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World Mental Health Day: facts, figures and the flaws of academia

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Attitudes toward mental illness and those that live with mental health problems have perpetuated stigma and discrimination since the very beginning of humankind. Today, even in countries where substantial efforts have been made to better understand mental health and work on destigmatization, those experiencing mental health problems still find themselves isolated. This is no different in the realm of academia, where graduate students and PhD candidates are facing some of the highest prevalence rates of mental health problems in any given work environment. In addition to early-career researchers experiencing the existing stigma and discrimination all those living with mental illness face, the academic setting seems to have some of the best conditions for cultivating mental health problems.

In honor of this year’s World Mental Health Day (10 October), here we present a general overview of what World Mental Health Day entails, general information about mental illness and a specific focus on how mental health issues are plaguing early-career researchers in academia.


Background information

World Mental Health Day was first celebrated in 1992 at the initiative of the World Federation for Mental Health [1]. In 1994, focus was placed on setting a theme annually. Since then, World Mental Health Day has focused on a variety of aspects concerning mental health. We overview them here in Table 1, beginning with most recent.

Table 1. World Mental Health Day themes: 1996–2019.
Year Themes
2019 Mental health promotion and suicide prevention
2018 Young people and mental health in a changing world
2017 Mental health in the workplace
2016 Psychological first aid
2015 Dignity in mental health
2014 Living with schizophrenia
2013 Mental health and older adults
2012 Depression: a global crisis
2011 The great push: investing in mental health
2010 Mental health and chronic physical illnesses
2009 Mental health in primary care: enhancing treatment and promoting mental health
2008 Making mental health a global priority: scaling up services through citizen advocacy and action
2007 Mental health in a changing world: the impact of culture and diversity
2006 Building awareness – reducing risk: mental illness & suicide
2005 Mental and physical health across the lifespan
2004 The relationship between physical & mental health: co-occurring disorders
2003 Emotional and behavioral disorders of children & adolescents
2002 The effects of trauma and violence on children & adolescents
2000–2001 Mental health and work
1999 Mental health and aging
1998 Mental health and human rights
1997 Children and mental health
1996 Women and mental health
Table adapted from World Federation for Mental Health [1].

 

One of the main goals of World Mental Health Day is to raise awareness. Educating ourselves with statistics and acquiring the facts is an essential part of this step.

What do the statistics say?

  • Mental health problems are one of the main contributors to overall disease burden and disability worldwide [2,3].
  • One in four individuals are estimated to live with mental illness globally [4,5], although there has been some contention on this figure through the years [6], and more recent data suggests this number is closer to one in six [8].
  • An overview of the prevalence of the most common mental illnesses reveal that an estimated:
    • 264–300 million individuals worldwide live with depression;
    • 284–300 million live with anxiety-related disorders;
    • 46–60 million live with bipolar affective disorder;
    • 20–23 million live with schizophrenia;
    • 16 million live with eating disorders [7,8].

Figure 1. Global mental health and substance use disorders. Figure source: IHME, Global Burden of Disease [9]. Based on data from 2017. Percentage = representative population of country.

Although the areas marked in red (Figure 1) have slightly higher reported rates, the discrepancies between countries may not be due to mental illness being more prevalent in these countries compared to others, but rather, that the quality of acquired data varies. We can also speculate that due to an under-diagnosis globally – which may be different between countries – these numbers are likely under-representative of the reality.

Knowing the global prevalence rates for various forms of mental illnesses is essential for being able to identify any deviation from the average. Using this as a reference point, one area where we observe a substantial deviation is in the realm of academia, where mental health problems seem to flourish.

Mental health: a focus on academia

Let’s start with the good news. Focus on mental health and wellbeing in academia has increased in recent years. Universities and research institutions are starting to listen to stressed graduate students and doctoral researchers, and even providing platforms for people to share their personal stories. Science writers, journalists and academic publishers are also doing their part to shed light on these issues.

Graduate students and PhD candidates are not shying away from being heard either, with many taking to social media platforms to discuss their struggles in a bid to normalize the discussion of mental health and highlight the extent to which academia can impact mental health and wellbeing. Online platforms have even emerged with the sole purpose of empowering graduate students to speak up on the topic. One such platform is PhD Balance, founded by Susanna Harris (The University of North Carolina at Chapel Hill, NC, USA), which has generated substantial interest since its emergence just last year. Despite these efforts, our work is not done. In fact, the most recent figures on prevalence of mental health issues in academia suggest we are far from it.

A closer look

Understanding the extent to which a career in academia can impact mental health is difficult given that the data is incomplete and sparse. However, there is still a wealth of surveys, studies and data that reveal it does impact mental health. Before we look at potential solutions, we have to first face the copious amount of hard truths of mental health issues in academia.

Nature recently highlighted some of these findings in an editorial on why ‘being a PhD student shouldn’t be bad for your health’ [10]. The article highlights a study in Belgium that assessed prevalence of mental health problems in 3659 PhD students and compared the findings to three other groups. Researchers found that 32% of PhD students were at risk of having or developing a psychiatric disorder, and that this estimate was significantly higher than those observed in the comparison groups [11]. Results from a survey carried out at the University of Arizona (AZ, USA) revealed three-quarters of doctoral students had more than average stress levels [12].

A more comprehensive online survey [13,14] that included respondents from 26 countries and 234 institutions echoed these findings, with respondents scoring 41% for moderate-to-severe anxiety and 39% for moderate-to-severe depression. What was more astounding was that these numbers represented approximately six-times the prevalence we see in the general population [13,14]. Similar results are observed in another survey carried out at Emory University (GA, USA), where more than 34% had moderate-to-severe depression, 7.3% reported suicidal thoughts and 2.3% reported having plans for suicide [15]. Sadly, plans for suicide have not been the last stop, with some having actually committed suicide, like in the case of PhD candidate Huixiang Chen reported in June earlier this year, a person whose circumstances were far too familiar to other PhD candidates with similar experiences.

Such is the prevalence of mental health problems in academia that it has even attracted media attention. As recently as May of this year, the BBC investigated referrals to counselling services in the UK and reported a rise in three-quarters between 2009–2016 [16]. The University of Warwick (UK) and University of Kent (UK) lead the race with a 316% and 292% increase respectively, rendering counselling and occupational health services as overwhelmed as their stressed students.

With the statistics being this dire, it warrants a look at the myriad of factors that contribute to this crisis and raises the question of what we can do to bring these figures down.

What are the causes?

Levecque et al. identify organizational policies such as job demands, supervisor’s leadership style and perception of a career outside academia as factors associated with mental health problems [11]. The data suggests that a disproportionate work–life balance and lack of perceived support from one’s principal investigator (PI) also impact negatively on mental health [13,14]. Graduate students and PhD candidates are consistently told they are expected to over-work for free, and that to work evenings and weekends is completely normal. Maybe it’s time to consider that what has been normal for so long has also been bad.

Another issue is pay and insecure employment. The Guardian highlighted the issue of pay as recently as May of last year in a report revealing how exploitative universities can be in their treatment of unpaid PhD students [17,18]. Academia has been infected with this insidious corporate culture of accepting unpaid labor as some passage of rights one must take to climb the academic ladder. PhD students go to absurd lengths globally to gain experience and add notches to the CV belt, usually while being underpaid in the process. Short-term contracts also allow employers to look the other way when it comes to duty of care [10]. In addition to these factors, PhD students have to worry about funding for conferences and courses, applying for competitive grants, and doing the work that is expected of them in often unrealistic timeframes, among other things.

What can be done?

  • Supervisors, PIs, research group leaders and faculty members at research institutes should receive comprehensive training to understand the mental health problems their employees and students are facing, in addition to training to help them identify signs when their students are struggling [10].
  • Job demands should be reasonable and there should be a reasonable time frame available that ensures the project at hand is viable to take on within the timeframe provided. Supervisors and PIs should be encouraged to promote work–life balance by leading by example [13,14], as research shows a work–life balance is one factor that contributes to better mental health [13,14].
  • Universities and research institutions should compensate their workers with a livable wage, whether they are part-time research assistants collecting data while studying, or full-time PhD candidates. Employers that expect students to work for free in a bid to earn a reference on their CV or teach them a good work ethic are exploiting their students for cheap labor.
  • Since stigma exists, students have to be provided with a route to access support without worrying about damaging their careers. We discuss stigma here as the perceived associated shame with experiencing mental health issues. People still feel the scrutiny of others when openly discussing their mental health. As such, we need to create avenues that do not run through one’s PI or supervisor when it comes to seeking mental health care. To have to go through one’s assessor of professional progress in order to get help may hinder a student’s desire to exercise potential care options.
  • Institutions and policy makers need to consider intervention strategies to provide avenues of help for the rising rates of mental health problems in academia. However, being reactive can’t be the only action taken, as merely providing more support addresses the symptoms but not the cause. Papering over cracks will not resolve the underlying issues at hand. In addition to intervention strategies, academia needs to address some of the aforementioned roots of the problem in order to reduce causal factors that have led to such high prevalence.

Closing message

Where there are humans, there will be mental illness. World Mental Health Day concerns all of us. We can all do our part to help destigmatize mental illness. We can all ensure those around us, including ourselves, are informed about the avenues they need to take if they are experiencing mental health difficulties. These can range from stress we encounter day to day, all the way to experiencing symptoms of some of the mental disorders discussed earlier.

Mental illness is not something that is universally accepted. Over the years, World Mental Health Day has helped put a spotlight on poorly understood disorders. Public engagement has elevated awareness and sparked discussion of a previously taboo subject. Now it is key to keep the conversation going and see mental health accepted by society on a global scale.

As for academia – I say no more seeing suffering as some sort of badge of honor. Our mental health is not some sacrifice to be given to the science gods. The life part of our work–life balance is not something to be traded in for peer and employer acceptance. There needs to be a cultural change that every level of the academic hierarchy is on board with. This in turn will foster better working conditions, save money, lead to the production of better work and most importantly, help keep researchers healthy.


[1] World Federation for Mental Health. World Mental Health Day History.
https://wfmh.global/world-mental-health-day/
[Accessed 25 September 2019]

[2] Vos T et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease StudyThe Lancet 386(9995), 743–800 (2015).

[3] Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010The Lancet 380(9859), 2095–2128 (2012).

[4] World Health Organization. World Health Report.
www.who.int/whr/2001/media_centre/press_release/en/
[Accessed 26 September 2019]

[5] Mental Health: Adults.
www.england.nhs.uk/mental-health/adults/
[Accessed 27 September 2019]

[6] Full Fact. One in four? How many people suffer from a mental health problem.
https://fullfact.org/health/one-in-four-people-suffer-mental-health-problem/
[Accessed 27 September 2019]

[7] World Health Organization. Mental Disorders.
www.who.int/en/news-room/fact-sheets/detail/mental-disorders
[Accessed 27 September 2019]

[8] Hannah Ritchie and Max Roser. Mental Health (2019).
https://ourworldindata.org/mental-health
[Accessed 27 September 2019]

[9] Institute for Health Metrics and Evaluation. GBD Compare.
https://vizhub.healthdata.org/gbd-compare/
[Accessed 25 September 2019]

[10] Being a PhD student shouldn’t be bad for your health.
www.nature.com/articles/d41586-019-01492-0
[Accessed 5 October 2019]

[11] Levecque K, Anseel F, De Beuckelaer A, Van der Heyden J, Gisle L. Work organization and mental health problems in PhD students. Elsevier 46(4), 868–879 (2017).

[12] Gratuate Student Mental Health 2015.
http://nagps.org/wordpress/wp-content/uploads/2015/06/NAGPS_Institute_mental_health_survey_report_2015.pdf
[Accessed 5 October 2019]

[13] Trainees and mental health: Let’s talk!
www.sciencemag.org/careers/2016/04/trainees-and-mental-health-let-s-talk
[Accessed 5 October 2019]

[14] Evans TM, Bira L, Beltran Gastelum J, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nature Biotechnol. 36, 282–284 (2018).

[15] Garcia-Williams AG Moffitt L, Kaslow NJ. Mental health and suicidal behavior among graduate students. Academic Psychiatry 38(5), 554–560 (2014).

[16] University counselling services ‘inundated by stressed academics’.
www.bbc.com/news/education-48353331
[Accessed 5 October 2019]

[17] We must stop universities exploiting the unpaid labour of PhD students.
www.theguardian.com/higher-education-network/2018/may/04/we-must-stop-universities-exploiting-the-unpaid-labour-of-phd-students.
[Accessed 6 October 2019]

[18] Academia is built on exploitation. We must break the vicious cycle.
www.theguardian.com/higher-education-network/2018/may/18/academia-exploitation-university-mental-health-professors-plagiarism
[Accessed 6 October 2019]

Disclaimer
The opinions expressed in this editorial are those of the author and do not necessarily reflect the views of Neuro Central or Future Science Group.

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