Not all bad, not all good: Considering the mental health of Early Career Researchers

Naomi: Maybe you could both start by telling us how you came to be involved with research around the topic of ECR mental health.

Cassie: This all started because I was finishing my PhD and was looking for postdoc roles. I had three part-time postdocs to make a full-time job, and one of those was working on a review of student mental health at the University of Sussex. The Chancellor had given a pot of money to review what was going on at the university, what services were available, and any gaps. One of the things that came out of that was that there was nothing for PhD students specifically, and then that started me off looking at the literature, and I found that there was not very much there at all, just lots of media headlines. So I spoke to Clio about it – because I speak to Clio about everything – and we came up with this project idea, and then in one of those weird kind of coincidences, this funding call (from the Office for Students) came out looking at PhD student mental health and we went for it.

Clio: I've always been interested in trying to help support junior researchers and PhD students. I did the first NHS-funded PhD studentship at Sussex University, so I definitely have had the experience myself of just floundering around and not knowing anybody, and I was really anxious, so I found it really difficult to make those connections. I very much missed having that sense of structure, so I will always have that sense of wanting to prevent other people having the same experience, and this work has taken that to a new level.

Naomi: Based on the research that you've done, what are the main mental health difficulties that PhD students tend to come up against?

Cassie: Our main paper reported the results of a national survey that we did, where we were obviously limited by what we looked at in the survey. We measured anxiety, depression, mania and suicidality, and we found that PhD students were more anxious and more depressed than our working professional control group. They weren't more suicidal but there were very high rates of suicide risk in both groups, more than you see in population cohort rates.

Clio: I mean it's not good, but it makes sense to see elevated levels of depression, anxiety, and maybe suicidality, when you consider that doing a PhD is a high stress occupation and it takes a long time, so you've got this sense of chronic stress. But there's a broader kind of youth mental health thing too, in that I think more than 50% of people starting a PhD are in that emerging adulthood phase, so they're still within that window of excess risk of mental health problems. Generally it seems to be the case that as more and more people are going to university to do an undergraduate degree, at least 25 per cent of undergrads, if not more, have some kind of mental health problem, so you'll likely see the same spread in people coming into PhDs. So Cassie's definitely right, it's different to other occupations, but you probably see similar things going on perhaps in other high-stress, potentially low-support environments.

Naomi: You've already alluded to the fact that a lot of people who come into doing a PhD are already in a high-risk group for developing mental health problems, but do you think that there are any specific populations, like people who belong to minority groups or who might have additional needs, that are at a higher risk of developing these kinds of problems when they do a PhD?

Cassie: Yes, some of our qualitative work is definitely showing that. One of the groups that really comes to mind is those that do field work, just because they're going to places that are not exactly holiday destinations, and going on their own for prolonged periods of time. International students as well, because you've got the stress of the PhD and then you also have the culture shock stuff that comes with it. And they have to pay more because their fees are higher. Quite often international students are self-funded, and they might have to bring families over with them or be away from families, which is also stressful. So they've got all the PhD stress plus all this other stuff on top of that.

Clio: There's definitely some suggestion that being visibly different in academia can be linked to stigma or discrimination, so if you're visibly different and then maybe on top of that you have mental health problems, then you're experiencing a lot that could be really difficult.

It's a funny one, thinking about mental health problems during a PhD, because a lot of the focus is often – understandably so – around this idea of asking if it is a triggering experience… like, what causes PhD students to have mental health problems. But obviously lots of them will have already experienced that before. We know that people who have already experienced mental health problems before the age of 18 are the most at risk for having enduring mental health problems, and my interest is not just around this idea of whether the PhD is triggering and how can we prevent or minimise that, but also about the people who've already had mental health problems coming in. That's a group that may come with coping skills that they've developed, but they are also a group that really are at risk for having a re-exacerbation in the chronic stress environment of a PhD.

You've got this kind of narrative in academia where people acknowledge that it's really stressful and there's almost an expectation that everybody has mental health problems, coupled with the idea that, if you do, then maybe you're not suited for it. It's a really weird narrative. It's like everybody will have these problems, but you can't really have them, because then you're too fragile, and you should leave, and I think that together is such a damaging culture.

Cassie: Exactly – there's this idea that you have to suffer for your PhD. That came across in some of our focus groups, and particularly in the physical sciences. For example, you need to be in the lab all the time doing experiments to be worthy, which is just ridiculous.

Naomi: Do you have any impression of how the pandemic is likely to have impacted on some of the issues that PhD students experience?

Cassie: Dr Nicola Byrom's research has shown that it wasn't a good time for PhD students at all, especially thinking about some of the risk factors that we looked at, like isolation. There were funding issues for PhD students as well – people's experiments had to be completely scrapped and restarted because they just weren't possible in the context of Covid – plus the actual stress of Covid. There's that thing, like we're all in the same storm, but we haven't all got the same boat. So we were all in a really difficult time, but PhD students, because of the nature of what they're doing and how the pandemic feeds into potential risk factors anyway, their boats weren't the greatest to be in. I take my hat off to anybody that did their PhD in the pandemic because it's a difficult thing to do.

Clio: When you have an occupation that's high stress anyway, low pay, low status and isolated, and then you add in something that's horrendously isolating, then that's going to be stressful. All of those natural social interactions that people might have had are gone, and all of the opportunities to do other things, and cultivate these other aspects of your life, your hobbies, your identity, all of that's kind of gone. And then, as Cassie says, just complete uncertainty around the planned activities within your PhD, the funding structure, people worrying about future employment and what the sector is going to look like, and you've got all of that on top.

Cassie: Yeah, and some PhD students, because of their funding, have smaller living environments. They're living in flats or studios and things like that, and so that kind of work/life separation is really difficult. So they're working in their bedroom and are also supposed to chill out in their bedroom. There is no separation, and so people end up working long hours.

Clio: There are some things that we will learn in the sector from the pandemic that perhaps have streamlined and improved some of the things that we do. But I think that bringing back in-person stuff is really important.

Naomi: Do you have any impression of how mental health related attrition affects people who do a PhD and do you think this has a wider impact on the overall academic workforce?

Clio: The data are really poor, because a lot of the data are poor in relation to PhD students, both from the institutions themselves, but also at a population level, because they're poorly differentiated in big health surveys and cohort studies. Also, on a more personal level, I think people won't always say, and they won't want to say that mental health problems are the reason why they're taking time off or having to quit a PhD. I've known lots of people myself who have finished early or not completed their PhD for that reason. We've got a paper that we're trying to get published now where we look at things like mental health related intermission and attrition and what it is that predicts that. It's going to be very variable, because for some people it will feel to them that they've made a positive informed choice: they've tried a PhD, they've thought "It's not for me", "I've learned that I don't want to pursue this and I'm going to quit", and that's a kind of positive thing, but for lots of other people it might be a source of sadness or regret, or people will attach feelings of failure to it, and with better support, for some people at least, that could have been preventable.

Cassie: And the other side to it is that from the university perspective, it doesn't look very good to have someone that doesn't complete their PhD, especially if you get past the first year. It's kind of like a black mark against the supervisor. So when somebody does decide it's not for them and they want to stop, then it does feel almost like you've been cast out, based on the anecdotes we've heard. So even when people do make that decision, they're not necessarily supported to wrap up. It just seems to be a kind of "You're out", which is a real shame and is not good for either party really.

Clio: This definitely doesn't always happen, but there can be a tendency for the people within the institutions to kind of locate the issue within the person that has left or is considering leaving, without examining the kind of environmental factors around that, like "How was the support?". It is often almost taking that individual deficit approach, like "They just weren't cut out to do it in the first place." And there's another interesting and problematic thing: in recent years, there's been a sort of social media thing around people publicly stating "I am leaving academia to protect my mental health, it's a terrible place and if you work in it, then you're sacrificing your mental health." It's a really difficult one, because, obviously everybody's entitled to say whatever they want, within reason, and particularly where people in the past may have not felt able to identify themselves as someone with mental health problems or leaving academia for that reason, it's really important that they feel able to do that, and I think it's generally a positive thing.

However, current PhD students have definitely said to us that being exposed to all that kind of messaging, like on Twitter, this "quit lit" as some of them have called it, can really contribute to the fear that PhD students have, like "What have I done to myself, I'm definitely going to end up with mental health problems". It's just a really difficult thing to get right, like how do you balance this legitimate awareness of the issues and consider support and prevention without reinforcing this really negative messaging that if you come in to do a PhD, chances are you're going to end up with mental health problems or you're going to have a terrible time.

Cassie: There was a paper that some PhD students recently published looking at all the positive aspects of doing a PhD, but then that paper got slated on Twitter, by people being like "You're trying to brush over the issue and ignore it". Being completely positive is not the right way but being completely negative is also not the right way forward, they're both damaging in different ways. As researchers we should be comfortable with the grey area because we're looking at something where there are no definite clear answers. Academia is not all bad and it's not all good, there's a middle ground where some bits are really toxic and need addressing, but there are some bits that are really great and there's pockets of good practice happening, and so we need to learn from that and keep evolving.

Marlene: We will try to talk about both the positive things as well as the negative things, and maybe to be able to finish more with the positive, we'll start with the negative. What kind of characteristics of the ECR experience, or academia more broadly, contribute to the mental health burden experienced by ECRs?

Clio: Again there's a data issue because all of the research is observational. We can't set up an experiment where we randomise people to do a PhD or not do a sPhD and get that causal sense of what's going on. But in our work, we looked at what are the correlates or the predictors of higher depression, anxiety and suicidality, and across the board loneliness was the thing that seemed to most robustly associate. Loneliness often goes hand in hand with actual deprivation of social contacts, but it isn't that simple. It's a more subjective experience, so it's saying "I am lonely because the amount of social contact or the social connectedness that I want isn't matched by what I have", so it can be quite difficult to tell if someone's lonely. It isn't as simple as saying they don't do anything, or they don't have any friends. They might actually appear to be quite sociable but for whatever reason it's not matching with their social needs.

There are also some things around individual psychological traits, like perfectionism. Not so much whether people have perfectionistic standards, the issue is where there's a discrepancy. It's where somebody has these high standards, and they don't think that they're meeting them. The supervisory relationship can be influential as well, say where there's a lack of interpersonal closeness or where the supervisor is perhaps more dictatorial or authoritarian, or where the supervisory relationship doesn't inspire the PhD student's own self agency. Those are the factors that emerged from our work, along with being younger – younger PhD students tended to be more depressed and anxious.

Cassie: One thing that someone said to me and which has always kind of stuck for me is that academia is one of the very few jobs where you have the highest possible qualifications that a person can have, and part of your day-to-day job is being told that you're not good enough. Like paper rejections, grant rejections, peer review - the infamous reviewer two. I remember getting my first paper back with the comments from supervisors and reviewers, and just seeing this sea of red and thinking "Oh my god, what have I done, what is this?". That's kind of part of it and it's a bit of a baptism of fire. 

Clio: It really ties into the perfectionism stuff. Say, you've got a bunch of people coming into a PhD who probably on the whole are naturally quite perfectionist anyway. And then you've got all of these very common, very visceral, very salient rejection cues, and you've got a bunch of supervisors who are often not very good at that kind of positive reinforcement. It's just this melting pot really driving that sense of perfectionistic discrepancy and that definitely is something that does seem to be pretty robustly linked with depression and anxiety.

Cassie: One thing that I do think we need to make sure we mention, because I know PhD students are lobbying for this at the moment, is the funding issue, and the crap stipends that everyone gets. [This interview was recorded on 5 August 2022, after an open letter was sent to UKRI in July, demanding action to support postgraduate students struggling with the costs of living. In September, UKRI announced that they would increase the minimum stipend by 10%, but there is still ongoing concern among many postgraduate students about how they will meet the rising costs of living.] We were really honoured actually that there was an open letter put out and they linked to some of our work within that open letter, but yeah, you have to pay people so that they can live.

Clio: I think that's really true and of fundamental importance is the actual lack of money to live safely, comfortably and healthily, but this is also about what it communicates. When it's just not funded properly and when it's openly funded below what is effectively liveable, what does that communicate about the worth of these people and their roles? Where there is this issue of enmeshment, which is just such a problematic and quite unique aspect of doing a PhD, your self-worth, your self-identity is so inextricably tied up with what you're doing, and then you're not even funded in a way that suggests there's any value to what you're doing, then that is very easy to internalise.

Marlene: You've mentioned that these financial issues are something that's really important to consider. Is there research showing the specific impact of financial precarity on ECRs and maybe comparisons to other countries with different funding systems?

Clio: It's not something that we have focused on much in our work. It is definitely identified as a reason to explain differences in the apparent prevalence of mental health problems across countries – comparisons have been made to other places in Europe where PhD students are employees of the university and they're given a wage that is much more commensurate with what they're actually doing. But it's difficult to conclude too much definitively because most of these data sets are self-selecting samples.

Cassie: PhD students were shouting about this issue even before the cost-of-living crisis was on the discussion table, so it's only going to get more difficult. As a first-generation student, I find that really upsetting because universities were very elitist and we were starting to move away from that, and I think this is potentially going to take us back a bit in that progress.

The financial issue goes beyond the PhD as well, like this whole idea of job insecurity. I recently advertised for a research assistant position, and I had so many PhD students applying for it who were just completely overqualified, and it's because there's a lack of jobs for them if they're wanting to stay in academia. It's not like you can save up during your PhD to support yourself afterwards – you're using everything you have to live.

Naomi: We're going to try and take that balanced approach that you were talking about earlier and move towards thinking about the positives of the ECR experience. Are there any characteristics of the ECR experience that are particularly positive or that can have a really positive impact on wellbeing?

Clio: Personally, I'm definitely someone that experienced mental health problems both before and during my PhD, but as well as a really stressful experience, it was also incredibly transformational. That sense of meaning and purpose, the enjoyment, the sense of passion. Nowhere else have I had the same feeling of having such a sense of authenticity, of working on something that feels so meaningful alongside other people that have the same passion and the same goal, and believe in something as much as I do.

Cassie: In some of our qualitative data there was a theme like "the PhD should give me purpose", and so a lot of people would echo this idea that being able to work on something that you're interested in and that you're passionate about is definitely one positive aspect of research. There's this idea that the world is different since you've done this piece of work, and that's pretty cool.

Clio: Yeah, and irrespective of whether people stay in academia or not, doing a PhD gives you so many really important transferable skills. You've got so much stuff around interpersonal skills, communication skills, supervising, managing teams, all of the technical stuff which will obviously be very different topic-to-topic or subject-to-subject, but that kind of analytical thinking, critical thinking, resilience. Those are the sorts of skills and qualities that doing a PhD or being an ECR can really enhance, and you can make great use of those skills within academia or outside of it.

Marlene: In connection with these positive aspects of the ECR experience, what kind of sources of support can help ECRs to maintain good mental health?

Clio: Sometimes people don't like to hear this or think about it, but your basic needs are really important. Things around good sleep, good nutrition, exercise, moving your body, those are always going to be important and those are always going to scaffold good mental health. And social support and connectedness are incredibly important, although what that looks like is going to vary massively person to person. The supervisory relationship is really key, having one or more supervisors who inspire you, who seem to care about you, who offer you some kind of interpersonal support and communicate a sense of hopefulness, that's really important.

Cassie: Yeah, and just remembering that you're more than your PhD is really important. Some of the stuff that's come from our qualitative data is about social connectedness in the context of your PhD, so making connections with other PhD students, postdocs, RAs, whoever's in your department, but also outside of it as well. It's really important to have some connections outside of the academia bubble, just to give you reality checks sometimes. Sometimes PhD students can almost kind of egg each other on a little bit with unhealthy work habits. Whereas if you've got your friend who works nine to five and they're like, "Why are you still in the office at eight o'clock at night? That's ridiculous!", those kinds of sounding boards can be really helpful. So yeah, connections both inside and outside academia can be really helpful to give you that balance of people that understand the process and empathise and can sympathise with you, and people who can kind of give you those reality checks.

Marlene: Something that you see a lot on Twitter is this whole critique around focusing too much on the individual and not enough on wider structural change. The university might offer something like a mindfulness session over lunch or an online resilience training, and then it seems like there's sometimes an attitude that it's suddenly all good.  Do you think these individual-focused solutions are actually working?

Clio: They definitely can work, but it's always going to be both, isn't it? Not necessarily within the same research group, but you need people who are looking at the kind of broader structural factors, you need people who are looking at more individual factors and, ideally, some people that are thinking about the interplay. It's really complicated but, for me, trying to ignore the individual level and trying to just focus on the structural factors doesn't help either, because PhD students are human beings and aside from the influence of those kind of broader structural factors, there will be influences of individual experiences, like physical illness and bereavement. And there's always going to be a place for individual interventions, whether it's kind of building resilience or mindfulness or individual therapy, because the same thing happening to different people will not necessarily have the same effect, and I don't think it helps to kind of suggest that there isn't an individual aspect to it. I think it makes a space for empowerment to acknowledge that individual changes, individual interventions, can have a big impact.

Cassie: People's frustration with it is where you get universities just offering individual stuff without any reflection on the structural issues. Part of the issue is that trying to get any change at a university at an organisational policy level is really difficult; it takes a really long time and involves a lot of sign offs from lots of different people, so the individual stuff is what is easier to do because you just need one person that's trained in something to offer a workshop and put it online.

Naomi: You've mentioned poor data and a lack of data in a lot of different areas. Are there any particular questions or particular areas where you think the research really needs to go next?

Clio: For me, on a much broader level, being able to detect PhD students within kind of government data, so better differentiation of different types of students within things like health survey for England, and those sorts of things would be really good because that lack of differentiation really blurs the issues around what we know about student mental health at the national level.

In terms of my own interests, I'm interested in the relational dynamics of hopefulness, so things around how supervisors can best scaffold PhD students and ECRs to develop this sense of self-agency and hopefulness, because that's such an important thing anyway, but also really protective in the context of mental health problems. I'm also interested, and Cassie is too, in people with more serious mental health problems, like how many of them are there doing PhDs, where are they, what's their experience like. Because a lot of the literature is patchy and just focuses on what we might call common mental health problems, like depression and anxiety. That is not to say that those aren't very serious and important, but what about people with perhaps more unusual experiences, what is it like for them to become an emerging academic.

Cassie: Yeah, and the work that we've done on suicide is something that we've all been quite struck by, and so that's definitely a piece of work that we need to continue. I feel like in our work so far we've identified issues and potential correlates, and now we're starting to move towards "Okay, how do we address those, what can we do about it?". We know there's an issue, we kind of know what it looks like, we know what some of the things that might predict or increase the risk of that are, so how can we support PhD students and hopefully prevent it.

Marlene: Is there anything already in place that you are aware of in terms of suicide prevention for postgraduate researchers?

Cassie: There's the suicide safer universities document, but that doesn't specifically mention postgraduate researchers from my understanding of it. And that's one of the frustrations that we've had looking at any kind of student-related documents, policies, datasets – PhD students are just forgotten or kind of mixed in, and their experience is very different so just acknowledging that difference and having bespoke interventions for that group is something that we think is important. You can't just assume that if it works for undergrads it will work for PhD students.

The Suicide-Safer Universities guidance was published in 2018 to help university leaders prevent student suicides. It provides guidance to help universities understand student suicide, mitigate risk, and provide effective intervention when students experience difficulties that could increase their suicide risk. ECRs struggling with their mental health, including issues around suicidality, can access the Samaritans for free by calling 116 123 at any time.

Marlene: Bringing together all of what we've discussed today, if you could pick one thing each that you would change to improve ECR mental health, what would it be, and why?

Clio: Higher stipends definitely. It's so fundamental, both in a literal practical health sense, but also in terms of communication of value.

Cassie: Yeah, the money thing is essential, you need to pay people because a lot of this trickles down from that. I was thinking about supervisors, and one thing that we haven't mentioned so far is that being a good academic doesn't make you a good manager. We just kind of assume that if you're a good researcher you'll be able to supervise PhD students and that's not necessarily the case. We need a way in which we can reflect on who is a good supervisor and allow those people to have PhD students and not kind of judge that based on metrics that aren't really related to supervising, like income and publications and reputation, when none of those things really have anything to do with being a good PhD supervisor.

Clio: For me there's something around a focus on kindness. Kindness can sometimes feel not that present in academia. That kind of inherent competitiveness and guardedness and kind of criticalness can feel much more pronounced. There's something really important about individually taking responsibility and accountability for being kind to each other and kind to yourself, and they go hand in hand.

About the interviewees

Cassie Hazell is a lecturer in psychology at the University of Surrey, and Clio Berry is a senior lecturer in healthcare evaluation and improvement at the Brighton and Sussex Medical School.

Further information

Bernery, C., Lusardi, L., Marino, C., et al. (2022). Research Culture: Highlighting the positive aspects of being a PhD student. ELife, 11, e81075.

Hazell, C.M., Niven, J.E., Chapman, L., et al. (2021). Nationwide assessment of the mental health of UK Doctoral Researchers. Humanities and Social Sciences Communications, 8(1), 1-9.

Jackman, P. C., Sanderson, R., Haughey, T. J., et al. (2021). The impact of the first COVID-19 lockdown in the UK for doctoral and early career researchers. Higher Education, 1-18.