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

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Abstract

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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Most cited references 117

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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2009)

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Author and article information

Contributors

Emily N. Satinsky: satinsky@usc.edu

Alexander C. Tsai: actsai@partners.org

Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2045-2322

Publication date (Electronic): 13 July 2021

Publication date PMC-release: 13 July 2021

Publication date Collection: 2021

Volume: 11

Electronic Location Identifier: 14370

Affiliations

[1 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Center for Global Health, , Massachusetts General Hospital, ; Boston, MA USA

[2 ]San Mateo County Behavioral Health and Recovery Services, San Mateo, CA USA

[3 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Epidemiology and Population Health, , Stanford University, ; Palo Alto, CA USA

[4 ]GRID grid.168010.e, ISNI 0000000419368956, Center for Population Health Sciences, , Stanford University School of Medicine, ; Palo Alto, CA USA

[5 ]GRID grid.38142.3c, ISNI 000000041936754X, Harvard Society of Fellows, Harvard University, ; Cambridge, MA USA

[6 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, Department of Electrical Engineering and Computer Science, , University of California Berkeley, ; Berkeley, CA USA

[7 ]GRID grid.252890.4, ISNI 0000 0001 2111 2894, Department of Economics, , Hankamer School of Business, Baylor University, ; Waco, TX USA

[8 ]GRID grid.4367.6, ISNI 0000 0001 2355 7002, Department of Sociology, , Washington University in St. Louis, ; St. Louis, MO USA

[9 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Department of Microbiology, Immunology, and Molecular Genetics, Institute for Quantitative and Computational Biosciences, , University of California Los Angeles, ; Los Angeles, CA USA

[10 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Departments of Newborn Medicine and Psychiatry, , Brigham and Women’s Hospital, ; Boston, MA USA

[11 ]GRID grid.38142.3c, ISNI 000000041936754X, Harvard Medical School, ; Boston, MA USA

[12 ]GRID grid.4305.2, ISNI 0000 0004 1936 7988, Centre for Global Health, Edinburgh Medical School, , Usher Institute, University of Edinburgh, ; Edinburgh, Scotland, UK

[13 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Psychiatry, , University of Michigan, ; Ann Arbor, MI USA

[14 ]GRID grid.11956.3a, ISNI 0000 0001 2214 904X, Department of Global Health, , Institute for Life Course Health Research, Stellenbosch University, ; Cape Town, South Africa

[15 ]GRID grid.4777.3, ISNI 0000 0004 0374 7521, School of Nursing and Midwifery, , Queens University, ; Belfast, UK

[16 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Fielding School of Public Health, , Los Angeles Area Health Services Research Training Program, University of California Los Angeles, ; Los Angeles, CA USA

[17 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Mongan Institute, Massachusetts General Hospital, ; Boston, MA USA

Article

Publisher ID: 93687

DOI: 10.1038/s41598-021-93687-7

PMC ID: 8277873

PubMed ID: 34257319

SO-VID: edba1926-2450-4ebe-8efb-02dd256662c1

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 31 March 2021

Date accepted : 24 June 2021

Funding

Funded by: Sullivan Family Foundation

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ScienceOpen disciplines: Uncategorized

Keywords: epidemiology,anxiety,depression,health policy,quality of life

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ScienceOpen disciplines: Uncategorized

Keywords: epidemiology, anxiety, depression, health policy, quality of life

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

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Most cited references 117

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

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Cited by 41

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