depression nach dissertation

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• v.20(3); Fall 2021

PhDepression: Examining How Graduate Research and Teaching Affect Depression in Life Sciences PhD Students

Logan e. gin.

† Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ 85281

Nicholas J. Wiesenthal

§ Department of Biology, University of Central Florida, Orlando, FL 32816

Katelyn M. Cooper

Graduate students are more than six times as likely to experience depression compared with the general population. However, few studies have examined how graduate school specifically affects depression. In this qualitative interview study of 50 life sciences PhD students from 28 institutions, we examined how research and teaching affect depression in PhD students and how depression in turn affects students’ experiences teaching and researching. Using inductive coding, we identified factors that either positively or negatively affected student depression. Graduate students more commonly mentioned factors related to research that negatively affected their depression and factors related to teaching that positively affected their depression. We identified four overarching aspects of graduate school that influenced student depression: the amount of structure in teaching and research, positive and negative reinforcement, success and failure, and social support and isolation. Graduate students reported that depression had an exclusively negative effect on their research, primarily hindering their motivation and self-confidence, but that it helped them to be more compassionate teachers. This work pinpoints specific aspects of graduate school that PhD programs can target to improve mental health among life sciences graduate students.

INTRODUCTION

In 2018, researchers found that graduate students were more than six times as likely to report experiencing depression and anxiety compared with the general population and subsequently declared a “graduate student mental health crisis” ( Evans et al. , 2018 ; Flaherty, 2018 ). Calls to identify which factors exacerbate graduate student mental health problems followed (“The Mental Health of PhD Researchers,” 2019; Woolston, 2019a ). However, few studies have taken an inductive approach to identifying what aspects of graduate school in particular affect student mental health. More commonly, large quantitative studies propose a limited number of factors that may affect student mental health that participants select from, few of which directly relate to graduate research or teaching ( Peluso et al. , 2011 ; Levecque et al. , 2017 ; Evans et al. , 2018 ; Liu et al. , 2019 ). In this interview study, we focus on depression in life sciences PhD students and examine which specific aspects of research and teaching graduate students report as affecting their depression. We also explore how depression affects students’ experiences in graduate school.

The American Psychiatric Association defines depression as a common and serious medical illness that negatively affects how one feels, the way one thinks, and how one acts ( American Psychiatric Association, 2020 ). Depression is characterized by nine symptoms: depressed mood; markedly diminished interest or pleasure in activities; reduced ability to think or concentrate, or indecisiveness; feelings of worthlessness, or excessive or inappropriate guilt; recurrent thoughts of death or suicidal ideation, or suicide attempts or plans; insomnia or hypersomnia; significant change in appetite or weight; psychomotor agitation or retardation; and fatigue or loss of energy ( American Psychiatric Association, 2013 ; Schmidt and Tolentino, 2018 ). For depression to be diagnosed, the presence of at least five of the symptoms is required most of the day, nearly every day, for at least 2 weeks in addition to the occurrence of either depressed mood or diminished interest or pleasure ( American Psychiatric Association, 2013 ). In the general U.S. population, depression affects approximately 6.7% of individuals and is estimated to affect 16.6% of individuals at some point in their lifetime.

Graduate students are far more likely to report experiencing depression compared with the general population ( Evans et al. , 2018 ; Barreira et al. , 2020 ). Specifically, a recent study of master’s and PhD students in programs across the world, spanning a variety of disciplines, found that 39% of graduate students reported having moderate to severe depression ( Evans et al. , 2018 ). Similar studies have demonstrated high rates of depression in graduate students in specific disciplines such as economics ( Barreira et al. , 2020 ), biochemistry ( Helmers et al. , 1997 ), pharmacology ( Helmers et al. , 1997 ), and physiology ( Helmers et al. , 1997 ). Depression rates have surged in recent years among graduate students ( American College Health Association, 2014 , 2019 ). Talking about depression has become more socially acceptable, particularly among younger adults ( Anxiety and Depression Association of America, 2015 ; Lipson et al. , 2019 ), which may have contributed to the number of students willing to reveal that they are struggling with mental health. Additionally, depression is highly related to burnout, defined as a work-related chronic stress syndrome involving emotional exhaustion, depersonalization, and reduced personal accomplishment ( Maslach et al. , 2001 ; Bianchi et al. , 2014 ). Graduate work environments appear to be increasingly characterized as stressful and demanding ( American College Health Association, 2014 , 2019 ; Woolston, 2017 ), which may also be contributing to the increase in graduate depression rates.

Increasingly, scientists, psychologists, and education researchers are recognizing graduate student mental health as a concern and calling for further investigation of graduate student mental health in hopes of identifying interventions to improve graduate student quality of life (“The Mental Health of PhD Researchers,” 2019; Woolston, 2019a , b ). For example, in 2019, Nature added a question to its annual survey of PhD students asking students from around the world whether they had sought help for anxiety or depression, and more than one-third (36%) confirmed they had ( Woolston, 2019b ). Additionally, notable publication outlets such as Nature (“The Mental Health of PhD Researchers,” 2019), Scientific American ( Puri, 2019 ), and Science ( Pain, 2018 ) have published blogs or editorials spotlighting the need to improve graduate student mental health.

Some recent studies have sought to uncover the factors affecting depression in graduate students. Primarily, survey studies with predetermined factors that researchers hypothesized impact student mental health have identified poor mentor–mentee relationships ( Peluso et al. , 2011 ; Evans et al. , 2018 ; Hish et al. , 2019 ; Liu et al. , 2019 ; Charles et al. , 2021 ), financial stress ( Hish et al. , 2019 ; Jones-White et al. , 2020 ; Charles et al. , 2021 ), and lack of work–life balance ( Evans et al. , 2018 ; Liu et al. , 2019 ) to be associated with depression or depressive symptoms among graduate students in various disciplines. Other variables shown to be predictive of depression include low research self-efficacy, defined as low confidence in one’s ability to do research ( Liu et al. , 2019 ), difficulty publishing papers ( Liu et al. , 2019 ), hours worked per week ( Peluso et al. , 2011 ), and perceived institutional discrimination ( Charles et al. , 2021 ). Factors that appear to be protective of depressive symptoms include social support ( Charles et al. , 2021 ), mastery, defined as the extent to which individuals perceive themselves to be in control of the forces that impact their lives ( Hish et al. , 2019 ), positive departmental social climate ( Charles et al. , 2021 ), optimism about career prospects ( Charles et al. , 2021 ), and sense of belonging to one’s graduate program ( Jones-White et al. , 2020 ). While these studies have identified some depression-related factors associated with graduate school broadly and emphasize the importance of positive mentor–mentee relationships, few studies have explored factors specifically associated with research and teaching, the two activities that graduate students engage in most frequently during their time in a program. Additionally, the extant literature has primarily focused on surface causes of graduate student depression, yet understanding the underlying causes may be key to developing meaningful interventions. For example, while it is well established that student perception of poor mentorship is related to student depression ( Evans et al. , 2018 ; Hish et al. , 2019 ; Liu et al. , 2019 ; Charles et al. , 2021 ), it is less well understood what specific behaviors mentors exhibit and how such behaviors negatively affect the cognitive and behavioral underpinnings of graduate student depression. Without this knowledge, it is difficult to develop strategies to help mentors be more inclusive of students.

Theories of depression seek to explain the causes of depression. No theoretical model is widely accepted as an overarching framework for depression within the psychological and psychiatric communities ( Mcleod, 2015 ; Ramnerö et al. , 2016 ); instead, there are a number of models addressing how different aspects of depression are associated with the disorder. Arguably, the three most prominent models are cognitive ( Beck et al. , 1979 ), behavioral ( Martell et al. , 2001 ), and psychodynamic ( Busch et al. , 2016 ). In brief, cognitive theories focus on an individual’s beliefs and propose that changes in thinking precede depressive symptoms; for example, negative views of oneself, the world, and the future are thought to be common for individuals with depression ( Beck et al. , 1979 ; Leahy, 2002 ). Behavioral theories emphasize that depression is a result of one’s interaction with the environment; depressive symptoms are thought to be the result of decreased reward, lack of positive reinforcement, encouragement of depressive or passive behaviors, and discouragement of healthy behaviors ( Lewinsohn, 1974 ; Martell et al. , 2001 ; Carvalho et al. , 2011 ). Psychodynamic theories of depression consider the role of feelings and behaviors in the etiology and persistence of depressive symptoms; these theories often focus on 1) one’s biology and temperamental vulnerabilities, 2) earliest attachment relationships, and 3) childhood experiences associated with frustration, helplessness, loss, guilty, or loneliness ( Busch et al. , 2016 ). While each group of theories has been critiqued and no one theory fully explains one’s experience with depression ( Mcleod, 2015 ; Ramnerö et al. , 2016 ), we propose that each may be helpful in understanding how aspects of graduate school may affect depression among PhD students.

The thoughts and behaviors associated with depression may in turn affect students’ experiences in graduate school, particularly their experiences with research and teaching. While no studies have examined how depression explicitly affects graduate students’ research experiences, studies have identified ways in which depression can affect students’ experiences in undergraduate research ( Cooper et al. , 2020a , b ). Undergraduate researchers report that their depression negatively affected their motivation, ability to concentrate and remember, intellectual engagement, and creativity in research ( Cooper et al. , 2020b ). Undergraduates described that their depression also caused them to be overly self-critical, less social, and ultimately negatively affected their research productivity. Additionally, undergraduates have been reluctant to share their depression with others in the lab, because they fear that they will be judged ( Cooper et al. , 2020b ). While these studies provide some insight into how depression may affect graduate students’ experience in research, there is much less information about how depression may affect graduate teaching.

In this study, we interviewed 50 PhD students in the life sciences who self-identified with having depression with the intent of answering two research questions that address gaps in the literature: 1) What specific aspects of graduate research and teaching affect PhD student depression? 2) How does PhD students’ depression affect their experience in research and teaching?

Student Interviews

This study was done under an approved Arizona State University Institutional Review Board protocol (no. 00011040).

In Fall 2019, we surveyed graduate students by sending an email out to program administrators of all life sciences graduate programs in the United States that are listed in U.S. News & World Report (2019) . Of the 259 graduate programs that we contacted, 75 (29.0%) program administrators agreed to forward our survey to students enrolled in their graduate programs. Of the 840 graduate students who participated in the survey, 459 (54.6%) self-identified as having depression based on general demographic questions on the survey. Of the 459 students who identified as having depression, 327 (71.2%) agreed to be contacted for a follow-up interview. In Summer 2020, we sent a recruitment email out to the 327 students who identified as having depression, asking to interview them about their experiences with depression in a PhD program. We specifically did not require that students be diagnosed with depression in order to participate in the interview study. We did not want to bias our sample, as mental health care is disproportionately unavailable to Black and Latinx individuals, as well as to those who come from low socioeconomic backgrounds ( Howell and McFeeters, 2008 ; Kataoka et al. , 2002 ; Santiago et al. , 2013 ). Of the students who were contacted, 50 PhD students (15.3%) enrolled across 28 life sciences PhD programs completed an interview.

The interview script was based on a previous interview script that we had developed, which successfully elicited what aspects of research affect depression in undergraduates and how depression affects their research ( Cooper et al. , 2020a ). Our previous work has shown that research experiences do not exclusively worsen depression, but that aspects of research can also help students manage their depression ( Cooper et al. , 2020a ). As such, our interview questions explored what aspects of research helped students manage their depression (positively affecting depression), and what aspects worsened students’ depression (negatively affecting depression). Additionally, we hypothesized that other prominent aspects of graduate school, such as teaching, would also affect PhD student depression and revised the interview script to include questions focused on examining the relationship between depression and teaching. We asked students what aspects of graduate research and teaching made their depression worse and what aspects helped them manage their depression. Participants were invited to come up with as many aspects as possible. We also asked how students perceived their depression affected their research and teaching. With the knowledge that we would be conducting interviews during summer of 2020 in the midst of the COVID-19 pandemic, and that the pandemic had likely exacerbated graduate student depression ( Chirikov et al. , 2020 ), we directed students to not reference aspects of research and teaching that were uniquely related to the pandemic (e.g., teaching remotely or halted research) when discussing the relationship between research, teaching, and depression. We were specifically interested in aspects of teaching and research that affected student depression before the pandemic and would presumably affect student depression afterward. We conducted think-aloud interviews with four graduate students who identified as having depression to ensure that our questions would not offend anyone with depression and to establish cognitive validity of the interview script by ensuring that each student understood what each question was asking. The interview script was iteratively revised after each think-aloud interview ( Trenor et al. , 2011 ). A final copy of the interview script can be found in the Supplemental Material.

All interviews were conducted using Zoom by one of two researchers (L.E.G. or K.M.C.). The average interview time was about 45 minutes. After the interview, all participants were sent a short survey to collect their demographics and additional information about their depression (a copy of the survey can be found in the Supplemental Material). Participants were provided a small monetary gift card in exchange for their time. All interviews were deidentified and transcribed before analysis.

Interview Analysis

Three researchers (L.E.G., N.J.W., and K.M.C.) independently reviewed 12 of the same randomly selected interviews to explore each idea that a participant expressed and to identify recurring themes ( Charmaz, 2006 ). Each researcher took detailed analytic notes during the review. After, the three researchers met to discuss their notes and to identify an initial set of recurring themes that occurred throughout the interviews ( Saldaña, 2015 ). The authors created an initial codebook outlining each theme and the related description. Together, the authors then reviewed the same set of five additional interviews to validate the themes outlined in the codebook and to identify any themes that may have been missed during the initial review. The researchers used constant comparison methods to compare quotes from the interviews to each theme and to establish whether any quotes were different enough from a particular theme to warrant an additional code ( Glesne and Peshkin, 1992 ). Together, the three researchers revised the codebook until they were confident that it captured the most common themes and that no new themes were emerging. A final copy of the codebook can be found in the Supplemental Material. Two authors (L.E.G. and N.J.W.) used the final codebook to code five randomly selected interviews (10% of all interviews) and their Cohen’s κ interrater score was at an acceptable level (κ = 0.94; Landis and Koch, 1977 ). Then, one researcher (N.J.W.) coded the remaining 45 interviews. In the text, we present themes mentioned by at least 10% of interviewees and use quotes to highlight themes. Some quotes were lightly edited for clarity.

Author Positionality

Some of the authors identify as having depression and some do not. One author had completed a PhD program (K.M.C.), one author was in the process of completing a PhD program (L.E.G.), and two authors were undergraduates (N.J.W. and I.F.) at the time when the interviews and analyses took place.

Interview Participants

Fifty PhD students agreed to participate in the study. Students were primarily women (58%), white (74%), and continuing-generation college students (78%). Twelve percent of students were international students, and the average age of the participants was 28 years old. While 20% of students were unsure of their career goals, 32% of students planned to pursue a career in academia, and 24% were planning to pursue a career in industry. Students reported how severe they perceived their depression to be, on average, during the time they had spent in their PhD programs. Most students reported their depression as either moderate (50%) or severe (28%). Eighty percent of students reported being diagnosed with depression, and 74% reported receiving treatment for depression. Participants were at different stages in their PhD programs ranging from first year to sixth year or more. Three students had graduated between the time they completed the initial survey and when they participated in the interview in Summer 2020. Students self-reported their main research areas and represented a broad range, with ecology and evolutionary biology (26%), animal science (14%), molecular biology (14%), and neurobiology (10%) being the most common. Eighty-six percent of students had experience teaching undergraduates, primarily as teaching assistants (TAs), at the time of the interviews. All student demographics are summarized in Table 1 .

Participant demographics

The Effect of Research on Graduate Student Depression

Students more commonly identified ways that research negatively affected their depression than ways research positively affected their depression. Considering all factors that students listed and not just those that were most common, students on average listed two ways in which an aspect of research negatively affected their depression and one way in which an aspect of research positively affected their depression.

The most commonly reported aspect of research that worsened students’ depression was experiencing failures, obstacles, or setbacks in research. Specifically, students cited that failed experiments, failed research projects, and the rejection of manuscripts and grants was particularly difficult for their depression. Conversely, students highlighted that their depression was positively affected when they were able to make substantial progress on their research projects; for example, if they wrote part of a manuscript or if an experiment worked. Students also explained that accomplishing smaller or mundane research tasks was helpful for their depression, both because they felt as though they were checking off a box and also because it allowed them to focus on something other than the negative thoughts often associated with depression.

Students also highlighted that the unstructured nature of graduate research worsened their depression. Specifically, students described that, in graduate research, there are often no clear directions, sets of guidelines, or deadlines to help structure their day-to-day activities. Without this structure, students need to rely on their own motivation to outline goals, accomplish tasks, or seek help, which participants described can be difficult when one is experiencing a depressive episode. However, students also felt as though the unstructured nature of research benefited their depression, because it allowed for flexibility. Those who did not have frequent deadlines or strict schedules were able to not conduct research on days when they needed to recover from a depressive episode or schedule research around therapy or other activities that had a positive impact on their depression. Finally, students highlighted that their passion for their research was protective against depression. Their love for the subject of their research or thinking about how their work may have a positive impact on others could positively affect their motivation or mood.

Students described that their relationships with others in the lab also affected their depression. Specifically, if their mentors or others in their lab had unreasonable or overwhelming expectations of them, it could make them feel as though they would never be able to meet such expectations. Research also provides an environment for students to constantly compare themselves with others, both those in supervisory roles as well as peers. Notably, when students mentioned comparing themselves with others, this comparison never made them feel good about themselves, but was exclusively detrimental to their depression; they felt as though they would never be able to accomplish what others had already accomplished. Students’ relationships with their mentors also seemed to have a notable impact on their depression. Having a positive relationship with their mentors or a mentor who provided psychosocial support positively affected their depression, whereas perceiving a negative relationship with their mentors, particularly a mentor who provided consistently harsh or negative feedback, was detrimental. Students who had absent mentors or mentors who provided infrequent technical support and guidance also felt as though this situation worsened their depression, because it prevented or prolonged their success in research. Finally, students highlighted that conducting graduate research can be isolating, because you are often working on something different from those in the lab or because those outside graduate school cannot relate to the stress and struggles associated with research. However, in instances in which students were able to collaborate with others, this could be protective against depression, because it gave students a sense of comradery or validated their feelings about specific aspects of research. The most common research-related factors that students reported negatively and positively affected their depression and example student quotes of each factor are reported in Tables 2 and ​ and3, 3 , respectively.

Research-related factors that PhD students reported negatively affected their depression

Research-related factors that PhD students reported positively affected their depression

The Effect of Teaching on Graduate Student Depression

We asked all graduate students who had teaching experience ( n = 43) how teaching affected their depression. Graduate students more commonly identified ways that teaching positively affected their depression than ways teaching negatively affected their depression. On average, considering all factors that graduate students listed and not just those that were most common, participants listed two ways in which teaching positively affected their depression and one way in which teaching negatively affected their depression.

Graduate students most commonly highlighted that teaching provided positive reinforcement from undergraduates, which helped them manage their depression. This positive reinforcement came in multiple forms ranging from formal teaching evaluations to positive verbal comments from undergraduates about how good a graduate student was at teaching to watching undergraduates accomplish academic goals or grasp complex concepts. A subset of graduate students highlighted that teaching was good for their depression, because it was something they were passionate about or that they genuinely enjoyed. As such, it was a source of happiness, as was being able to collaborate and form friendships with other TAs or instructors. Some graduate students also acknowledged that they felt confident teaching, often because they had mastered content that undergraduates had not. However, this was not always the case; some graduate students highlighted that a lack of teaching training and preparation negatively affected their self-efficacy as instructors, which in turn exacerbated their depression. This was further exacerbated by the pressure that graduate students put on themselves to perform well as instructors. The potential to have a negative impact on undergraduates and their learning experiences could worsen students’ depression by increasing the stress surrounding their performance as a teacher. Additionally, some graduate students received negative reinforcement from undergraduates, in the form of negative comments on formal teaching evaluations or disrespectful behavior from undergraduates such as groans or eye rolls, which graduate students explained negatively affected their self-efficacy, further worsening their depression.

Students also highlighted that teaching could negatively affect their depression because it interfered with the time they felt they needed to be spending on research or added to the large number of responsibilities they had as graduate students. However, some students welcomed time away from research; teaching sometimes served as a distraction from research-related stressors. Students also highlighted that teaching is structured, which positively affected their depression. That is, there are concrete tasks, such as grading, that need to be accomplished or places that the graduate student needs to be during a specific time. This structure helped motivate them to accomplish teaching goals, even if they were feeling a lack of motivation because of their depression. The most common teaching-related factors that graduate students reported negatively and positively affected their depression and example student quotes for each factor are reported in Tables 4 and ​ and5, 5 , respectively.

Teaching-related factors that PhD students reported negatively affected their depression

a Forty-three out of the 50 students who participated in the study had experience teaching undergraduates either as a TA or as an instructor of record. We only considered the responses from the TAs with teaching experiences when calculating the percent of students who reported each factor.

Teaching-related factors that PhD students reported positively affected their depression

The Effect of Depression on Graduate Research

In the interviews, we asked graduate students how their depression affected their graduate research, if at all. They identified three primary ways in which depression could affect research, all of which were negative. The most common way depression affected research was interfering with students’ motivation, which in turn affected their productivity. Students described that their productivity was affected immediately, for example, struggling to execute daily tasks like collecting or analyzing data. However, graduate students described that their lack of motivation ultimately resulted in larger consequences, such as delays in getting papers submitted and published. In fact, some graduate students explicitly stated that they felt as though they would have been able to graduate earlier if they had not had depression. The second way in which depression affected graduate students’ research is that it interfered with their ability to focus or concentrate. Students primarily explained that the lack of focus did not delay their research but caused their research to be less enjoyable or made them frustrated because they had to expend additional mental energy to execute tasks. Depression also caused students to be less confident or overly critical of themselves. Specifically, if an experiment did not go right or they experienced rejection of a manuscript, they tended to internalize it and blame themselves. This lack of confidence often inhibited students’ abilities to make decisions about research or take risks in research. They described frequently second-guessing themselves, which made decisions and taking risks in research more difficult. The most common ways students reported that their depression affected their research and example student quotes are reported in Table 6 .

Self-reported ways that depression affected PhD students’ research or the student as a researcher

The Effect of Depression on Teaching

Graduate students described one positive way and two negative ways that depression affected their teaching. Students explained that, because they had experienced depression, they were more compassionate and empathetic toward the undergraduates in their courses. Specifically, they felt they could better understand some of the struggles that undergraduates experience and were sometimes more likely to be flexible or lenient about course requirements and deadlines if an undergraduate was struggling. However, graduate students reported that depression also negatively affected their teaching. Specifically, depression could cause graduate students to feel disconnected or disengaged from undergraduates. It could also cause graduate students to feel as though they had a lack of energy or felt down when teaching. The common self-reported ways that depression affected PhD students’ teaching and example quotes are reported in Table 7 .

Self-reported ways that depression affected PhD students’ teaching or the graduate student as an instructor

a Forty-three out of the 50 students who participated in the study had experience teaching undergraduates either as a TA or as an instructor of record. We only considered the responses from the TAs with teaching experiences when calculating the percent of students who reported each theme.

Despite the increasing concern about graduate student mental health among those in the scientific community ( Pain, 2018 ; “The Mental Health of PhD Researchers,” 2019; Puri, 2019 ), there is a lack of information about how specific aspects of science PhD programs affect students with depression. This is the first study to explicitly investigate which particular aspects of research and teaching affect depression among life sciences PhD students and how depression, in turn, affects graduate students’ experiences in research and teaching. Overall, graduate students highlighted factors related to teaching and research that both alleviated and exacerbated their symptoms of depression. Graduate students more commonly brought up ways that research negatively affected their depression, than ways that it positively affected their depression. Conversely, graduate students more commonly mentioned ways that teaching had a positive effect on their depression compared with a negative effect. The requirement and opportunity to teach differs among life sciences graduate programs ( Schussler et al. , 2015 ; Shortlidge and Eddy, 2018 ). As such, future research should investigate whether the amount of teaching one engages in during graduate school is related to levels of graduate student depression. Despite differences in how teaching and research affect student depression, this study unveiled factors that protect against or worsen depressive symptoms. Specifically, four overarching factors affecting graduate student depression emerged from the interviews: 1) Structure; 2) Positive and Negative Reinforcement; 3) Failure and Success; 4) Social Support and Isolation. We discuss here how each of these factors may positively and negatively affect graduate student depression.

One stark contrast between research and teaching is the amount of structure in each activity. That is, students expressed that research goals are often amorphous, that there are not concrete instructions for what needs to be accomplished, and that there is often no set schedule for when particular tasks need to be accomplished. Conversely, with teaching, graduate students often knew what the goals were (e.g., to help students learn), exactly what they needed to accomplish each week (e.g., what to grade, what to teach), and when and where they needed to show up to teach (e.g., a class meets at a particular time). Graduate students highlighted that a lack of structure, particularly in research, was detrimental for their depression. Their depression often made it difficult for them to feel motivated when there was not a concrete task to accomplish. Major depression can interfere with executive function and cognition, making goal setting and goal achievement particularly difficult ( Elliott, 1998 ; Watkins and Brown, 2002 ). In fact, research has documented that individuals with depression generate less specific goals and less specific explanations for approaching a goal than individuals who do not have depression ( Dickson and Moberly, 2013 ). As such, it may be particularly helpful for students with depression when an activity is structured, relieving the student from the need to articulate specific goals and steps to achieve goals. Students noted that the lack of structure or the flexibility in research was helpful for their depression in one way: It allowed them to better treat their depression. Specifically, students highlighted that they were able to take time to go to therapy or to not go into the lab or to avoid stressful tasks, which may be important for successful recovery from a depressive episode ( Judd et al. , 2000 ).

Compared with conducting research, many participants reported that the concrete tasks associated with teaching undergraduates were helpful for their depression. This is supported by literature that illustrates that concrete thinking, as opposed to abstract thinking, can reduce difficulty making decisions in individuals with depression ( Dey et al. , 2018 ), presuming that teaching often requires more concrete thinking compared with research, which can be more abstract. Additionally, cognitive-behavioral treatments for depression have demonstrated that developing concrete goals for completing tasks is helpful for individuals with depression ( Detweiler-Bedell and Whisman, 2005 ), which aligns with graduate students’ perceptions that having concrete goals for completing teaching tasks was particularly helpful for their depression.

Positive and Negative Reinforcement

Graduate students reported that the negative reinforcement experienced in research and teaching had a significant negative effect on their depression, while the positive reinforcement students experienced only in teaching had a positive effect. Notably, students did not mention how positive reinforcement affected their depression in the context of research. Based on student interviews, we predict that this is not because they were unaffected by positive reinforcement in research, but because they experienced it so infrequently. Drawing from behavioral theories of depression, the concept of response-contingent positive reinforcement (RCPR; Lewinsohn, 1974 ; Kanter et al. , 2004 ) helps explain this finding. As summarized by Kanter and colleagues (2004) , RCPR describes someone seeking a response and being positively reinforced; for example, graduate students seeking feedback on their research are told that what they have accomplished is impressive. Infrequent RCPR may lead to cognitive symptoms of depression, such as low self-esteem or guilt, resulting in somatic symptoms of depression, such as fatigue and dysphoria ( Lewinsohn, 1974 ; Martell et al. , 2001 ; Manos et al. , 2010 ). RCPR is determined by three factors. 1) How many potential events may be positively reinforcing to an individual. For example, some people may find an undergraduate scoring highly on an exam in a class they are teaching to be reinforcing and others may find that they only feel reinforced when an undergraduate explicitly compliments their teaching. 2) The availability of reinforcing events in the environment. If graduate students’ mentors have the ability to provide them with RCPR but are never able to meet with them, these reinforcing events are unavailable to them. 3) The instrumental behavior of an individual. Does the individual exhibit the behavior required to obtain RCPR? If graduate students do not accomplish their research-related tasks on time, they may not receive RCPR from their mentor. If individuals are not positively reinforced for a particular behavior, they may stop exhibiting it, further exacerbating the depressive cycle ( Manos et al. , 2010 ). Therefore, the lack of positive reinforcement in research may be particularly damaging to graduate students, because it may discourage them from completing tasks, leading to additional depressive symptoms. Conversely, teaching presents many opportunities for positive reinforcement. Every time graduate students teach, they have the opportunity to receive positive reinforcement from their students or to witness a student’s academic accomplishment, such as an undergraduate expressing excitement when they understand a concept. As such, it is not surprising that positive reinforcement was the primary teaching-related factor that graduate students reported helped with their depression. Despite the positive reinforcement of teaching for graduate students with depression, we are not suggesting that graduate students should take on additional teaching loads or that teaching should be viewed as the sole respite for graduate students with depression. Overwhelming students with increased responsibilities may counteract any positive impact that teaching could have on students’ depression.

Failure and Success

Failure and success affected student depression, but only in the context of research; contrary to research, students rarely mentioned concrete metrics for success and failure in teaching. While graduate students highlighted receiving positive or negative reinforcement from undergraduates, they did not relate this to being a “successful” instructor. It is unsurprising that graduate students did not mention failing or succeeding at teaching, given that experts in teaching agree that it is difficult to objectively evaluate quality teaching ( d’Apollonia and Abrami, 1997 ; Kember et al. , 2002 ; Gormally et al. , 2014 ). In fact, the lack of teacher training and knowledge about how to teach effectively negatively affected student depression, because it could cause students to feel unprepared as an instructor. Integrating teacher training into graduate programs has been championed for decades ( Torvi, 1994 ; Tanner and Allen, 2006 ; Schussler et al. , 2015 ); however, the potential for such training to bolster graduate student mental health is new and should be considered in future research. With regard to graduate students’ research, the concept of success and failure was far more concrete; students mentioned failing in terms of failed experiments, research projects, and rejected manuscripts and grant proposals. Successes included accepted manuscripts, funded grant proposals, and concrete progress on significant tasks, such as writing or conducting an experiment that yielded usable data. Failure has been shown to negatively affect depression among undergraduate researchers ( Cooper et al. , 2020a ), who are hypothesized to be inadequately prepared to experience failure in science ( Henry et al. , 2019 ). However, it is less clear how well prepared graduate students are to experience failure ( Simpson and Maltese, 2017 ). Drawing from cognitive theories of depression, depression is associated with dysfunctional cognitive schemas or dysfunctional thinking that can lead individuals with depression to have negative thoughts about the world, themselves, and the future and to interpret information more negatively than is actually the case (called negative information-processing biases; Beck, 1967 ; Beck et al. , 1979 ; Gotlib and Krasnoperova, 1998 ; Maj et al. , 2020 ). Related to failure, individuals with dysfunctional cognitive schemas may harbor beliefs such as if something fails at work (or in graduate research), they are a failure as a person or that a small failure can be as detrimental as a larger failure ( Weissman, 1979 ; Miranda and Persons, 1988 ). As such, setbacks in research may be particularly difficult for PhD students with depression. Graduate students in our study also mentioned how failing in research was often out of their control, particularly failure related to experiments and research projects. The extent to which one feels they can control their environment is important for mental health, and lower estimates of control have been hypothesized to be an important factor for depression ( Grahek et al. , 2019 ). Therefore, this feeling of being unable to control success in research may further exacerbate student depression, but this would need to be tested. Importantly, these findings do not imply that individuals with depression are unable to cope with failure; they only suggest that individuals perceive that failure in science can exacerbate their depression.

Social Support and Isolation

Graduate students reported that feelings of isolation in research could worsen their depression. Specifically, they highlighted that it can be difficult for their mental health when their friends outside graduate school cannot relate to their struggles in research and when others in their research group are not working on similar projects. One study of more than 1400 graduate students at a single university found that feeling isolated from fellow graduate students and faculty positively predicted imposter phenomenon ( Cohen and McConnell, 2019 ), defined as the worry that they were fooling others about their abilities and that their fraudulence would be exposed ( Clance and Imes, 1978 ), which is positively correlated with depression among college students ( McGregor et al. , 2008 ). Developing a positive lab environment, where undergraduates, graduate students, and postgraduates develop positive relationships, has been shown to positively affect undergraduates ( Cooper et al. , 2019 ) and may also positively affect graduate students who experience such feelings of isolation. Graduate students in this study described that both teaching and research had the potential to be a source for relationship development and social support. Students who described positive collaborative relationships in research and teaching felt this had a positive impact on their depression, which aligns with a review of studies in psychiatry concluding that being connected to a large number of people and having individuals who are able to provide emotional support by listening or giving advice is protective against depression ( Santini et al. , 2015 ), as well as a study that found that social support is protective against depression, specifically among the graduate population ( Charles et al. , 2021 ).

These four factors provide clear targets for graduate programs looking to improve the experiences of students with depression. For example, increasing structure in research could be particularly helpful for graduate students with depression. Ensuring that students have concrete plans to accomplish each week may not only positively impact depression by increasing structure, but ultimately by increasing a student’s success in research. Research mentors can also emphasize the role of failure in science, helping students realize that failure is more common than they may perceive. Increasing opportunities for positive reinforcement in teaching and research may be another avenue to improving student mental health. Providing students with appropriate teacher training is a first step to enhancing their teaching skills and potential for positive reinforcement from undergraduate students ( Schussler et al. , 2015 ). Additionally, teaching evaluations, a common form of both positive and negative reinforcement, are known to be biased and disadvantage women, People of Color, and those with non–English speaking backgrounds ( Fan et al. , 2019 ; Chávez and Mitchell, 2020 ) and arguably should not be used to assess teaching. In research, mentors can make an effort to provide positive feedback or praise in meetings in addition to critiques. Finally, to provide social support to graduate students with depression, graduate programs could consider creating specific initiatives that are related to supporting the mental health of graduate students in their departments, such as a support group for students to meet and discuss their experiences in graduate school and how those experience pertain to their mental health.

Limitations and Directions for Future Research

In this study, we chose to only interview students with the identity of interest (depression), as is common with exploratory studies of individuals with underserved, underrepresented, or marginalized identities (e.g. Carlone and Johnson, 2007 ; Cooper and Brownell, 2016 ; Barnes et al. , 2017 , 2021 ; Downing et al. , 2020 ; Gin et al. , 2021 ; Pfeifer et al. , 2021 ). However, in future studies, it would be beneficial to also examine the experiences of individuals who do not have depression. This would provide information about the extent to which specific aspects of graduate research and teaching are disproportionately beneficial or challenging for students with depression. In this study, we did not explicitly examine whether there was a relationship between students’ identities and depression because of the small number of students in particular demographic groups. However, a theme that occurred rather infrequently (but is included in the Supplemental Material) is that discrimination or prejudice in the lab or academia could affect depression, which was reported exclusively by women and People of Color. As such, disaggregating whether gender and race/ethnicity predicts unique factors that exacerbate student depression is an important next step in understanding how to create more equitable and inclusive research and teaching environments for graduate students. Moreover, our sample included a significant number of students from ecology and evolutionary biology PhD programs, which may limit the generalizability of some findings. It is important to acknowledge potential subdisciplinary differences when considering how research may affect depression. Additionally, some of the factors that affect student depression, such as lack of teaching training and confidence in teaching, may be correlated with time spent in a graduate program. Future quantitative studies would benefit from examining whether the factors that affect student depression depend on the student’s subdiscipline and time spent in the graduate program. The primary focus of this study was the relationship between depression and graduate teaching/research. Many of the factors that emerged from the interviews are also associated with burnout ( Bianchi et al. , 2014 ; Maslach et al. , 2001 ). Burnout and depression are known to be highly related and often difficult to disaggregate ( Bianchi et al. , 2014 ). It was beyond the scope and design of this study to disaggregate which factors relate exclusively to the condition of burnout. Additionally, the interviews in this study were collected at a single time point. Thus, we are unable to differentiate between students who had depression before starting graduate school and students who experienced depression after starting graduate school. Future longitudinal studies could explore the effects of students’ experiences in research and teaching on their depression over time as well as on long-term outcomes such as persistence in graduate programs, length of time for degree completion, and career trajectory. This study identified a number of factors that graduate programs can address to benefit graduate student mental health, and we hope that future studies design and test interventions designed to improve the experiences of graduate students in teaching and research.

In this interview study of 50 life sciences PhD students with depression, we examined how graduate research and teaching affect students’ depressive symptoms. We also explored how depression affected graduate students’ teaching and research. We found that graduate students more commonly highlighted ways that research negatively affected their depression and ways that teaching positively affected their depression. Four overarching factors, three of which were related to both teaching and research, were commonly associated with student depression, including the amount of structure provided in research and teaching, failure and success, positive and negative reinforcement, and social connections and isolation. Additionally, graduate students identified depression as having an exclusively negative effect on their research, often hindering motivation, concentration, and self-esteem. However, they did note that depression made them more compassionate teachers, but also could cause them to have low energy or feel disconnected when teaching. This study provides concrete factors that graduate programs can target in hopes of improving the experiences of life sciences PhD students with depression.

Important Note

There are resources available if you or someone you know is experiencing depression and want help. Colleges and universities often have crisis hotlines and counseling services designed to provide students, staff, and faculty with treatment for depression. These can often be found by searching the university website. Additionally, there are free 24/7 services such as Crisis Text Line, which allows you to text a trained live crisis counselor (text “CONNECT” to 741741; Text Depression Hotline, 2019 ), and phone hotlines such as the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). If you would like to learn more about depression or depression help and resources near you, visit the Anxiety and Depression Association of American website: https://adaa.org ( Anxiety and Depression Association of America, 2019 ) and the Depression and Bipolar Support Alliance: http://dbsalliance.org ( Depression and Bipolar Support Alliance, 2019 ).

Acknowledgments

We are incredibly grateful to the 50 graduate students who were willing to share their personal experiences with us. We thank Sara Brownell, Tasneem Mohammed, Carly Busch, Maddie Ostwald, Lauren Neel, and Rachel Scott for their helpful feedback on earlier drafts of this work. L.E.G. was supported by an NSF Graduate Fellowship (DGE-1311230). Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF.

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• Affiliation: Gillings School of Global Public Health, Department of Epidemiology
• Globally, depression is prevalent and burdensome. People with depression that hold stigmatizing beliefs related to their condition are at higher risk of never seeking treatment and/or falling out of treatment after initial engagement, posing significant risks to depression recovery. Research in the U.S. found a reduction in stigma after patients engaged in supportive counseling compared to other treatment methods for depression. There has not been much research on mental health stigma in Malawi. Therefore, using data from the Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building scale-up trial, this dissertation expands upon ongoing depression-related implementation science research efforts in the region by exploring the role of stigma during depression care. Patients in the cohort (N=743) were largely treatment-naïve and had depressive symptoms indicated by the Patient Health Questionnaire-9. This dissertation aimed to 1) estimate the effect of baseline anticipated treatment-related stigma on the 3-month probability of depression remission and 2) estimate the association between referral to clinically appropriate problem-solving based therapy and internalized depression stigma three months later. We found that the probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment-related stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among patients who had low or neutral levels of anticipated treatment-related stigma (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003). In our analysis of the effect of counseling referral on 3-month probability of having high internalized depression stigma, we found that the probability of high internalized stigma was 33 percentage points greater (95% Confidence Interval [CI]: 0.16, 0.50) among patients who were referred to counseling (0.43; 95% CI: 0.32, 0.55) compared to those who were not referred to counseling (0.10; 95% CI: -0.10, 0.30). Taken together, the results from this dissertation highlight 1) the critical role that treatment-related stigma plays in the path to depression recovery, 2) the lack of adequate solutions currently being implemented to address internalized stigma during depression treatment, and 3) the potential impact of an intervention targeting depression-related stigma among patients receiving depression care in Malawi.
• Public health
• Mental health
• https://doi.org/10.17615/0gj3-ya05
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• Pence, Brian W
• Gaynes, Bradley N
• Hill, Sherika
• Aiello, Allison E
• Keil, Alexander
• Doctor of Philosophy
• University of North Carolina at Chapel Hill Graduate School

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• Published: 13 July 2021

Systematic review and meta-analysis of depression, anxiety, and suicidal ideation among Ph.D. students

• Emily N. Satinsky 1 ,
• Tomoki Kimura 2 ,
• Mathew V. Kiang 3 , 4 ,
• Rediet Abebe 5 , 6 ,
• Scott Cunningham 7 ,
• Hedwig Lee 8 ,
• Xiaofei Lin 9 ,
• Cindy H. Liu 10 , 11 ,
• Igor Rudan 12 ,
• Srijan Sen 13 ,
• Mark Tomlinson 14 , 15 ,
• Miranda Yaver 16 &
• Alexander C. Tsai 1 , 11 , 17  

Scientific Reports volume  11 , Article number:  14370 ( 2021 ) Cite this article

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• Epidemiology
• Health policy
• Quality of life

University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I 2  = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I 2  = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.

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Introduction.

Mental health problems among graduate students in doctoral degree programs have received increasing attention 1 , 2 , 3 , 4 . Ph.D. students (and students completing equivalent degrees, such as the Sc.D.) face training periods of unpredictable duration, financial insecurity and food insecurity, competitive markets for tenure-track positions, and unsparing publishing and funding models 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 —all of which may have greater adverse impacts on students from marginalized and underrepresented populations 13 , 14 , 15 . Ph.D. students’ mental health problems may negatively affect their physical health 16 , interpersonal relationships 17 , academic output, and work performance 18 , 19 , and may also contribute to program attrition 20 , 21 , 22 . As many as 30 to 50% of Ph.D. students drop out of their programs, depending on the country and discipline 23 , 24 , 25 , 26 , 27 . Further, while mental health problems among Ph.D. students raise concerns for the wellbeing of the individuals themselves and their personal networks, they also have broader repercussions for their institutions and academia as a whole 22 .

Despite the potential public health significance of this problem, most evidence syntheses on student mental health have focused on undergraduate students 28 , 29 or graduate students in professional degree programs (e.g., medical students) 30 . In non-systematic summaries, estimates of the prevalence of clinically significant depressive symptoms among Ph.D. students vary considerably 31 , 32 , 33 . Reliable estimates of depression and other mental health problems among Ph.D. students are needed to inform preventive, screening, or treatment efforts. To address this gap in the literature, we conducted a systematic review and meta-analysis to explore patterns of depression, anxiety, and suicidal ideation among Ph.D. students.

Flowchart of included articles.

The evidence search yielded 886 articles, of which 286 were excluded as duplicates (Fig.  1 ). An additional nine articles were identified through reference lists or grey literature reports published on university websites. Following a title/abstract review and subsequent full-text review, 520 additional articles were excluded.

Of the 89 remaining articles, 74 were unclear about their definition of graduate students or grouped Ph.D. and non-Ph.D. students without disaggregating the estimates by degree level. We obtained contact information for the authors of most of these articles (69 [93%]), requesting additional data. Three authors clarified that their study samples only included Ph.D. students 34 , 35 , 36 . Fourteen authors confirmed that their study samples included both Ph.D. and non-Ph.D. students but provided us with data on the subsample of Ph.D. students 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 . Where authors clarified that the sample was limited to graduate students in non-doctoral degree programs, did not provide additional data on the subsample of Ph.D. students, or did not reply to our information requests, we excluded the studies due to insufficient information (Supplementary Table S1 ).

Ultimately, 32 articles describing the findings of 29 unique studies were identified and included in the review 16 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 (Table 1 ). Overall, 26 studies measured depression, 19 studies measured anxiety, and six studies measured suicidal ideation. Three pairs of articles reported data on the same sample of Ph.D. students 33 , 38 , 45 , 51 , 53 , 56 and were therefore grouped in Table 1 and reported as three studies. Publication dates ranged from 1979 to 2019, but most articles (22/32 [69%]) were published after 2015. Most studies were conducted in the United States (20/29 [69%]), with additional studies conducted in Australia, Belgium, China, Iran, Mexico, and South Korea. Two studies were conducted in cross-national settings representing 48 additional countries. None were conducted in sub-Saharan Africa or South America. Most studies included students completing their degrees in a mix of disciplines (17/29 [59%]), while 12 studies were limited to students in a specific field (e.g., biomedicine, education). The median sample size was 172 students (interquartile range [IQR], 68–654; range, 6–6405). Seven studies focused on mental health outcomes in demographic subgroups, including ethnic or racialized minority students 37 , 41 , 43 , international students 47 , 50 , and sexual and gender minority students 42 , 54 .

In all, 16 studies reported the prevalence of depression among a total of 23,469 Ph.D. students (Fig.  2 ; range, 10–47%). Of these, the most widely used depression scales were the PHQ-9 (9 studies) and variants of the Center for Epidemiologic Studies-Depression scale (CES-D, 4 studies) 63 , and all studies assessed clinically significant symptoms of depression over the past one to two weeks. Three of these studies reported findings based on data from different survey years of the same parent study (the Healthy Minds Study) 40 , 42 , 43 , but due to overlap in the survey years reported across articles, these data were pooled. Most of these studies were based on data collected through online surveys (13/16 [81%]). Ten studies (63%) used random or systematic sampling, four studies (25%) used convenience sampling, and two studies (13%) used multiple sampling techniques.

Pooled estimate of the proportion of Ph.D. students with clinically significant symptoms of depression.

The estimated proportion of Ph.D. students assessed as having clinically significant symptoms of depression was 0.24 (95% confidence interval [CI], 0.18–0.31; 95% predictive interval [PI], 0.04–0.54), with significant evidence of between-study heterogeneity (I 2  = 98.75%). A subgroup analysis restricted to the twelve studies conducted in the United States yielded similar findings (pooled estimate [ES] = 0.23; 95% CI, 0.15–0.32; 95% PI, 0.01–0.60), with no appreciable difference in heterogeneity (I 2  = 98.91%). A subgroup analysis restricted to the studies that used the PHQ-9 to assess depression yielded a slightly lower prevalence estimate and a slight reduction in heterogeneity (ES = 0.18; 95% CI, 0.14–0.22; 95% PI, 0.07–0.34; I 2  = 90.59%).

Nine studies reported the prevalence of clinically significant symptoms of anxiety among a total of 15,626 Ph.D. students (Fig.  3 ; range 4–49%). Of these, the most widely used anxiety scale was the 7-item Generalized Anxiety Disorder scale (GAD-7, 5 studies) 64 . Data from three of the Healthy Minds Study articles were pooled into two estimates, because the scale used to measure anxiety changed midway through the parent study (i.e., the Patient Health Questionnaire-Generalized Anxiety Disorder [PHQ-GAD] scale was used from 2007 to 2012 and then switched to the GAD-7 in 2013 40 ). Most studies (8/9 [89%]) assessed clinically significant symptoms of anxiety over the past two to four weeks, with the one remaining study measuring anxiety over the past year. Again, most of these studies were based on data collected through online surveys (7/9 [78%]). Five studies (56%) used random or systematic sampling, two studies (22%) used convenience sampling, and two studies (22%) used multiple sampling techniques.

Pooled estimate of the proportion of Ph.D. students with clinically significant symptoms of anxiety.

The estimated proportion of Ph.D. students assessed as having anxiety was 0.17 (95% CI, 0.12–0.23; 95% PI, 0.02–0.41), with significant evidence of between-study heterogeneity (I 2  = 98.05%). The subgroup analysis restricted to the five studies conducted in the United States yielded a slightly lower proportion of students assessed as having anxiety (ES = 0.14; 95% CI, 0.08–0.20; 95% PI, 0.00–0.43), with no appreciable difference in heterogeneity (I 2  = 98.54%).

Six studies reported the prevalence of suicidal ideation (range, 2–12%), but the recall windows varied greatly (e.g., ideation within the past 2 weeks vs. past year), precluding pooled estimation.

Additional stratified pooled estimates could not be obtained. One study of Ph.D. students across 54 countries found that phase of study was a significant moderator of mental health, with students in the comprehensive examination and dissertation phases more likely to experience distress compared with students primarily engaged in coursework 59 . Other studies identified a higher prevalence of mental ill-health among women 54 ; lesbian, gay, bisexual, transgender, and queer (LGBTQ) students 42 , 54 , 60 ; and students with multiple intersecting identities 54 .

Several studies identified correlates of mental health problems including: project- and supervisor-related issues, stress about productivity, and self-doubt 53 , 62 ; uncertain career prospects, poor living conditions, financial stressors, lack of sleep, feeling devalued, social isolation, and advisor relationships 61 ; financial challenges 38 ; difficulties with work-life balance 58 ; and feelings of isolation and loneliness 52 . Despite these challenges, help-seeking appeared to be limited, with only about one-quarter of Ph.D. students reporting mental health problems also reporting that they were receiving treatment 40 , 52 .

Risk of bias

Twenty-one of 32 articles were assessed as having low risk of bias (Supplementary Table S2 ). Five articles received one point for all five categories on the risk of bias assessment (lowest risk of bias), and one article received no points (highest risk). The mean risk of bias score was 3.22 (standard deviation, 1.34; median, 4; IQR, 2–4). Restricting the estimation sample to 12 studies assessed as having low risk of bias, the estimated proportion of Ph.D. students with depression was 0.25 (95% CI, 0.18–0.33; 95% PI, 0.04–0.57; I 2  = 99.11%), nearly identical to the primary estimate, with no reduction in heterogeneity. The estimated proportion of Ph.D. students with anxiety, among the 7 studies assessed as having low risk of bias, was 0.12 (95% CI, 0.07–0.17; 95% PI, 0.01–0.34; I 2  = 98.17%), again with no appreciable reduction in heterogeneity.

In our meta-analysis of 16 studies representing 23,469 Ph.D. students, we estimated that the pooled prevalence of clinically significant symptoms of depression was 24%. This estimate is consistent with estimated prevalence rates in other high-stress biomedical trainee populations, including medical students (27%) 30 , resident physicians (29%) 65 , and postdoctoral research fellows (29%) 66 . In the sample of nine studies representing 15,626 Ph.D. students, we estimated that the pooled prevalence of clinically significant symptoms of anxiety was 17%. While validated screening instruments tend to over-identify cases of depression (relative to structured clinical interviews) by approximately a factor of two 67 , 68 , our findings nonetheless point to a major public health problem among Ph.D. students. Available data suggest that the prevalence of depressive and anxiety disorders in the general population ranges from 5 to 7% worldwide 69 , 70 . In contrast, prevalence estimates of major depressive disorder among young adults have ranged from 13% (for young adults between the ages of 18 and 29 years in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions III 71 ) to 15% (for young adults between the ages of 18 and 25 in the 2019 U.S. National Survey on Drug Use and Health 72 ). Likewise, the prevalence of generalized anxiety disorder was estimated at 4% among young adults between the ages of 18 and 29 in the 2001–03 U.S. National Comorbidity Survey Replication 73 . Thus, even accounting for potential upward bias inherent in these studies’ use of screening instruments, our estimates suggest that the rates of recent clinically significant symptoms of depression and anxiety are greater among Ph.D. students compared with young adults in the general population.

Further underscoring the importance of this public health issue, Ph.D. students face unique stressors and uncertainties that may put them at increased risk for mental health and substance use problems. Students grapple with competing responsibilities, including coursework, teaching, and research, while also managing interpersonal relationships, social isolation, caregiving, and financial insecurity 3 , 10 . Increasing enrollment in doctoral degree programs has not been matched with a commensurate increase in tenure-track academic job opportunities, intensifying competition and pressure to find employment post-graduation 5 . Advisor-student power relations rarely offer options for recourse if and when such relationships become strained, particularly in the setting of sexual harassment, unwanted sexual attention, sexual coercion, and rape 74 , 75 , 76 , 77 , 78 . All of these stressors may be magnified—and compounded by stressors unrelated to graduate school—for subgroups of students who are underrepresented in doctoral degree programs and among whom mental health problems are either more prevalent and/or undertreated compared with the general population, including Black, indigenous, and other people of color 13 , 79 , 80 ; women 81 , 82 ; first-generation students 14 , 15 ; people who identify as LGBTQ 83 , 84 , 85 ; people with disabilities; and people with multiple intersecting identities.

Structural- and individual-level interventions will be needed to reduce the burden of mental ill-health among Ph.D. students worldwide 31 , 86 . Despite the high prevalence of mental health and substance use problems 87 , Ph.D. students demonstrate low rates of help-seeking 40 , 52 , 88 . Common barriers to help-seeking include fears of harming one’s academic career, financial insecurity, lack of time, and lack of awareness 89 , 90 , 91 , as well as health care systems-related barriers, including insufficient numbers of culturally competent counseling staff, limited access to psychological services beyond time-limited psychotherapies, and lack of programs that address the specific needs either of Ph.D. students in general 92 or of Ph.D. students belonging to marginalized groups 93 , 94 . Structural interventions focused solely on enhancing student resilience might include programs aimed at reducing stigma, fostering social cohesion, and reducing social isolation, while changing norms around help-seeking behavior 95 , 96 . However, structural interventions focused on changing stressogenic aspects of the graduate student environment itself are also needed 97 , beyond any enhancements to Ph.D. student resilience, including: undercutting power differentials between graduate students and individual faculty advisors, e.g., by diffusing power among multiple faculty advisors; eliminating racist, sexist, and other discriminatory behaviors by faculty advisors 74 , 75 , 98 ; valuing mentorship and other aspects of “invisible work” that are often disproportionately borne by women faculty and faculty of color 99 , 100 ; and training faculty members to emphasize the dignity of, and adequately prepare Ph.D. students for, non-academic careers 101 , 102 .

Our findings should be interpreted with several limitations in mind. First, the pooled estimates are characterized by a high degree of heterogeneity, similar to meta-analyses of depression prevalence in other populations 30 , 65 , 103 , 104 , 105 . Second, we were only able to aggregate depression prevalence across 16 studies and anxiety prevalence across nine studies (the majority of which were conducted in the U.S.) – far fewer than the 183 studies included in a meta-analysis of depression prevalence among medical students 30 and the 54 studies included in a meta-analysis of resident physicians 65 . These differences underscore the need for more rigorous study in this critical area. Many articles were either excluded from the review or from the meta-analyses for not meeting inclusion criteria or not reporting relevant statistics. Future research in this area should ensure the systematic collection of high-quality, clinically relevant data from a comprehensive set of institutions, across disciplines and countries, and disaggregated by graduate student type. As part of conducting research and addressing student mental health and wellbeing, university deans, provosts, and chancellors should partner with national survey and program institutions (e.g., Graduate Student Experience in the Research University [gradSERU] 106 , the American College Health Association National College Health Assessment [ACHA-NCHA], and HealthyMinds). Furthermore, federal agencies that oversee health and higher education should provide resources for these efforts, and accreditation agencies should require monitoring of mental health and programmatic responses to stressors among Ph.D. students.

Third, heterogeneity in reporting precluded a meta-analysis of the suicidality outcomes among the few studies that reported such data. While reducing the burden of mental health problems among graduate students is an important public health aim in itself, more research into understanding non-suicidal self-injurious behavior, suicide attempts, and completed suicide among Ph.D. students is warranted. Fourth, it is possible that the grey literature reports included in our meta-analysis are more likely to be undertaken at research-intensive institutions 52 , 60 , 61 . However, the direction of bias is unpredictable: mental health problems among Ph.D. students in research-intensive environments may be more prevalent due to detection bias, but such institutions may also have more resources devoted to preventive, screening, or treatment efforts 92 . Fifth, inclusion in this meta-analysis and systematic review was limited to those based on community samples. Inclusion of clinic-based samples, or of studies conducted before or after specific milestones (e.g., the qualifying examination or dissertation prospectus defense), likely would have yielded even higher pooled prevalence estimates of mental health problems. And finally, few studies provided disaggregated data according to sociodemographic factors, stage of training (e.g., first year, pre-prospectus defense, all-but-dissertation), or discipline of study. These factors might be investigated further for differences in mental health outcomes.

Clinically significant symptoms of depression and anxiety are pervasive among graduate students in doctoral degree programs, but these are understudied relative to other trainee populations. Structural and clinical interventions to systematically monitor and promote the mental health and wellbeing of Ph.D. students are urgently needed.

This systematic review and meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach (Supplementary Table S3 ) 107 . This study was based on data collected from publicly available bibliometric databases and did not require ethical approval from our institutional review boards.

Eligibility criteria

Studies were included if they provided data on either: (a) the number or proportion of Ph.D. students with clinically significant symptoms of depression or anxiety, ascertained using a validated scale; or (b) the mean depression or anxiety symptom severity score and its standard deviation among Ph.D. students. Suicidal ideation was examined as a secondary outcome.

We excluded studies that focused on graduate students in non-doctoral degree programs (e.g., Master of Public Health) or professional degree programs (e.g., Doctor of Medicine, Juris Doctor) because more is known about mental health problems in these populations 30 , 108 , 109 , 110 and because Ph.D. students face unique uncertainties. To minimize the potential for upward bias in our pooled prevalence estimates, we excluded studies that recruited students from campus counseling centers or other clinic-based settings. Studies that measured affective states, or state anxiety, before or after specific events (e.g., terrorist attacks, qualifying examinations) were also excluded.

If articles described the study sample in general terms (i.e., without clarifying the degree level of the participants), we contacted the authors by email for clarification. Similarly, if articles pooled results across graduate students in doctoral and non-doctoral degree programs (e.g., reporting a single estimate for a mixed sample of graduate students), we contacted the authors by email to request disaggregated data on the subsample of Ph.D. students. If authors did not reply after two contact attempts spaced over 2 months, or were unable to provide these data, we excluded these studies from further consideration.

Search strategy and data extraction

PubMed, Embase, PsycINFO, ERIC, and Business Source Complete were searched from inception of each database to November 5, 2019. The search strategy included terms related to mental health symptoms (e.g., depression, anxiety, suicide), the study population (e.g., graduate, doctoral), and measurement category (e.g., depression, Columbia-Suicide Severity Rating Scale) (Supplementary Table S4 ). In addition, we searched the reference lists and the grey literature.

After duplicates were removed, we screened the remaining titles and abstracts, followed by a full-text review. We excluded articles following the eligibility criteria listed above (i.e., those that were not focused on Ph.D. students; those that did not assess depression and/or anxiety using a validated screening tool; those that did not report relevant statistics of depression and/or anxiety; and those that recruited students from clinic-based settings). Reasons for exclusion were tracked at each stage. Following selection of included articles, two members of the research team extracted data and conducted risk of bias assessments. Discrepancies were discussed with a third member of the research team. Key extraction variables included: study design, geographic region, sample size, response rate, demographic characteristics of the sample, screening instrument(s) used for assessment, mean depression or anxiety symptom severity score (and its standard deviation), and the number (or proportion) of students experiencing clinically significant symptoms of depression or anxiety.

Risk of bias assessment

Following prior work 30 , 65 , the Newcastle–Ottawa Scale 111 was adapted and used to assess risk of bias in the included studies. Each study was assessed across 5 categories: sample representativeness, sample size, non-respondents, ascertainment of outcomes, and quality of descriptive statistics reporting (Supplementary Information S5 ). Studies were judged as having either low risk of bias (≥ 3 points) or high risk of bias (< 3 points).

Analysis and synthesis

Before pooling the estimated prevalence rates across studies, we first transformed the proportions using a variance-stabilizing double arcsine transformation 112 . We then computed pooled estimates of prevalence using a random effects model 113 . Study specific confidence intervals were estimated using the score method 114 , 115 . We estimated between-study heterogeneity using the I 2 statistic 116 . In an attempt to reduce the extent of heterogeneity, we re-estimated pooled prevalence restricting the analysis to studies conducted in the United States and to studies in which depression assessment was based on the 9-item Patient Health Questionnaire (PHQ-9) 117 . All analyses were conducted using Stata (version 16; StataCorp LP, College Station, Tex.). Where heterogeneity limited our ability to summarize the findings using meta-analysis, we synthesized the data using narrative review.

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Acknowledgements

We thank the following investigators for generously sharing their time and/or data: Gordon J. G. Asmundson, Ph.D., Amy J. L. Baker, Ph.D., Hillel W. Cohen, Dr.P.H., Alcir L. Dafre, Ph.D., Deborah Danoff, M.D., Daniel Eisenberg, Ph.D., Lou Farrer, Ph.D., Christy B. Fraenza, Ph.D., Patricia A. Frazier, Ph.D., Nadia Corral-Frías, Ph.D., Hanga Galfalvy, Ph.D., Edward E. Goldenberg, Ph.D., Robert K. Hindman, Ph.D., Jürgen Hoyer, Ph.D., Ayako Isato, Ph.D., Azharul Islam, Ph.D., Shanna E. Smith Jaggars, Ph.D., Bumseok Jeong, M.D., Ph.D., Ju R. Joeng, Nadine J. Kaslow, Ph.D., Rukhsana Kausar, Ph.D., Flavius R. W. Lilly, Ph.D., Sarah K. Lipson, Ph.D., Frances Meeten, D.Phil., D.Clin.Psy., Dhara T. Meghani, Ph.D., Sterett H. Mercer, Ph.D., Masaki Mori, Ph.D., Arif Musa, M.D., Shizar Nahidi, M.D., Ph.D., Arthur M. Nezu, Ph.D., D.H.L., Angelo Picardi, M.D., Nicole E. Rossi, Ph.D., Denise M. Saint Arnault, Ph.D., Sagar Sharma, Ph.D., Bryony Sheaves, D.Clin.Psy., Kennon M. Sheldon, Ph.D., Daniel Shepherd, Ph.D., Keisuke Takano, Ph.D., Sara Tement, Ph.D., Sherri Turner, Ph.D., Shawn O. Utsey, Ph.D., Ron Valle, Ph.D., Caleb Wang, B.S., Pengju Wang, Katsuyuki Yamasaki, Ph.D.

A.C.T. acknowledges funding from the Sullivan Family Foundation. This paper does not reflect an official statement or opinion from the County of San Mateo.  

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A.C.T. conceptualized the study and provided supervision. T.K. conducted the search. E.N.S. contacted authors for additional information not reported in published articles. E.N.S. and T.K. extracted data and performed the quality assessment appraisal. E.N.S. and A.C.T. conducted the statistical analysis and drafted the manuscript. T.K., M.V.K., R.A., S.C., H.L., X.L., C.H.L., I.R., S.S., M.T. and M.Y. contributed to the interpretation of the results. All authors provided critical feedback on drafts and approved the final manuscript.

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Late-life depression: the interplay between cerebrovascular risk, cortical and subcortical atrophy, and treatment response.

Dakota Egglefield , The Graduate Center, City University of New York Follow

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Valentina Nikulina

Justin Storbeck

Laura Rabin

David Rindskopf

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late life depression; treatment response; vascular depression; neuroanatomy

Late-life depression (LLD) is associated with poor response to antidepressant medication treatment, cognitive impairment, cerebrovascular disease, and brain changes both in white and gray matter. Of particular interest is the vascular subtype of LLD, vascular depression (VD). Although LLD and VD have received considerable research attention, there are still areas that must be further clarified to adequately characterize aspects of LLD and VD that provide valuable information for possible interventions. Such areas include a stronger understanding of the moderating role of brain atrophy and changes in cognition in treatment response in LLD. This dissertation consists of three separate studies aimed at addressing gaps in the literature on LLD and treatment response. By better ascertaining the relationships between vascular risk, brain atrophy, cognitive changes, and treatment response in LLD, information integral to clarifying the late-life subtype of VD is established. The first study evaluated measures of cortical thickness and hippocampal volume between LLD patients with and without vascular risk. The second study used data from a placebo-controlled trial to evaluate the relationship between white matter hyperintensity (WMH) volume, executive function, processing speed, and treatment response in LLD. As literature investigating the relationship between WMH and treatment response is inconsistent, the third study utilized meta-analytic methods to critically evaluate data of well-controlled treatment response outcome studies in LLD and determine whether WMH do in fact predict treatment response in this population. The three studies together aid in further evaluation of the validity of the VD hypothesis and results shed light on areas important for clinical implications and future research.

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Egglefield, Dakota, "Late-Life Depression: The Interplay Between Cerebrovascular Risk, Cortical and Subcortical Atrophy, and Treatment Response" (2024). CUNY Academic Works. https://academicworks.cuny.edu/gc_etds/5958

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Prävalenz von depressiver Symptomatik und diagnostizierter Depression bei Erwachsenen in Deutschland

Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)

Prevalence of depressive symptoms and diagnosed depression among adults in Germany

Results of the German Health Interview and Examination Survey for Adults (DEGS1)

• Published: 25 May 2013
• Volume 56 , pages 733–739, ( 2013 )

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• M.A. Busch 1 ,
• U.E. Maske 1 ,
• R. Schlack 1 &
• U. Hapke 1  

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Zusammenfassung

In der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurden von 2008 bis 2011 in einer bevölkerungsrepräsentativen Stichprobe von 7988 Personen im Alter von 18 bis 79 Jahren aktuelle depressive Symptome mit dem „Patient Health Questionnaire“ (PHQ-9) erfasst. Zusätzlich wurden diagnostizierte Depressionen in einem ärztlichen Interview erfragt. Eine depressive Symptomatik (PHQ-9 ≥ 10 Punkte) besteht bei 8,1 % der Erwachsenen (Frauen 10,2 %; Männer 6,1 %). Bei beiden Geschlechtern ist die Prävalenz bei 18- bis 29-Jährigen am höchsten und fällt danach ab. Bei Männern und Frauen mit höherem sozioökonomischem Status besteht seltener eine depressive Symptomatik. Die Lebenszeitprävalenz einer diagnostizierten Depression beträgt 11,6 % (Frauen 15,4 %; Männer 7,8 %) und ist am höchsten bei 60- bis 69-Jährigen; die 12-Monats-Prävalenz liegt bei 6,0 % (Frauen 8,1 %; Männer 3,8 %) und ist am höchsten bei 50- bis 59-Jährigen. Bei Frauen, aber nicht bei Männern sinken die Diagnoseprävalenzen mit steigendem sozioökonomischem Status. Die Ergebnisse beschreiben die weite Verbreitung von depressiver Symptomatik und diagnostizierter Depression in der Erwachsenenbevölkerung in Deutschland und bestätigen bekannte Zusammenhänge von Depression mit Alter, Geschlecht und sozioökonomischem Status.

In the German Health Interview and Examination Survey (DEGS1), current depressive symptoms were assessed with the “Patient Health Questionnaire” (PHQ-9) in a representative population-based sample of 7,988 adults 18–79 years old. In addition, previously diagnosed depression was assessed by physician interview. The prevalence of current depressive symptoms (PHQ-9 ≥ 10 points) is 8.1 % (women: 10.2 %; men: 6.1 %). For both sexes, the prevalence is highest among 18- to 29-year-olds and decreases with age. Persons with higher socioeconomic status (SES) are less likely to have current depressive symptoms. The lifetime prevalence of diagnosed depression is 11.6 % (women: 15.4 %; men: 7.8 %) and is highest among persons 60–69 years old. The 12 month prevalence is 6.0 % (women: 8.1 %; men: 3.8 %) and is highest among 50- to 59-year-olds. In women, but not in men, prevalences decrease with increasing SES. The results describe the distribution of two important aspects of depression among the adult population in Germany and confirm previously observed associations with age, gender and SES. An English full-text version of this article is available at SpringerLink as supplemental.

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Die Studie wurde finanziert mit Mitteln des Robert Koch-Instituts und des Bundesministeriums für Gesundheit.

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Busch, M., Maske, U., Ryl, L. et al. Prävalenz von depressiver Symptomatik und diagnostizierter Depression bei Erwachsenen in Deutschland. Bundesgesundheitsbl. 56 , 733–739 (2013). https://doi.org/10.1007/s00103-013-1688-3

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Published : 25 May 2013

Issue Date : May 2013

DOI : https://doi.org/10.1007/s00103-013-1688-3

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Nach emotionalem Kate-Video: Jetzt spricht erstmals Prinz William

Stand: 11.09.2024, 19:57 Uhr

Von: Annemarie Göbbel

Nach Kates erfreulichem Gesundheits-Update ist Prinz William nach Wales gereist. Der Thronfolger bricht dort sein Schweigen und sorgt für einen besonderen Moment beim Treffen mit einem Royal-Fan.

Llanelli – Prinz William (42) reiste nur wenige Stunden nach der überraschenden Veröffentlichung des Videos seiner Ehefrau Prinzessin Kate (42) , in dem sie ein erfreuliches Gesundheit-Update übermittelte, für einige Termine nach Wales. Als Namensgeber für seinen royalen Titel (Prince of Wales) haben Besuche dort besondere Bedeutung. Seine Worte wurden demnach mit Spannung erwartet.

Fans warten auf Prinz William, um ihn nach Prinzessin Kates Video zu begrüßen

Die Menschenmenge, die sich Stunden zuvor vor der Swiss Valley Community Primary School versammelt hatte, um einen Blick auf William zu erhaschen, wurde nicht enttäuscht. Der Prinz trug wieder seinen Dreitagebart , sah entspannt aus und ließ die Fans auch nicht lange zappeln. Seine Ehefrau hatte in einer emotionalen Videobotschaft mitgeteilt, dass sie ihre Chemotherapie abgeschlossen habe. In dem Video waren auch William und ihre drei Kinder, Prinz George (11), Prinzessin Charlotte (9) und Prinz Louis (6), zu sehen.

William dankte noch vor der Grundschule allen Anteilnehmenden, die Prinzessin Kate ihre besten Wünsche überbrachten, und fügte hinzu: „Das sind gute Nachrichten, aber es liegt noch ein langer Weg vor uns.“ Prinz William nahm sich Zeit und blieb auch für mehrere Gespräche stehen. Der Mirror zitiert eine Unterhaltung mit Royal-Fan Sandra Peters (79).

Große Anteilnahme für das Prinzenpaar von Wales: Wiliam zeigt sich dankbar und gerührt

Sie berichtete von ihrem Gespräch: „Ich habe zu Prinz William gesagt: ‚Sie haben eine wundervolle Familie. Ich freue mich so, dass Kate sich erholt.‘ Er hat sich sehr herzlich bedankt. Er war reizend, er ist so charmant.“ Sandra und ihre Freundin Jane Stoneman (61) gaben ihm Briefe, die er an Kate weiterreichen sollte. Jane schwärmte: „Er ist so hübsch und schön. Wir sind so glücklich, ihn zu haben.“ Aleena Haider (30), Kardiologin am Hammersmith Hospital, reiste extra über 300 Kilometer von London nach Südwales, um den Prinzen zu Gesicht zu bekommen.

Bei aller Herzlichkeit kam der Thronfolger auf den eigentlichen Sinn seines Besuchs zurück. Er traf Schüler, die an einem großen walisischen Jugendfestival teilnahmen, darunter die zehnjährige Gewinnerin Ruby Davies. Er gab von sich persönlich preis, Walisisch via Sprachlern-App „phonetisch“ lernen zu wollen.

Prinz William ist nicht erst, seit er Prinz von Wales ist, im Lande beliebt . William, der als Hubschrauberpilot sowohl bei East Anglian Air Ambulance als auch bei RAF Search and Rescue arbeitete, sprach darüber, wie sehr er diese Rolle vermisse. Er schlug vor, zurückzukommen und für ein Wochenende bei der Wales Air Ambulance zu arbeiten. William und Kate absolvierten im September in ihren neuen Rollen ihren ersten Besuch in Wales, und zwar am 27. Februar 2022 in Anglesey, wo sie als Jungvermählte gelebt hatten. Verwendete Quellen: mirror.co.uk, people.com

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