Day 11. Evidence for a mental health crisis in graduate education

Title:
Evidence for a mental health crisis in graduate education
研究生教育中心理健康危机的证据

With mental illness a growing concern within graduate education, data from a new survey should prompt both academia and policy makers to consider intervention strategies.
随着研究生教育越来越关注精神疾病，一项新的调查数据应该促使学术界和决策者考虑干预策略。

There is a growing cry for help from graduate students across the globe who struggle with significant mental health concerns1. Despite increased discussion of the topic, there remains a dire need to resolve our understanding of the mental health issues in the trainee population.
面对严重的心理健康问题，全球范围内的研究生不断寻求帮助。 尽管对该主题的讨论有所增加，但仍然迫切需要解决我们对受训人员心理健康问题的理解。

Recent research on mental health in the trainee population has focused on within-institution cohorts, such as the 2014 UC Berkeley report, which found that 43–46% of graduate students in the biosciences were depressed, and the 2015 University of Arizona report3, which found that a majority of doctoral students reported “more than average” current stress or “tremendous” stress and endorsed school and education-related issues as the most significant contributors to their stress. Although these studies demonstrate the mental health concerns in this population, more research is needed to better define the prevalence of mental health issues and the role of key variables such as gender, mentorship relationships and perceived work–life balance on susceptibility to mental health struggles in the trainee population.
最近对受训人群心理健康的研究主要集中在机构内人群，如2014年加州大学伯克利分校报告2，其中发现43–46%的生物科学研究生患有抑郁症，2015年亚利桑那大学报告3，研究发现大多数博士生报告的当前压力或巨大压力超过平均水平，并认可学校和教育相关问题是造成他们压力的最重要因素。尽管这些研究表明了这一人群的心理健康问题，但还需要更多的研究来更好地定义心理健康问题的患病率，以及性别、导师关系和感知的工作环境平衡等关键变量在受训人群中对心理健康斗争易感性的作用。

In order to address gaps in the understanding of mental health prevalence in the graduate trainee population, we deployed a comprehensive survey that included clinically validated scales for anxiety (GAD07) and depression (PHQ09) via social media and direct email. We surveyed a total of 2,279 individuals (90% PhD students and 10% Master’s students). Respondents were from 26 countries and 234 institutions (Supplementary Tables 1 and 2) and represented diverse fields of study including, biological/physical science (38%), engineering (2%), humanities/social sciences (56%) and “other” (4%). The data presented here demonstrate that the graduate trainee community has a considerable prevalence of individuals with anxiety and depression. Although this is a convenience sample in which respondents who have had a history of anxiety or depression may have been more apt to respond to the survey, the data should prompt both academia and policy makers to consider intervention strategies.
为了解决在研究生生群体中对心理健康患病率的理解上的差距，我们通过社交媒体和直接电子邮件进行了一项综合调查，包括临床验证的焦虑量表（GAD07）和抑郁量表（PHQ09）。我们总共调查了2279人（90%的博士生和10%的硕士生）。受访者来自26个国家和234个机构（表1和表2），代表不同的研究领域，包括生物/物理科学（38%）、工程（2%）、人文/社会科学（56%）和其他（4%）。这里提供的数据表明，研究生群体中有相当多的焦虑和抑郁患者。尽管这是一个方便的样本，其中有焦虑或抑郁病史的受访者可能更倾向于回答调查，但数据应该促使学术界和决策者考虑干预策略。

Mental health crisis in the graduate student population
Our results show that graduate students are more than six times as likely to experience depression and anxiety as compared to the general population. Forty-one percent of graduate students scored as having moderate to severe anxiety on the GAD07 scale as compared to 6% of the general population, as demonstrated previously4. Additionally, 39% of graduate students scored in the moderate to severe depression range in our study, as compared to 6% of the general population measured previously with the same scale5 (Fig. 1a). In order to better understand the factors influencing this significantly higher prevalence of anxiety and depression in this population compared to the general population, we also examined their prevalence across genders and in association with perceived work–life balance and mentorship quality.
我们的研究结果表明，与普通人群相比，研究生患抑郁和焦虑的可能性高出六倍。 如前所述，在GAD07量表中，有41％的研究生得分为中度至重度焦虑，而在总人口中这一比例为6％。此外，在我们的研究中，有39％的研究生得分在中度至重度抑郁范围内，而以前使用相同的量表测得的普通人群中只有6％（图1a）。 为了更好地了解与普通人群相比，此人群焦虑和抑郁患病率显着提高的因素，我们还检查了其在不同性别中的患病率，以及与工作-生活平衡和指导质量相关的信息。

The transgender and/or gender-nonconforming population faces an increased risk of depression and anxiety. Further, women consistently are more likely to suffer from mental health disorders than men. Our results corroborate these findings within the graduate trainee population; both transgender/gender-nonconforming and female graduate students are significantly more likely to experience anxiety and depression than their male graduate student counterparts (Fig. 1b). Our study found that the prevalence of anxiety and depression in transgender/gender-nonconforming graduate students was 55% and 57%, respectively, compared with their nongender minority counterparts (43% and 41% in females and 34% and 35% in males, respectively).
跨性别者和或性别不合人群面临抑郁和焦虑的风险增加。此外，女性比男性更容易患精神疾病。我们的研究结果证实了研究生人群中的这些发现；与男性研究生相比，跨性别者和/或性别不合者和女性研究生更容易经历焦虑和抑郁（图1b）。我们的研究发现，与非性别少数民族研究生相比，跨性别者和或性别不合者研究生的焦虑和抑郁患病率分别为55%和57%（女性分别为43%和41%，男性分别为34%和35%）。

Work–life balance is associated with physical and mental well-being, and among academic faculty there are long work hours and varying degrees of work–life balance as a result. However, little is known about work–life balance in the graduate trainee population. Our respondents were asked if they agree with the statement, “I have a good work–life balance.” Of the graduate students who experienced moderate to severe anxiety, 56% did not agree with this statement versus 24% who agreed (Fig. 1c). Additionally, of those graduate students with depression, 55% did not agree with the statement versus 21% who agreed. These results show that good work–life balance is significantly correlated with better mental health outcomes.
工作与生活的平衡与身心健康息息相关，学术教师之间的工作时间长，工作与生活之间的平衡程度也不同。 但是，关于研究生人群中的工作与生活平衡知之甚少。 我们询问了受访者是否同意“我在工作与生活之间保持良好的平衡”这一说法。在经历了中度至重度焦虑的研究生中，有56％的人不同意这一说法，而有24％的人表示同意（图1c）。此外，在抑郁症的研究生中，有55％的人不同意该说法，而有21％的人不同意。 这些结果表明，良好的工作与生活平衡与改善心理健康状况显着相关。

Lastly, the principal investigator (PI)/advisor relationship with graduate students affects the quality of training in graduate education9. Therefore, it is alarming to find that of graduate students who experienced anxiety and/or depression, 50% did not agree with the statement that their PI or advisor provides “real” mentorship as compared to 36% and 33% who agreed, respectively (Fig. 1d; see Supplementary Data). The majority of those who experienced anxiety (49%) and depression (50%) disagreed with the statement that their PI/advisor provides ample support versus 35% and 32% who agreed. When asked if their PI/advisor positively impacts their emotional or mental well-being, 48% with anxiety and 47% with depression did not agree versus 34% and 31% who agreed. Further, the majority of graduate students experiencing anxiety and/or depression did not agree with the statements that their PI/advisor is an asset to their career (53% and 54% versus 37% and 35% who agreed) or that they feel valued by their mentor (55% and 56% versus 34% and 30% who agreed). These data indicate that strong, supportive and positive mentoring relationships between graduate students and their PI/advisors correlate significantly with less anxiety and depression.
最后，与研究生的首席研究员/导师关系会影响研究生教育的培训质量。因此，令人震惊的是，发现经历过焦虑和/或抑郁的研究生中，有50％的人不同意他们的PI或导师提供“真正的”指导的说法，而同意者为36％和33％（图1d；请参阅补充数据）。大多数经历焦虑症（49％）和抑郁症（50％）的人不同意他们的PI /顾问提供足够支持的说法，而同意的是35％和32％。当被问及他们的PI /顾问是否对他们的情绪或心理健康产生积极影响时，有48％的焦虑者和47％的抑郁症患者不同意，而同意的有34％和31％。此外，大多数经历焦虑和/或沮丧的研究生不同意以下观点，即他们的PI /导师是其职业的资产（53％和54％，而同意的37％和35％）或者他们觉得自己受到导师的重视（55％和56％，而同意的34％和30％）。这些数据表明，研究生与其PI /导师之间的强有力的、支持性的和积极的指导关系与较少的焦虑和抑郁显著相关。

Intervention strategies Enhanced access to mental health support
There has been a keen focus on building the biomedical workforce of tomorrow among graduate institutions and the US National Institutes of Health (NIH). The NIH has provided a model through efforts such as the Broadening Experiences in Scientific Training (BEST) award program and within the NIH campus through establishing the Office of Intramural Training and Education that houses many programs to support the career development of intramural trainees. Although these resources have served as a scaffold for the development of local programs at many graduate institutions, there are still many universities that lack adequate career and professional development programs.
研究生院和美国国立卫生研究院（NIH）一直热衷于培养未来的生物医学人才。国家卫生研究院通过努力提供了一个模式，例如扩大了科学培训（BEST）奖励计划的经验，并在国家卫生研究院校园内建立了校内培训和教育办公室，其中包含许多支持校内学员职业发展的计划。尽管这些资源已成为许多研究生院发展地方项目的一个支架，但仍有许多大学缺乏足够的职业和专业发展项目。

Career development encompasses many skills that are vital to graduate student success but is often not included under this umbrella as mental health. We believe that our data support the need for a more comprehensive development of more adequate career development offices across institutions to ensure that they can serve to educate students about mental health and refer those who need mental health support. Establishing this infrastructure is a foundational step for institutions to ensure that students are prepared to become the biomedical workforce of tomorrow. Further, creating programs and interventions within career development offices that promote mental health will result in a competitive advantage for institutions and increase retention, thus strengthening the bioscience workforce pipeline.
职业发展包括许多对研究生成功至关重要的技能，但通常不包括在心理健康方面。 我们认为，我们的数据支持需要在机构之间更全面地发展更充分的职业发展办公室，以确保它们可以用来教育学生心理健康，并推荐需要心理健康支持的人员。 建立这种基础设施是机构确保学生准备成为明天的生物医学劳动力的基础性步骤。 此外，在职业发展机构内制定促进精神健康的计划和干预措施，将为机构带来竞争优势并增加保留率，从而加强生物科学人才队伍。

Call for cultural change.
There is a grave need to educate faculty about the impact of graduate education on the mental health of graduate students. The NIH Office of Intramural Training and Education recently used a train-the-trainers model at a highly successful event where career development leaders trained the next generation of career development professionals on topics that are vital to their success. Using a similar train-the-trainers model, faculty and administration could be trained by mental health professionals to ensure that those in a position to directly support graduate students are equipped to identify student mental health needs and provide adequate guidance and referrals as needed.
This model could also be used by career development professionals to provide faculty with training in the fundamental skills and knowledge needed to mentor today’s PhD students in the vast and ever-changing job market.
研究生教育对研究生心理健康的影响是教育教师的迫切需要。美国国立卫生研究院校内培训和教育办公室最近在一个非常成功的活动中采用了培训师模式，职业发展领导人就对他们的成功至关重要的主题对下一代职业发展专业人员进行了培训。利用类似的培训师模式，心理健康专业人员可以对教员和行政人员进行培训，以确保那些能够直接支持研究生的人员能够确定学生的心理健康需求，并根据需要提供充分的指导和转介。职业发展专业人士也可以利用这一模式为教员提供培训，使他们掌握在广阔和不断变化的就业市场中指导当今博士生所需的基本技能和知识。

Many in academia have spoken out about their own mental illnesses and the stigma they faced within the academic community. Fears of not gaining tenure or judgments being cast by colleagues are just a few of the major concerns faced by those who suffer from mental health disorders in academia. Fundamentally, data such as ours call for a shift in the culture within academia to eliminate the stigma and ensure that students are not reluctant to communicate openly with their faculty advisors.
学术界的许多人都公开谈论自己的精神疾病以及他们在学术界面临的耻辱。担心得不到终身教职或被同事做出判断，这只是学院里那些患有精神疾病的人面临的主要担忧之一。从根本上说，像我们这样的数据要求学术界转变文化，消除耻辱感，确保学生不会不愿意与导师公开交流。

Work–life balance is hard to attain in a culture where it is frowned upon to leave the laboratory before the sun goes down. The stress of increased pressure to produce data in order to compete for funding has increased exponentially, and science fields are feeling immense pressure. Faculty and administrators must set a tone of self-care as well as an efficient and mindful work ethic in order to move to a healthier work and education environment.
在一个不赞成在太阳落山之前离开实验室的文化中，工作与生活的平衡是很难达到的。为了争夺资金而产生数据的压力越来越大，这种压力成倍增加，科学领域也感受到了巨大的压力。教师和管理者必须树立一种自我照顾的基调，以及一种高效和谨慎的职业道德，以便转向一个更健康的工作和教育环境。

Call to action.
These data demonstrate a critical need for additional studies that investigate intervention strategies that could address the mental health crisis in the graduate trainee population. It is only with strong and validated interventions that academia will be able to provide help for those who are traveling through the bioscience workforce pipeline.
这些数据表明，迫切需要更多的研究，调查干预策略，可以解决在研究生培训生群体的心理健康危机。只有通过强有力和有效的干预措施，学术界才能为那些通过生物科学工作队伍管道的人提供帮助。

Conclusions
Our studies show a high prevalence of anxiety and depression in a diverse graduate student ample. The strikingly high rates of anxiety and depression support a call to action to establish and/or expand mental health and career development resources for graduate students through enhanced resources within career development offices, faculty training and a change in the academic culture.
我们的研究表明，在充裕的多元化研究生中，焦虑和抑郁的患病率很高。 焦虑症和抑郁症的高发率促使人们呼吁采取行动，通过增加职业发展办公室内的资源，教师培训和改变学术文化，为研究生建立和/或扩大心理健康和职业发展资源。