More Work Needed on Graduate Student Behavioral Health

More Work Needed on Graduate Student Behavioral Health

Paul J. Barreira, M.D., Christie Campus Health Advisor and Former Director of Harvard University Health Services

Universities are confronting the challenges posed by a significant increase in the prevalence of emotional distress amongst their students. Most of the attention has been focused on undergraduates. However, recent studies of graduate students indicate that they experience behavioral health problems at rates that equal or even exceed those found in undergraduates.

Common sources of stress for graduate students include fear of failure, perseveration on setbacks and struggles, self-consciousness, fears of judgment, conflicted advising relationship, and general anxiety. Important factors associated with graduate student behavioral health include feelings of loneliness and lack of social support, competitiveness of academic program, poor work-life balance, financial concerns, and lack of support from academic advisors, identifying as female, transgender, or non-binary, and being a sexual minority, or international student.

These dynamics pose serious threats to graduate student well-being and academic success, and more needs to be done to better understand how schools can respond. The small number of studies conducted thus far on graduate student behavioral health have documented high prevalence of anxiety and depression. However, these studies have several limitations including low response rates, lack of department-specific data, lack of standardized tools to evaluate depression and anxiety, and selection effects.

The organization and culture of doctoral education are critical factors that need to be studied separately from the overall student population. Graduate education occurs in departments that have different cultures, and it is highly dependent on faculty advisors. These factors create special challenges in understanding and improving the behavioral health of graduate students. Behavioral health approaches aimed at undergraduates may not be appropriate or sufficient for graduate students: the behavioral health issues of graduate students are distinct enough from those of undergraduates that they are likely to require somewhat different interventions.

The small number of studies that have been done are instructive. In 2016, the University of California administered a survey of 13,400 graduate students across all ten campuses that was completed by 5,356 students for a 40% response rate. Utilizing the CESD-R to measure depression, 35% of survey respondents self-reported experiencing symptoms that met the clinical cutoff for a major depressive disorder. Students in the humanities reported higher rates of depression and lower life satisfaction than those in STEM or professional fields.

Evans et al. employed convenience sampling via email and social media to PhD graduate students in US and internationally and received 2,279 respondents. Using PHQ9 and GAD7 scales, they reported 39% of respondents scored positive in the moderate to severe depression range and 40% scored positive for moderate to severe anxiety. Consistent with other studies they report that the LGBQ students and women record higher scores. Additionally, they report a negative correlation between self-reported advising relationship and work-life balance with rates of depression and anxiety.

The departmental organization of graduate education is a unique and important factor in addressing the behavioral health of graduate students. Yet few studies have examined the relationship between behavioral health problems and other variables at the departmental level. Lipson and colleagues using the Healthy Minds Study data identified academic disciplines that were associated with higher rates of depression and anxiety in both undergraduate and graduate programs. Students in humanities and art and design were significantly more likely to have mental health problems, while treatment rates were lowest among business and engineering students.

The Department of Chemistry at the University of Minnesota is engaged in a multi-year initiative to support the behavioral health of their graduate students through a partnership with the graduate students, the director of graduate studies, and the campus health service. New policies and programs have been developed that are aimed to offer more support, reduce stigma, and encourage students to seek professional help. They developed a mental health survey that is administered every 2-3 years that measures students’ mental health and evaluates the effectiveness of the programs. Students’ response rate has increased from 49.2% to 59.3%. The main limitation to this study is the absence of standardized screening tools that would allow comparisons of rates for depression and anxiety reported in other studies.

It is clear that more research, at more granular levels, must be conducted to better understand and address the unique dynamics of graduate student behavioral health. At a minimum, planning efforts must take graduate student needs into consideration. And campus-wide solutions that are actively marketed to graduate students should include content and care elements that are relevant to their situations. 

About Christie Campus Health

At Christie Campus Health, we are dedicated to improving the behavioral health and wellbeing of college students by helping colleges and universities expand the way they reach and support students in need. Our Solution, CONNECT@College offers four integrated components that provide a student behavioral health safety net, as well as a broad range of options for students with varying behavioral health needs.

We believe today's students will respond well to increased options and entry points for assessment and support in ways that are comfortable and empowering for them. We believe counseling centers can be well served by partners that can assist them in appropriate areas, helping them to be more effective and efficient in their efforts. We take a public health approach to student behavioral health, focusing on the entire student population in our efforts to increase knowledge, reduce stigma, and address a full range of behavioral health care needs.

About Dr. Paul Barreira

Dr. Paul J. Barreira is the former Director of Harvard University Health Services in which capacity he oversaw all health services provided to students, faculty and staff. He is currently the Henry K. Oliver Professor of Hygiene Emeritus and Associate Professor of Psychiatry at Harvard Medical School, and he directs the Graduate Student Mental Health Initiative at Harvard University.

Dr. Barreira previously served as the Director of Behavioral Health and Academic Counseling at Harvard University Health Services, in which capacity he managed Harvard’s mental health services. Earlier in his career, Dr. Barreira was the Deputy Commissioner and Medical Director of the Massachusetts Department of Mental Health, Residency Training Director at the University of Massachusetts Medical School, and Director of Community Clinical Services at McLean Hospital.

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