also evidence that real work-life experiences such as clinical work can inspire candidates in their doctoral studies, and thus contribute to increased engagement (see Vekkaila et al., 2013 ). In a qualitative case study, comparing clinically active and basic science PhD candidates in the same context, Naylor and others (2016) showed that clinical doctoral candidates were initially less competent in basic research skills than candidates who had learned these skills at earlier stages of their basic science education. An adjustment from an established position at the clinic to being a junior researcher in the laboratory was challenging. On the other hand, financial stress characterized the experience of the science candidates more than that of the clinicians. Clinical PhD candidates also saw research education as being more clearly connected to career opportunities in the future than their basic science counterparts in the same setting did. Perceived employment opportunities have been associated with lower burnout levels in biomedical PhD candidates ( Nagy et al., 2019 ). Differences in the working conditions of medical PhD candidates may thus affect the levels of burnout and engagement in differing ways.

Research group status, i.e., whether the PhD candidate is undertaking their doctoral research within a research group or alone, can be assumed to have impact on study well-being. Research group has been shown to be an important source of social support to PhD candidates, and hence, working in a research group can be assumed to increase the experienced engagement ( Stubb et al., 2011 ; Peltonen et al., 2017 ). However, it has also been found that working within a research group can be a source of stress ( Stubb et al., 2011 ). Moreover, study status, i.e., whether the PhD candidate is undertaking their degree part-time vs. full-time, may have an impact on their study well-being. Yet, the evidence in this regard is partly contradictory. While those who work full-time are shown to be more satisfied with their supervision and perceive the scholarly community as empowering compared to those who work part-time ( Stubb et al., 2011 ; Pyhältö et al., 2016 ), candidates working part-time are shown to be more satisfied with their mental health and friendships ( Isohätälä et al., 2017 ).

Aim of the Study

The aim of the study was to understand the individual differences in study well-being among PhD candidates in medicine. More specifically, we explored the PhD candidates’ study engagement–burnout profiles and their associations with background variables that have previously shown to be associated with PhD candidates’ well-being [i.e., gender, country of origin, and study status (i.e., whether they were completing their doctorate full-time or part-time], and research group status). We also explored whether PhD candidates classified into different study well-being profiles differed in their intensions to drop out from doctoral studies. The following general hypotheses were formulated:

H1 : Different study engagement–burnout profiles can be detected among PhD candidates in medicine, ranging from profiles with high levels of burnout and low levels of engagement to profiles with low levels of burnout and high levels of engagement. H2 : The PhD candidates in the different study well-being profiles differ from each other in terms of gender, country of origin (i.e., domestic/international), and whether they are completing their doctorate full-time or part-time, and whether they work in hospital/clinical unit or not, and whether they worked with their doctorate alone or as a part of a research group (i.e., research group status). H3 : The PhD candidates with different study well-being profiles differ in their intentions to quit the doctoral studying, i.e., the students with high levels of burnout and low level of engagement are more likely to consider dropping out from the doctorate than those with low levels of burnout and high levels of engagement.

Materials and Methods

Research context.

This study had a cross-sectional design. The data were collected during 2015–2016 through a web-based survey using a secure platform (Artologik). The survey was conducted in English. All PhD candidates at Karolinska Institutet with an activity rate of more than 10% 1 received an invitation to participate in the survey. Karolinska Institutet is a research-oriented medical university with more than 2000 PhD candidates enrolled. “Medical” is understood as an umbrella term encompassing a wide array of fields with a connection to medicine: From clinical research to a wide variety of basic research topics in microbiological and life sciences. Several allied health sciences, behavioral and medical social sciences, such as nursing, physiotherapy, occupational therapy, psychology, medical ethics, and management are also represented.

All participants were enrolled in the same university-wide research education program and have the same overall formal requirements for their training, regarding the number of credits required from research education courses, general criteria for quality of research work, and basic structures of supervision and quality control of the research education process. However, within that universal organizational framework there is great variation in terms of the topics investigated, practices of individual research groups and supervisors and departmental structures.

There are clinical and basic science PhD candidates at Karolinska Institutet. The clinical PhD candidates typically work within two organizations: The hospital clinic or another health care organization (the manager or supervisor of the clinical work being the person the clinician reports to) and another one in the research group on the university side (the main doctoral supervisor most often being the candidate’s responsible manager). The basic science PhD candidates only work within one organization, the university, and have their main supervisor in doctoral education.

In Sweden, all PhD candidates are fully financed, meaning that they get a monthly salary. Their salary level depends on a variety of factors, mainly the source of finance (for example, grants from abroad, external competitive research funding, research funding from medical industry, or funding provided by the healthcare system for their employees). Clinical PhD candidates typically have considerably higher salaries than their basic science counterparts.

The context of the current study is similar to many other natural science contexts in that much of the research work is done within a research group, and a collaborative “teamwork research training structure” ( Chiang, 2003 ) is prevalent. However, there is considerable variation in this regard. At least two co-supervisors in addition to a main supervisor is an organizational norm.

Participants

In total, 2044 PhD candidates were invited and 692 responded to the survey (response rate 34%). PhD candidates were all in the medical fields. Of the participants, 61.3% were females and 36.6% males. The age of the participants ranged from 24 to 88, the mean being 35years. Forty six percent of the participants ( n =320) were Swedish and 53% ( n =366) were from another country. Of the participants, 67.2% ( n =465) reported that they were completing their doctorate full-time and 32.7% part-time. Nearly one-third (32.7%, n =226) of the participants were working in a hospital or a clinical unit. The proportion of those working mainly on their own with their doctorate was 54.8% ( n =379), and 44.4% ( n =307) of the participants reported that they were working in a research team.

Participants were informed that participation was completely voluntary and that they may withdraw from the study at any time without providing any explanation. They were also informed that all of the data which they provided would be strictly anonymous and treated confidentially, responses to the survey would not be linked to any other personal data and that analyses would be made at the group level. Before completing the survey, participants indicated that they had read and understood the information provided above and whether they agreed to participate in the study. The research was approved by the Swedish Central Ethical Review Board (Ref. No#2015/1626-31/5).

The participants completed the cross-country doctoral experience (C-DES) survey (see C-DES manual Pyhältö et al., 2018 ; Castelló et al., 2018 ). In this study, we used the following C-DES-scales to study PhD students’ study well-being: (1) research engagement (5 items) and (2) burnout in studying consisting of two factors: (a) exhaustion (4 items) and (b) cynicism (5 items). All items were rated on seven-point scales (1=not at all, 2=very rarely, 3=rarely, 4=sometimes, 5=often, 6=very often, 7=all the time; See Appendix 1 for the items). Mean variables were formed to represent research engagement, exhaustion, and cynicism in studying. The Cronbach alpha reliability and descriptive statistics of the subscales are shown in Table 1 .

Descriptive statistics and correlations of the study variables.

Data Analyses

A latent profile analysis (LPA) was used to identify subgroups of individuals based on their experiences of study engagement and burnout. LPA is a person-centered approach that involves grouping individuals into latent classes based on their observed response patterns on specific variables instead of exploring the relationships between the variables ( Berlin et al., 2014 ). LPA provides statistical criteria for model comparisons in selecting the best-fitting number of latent classes and opportunity to include predictors and outcomes compared to other clustering approaches (e.g., Vermunt and Magidson, 2002 ; Morin et al., 2018 ). The analyses were carried out using Mplus version 8.6 and MLR estimator that produces maximum likelihood estimates with standard errors and χ 2 test statistics that are robust to non-normality ( Muthén and Muthén, 1998–2017 ). Within-class variances were held constant across classes. We used several statistical criteria to choose the best fitting model: The Akaike (AIC), the Bayesian (BIC), adjusted Bayesian (aBIC) information-based measures of fit, and a Vuong-Lo-Mendell-Rubin (VLMR) and Lo-Mendell-Rubin (aLRT), and bootstrapped (BLRT) likelihood ratio tests ( Nylund et al., 2007 ; Berlin et al., 2014 ). In addition, the theoretical meaningfulness of the profile solution was emphasized in selecting the number of profiles. The average latent class probabilities and entropy values were used to evaluate the clarity of different profile solutions.

To explore whether the PhD candidates with different study well-being profiles differed from each other in terms of background variables (gender, country of origin, working in clinical unit or hospital, study status (full-time or part-time), research group status), we used auxiliary Mplus command ( Muthén and Muthén, 1998–2017 ). The background variables were included as antecedents of the latent class variable while accounting for the measurement error in classification ( Asparouhov and Muthén, 2014 ). This analysis was carried out with the R3STEP procedure of Mplus that performs a multinomial logistic regression and provides the odds ratios describing the effect of background variables on the likelihood of membership in each of the latent profiles compared to other profiles ( McLarnon and O’Neill, 2018 ). DCAT procedure for Mplus was used for examining whether candidates in different profiles differed from each other in terms of their intentions to quit studying for their doctorate.

The Study Well-Being Profiles

LPAs were run with 1–6 classes ( Table 2 ). According to VLMR and aLRT likelihood ratio tests, adding a subsequent class increased the model fit all the way to six classes, while the information criteria (AIC, BIC, and aBIC) showed that adding a new latent profile enhanced the model fit all the way to five profiles. However, the elbow plot ( Figure 1 ) showed that the BIC and aBIC values clearly decreased from one to four profiles, after which the decline levelled off. Therefore, the four-profile solution was selected. The four-profile solution was also considered to be the most parsimonious model, had a clear theoretical interpretation, and included profiles with sufficiently large memberships (i.e., >5% of the cases). The entropy value (0.80) and latent class probabilities (>0.80) also showed sufficient separation between the profiles in the four-profile solution showed sufficient separation between the profiles.

Information criteria values for different profile solutions in LPAs.

LogL , log likelihood value; nf , number of free parameters; AIC , Akaike information criterion; BIC , Bayesian information criterion; aBIC, adjusted Bayesian information criterion; VLMR, VuongLo-Mendell–Rubin likelihood ratio test; aLRT, Lo-Mendell-Rubin adjusted likelihood ratio test; BLRT , bootstrapped likelihood ratio test. The selected model is in boldface .

Elbow plot of information criteria for different profile solutions.

Four well-being profiles were identified ( Figure 2 ). The first study well-being profile was high engagement–low burnout profile (see Table 3 ). It was the second most common profile among the participants with a 32.7 percent share ( n =226). The PhD candidates in this profile reported rather high levels of study engagement meaning that they often felt enthusiastic and inspired by their doctoral work. They reported low levels of cynicism, but moderate levels of exhaustion. However, when compared to other profiles, the exhaustion levels were lowest in this profile.

Study well-being profiles of the PhD candidates in medicine.

Profile means and standard deviations.

The second profile was high engagement–moderate burnout profile, and it was the most common profile among the participants with a 33.2 percent share ( n =230). The PhD candidates within this profile reported moderate levels of both exhaustion and cynicism, and high levels of study engagement. The third profile was moderate engagement–moderate burnout profile. It represented 25.1 percent of the participants ( n =174). The PhD candidates with this profile demonstrated moderate levels of study engagement, exhaustion, and cynicism. This means that although the PhD candidates within this profile felt rather inspired and enthusiastic about their doctoral studies, they also sometimes felt overwhelmed by the doctoral study related workload and perceived their doctoral studies as meaningless. The fourth profile was moderate engagement–high burnout profile. The PhD candidates with this profile reported high levels of both exhaustion and cynicism. The candidates’ high levels of study burnout were combined with moderate levels of study engagement. This profile represented 9.0 percent of the participants ( n =62) being the least common profile.

The profiles differed statistically significantly ( p <0.01) from each other in all study variables, research engagement, exhaustion, and cynicism.

The Antecedents of Study Well-Being Profiles

Gender and country of origin did not have statistically significant relationships with study well-being profiles. Whether the PhD candidates were completing their doctorate full-time or part-time did not predict the profile membership either.

The PhD candidates who reported that they were working alone with their doctoral thesis had higher odds of belonging to moderate engagement–high burnout profile than to high engagement–moderate burnout profile ( b =0.98, SE=0.38, p =0.011, OR=2.86, 95%CI[1.25–5.64]) or high engagement–low burnout profile ( b =1.35, SE=0.38, p <0.001, OR=4.22, 95%CI[1.83–8.11]) compared to those who were completing their doctorate in a research group. In addition, the PhD candidates who reported that they were working alone with their doctorate had higher odds of belonging to the moderate engagement–moderate burnout profile than to the high engagement—low burnout profile ( b =0.83, SE=0.25, p =0.001, OR=2.28, 95%CI[1.39–3.75]) compared to those working in research groups.

The PhD candidates who were working in a clinical unit or hospital had higher odds of belonging to high engagement–low burnout profile than to moderate burnout–moderate engagement ( b =0.61, SE=0.29, p =0.037, OR = 1.85, 95%CI[1.04–3.25]) or moderate engagement–high burnout ( b =1.30, SE=0.52, p =0.012, OR=3.56, 95%CI[1.30–9.72]) profiles compared to those who reported that they were not working in a clinical unit or hospital. Those working in hospital or clinical unit also had higher odds of belonging to high engagement–moderate burnout ( b =1.23, SE=0.50, p =0.015, OR=3.66, 95%CI[1.33–10.10]) profile than to moderate engagement–high burnout profile than those who were not working in a clinical unit or hospital.

Taken together, the PhD candidates who reported that they were working alone with their doctorate had higher odds of belonging to profiles displaying lower levels of engagement and higher levels of burnout compared to those working in a research group. In turn, the PhD candidates who reported working in a clinical unit or hospital had higher odds of belonging to profiles displaying higher levels of engagement and lower levels of burnout compared to those who were not at a clinical unit or hospital.

Differences Between PhD Candidates in Different Profiles in Their Dropout Intentions

The PhD candidates in various profiles differed statistically significantly from each other in terms of their dropout intentions [ χ 2 (3, N =690)=147.6, p <0.001]. The intentions to interrupt one’s doctoral studies were most frequently reported in the following profiles: moderate engagement–high burnout profile (74.7%) of the PhD candidates with this profile had considered dropping out) and moderate engagement–moderate burnout profile (53.4%). However, the candidates with profiles characterized by high study engagement reported less intentions to interrupt their doctoral studies: 7.2% of the PhD candidates with high engagement–low burnout profile and 16.6% with the high engagement–moderate burnout profile had considered dropping out.

Findings in the Light of the Literature

In this study, we explored PhD candidates’ research engagement–burnout profiles. Adopting a person-centered approach allowed us to explore individual variation in PhD candidates’ study well-being by considering both positive and negative attributes of well-being at the same time rather than concentrating on the negative ones which has been the focus of several previous studies (e.g., Oswalt and Riddock, 2007 ; Peluso et al., 2011 ; Levecque et al., 2017 ; Pappa et al., 2020 ). Four distinct profiles among the PhD candidates in the field of medicine were identified: high engagement–low burnout, high engagement–moderate burnout, moderate engagement–moderate burnout, and moderate engagement–high burnout. The person-oriented approach complements variable-based studies showing a negative association between engagement and burnout ( Schaufeli et al., 2002a ; González-Romá et al., 2006 ; Salmela-Aro and Upadyaya, 2012 ; Swords and Ellis, 2017 ) by indicating that there are individual differences in how exhaustion, cynicism, and engagement can combine within a person. Our findings supported the bivariant approach on burnout and engagement, positing that burnout and engagement present two distinct, yet related dimensions of the individual’s affective study related experiences ( Shraga and Shirom, 2009 ; Larsen and McGraw, 2011 ; Shirom, 2011 ).

The results showed that the levels of research engagement were high or moderate in all the profiles and the most common profiles were those displaying high levels of engagement. Thus, the results indicate that undertaking doctoral studies in the field of medicine is a highly engaging experience. However, the results also showed that the risk of experiencing study burnout was also elevated (i.e., moderate or high) among most of the PhD candidates. These results are in line with earlier findings ( Kusurkar et al., 2021 ) suggesting an increased risk of burnout in medical researcher education.

The results also showed that those PhD candidates who reported working alone with their doctoral studying were more likely to belong to the profiles displaying moderate levels of engagement and higher levels of burnout. This implies that engaging in researcher group provides a potential resource for cultivating not only study progress but also the candidate’s well-being, identified also in previous studies ( Pyhältö et al., 2009 ; Stubb et al., 2011 ; Peltonen et al., 2017 ). Interestingly, although medicine presents typical group-based discipline, i.e., the basic unit for conducting research is a research group providing the platform for researcher education, according to our results only about half of the candidates reported that they were engaged in a research group. This implies that formal research group structure does not automatically guarantee an experience of membership or a well-functioning collaboration with the research group.

The results showed that the PhD candidates who were working in a hospital or clinical unit had lower risk of experiencing burnout and were more likely to experience high levels of study engagement than others. This means that undertaking one’s doctoral degree when having clinical responsibilities might protect the PhD candidates from study burnout and support their study engagement. On the contrary, Kusurkar et al. (2021) found that candidates in clinical departments had lower autonomy and higher levels of conflict between work responsibilities, especially among those PhD candidates who were working with patients. A variety of factors may explain our finding. The relevance of the research itself and doctoral studies in general might become apparent in the clinical work and hence, be a source of research engagement (see also Vekkaila et al., 2013 ). On the other hand, the candidates engaging in clinical work might have more extensive support networks to draw from as a resource for their studying and recovery when needed. They might be also less stressed by their career prospects after completing the PhD degree or they might be aiming for a non-academic career to reduce the stress caused by the doctoral studies (see Nagy et al., 2019 ). In addition, financial security may explain the differences in burnout levels: Clinical PhD candidates typically receive a much higher salary than PhD candidates who do not have clinical training or employment. In addition, basic science researchers will typically rely on external, competitive funding not only for the research work itself but even for maintaining a position at the university, thereby having much lower job security than their clinically active counterparts, who always have the chance of increasing the proportion of clinical work, should funding for research be scarce.

International PhD candidates did not differ in their likelihood of belonging to any subgroup. As previous studies have suggested that although international students might be prone to experience stress ( Pappa et al., 2020 ), they are also likely to be motivated and satisfied with their studying ( Harman, 2003 ; Sakurai et al., 2017 ), and thus be likely to experience research engagement. To our knowledge, no earlier study has looked at engagement and burnout of international doctoral students specifically in the medical research education, a context that tends to be extremely international and intercultural. Based on this finding, it seems that there were no distinctive differences between the international and native PhD candidates regard to their engagement-burnout-profiles. Accordingly, this suggests that the international PhD candidates in the field of medicine are highly heterogeneous group in terms of study well-being, not primarily determined by their status as international students. For example, it might be that whether they experienced working alone or within a research group or were clinical vs. basic science medical PhD candidates, were more significant in terms of their well-being than being an international PhD student.

The PhD candidates within the profiles displaying moderate levels of engagement and moderate or high levels of burnout symptoms more often reported intention to quit the doctoral degree than those with high levels of engagement, which was in line with previous findings ( Anttila et al., 2015 ; Cornér et al., 2017 ). Hence, in addition to having mental health benefits, high levels of experienced engagement are related to study progress among PhD candidates in the field of medicine. Accordingly, investing in developing engaging doctoral education environments has potentially significant individual and organizational benefits, considering that according to previous studies, drop-out rates among the PhD candidates typically range from 25 to 60% (e.g., Council of Graduate Schools, 2004 ; Golde, 2005 ; McAlpine and Norton, 2006 ; Gardner, 2009 ).

Limitations of the Study

There are some methodological limitations in the study that need to be considered when interpreting the results. First, the criteria for selecting the number of profiles were ambiguous ( Nylund et al., 2007 ), and hence, further studies exploring whether similar profiles can be found among other groups of PhD candidates are needed. For example, models for how profiles can be reproduced in new samples are being developed and may be helpful in exploring the well-being of PhD candidates across different medical research contexts (e.g., Gillet et al., 2021 ). Second, it is important to note that due to cross-sectional design, causal or process-related conclusions between study well-being and dropping out cannot be drawn. Third, the survey was sent to all doctoral students at the university simultaneously. Although the number of students who responded is sufficient for the analyses conducted, the sample only represents 36% of all doctoral students enrolled in the program. This should be kept in mind when generalizing, as we do not know whether self-selection might have affected the results. Fourth, the study was carried out in a specific social-cultural country context and in health sciences, accordingly one should be careful in drawing conclusions based on the results, across the doctoral education systems or disciplines. Last, it is important to note that data were collected before the COVID-19-pandemic. The pandemic has affected both the clinical and basic-science doctoral students in many ways. Further studies are needed to explore how stress, engagement and well-being of doctoral students working in the medical context have been affected by the pandemic at its different phases and afterwards.

Undertaking a PhD in medical fields is an engaging experience for most of the PhD candidates. However, the results suggested that there are several PhD candidates with high or increased risk of burnout. Thus, it seems that individual differences occur between PhD candidates in terms of their well-being. For individuβals displaying a higher risk of burnout, it was more common to experience studying alone in their PhD compared to those with lower burnout risk. In addition, the lower risk of burnout was related to working in a clinical unit or hospital. Therefore, it can be concluded that in the field of medicine, working in research group, and in a clinical unit or hospital during their PhD can help buffering study burnout and provide sources of research engagement.

Practical Implications

The results of the present study can be used by educational developers and staff trainers working with doctoral education. The stressors experienced by basic science PhD candidates in the highly competitive, externally funded research universities need to be taken into consideration by supervisors and policymakers. Particular attention should be paid to the candidates who experience that they are studying alone. Supervisors should be encouraged to be particularly careful in mapping out the actual support networks of their PhD candidates, instead of just formal connections to officially defined research groups. Moreover, the similarities and differences between the conditions of the clinical and non-clinical PhD candidates are worth discussing, as they work in the same general setting. The positive news for medical universities is that despite the pressures and competing responsibilities, the medical research setting is often experienced as engaging and does not automatically lead to burnout, a message worth spreading in this community engaged with cutting-edge, life-saving academic research. The study also has implications for policymakers: the findings highlight the importance of surveillance of the occupational health within the hospitals to check the psychosocial risk factors for staff undergoing research education, not merely that of residents and other health care workers.

The results also provide directions for future research on PhD candidates’ well-being. Our findings suggested that although an official membership in a research group is common in medical university, over half of the participants in this study reported that they were working alone. Working alone instead of within a research group was more common in profiles with higher burnout levels and lower levels of engagement. Therefore, reasons for the finding that most of the participants experienced working alone needs to be studied further. For example, investigation is needed to see if working alone is an active choice of a candidate or whether it represents a failure of the research education system in ensuring a supportive setting for doctoral students. In such further investigations, special attention should be paid to the actual networks, communities of practice and support. Also, factors involved in medical doctoral students’ engagement and burnout warrant closer investigation. As engagement may be more of a day-to-day experience, while burnout takes more time to develop ( Sonnentag, 2017 ), it might be useful to look more closely at the sources of engagement for both the clinically active and the basic science subgroups of medical PhD candidates, both to identify them more precisely and to investigate the variability and trajectory of them. Given the highly competitive, high-pressure nature of research-oriented medical contexts, it might also be useful to look at experiences of exhaustion as separate from fully developed burnout, as recent research indicates that weariness does not necessarily develop into more serious burnout ( Gustavsson et al., 2010 ; Gillet et al., 2021 ). For PhD candidates, supervisors, and decision-makers in these competitive environments, where high workload is more the norm than the exception, a more detailed understanding of these processes would be invaluable in terms of identifying high-risk situations and individuals in urgent need of help.

Data Availability Statement

Ethics statement.

The research was approved by the Swedish Central Ethical Review Board (Ref. No#2015/1626-31/5). The participants provided their written informed consent to participate in this study.

Author Contributions

LT, KP, AB, and JN have contributed to writing the original draft and editing it. AB has contributed to data collection and project administration. LT has contributed to conducting the analyses. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1 Time devoted to a thesis is more than 4 h/week.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.727746/full#supplementary-material

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10 Effective Stress Management Tips for Ph.D. Students

Did you embark on a PhD with a preconceived notion that it’s going to be a stressful journey? If your answer to that was a resounding yes, then you are not alone and definitely not wrong about it either! Sailing through a PhD can be quite daunting. As revealed by a survey conducted by  Nature , over 36% of the total researchers seek help for anxiety or depression related to their PhD. Although these results come from a small sample of around 6300 PhD students worldwide, the results are significant enough to address the prevalence of mental health issues in academia. Stress management is imperative for a smoother and tension-free research outcome.

With passing years, the stress levels among PhD students is worsening. Much has been spoken and written about how to overhaul the system and help students in their battle of coping with stress. However, in reality, the advice to PhD students is just a concept that’s heard and read about.

This article will guide PhD students and will discuss various factors that trigger stress levels at different stages in the life of a researcher. The tips for new PhD students will help them to combat stress and preserve your mental health.

Factors Causing Stress and Depression in PhD Students

Stress management of next generation researchers needs a systematic approach . However, before finding solutions, knowing the root cause is necessary to avoid similar situations in the future.

1. Growing Competition in Your Field

Students often get intimidated by the ongoing research in their field and compare the progress and status of their work with other researchers’ work.

2. Work Overload

Excessive work pressure and relentless overtime working induces anxiety and increases stress levels amongst PhD students.

3. Role Ambiguity

It is often seen that a candidate is unaware about their role in the study and what the supervisor or the Principal Investigator (P.I.) expects out of them as a peer.

4. Physiological Factors

While embarking on a PhD., students often take time to adapt to the physiological changes that come along. Dealing with physical health issues diverts your mind from focusing on your research work.

5. Behavioral Approach

Researchers tend to follow a fixed framework to complete their experiments. When unexpected results are derived, finding an alternative solution to obtain conclusions and scheduling a proper action plan encroaches the minds of a PhD student.

6. Performance Pressure

Most Ph.D students also work while pursuing their research. Hence, maintaining regular attendance, achieving goals, keeping the grades high, and completing assignments while adhering to deadlines can take a toll on their mental health.

7. Relationship with Supervisor

Working in isolation will not take you a long way. Not maintaining a healthy work-relationship with your supervisor affects the research outcome and by extension affects your mental health.

Tips for PhD Students to Overcome Anxiety

The solution to the  rising stress levels and mental health issues  faced by PhD researchers does not solely lie in the institutions providing on-campus mental-health support. Furthermore, it also does not depend on the institutions providing training for supervisors to deal with their group of students in coping with the stress. It also lies in understanding that stress is a consequence of an excessive focus on measuring performance. In addition, other entities such as the funders, academic institutions, journals, and publishers must also take responsibility of the mental health of researchers in a way that is feasible and within their limits.

The late nights and early mornings spent within four walls while completing your PhD, juggling between work and study, papers to publish, supervisors to please, and perhaps also living up to your family’s expectations takes a toll on you.These are some common instances where most Ph.D students are taken aback and left clueless.

The first step in fixing the problem is acknowledging it!

1. Finding an Credible Supervisor

As your supervisor is someone who will guide you throughout your program and help you face challenges, it is imperative to select your supervisor carefully. This process of identifying an incredible supervisor could get difficult and leave you confused. But a trick to deal with this is identifying a supervisor who is supportive, actively working in your field, has a strong publication record, and can give you sufficient time for mentoring.

2. Find the Right Research Funding Body

High rates of stress and depression arises at this stage of your PhD Strategizing your path into  choosing the right funding body for your research  is very important. Focus on maximizing the value of your research rather than just looking for monetary support.

3. Time Management

As a researcher, the key to a  stress-free research workflow is effective time management . Prioritize your tasks and plan your day based on the same. Set realistic and achievable goals. Do not overwhelm yourself with too many tasks to be done on a single day. Online project management tools such as Asana, Trello, ProofHub, etc. will help you to be on the top of your tasks.

4. Maintain a Healthy and Professional Supervisor‒Student Relationship

Finding yourself alone is quite normal for most people. Try building new connections with your colleagues and be affable to everyone. Maintaining a healthy and professional supervisor-student relationship is critical for the success of any research work.  Good communication will give you and the supervisor a clearer picture of your work. Share your honest concerns with your colleagues and supervisor in the most respectful way. If there is minimal response, reach out to the mental health team of your institution to resolve any conflicts amicably.

5. Presenting Negative or In-conclusive Results

There’s nothing to be ashamed of if your experiment does not deliver the expected results. Honest presentation of results is what makes you an ethical and respected researcher in the community,  irrespective of the results being positive, negative, or mixed . Compare your results and review them using tables or charts for effective presentation.

6. Writing Your Thesis

Here’s when you are one step closer to completing your PhD! The journey from here on is only uphill. So don’t push yourself back now. Start with planning your writing activities with a fresh mind. Furthermore, define sections of your thesis and focus on one section at a time. Don’t bother yourself with editing and formatting of the thesis. Complete the writing part first. Work on editing and finally  proofreading  your article to refurbish it in the next stage.

7. Select the Right Journal

Now that the writing process is completed, there’s no looking back from here. But the threat of falling prey to predatory journals cannot be unseen. Make this process easier by finding a journal that is related to your discipline. Consider the impact factor of the journal. Use journal finder tools such as  Enago’s Open Access Journal Finder , Elsevier Journal Finder , Springer Journal Suggester, Manuscript Matcher Tool in Web of Science Master List, etc. Once you have a list of journals, check their aims and scope to ensure your article fits their criteria.

Stress Management Tips for PhD Students and Early Career Researchers

Researchers must understand that completing their PhD is a part of their life and that it will come to an end someday. Whilst pursuing PhD  neglecting your mental health will eventually affect your research outcomes  in future. Therefore, stress management is very crucial to preserve your mental health and lead a peaceful life.

Follow these tips to maintain a work­‒life balance and preserve your mental health:

1. Acknowledging the Problem

We often deny that our mental health is affected by an external factor. It is important to understand what is bothering you and keeping you from achieving your goals. Therefore, once you are aware of the cause, accept it and work in a way to combat it.

2. Talk About the Problem

Being negligent and keeping those bothersome thoughts to yourself will only worsen the situation. Talk about your concerns with people who would care about it and help you deal with your anxiety.

3. Improve Your Organizational Skills

Your  key to successfully completing your PhD  is by managing your tasks efficiently without over-committing. Hence, maintaining a balance between professional and personal work is crucial.

4. Social Involvement

Engage yourself in social activities to keep your mind from spiraling in the pool of negative thoughts. Additionally, join groups that are not related to your domain. Learn to make connections with new people and get to know them better.

5. Rekindle Long Lost Hobbies

Get that old sketch book you left in the groove! Reembrace hobbies you haven’t been able to catch up with for a really long time. In addition, engage in fun activities or games that make you happy.

6. Practice Mindfulness

Try the 2-step exercise called “ The Mindful Pause ”. In this, you pause before or during a stressor and attentively breathe for 15 seconds, followed by one question for yourself — how might I use one of my character strengths right now? Take positive action with any character strength that pops up.

7. Meditate as a Relaxation Response

Spare 10-20 minutes a day, preferably in the morning to meditate. This involves silent repetition of a word, sound, or phrase while sitting quietly with a good posture and eyes closed.

8. Get Involved in Any Form of Physical Activity

Implement any form of physical activity in your daily routine to improve your cognitive and physical abilities. Consequently, the release of endorphins whilst exercising acts as a catalyst in keeping your spirits high.

9. Be Grateful

Acknowledge and appreciate the gift of life. Unleash your gratitude for being able to fulfil your dreams. Furthermore, remember every positive thing that has ever happened to you and express gratitude for having made things possible.

How often have you been stressed out while pursuing your PhD? Have you ever followed any stress management tricks? What are your thoughts on these advices to PhD students? What was your move in coping with stress associated to your research? Has maintaining proper work-life balance been easy for you? Let us know about your and your colleagues’ experiences in combating stress in the comments section below!

I have faced stress and maintaining balance in my life. Working full-time while pursuing a Ph.D. full-time with a family has been challenging thus far. I am going to try utilizing these tips to see how they help.

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Deadlines, panic attacks, and the PhD student

As I was preparing my coffee one morning, I was rubbing my jaw, trying in vain to work out the tension that had built overnight from a serious teeth-grinding workout.

Hi! I’m Stressed, nice to meet you!

The day before, I had a meeting with my PhD supervisors, and we agreed that I should apply for an extension on my thesis submission. The submission date was looming, and I had been staunchly ignoring the bubbling magma of terror that was slowly rising within me the past few months.

Sure, doing a PhD is stressful. That’s a given, no argument there. But I was noticing that the thing I was calling “PhD stress” had been quietly morphing into something closer to panic. Ah, hello old friend.

Me and Panic go way back. We were formally introduced 15 years ago when I had my first full-blown panic attack, and we’ve known each other ever since.

To be honest, she’s a bit of an asshole. One of her favourite pastimes is to pop by when I’m in the midst of a record-breaking life-juggling act, and lovingly put a megaphone up to the critical voices in my head that are saying: “You’re doing that wrong.”

She has a tendency to shape-shift, so sometimes it takes me a while to notice when she’s shown up. But that morning, over coffee and a self-administered jaw massage, I noticed the tell-tale trail of banana peels she likes to leave throughout the corridors of my mental house.

I started wondering what invitation I had sent out that inspired her to come back to town. I was checking in with loved ones regularly, eating pretty well, avoiding alcohol, and going for long walks each day.

Since when did she respond to that? But then, like a tension headache, it hit me: I’m really bad at self-validation.

I was focusing so much on doing things right in my external world that I had gotten completely off-track in my internal world.

I noticed one pattern in particular: I felt good about myself when I received overtly positive feedback from external sources, but only when that positive feedback aligned with what I felt I deserved.

When the single source of validation was me, or when I felt like I didn’t deserve the external feedback I was receiving, I felt bad. It’s like the mental equivalent of cross-validation; I needed multiple models to come to a similar positive conclusion about me in order to feel OK.

For months without realising it, I had been telling myself that I wasn’t smart enough or creative enough or hard-working enough; I wasn’t good enough to finish this PhD.

As humans, this makes a lot of sense. We’re social animals, and being positively regarded by our friends, family and mentors is as important as, and even contributes to, our physical health. But when external validation is the main source of positive self-regard...Well, that’s when we end up in the hot seat. And that’s where I found myself.

I realised that, due to heightened self-criticism, there was actually no way for me to feel OK without the help of others, and when I felt I didn’t deserve positive feedback, those self-criticisms got even louder and meaner.

In a brain that relies on cross-validation as its main mode of understanding self, how could I expect to hold myself up when things got hard?

So I made a decision. I would notice self-critical thoughts, and I would check them. I would test the underlying assumptions and see if they held up under the harsh light of objectivity.

I would self-correct when criticisms were too harsh, and I would find ways to improve myself when criticisms maybe kind of had a point.

This kind of self-assessment is an aspect of cognitive behavioural therapy (CBT) that I learned when I first started seeking support from psychologists 15 years ago.

I’ve learned a lot over the years, and while I’m still thwarted by the occasional metaphorical banana peel, one of the most important things I’ve learned is that we can be our own worst enemy, or our own best friend.

It’s easier to be your own enemy, but life is immeasurably better when you actively choose, day in and day out, to be your own best friend.

So I drank my coffee and began rekindling my friendship with myself, and before long, sweet old Panic humbly set about picking up the banana peels she’d scattered before quietly showing herself out.

• PhD students
• PhD deadlines

Alexandra Nance

PhD Candidate, School of Biological Science

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How to manage Phd stress, anxiety and disillusionment

Either that or they feel like this is the only path that could possibly delay the pains of job hunting.

Whatever be the reason, one ends up in grad school, one looks forward to an experience of academic growth, with the professors. The professors, they think and hope, will walk them through the expansive mire of intellectual space.

All that quickly fades away, much like the career of a-once-popular Baba Sehgal. It starts with qualifiers, comprehensive exams, proposal defense- many names but all with the same intent, an initiation of sorts, to getting used to being intimidated.

With the load of courses and teaching assistantships , one gets little time, if any, to start research. Well, at least that’s how it works in most of the US, unless you get some kind of a fellowship and don’t have to worry about earning a living through teaching. When I say earning, though not being paid in peanuts, it is just enough to buy a sack of peanuts and rent a measly apartment to store it in.

Now, having completed the obligatory dance-around-the-fire, one is ready to start on their doctorateship . After careful consideration of – which field to go to, whether Prof. X has funding to last ones’ thesis, and whether he would pass the congeniality test, in the last month’s issue of the Cosmopolitan – one chooses their advisor, Prof. Right.

Call me cynical, but six and a half times out of ten, advisors turn out to be that guy your Mom warned you about. It is not that advisors want to be mean. It just so happens that after years and years of dealing with students, bean counting funding agencies, over-critical paper reviewers, school administrators and financially disappointed family members, the only people they feel almighty over, are their PhD students.

Since, churning anecdotes is my favorite thing, here’re some.

In an unnamed school, an unnamed advisor had forbidden, his unnamed student, to return to his home-country to visit his critically ill father-in-law, Mr. Patel. There is no need to take leave to meet distant relatives. Try telling your wife that her parents are nothing but distant relatives who don’t concern you!

In another unnamed school, another unnamed advisor made his student work 7 days a week, without a break, for 15 hrs everyday. The student was from one of those troubled countries who couldn’t just visit home, on a whim. He sent for his mom, to meet him after 5 years. In the two weeks she was visiting, his advisor let him stay home for just one weekend!

I know, I am known to see the worst in people, and there are advisors who treat their students with respect and consideration. But that doesn’t take away from the fact that the system relies a lot on the relationship between students and their advisors. And such a system is too delicate to not cause any stress.

PhD research is a demon in itself. It is not always easy for students to transition from the receiving end, of education, to being the ones who are finding new things about a subject matter. One can spend 5-6 years on a project and end up with no result, or be told that someone has already published a paper on the same problem she/he has been pursuing. It is not uncommon to find PhD students, in their final years, to reach a state of impasse. Often students show symptoms of, what is called, an impostor syndrome . Feeling like they are frauds, pretending to be intellectuals, in academia. With constant intimidation from advisors and bleak job prospects, this feeling is quite understandably reinforced. Questioning, ones’ decision to pursue a PhD, becomes a common theme among students.

With this much overwhelming cynicism, disappointment, intimidation and overall disillusionment, how can a PhD student keep up with demands of the program?

According to a study, at University of California at Berkeley , nearly 47% of surveyed PhD students showed signs of depression, highest numbers being in the humanities and arts departments. Nearly 10% of them had even contemplated suicide during their program.

The root of these depressive feelings are related to their PhD in more ways than one. Feelings of disillusionment, are also woven into the feelings that lead to depression. Uncertainty in future job prospects, financial instability, isolation, lack of clear academic progress, not feeling valued, strained relationship with advisor, health and sleep deprivation, all add fuel to the fire.

How then, can a student seek help? One can begin to answer by suggesting a few things.  

How to manage Phd Stress, Anxiety and Disillusionment

1. have a social life.

It is absolutely essential to have friends/agreeable family as a support system. You can always find this one gal/guy who is always in the lab, in the library, reading papers, studying. While still being an excellent means to complete ones’ PhD a year before others, it can make such a student unable to define her/his existence beyond the program. In its worst form, it can even lead to depression.  

2. Cultivate Hobbies and Interests

I got hooked on carpentry and old TV shows, during my PhD. In fact I know enough American criminal law, from Law & Order , to arraign and prosecute any psychopathic murderer…as long as they confess. Hobbies are an excellent medium to channel ones’ frustrations away. Hobbies are a well-suggested means of countering stress and depression. It takes care of the constant obsessive pattern of research, that students subject themselves to.  

3. Stay Healthy

PhD students are notorious in treating their health as secondary. Sleeping 3-4 hours, keeping odd hours, surviving on cheap and low quality food, and stressing way too much. All this comes at the cost of a healthy body. Stress, being a self-feeding phenomenon, makes it easy to prey on constitutionally weak students.  

4. Improve relationship with advisor

During my PhD at Michigan State University, I was blessed with an excellent advisor who, however, was not beyond the occasional loss of temper. After one such occasion, I had gone back to his office, later, to tell him that I couldn’t continue working for him if I was going to be scared of his temper all the time.

And amazingly, he apologized. I, who had never spoken my mind to another Professor, before in India, wasn’t expecting to be apologized to.

But I learnt a lesson from that episode. Professors are just humans, not aliens with superpowers. An honest confrontation could possibly be their kryptonite.

With an open relationship, with ones’ advisor, a student can begin to address the feelings of inadequacy in her/his work. With that, will come, confidence and the much needed self reliance.  

5. Have a Plan B

What if academia is not your thing? You can get a PhD and still decide to go do something else. The web is full of career change stories . Having some plan to fall back on, can be the reassurance needed to carry on and not be stressed about the what-ifs .  

6. Don’t be afraid to seek help

Follow some simple steps to manage stress, as has been summarized in the articles, 5-a day stress management techniques or 15 stress management tips . Talk to friends/family and seek counseling, at the University health facilities or avail of a free online counseling startup facility .

In the end, PhD is an ambitious and challenging program. The optimum qualities, for success, are determined by many factors, many of which are beyond hard-work and intellect.

PhD students have more to gain by learning how to keep themselves from getting carried away with stress and doubt. One can then hope to still keep up with the optimism, one started with, and leave that much-desired mark, and not a stain, in academia.

3 thoughts on “How to manage Phd stress, anxiety and disillusionment”

Very useful article! Interestingly, these constitute a healthy practice at any stage of life. We have a tendency of taking ourselves seriously, perhaps, a little too seriously. And that too in our familiar and comfortable constructs, whatever those may be. For me, the entire phD-experience kept shattering this, repeatedly. With some combination of the above, it was possible to improvise and adapt, to the point that stress could induce creativity, almost a Pavlovian one.

At any rate, for me, phD and managing through it would remain as a trailer to how life in the real world is.

@rakhi, How can you have the patience for post doc. Am confused between phd and ms because i think i may not have the endurance for phd though i like that option

The answer is so subjective, Ronit. All I can tell you is that whatever program decision you make, you should be looking into its benefits after you get the degree. What field are you in? It always helps to see the career path that your seniors have followed. What job options are there post MS and/or post PhD? By what age would you be possibly graduating from your PhD (‘coz trust me, that matters)? And many more considerations that would be pertinent to your field, personality, institution, your adviser and so and so. I guess what you can do is identify your field of interest, talk to potential advisers, see if you think it is feasible in terms of time and money and then perhaps you will have more information to make the decision. Did that sound helpful?

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Stress levels: PhD versus non-academic full-time job

Is pursuing a PhD as stressful as a full-time job? This is a question that many prospective PhD students ask themselves. While it depends on your personality, a PhD can be more stressful than a full-time job outside of academia. Several specific circumstances trigger high-stress levels among PhD students.

Stress as a subjective experience

Phd students tend to be perfectionists, a phd requires a lot of self-responsibility, phd work feels very personal, phds students have a less external structure, phd research is often underpaid.

Stress is subjective. Every person experiences mental or emotional strain resulting from demanding circumstances differently. Therefore it is difficult to generalize. However, doing a PhD is a unique situation that tends to trigger high levels of stress.

It is useful to have a good understanding of the common types of stress that PhD students experience, and why. On that basis, prospective candidates can evaluate for themselves whether it would be more or less stressful for them to pursue a PhD instead of working full-time outside of academia.

The world is full of perfectionists. However, the percentage of perfectionists in academia tends to be higher than in other professions.

Character traits such as an eye for detail and conscientiousness make for a good university student. Standing out by delivering excellent work during a bachelor’s and master’s programme is directly linked to chances of getting a PhD position.

PhD students are often driven and have a high degree of self-awareness. While this has obvious benefits, it often goes hand in hand with excessive self-criticism and unrealistic expectations of themselves.

Perfectionists might strive in demanding circumstances in terms of delivering good outputs. But the process and emotions that they have to go through to achieve these results are often crippling.

To make things worse, perfectionists often compare themselves to others. These ‘others’ in academia are often equally self-critical and work extra hard to overcome insecurities.

Constant stress due to perfectionism and a fear of failure can have real mental and physical consequences (think of depression, arrhythmia or insomnia).

Of course, a PhD student (ideally) gets a lot of support from supervisors as well as peers. Some PhD students also work as part of a project team.

However, at the end of the day, the PhD is your project. It has to be written by you alone. And if you succeed, the degree will be awarded to you .

PhD work requires a high degree of self-initiative and proactiveness. Ultimately, you are responsible for the outcome. But this can be challenging when you suffer from perfectionism and imposter syndrome:

Constantly questioning your academic ability, and feeling like a fraud who is not smart enough to deserve a PhD position can create a lot of stress.

When you work for a company or organization, be it in the public or private sector, you are more likely to work as part of a team. I am not saying that you might not feel performance-related stress outside of academia.

Yet, experiencing performance-related stress is often much more individualized when doing a PhD compared to many non-academic full-time jobs.

In a PhD, the aim is to further academic knowledge. To branch out into unknown territories. To test novel methodologies and develop new theories.

In non-academic jobs, you often learn certain skills and can deal with situations based on existing knowledge. You have a backup, so to speak, from people who generated that knowledge and have done it before you.

In a PhD, you enter unchartered territory. That is the whole point of it. You are supposed to do something new.

Therefore, a PhD feels much more personal.

Feedback and criticism can sting. It can feel like a punch to the gut. It feels like you are criticized personally as if something is wrong with your way of thinking, and your ideas.

During a PhD, your identity becomes very much intertwined with your research. Separating yourself (and your worth) from your work is very hard for PhD students.

Questioning your whole identity is a different – and more constant – stressor than dealing with, for example, a busy period in a non-academic full-time job

Many people doing non-academic work have well-established routines. Very often, working times are non-negotiable.

Yes, it sucks if you have to be up every day at 7, and present at the office at 8. But at some point, you might not even think about getting up anymore. You simply do not have a choice. External pressure is, at times, good.

Have you ever tried getting up early without having to? It requires so much more effort and willpower. Pushing yourself out of bed to start writing on a PhD without a real deadline or external pressure is hard. Like, real hard.

PhD students often have little external structure to their day. They are largely responsible for their time management. Which can be fabulous and I guess that many non-academics envy this flexibility.

However, practising constant self-discipline can also be stressful. Especially when you are stuck and do not know what to do next in your PhD.

Very often, it results in feelings of not working enough. Or the failure to get up at 7, as planned. Which in turn leads to a feeling of guilt to take proper breaks and rest. Long-term stress is a real thing.

Thus, the constant need for self-discipline can create a different type of stress than having to be present in the office from 9-5 every day.

Last but not least, when you have a full-time job and consider doing a PhD, the chances are high that you earn a decent salary.

With a few lucky expectations, PhD pay is not great. Or PhD students are only paid part-time and have to take over heavy teaching loads next to their PhD. Or, they are not paid at all.

The effects of lingering financial stress in the background should not be underestimated.

This is coupled with the knowledge that academia is an extremely competitive place. Jobs are scarce. Consequently, many PhDs experience existential stress. Financial stress in the present, while also stressing about the future.

Every person has their own story, their personality and their coping mechanisms to deal with stress. There are also still very good reasons to pursue an academic career.

Simultaneously, many non-academic jobs can be extremely stressful. And if you long for more independent work, self-responsibility and a flexible schedule, a PhD might be the right fit.

( When you experience high levels of stress during your PhD, and if it is negatively affecting your mental health, please reach out to your supervisor or institution for help. )

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Undergraduate Education

March 28, 2024

End of semester mental health maintenance tips: What to notice in students

By hannah henry, advocate for professional wellbeing, undergraduate education.

What these tips and tricks lists tend to overlook is how difficult any one item on that list can be for someone that may be experiencing a mental health concern (see the difference between mental health and mental illness ). What these lists imply is that you can do all of this alone– until you need professional help. While it may be true that students could amend their sleep schedule, set more alarms, and step outside, lists like this cause them to simultaneously buy into the myth that they need to do it on their own, while devaluing the need for social connection during times of distress. 

Social connection is one of the greatest tools we have as humans to combat depression, anxiety, disease and so much more. The Surgeon General’s Report on The Epidemic of Loneliness goes on to say that, “lack of social connection inhibits student progression even in higher education settings. For example, among medical students, feeling socially isolated is associated with dropping out.” With social isolation and disconnection at an all time high, faculty and staff can (and should) become part of a student’s network of care. 

According to a study from Boston University’s School of Public Health, the Marie Christie Foundation, and the Healthy Minds Network , faculty are “gatekeepers” of student mental health, which means faculty are the front line to notice signs and symptoms of mental health struggles before they get worse. This is not meant to imply that faculty and staff should function as trained mental health professionals, but that we should aim to work alongside those professionals to coordinate care.

In order to be “gatekeepers,” we need to know what to look for. Below are some signs that a student may need to be checked in with:

More noticeable symptoms:

• A serious drop or change in grade or work performance
• Excessive absences or inconsistent attendance
• Sleeping during class frequently
• Change in personal dress and/or hygiene
• Unusual or exaggerated emotional responses; irritability or outbursts
• New or repeated behaviors that inhibit classroom management
• Repeated requests for extensions or accommodations not previously requested
• Less noticeable symptoms:
• Putting head down
• Inattentive - zoning out/dazing off
• Sitting further back or to the side than normal
• Picking at clothes, nails, skin

What to do when you notice these symptoms? Sometimes a simple private conversation is enough to show a student that someone sees and hears them. It is important to enter these conversations with curiosity or concern, and without the goal of problem solving. If the behaviors or feelings expressed feel outside of the norm to you (inability to communicate verbally, loss of contact with reality, stalking behaviors, self harm, suicidal ideation, etc.) then you should refer to CAPS - or better yet, if comfortable, walk them over to CAPS so that they have a supportive presence while securing professional help. There are also several resources outlined on CAPS Resources . 

Creating and maintaining relationships with students should be our goal as educators, allowing students to feel safe wherever they are. In order to foster a supportive relationship, we should be mindful of the power differential between staff and students, and that there is a lack of safety when approaching a superior. We also need to keep in mind the numerous barriers surrounding asking for help that exist for marginalized student populations. The social connection that can come from classrooms, programs, or organizations will help provide a framework for student mental health and wellbeing for not only the end of the semester blues, but for their entire college career and beyond.

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What Doctors Want You to Know About Beta Blockers for Anxiety

Start-ups are making it easier to get the pills online, but experts warn they should be used with caution.

By Christina Caron

Anxious ahead of a big job interview? Worried about giving a speech? First date nerves?

The solution, some digital start-ups suggest, is a beta blocker, a type of medication that can slow heart rate and lower blood pressure — masking some of the physical symptoms of anxiety.

Typically a trip to the doctor’s office would be necessary to get a prescription, but a number of companies are now connecting patients with doctors for quick virtual visits and shipping the medication to people’s homes.

“No more ‘Shaky and Sweaty,’” one online ad promised. “Easy fast 15 minute intake.”

That worries Dr. Yvette I. Sheline, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.

“The first question is: What is going on with this person?” Dr. Sheline said. Are they depressed in addition to anxious? Do they have chronic anxiety or is it just a temporary case of stage fright? “You don’t want to end up prescribing the wrong thing,” she added.

In addition, although beta blockers are generally considered safe, experts say they can carry unpleasant side effects and should be used with caution.

What are beta blockers?

Beta blockers such as propranolol hydrochloride have been approved by the Food and Drug Administration for chest pain, migraine prevention, involuntary tremors, abnormal heart rhythms and other uses.

Some are still prescribed for hypertension, although they’re no longer considered the preferred treatment , mainly because other medications are more effective in preventing stroke and death.

Beta blockers can ease the physical symptoms of the “fight or flight” response to stress, such as tremors, sweaty palms or a racing heart, but they are not F.D.A.-approved to treat anxiety disorders.

For decades, doctors have prescribed them for issues other than their approved uses, including for problems like stage fright. In recent years, celebrities like Robert Downey Jr. and Khloé Kardashian have said the medications helped them overcome performance anxiety.

How do they work?

When we start feeling anxious or stressed, our bodies produce adrenaline, which prepares us to respond to perceived danger. The hormone signals our heart to beat faster and narrows our blood vessels to redirect blood to important organs like the heart and lungs. Breathing quickens, and we start to sweat.

Beta blockers work by “blocking” the effects of adrenaline. They cause the heart to beat more slowly and with less force, which helps lower blood pressure.

But if you’re feeling especially anxious, “your mind is still going to race, you’re still going to ruminate and worry,” said Regine Galanti, a psychologist in Cedarhurst, N.Y., who treats people with anxiety disorders.

In other words, beta blockers are not going to address the root of your fears. “If it becomes like a weekly, ‘Oh, I’m just having a hard time in this course. I’ll just pop a beta blocker every single time.’ I would say, ‘What’s the long-term goal here?’” she added.

Patients are typically only prescribed a few pills for specific situations where they might experience performance anxiety, said Dr. Joseph Bienvenu, a professor of psychiatry at Johns Hopkins University School of Medicine. But some online companies dole out as many as 48 at a time.

Are there any side effects?

Yes. Beta blockers can make people feel dizzy. Other potential side effects include fatigue, cold hands or feet, trouble sleeping and nightmares. They can also cause stomach problems like nausea or diarrhea and, less often, difficulty breathing.

This is why some doctors tell their patients to avoid taking them for the first time on the day of a big event.

Dr. Bienvenu advises patients to initially try the medication on the weekend, or “when you don’t have anything else to do.”

“I just want people to know how it’s going to affect them,” he said.

Is it OK to take them for a potentially scary task, like a big presentation?

Possibly. But experts suggested visiting your general practitioner first.

Beta blockers may not be advised for some people with diabetes, low blood pressure or bradycardia, which is a slow heart beat — or people with asthma or another lung disease. And certain drugs, including some cholesterol and cardiovascular medications, can interact with them.

Online doctors do not have your full medical history and have not examined you in person, said Arthur Caplan, a professor of bioethics at the N.Y.U. Grossman School of Medicine.

Without a physical exam, some patients might not know that they have an underlying issue like an irregular heartbeat, he added. And they may not know who to call if they have questions after getting a prescription.

“You need to be managed on these kinds of drugs,” he said.

For those who often face anxiety-provoking tasks like public speaking, the experts said, it might be most beneficial to try breathing techniques or exposure therapy , which involves directly confronting what makes us anxious to break a pattern of fear and avoidance.

“Masking your anxiety symptoms is not going to teach you how to manage your anxiety symptoms,” Dr. Galanti said.

Christina Caron is a Times reporter covering mental health. More about Christina Caron

Managing Anxiety and Stress

Stay balanced in the face of stress and anxiety with our collection of tools and advice..

How are you, really? This self-guided check-in will help you take stock of your emotional well-being — and learn how to make changes .

These simple and proven strategies will help you manage stress , support your mental health and find meaning in the new year.

First, bring calm and clarity into your life with these 10 tips . Next, identify what you are dealing with: Is it worry, anxiety or stress ?

Persistent depressive disorder is underdiagnosed, and many who suffer from it have never heard of it. Here is what to know .

If you notice drastic shifts in your mood during certain times of the year, you could have seasonal affective disorder. Here are answers to your top questions about the condition .

How much anxiety is too much? Here is how to establish whether you should see a professional about it .

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• CAREER FEATURE
• 08 October 2019

Don’t miss your PhD deadline

• Nic Fleming 0

Nic Fleming is a freelance writer based in Bristol, UK.

You can also search for this author in PubMed   Google Scholar

Horror stories about the final weeks, days and hours before a thesis submission deadline are common among people with PhDs in both the sciences and humanities.

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doi: https://doi.org/10.1038/d41586-019-03020-6

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