Today I would like to take a break from both the story of how I ended up doing a PhD in Germany and the news from the scientific world, and I would like to talk to you about depression and its link with PhD studies. Even though it is a fact of lab life that a student in pursuit of a doctorate is likely to experience what we can define the “PhD blues” at some point along the training, recent surveys have linked academia and PhD studies to a risk of experiencing mental health issues such as anxiety (that will be the topic of ones of my next posts) and depression.
But what is depression?
Major depressive disorder (MDD) is a debilitating disease and public health problem of very high prevalence, characterized by well-defined changes in mood, interests and pleasure, changes in cognition and vegetative symptoms. MDD is twice as common in women as in men, and, as you can imagine, it causes considerable impairment. The age-of-onset distributions suggest that depression is prevalent for the entire lifespan. The disorder not only produces decrements in health equivalent to those of other chronic diseases (for example angina, asthma and diabetes), but it also worsens mean health scores substantially more when present with these diseases, than when one of these diseases occurs alone. Moreover, the presence of anxiety with depression can increase difficulties in diagnosis.
Despite advances in the understanding of the neurobiology of MDD, no established mechanism can explain all aspects of the disease. Identifying single candidate genes associated with MDD has been difficult because of the likelihood that complex psychiatric illnesses might be under the influence of many genes and might be associated with environmental exposures. On top of this, the neural systems important to understand MDD include those that support emotion processing, reward seeking, and regulate emotion, all of which are dysfunctional in the disorder. Therefore, MDD affects many different areas that show changes among depressed individuals without showing a single clear answer to the question of what is causing depression. Both psychotherapy and psychopharmacology are effective in treating MDD. However, approximately 30% of patients do not remit from MDD, even after several treatment attempts.
One of the latest surveys I found online on the lives and careers of roughly 5,700 PhD students worldwide reported that more than a quarter saw mental health as an area of concern, with 12% having sought help for anxiety or depression caused by their PhD studies (see a couple of the questions asked in the charts below). Even before starting your PhD, you are bombarded with discouraging messages — that it is hard to get in, that 50% do not finish, that it is hard to get postdocs and so on. But at the same time, you are surrounded by people who have PhDs. If you already have a tendency toward perfectionism or self-doubt, it feeds that quite well. Moreover, as a graduate student you suddenly have to face high expectations and low salaries and realise that your fate lies in the hands of advisers, who sometimes forgot what they had to go through during their PhD studies back in the days.
The more I read about this topic, the more I realise that the core of these pressures is the nature of the work itself: starting a project and completing it requires hard work and dedication, self-motivation and resilience. The time demands of lengthy and complex experiments can also lead to unpredictable working hours, irregular work-life balance and a sense of loss of control. You have to harden yourself to failure, but the pressure to obtain results and succeed sometimes can be stressful even for the most strong-willed scientists. Unfortunately, there is not a one-size-fits-all solution for such a complex problem.
Definitely prevention strategies such as strengthening protective factors (for example, increasing social support or problem-solving skills) or diminishing prodromal disease stages (such as reducing depressive symptoms before they fulfil criteria for MDD) might have a big health impact in reducing disease burden. Therefore, I believe that providing an environment able to recognise signs of mental distress and respond with guidance and appropriate resources is essential during your PhD studies. Also, a good relationship with your supervisor can counteract some of the daily pressures faced by students. However, what I think is essential in my personal experience of struggles and depression during my current studies is inspiring a sense of accomplishment in smaller achievements – a well-performed experiment, a successful presentation, a productive collaboration. Finally, the last thing that I believe is necessary for PhD students, in order to prevent or limit a large source of stress, is the possibility of being offered guidance about career paths and support by listening and directing students to suitable resources for obtaining further help.