TY - JOUR
AU - Hayter, Christopher S
AB - Abstract Despite increasing interest related to the role of graduate students in economic and social development, science policy scholars have overlooked the role of stress and its broader impact on the conduct of science. To motivate future empirical research, this study systematically reviews the literature on antecedents and impact of stress among graduate students, examining thirty-four journal articles published from 2000 to 2018. We find that not only do multiple definitions of stress exist, but also that scholars have neglected broader theoretical implications and comparative dimensions of the phenomenon. While this outcome can be explained partially by the paucity of different national and disciplinary perspectives, these factors nonetheless hinder the design and implementation of effective interventions that can help graduate students reduce and manage stress levels and thus improve the conduct of science. We introduce a conceptual model of our findings and discuss implications for future research and policy. 1. Introduction Graduate education1 not only enables individuals to improve the knowledge, health, and incomes of individuals, it is also critical to the social and economic development of society (Council of Graduate Schools 2008). Graduate students including individuals enrolled in masters and doctoral programs, constitute the future professional and academic workforce and, along with postdoctoral fellows, form the backbone of academic science. There is increasing evidence, however, that graduate students are experiencing growing levels of stress, with important implications for the physical and mental health of these individuals. A recent survey by Nature, for example, found that among 6,300 PhD students located around the world, 36 per cent have sought help for anxiety or depression, often as a result of being over-extended and stressed (Woolston 2019). An extensive literature has emerged that examines the incidence and impact of stress among university students writ large (e.g. Hurst et al. 2013; Hope and Henderson 2014; Ribeiro et al. 2018). While there is some disagreement around how to define stress (Segerstrom and Miller 2004), scholars generally agree that stress is a state of imbalance between a rigorous environment and an individual’s ability to cope with these pressures (Cohen and Wills 1985; Folkman and Lazarus 1985; Hobfoll 2001). Although a recent study shows that stress can be a positive motivational force (Pappa et al. 2020), most research demonstrates that increasing levels of stress in academic environments, or ‘stress overload’ (Amirkhan 2012), are generally correlated with declining physical and mental health outcomes among faculty and students at all levels (e.g. Austin and Pilat 1990; Hurst et al. 2013; Elani et al. 2014; Denovan et al. 2019; Ribeiro et al. 2018; Amirkhan et al. 2019; Kennett et al. 2020). Though science policy and higher education scholars have paid relatively little attention to stress-related dynamics at the graduate level (Wang 2015), a recent press article focuses on the impact of stress among students at the University of California at Berkeley (Djokić and Lounis 2014). Nearly half of students surveyed experienced a stress-related health problem during the previous year, with women and international students impacted disproportionately. Graduate students differ from undergraduates because, as adults typically in their 20 s and 30 s, they are already prone to stress associated with their efforts to establish professional identifies, earn income, and pay off student debt (Djokić and Lounis 2014). Stress associated with graduate education also magnifies other types of personal stress (e.g. family related challenges) negatively impacting productivity, diminishing mental and physical wellness (Djokić and Lounis 2014; Wang 2015). Among graduate students, doctoral candidates in Science, technology, engineering, and mathematics (STEM)-related fields are especially susceptible to stress (Djokić and Lounis 2014). Evans et al. (2018), for example, describe a 2015 study at the University of Arizona that shows ‘A majority of doctoral students reported “more than average” stress levels or “tremendous” stress and endorsed school and education-related issues as the most significant contributors to their stress’ (p. 282). Stress among doctoral students is a reflection not only of a stagnant academic job market, it is also a symptom of growing expectations from faculty advisors who face increasing pressure to produce data and compete for funding (Evans et al. 2018). High stress levels lead to fatigue, depression, and may motivate doctoral students to leave their program (Wang 2015). Perhaps the most troubling aspect of stress among graduate students in masters and doctoral programs is its link to mental illness. Recent articles lament the growing mental health crisis (Evans et al. 2018) and attribute recent spikes to increasing levels of stress among graduate students (Wang 2015). Levecque et al. (2017) similarly highlight the growing problem of mental illness among doctoral candidates in Belgium. While the authors do not systematically investigate causal factors, they nonetheless attribute mental health problems to ‘distress’ associated with the rigors of academic life. Despite reports of mounting accounts of stress among graduate students, Wang (2015) highlights the paucity of empirical research that examines its incidence and impact. Most student-related stress studies focus on undergraduate student populations which, according to Djokić and Lounis (2014), are not only larger in number, they are also the primary focus of university support programs (See Robotham (2008) for a review of studies on stress among undergraduate students). In contrast, graduate students face different types and higher levels of stress but are often overlooked in terms of available support services (Wang 2015). Thus, understanding the incidence and impact of stress among graduate students has critical implications not only for higher education and science policy around the world. This article seeks to illuminate this conspicuous gap in the literature to motivate systematic empirical examination of the antecedents and impact of stress among graduate students within different institutional and national contexts. It does so through a systematic review of thirty-four publications published between 2000 and 2018 from several bodies of research, including the science policy, higher education, and psychology. The next section describes the study methodology in greater detail. After providing descriptive statistics of the publication sample selected for review, we discuss the findings of the review. Finally, an analytical discussion of the review findings is provided with suggestions for policy and research. 2. Methodology 2.1 Research design This study employs a systematic literature review approach, which is useful to thoroughly and transparently review empirical studies focused on the incidence and impact of stress among graduate students (Petticrew and Roberts 2008; Denyer and Tranfield 2009; Wolfswinkel et al. 2013). This review thus aims to critically evaluate findings from the extant literature in comprehensive and reproducible ways (Okoli and Schabram 2010; Siddaway 2014). Using this approach, the study examines factors associated with stress (or, stressors) as well as its impacts among graduate students within and among thirty-four peer-reviewed journal articles published between 2000 and 2018.2 2.2 Literature search Following Denyer and Tranfield (2009), the study team articulated search terms to guide the search among four different search engines (Web of Science, ScienceDirect, EBSCOhost, and ProQuest) to identify articles for the study. These search terms (illustrated in Table 1) were then inputted into search engines to scan over 18,000 journals. Additional keywords were also utilized during the inductive search processes.3 Although the input method differs by search engine, the same combination of keywords was nonetheless utilized to scan journal databases for relevant publications. Additional search criteria included language (English), peer review quality, and publication dates between 2000 and 2018. The search of available collections4 yielded 3,452 results. Table 1. Study search terms Search terms . (TS = (PhD OR doctoral OR ‘master's’ OR ‘graduate student’ OR ‘graduate school’) AND TS=(stress*)) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Indexes = SCI-EXPANDED, SSCI, A&HCI, ESCI Timespan = 2000–2018 Search terms . (TS = (PhD OR doctoral OR ‘master's’ OR ‘graduate student’ OR ‘graduate school’) AND TS=(stress*)) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Indexes = SCI-EXPANDED, SSCI, A&HCI, ESCI Timespan = 2000–2018 Open in new tab Table 1. Study search terms Search terms . (TS = (PhD OR doctoral OR ‘master's’ OR ‘graduate student’ OR ‘graduate school’) AND TS=(stress*)) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Indexes = SCI-EXPANDED, SSCI, A&HCI, ESCI Timespan = 2000–2018 Search terms . (TS = (PhD OR doctoral OR ‘master's’ OR ‘graduate student’ OR ‘graduate school’) AND TS=(stress*)) AND LANGUAGE: (English) AND DOCUMENT TYPES: (Article) Indexes = SCI-EXPANDED, SSCI, A&HCI, ESCI Timespan = 2000–2018 Open in new tab 2.3 Screening and evaluation The initial search yielded 1,182 duplicates, which were subsequently excluded from the publication list. The remaining 2,270 studies were evaluated by hand for relevance. The study team read the title and abstract for each article and excluded those not related to stress or graduate students, guided by inclusion and exclusion criteria outlined in Table 2; the scan identified terms that did not otherwise apply to the phenomenon of interest and excluded the associated publication. For example, publications that utilize the word ‘stress’ as a verb or articles whereby the acronym ‘PHD’ refers to ‘prolyl hydroxylase domain.’ More importantly, the initial scan enabled identification of articles that include the words stress and graduate students but did not otherwise examine the relationship between the two. The initial screening excluded 2,030 articles, leaving 240 articles for the second round of screening. Table 2. Inclusion/exclusion criteria for evaluating focused search results Screening stage . Criteria . Inclusion . Exclusion . First Stage (evaluation based on title and abstract) Research topic Factors associated with stress and/or impacts of stress among graduate students Any other topics Use of word ‘stress’ As a noun meaning psychological and/or mental stress As a verb Use of the word ‘Masters’ As an academic degree conferred to graduate students Use of the word in any other context Use of word ‘PhD’ As an academic degree conferred to graduate students As any other meanings (e.g. prolyl hydroxylase domain) Second stage (evaluation based on the whole text) Research design Empirical Theoretical Method Quantitative, qualitative Theoretical, philosophical Sample/participants Graduate students (e.g. master’s students, doctoral students, medical students, dental students, etc.) Any other populations (e.g. faculty, nurses, counselors, etc.) Publication form Peer-reviewed journal article Book chapter, Conference paper, Other Quality of journal IF > 1 or SJR’s Citations Per Document (2 y) > 1 in 2018 Any other journals Language English Any other languages Screening stage . Criteria . Inclusion . Exclusion . First Stage (evaluation based on title and abstract) Research topic Factors associated with stress and/or impacts of stress among graduate students Any other topics Use of word ‘stress’ As a noun meaning psychological and/or mental stress As a verb Use of the word ‘Masters’ As an academic degree conferred to graduate students Use of the word in any other context Use of word ‘PhD’ As an academic degree conferred to graduate students As any other meanings (e.g. prolyl hydroxylase domain) Second stage (evaluation based on the whole text) Research design Empirical Theoretical Method Quantitative, qualitative Theoretical, philosophical Sample/participants Graduate students (e.g. master’s students, doctoral students, medical students, dental students, etc.) Any other populations (e.g. faculty, nurses, counselors, etc.) Publication form Peer-reviewed journal article Book chapter, Conference paper, Other Quality of journal IF > 1 or SJR’s Citations Per Document (2 y) > 1 in 2018 Any other journals Language English Any other languages Open in new tab Table 2. Inclusion/exclusion criteria for evaluating focused search results Screening stage . Criteria . Inclusion . Exclusion . First Stage (evaluation based on title and abstract) Research topic Factors associated with stress and/or impacts of stress among graduate students Any other topics Use of word ‘stress’ As a noun meaning psychological and/or mental stress As a verb Use of the word ‘Masters’ As an academic degree conferred to graduate students Use of the word in any other context Use of word ‘PhD’ As an academic degree conferred to graduate students As any other meanings (e.g. prolyl hydroxylase domain) Second stage (evaluation based on the whole text) Research design Empirical Theoretical Method Quantitative, qualitative Theoretical, philosophical Sample/participants Graduate students (e.g. master’s students, doctoral students, medical students, dental students, etc.) Any other populations (e.g. faculty, nurses, counselors, etc.) Publication form Peer-reviewed journal article Book chapter, Conference paper, Other Quality of journal IF > 1 or SJR’s Citations Per Document (2 y) > 1 in 2018 Any other journals Language English Any other languages Screening stage . Criteria . Inclusion . Exclusion . First Stage (evaluation based on title and abstract) Research topic Factors associated with stress and/or impacts of stress among graduate students Any other topics Use of word ‘stress’ As a noun meaning psychological and/or mental stress As a verb Use of the word ‘Masters’ As an academic degree conferred to graduate students Use of the word in any other context Use of word ‘PhD’ As an academic degree conferred to graduate students As any other meanings (e.g. prolyl hydroxylase domain) Second stage (evaluation based on the whole text) Research design Empirical Theoretical Method Quantitative, qualitative Theoretical, philosophical Sample/participants Graduate students (e.g. master’s students, doctoral students, medical students, dental students, etc.) Any other populations (e.g. faculty, nurses, counselors, etc.) Publication form Peer-reviewed journal article Book chapter, Conference paper, Other Quality of journal IF > 1 or SJR’s Citations Per Document (2 y) > 1 in 2018 Any other journals Language English Any other languages Open in new tab Next, the research team read each article and again excluded publications based on the second-stage exclusion/inclusion terms provided in Table 2. For example, in the second stage, the study team excluded articles based on quality, defined as publication within a peer-reviewed journals which, as of 2018, possessed an impact factor (IF) or IF approximation5 <1 (Imperial and Rodríguez-Navarro 2007; Kleinmann 2014). Furthermore, the research team identified articles that were published as conference proceedings (but were not published in a peer-reviewed journal) as well as publications where the abstract is written in English but the body of article is not. This second round of screening led to the exclusion of 206 irrelevant articles thus yielding thirty-four relevant articles for the analysis. Figure 1 summarizes the above-described procedures; the next section describes the descriptive statistics associated with the thirty-four articles selected for review. Figure 1. Open in new tabDownload slide Literature search and evaluation process. Figure 1. Open in new tabDownload slide Literature search and evaluation process. 3. Descriptive statistics 3.1 Definitions of stress As mentioned in the introduction, little consensus generally exists regarding a common definition of stress (Segerstrom and Miller 2004). This study defines stress as a state of imbalance between a rigorous environment and an individual’s ability to cope with these pressures (Cohen and Wills 1985; Folkman and Lazarus 1985; Hobfoll 2001) thus enabling the discovery and analysis of different types of stress-related articles. However, as illustrated in Table 3, scholars use multiple definitions of stress to frame their study. Table 3. Definitions of Stress Employed in the Literature. Publication . Definition of stress . Brown (2008) ‘Stress is considered to be a generalised physiological and psychological state brought about by the experience of stressors in the environment, identified as having their source in the process of acculturation’ Stubb et al. (2011) ‘Stress means a situation in which a person feels tense, restless, nervous, or anxious or is unable to sleep because his/her mind is troubled all the time’ Jungbluth et al. (2011) ‘One widely-used definition of stress derives from Folkman and Lazarus’ (1985) transactional model. They define stress as “a relationship between the person and the environment that is appraised [emphasis added] by the person as relevant to his or her well-being and in which the person’s resources are taxed or exceeded”; stress is a cognitive process related to one’s ability to cope, while anxiety is an unpleasant affective state associated with biological responses’ Van Laethem et al. (2017) ‘subjective and physiological state characterized by a combination of displeasure and high arousal’ Ayala et al. (2017) ‘stress occurs when environmental demands exceed a person's resources or threaten well-being’ Publication . Definition of stress . Brown (2008) ‘Stress is considered to be a generalised physiological and psychological state brought about by the experience of stressors in the environment, identified as having their source in the process of acculturation’ Stubb et al. (2011) ‘Stress means a situation in which a person feels tense, restless, nervous, or anxious or is unable to sleep because his/her mind is troubled all the time’ Jungbluth et al. (2011) ‘One widely-used definition of stress derives from Folkman and Lazarus’ (1985) transactional model. They define stress as “a relationship between the person and the environment that is appraised [emphasis added] by the person as relevant to his or her well-being and in which the person’s resources are taxed or exceeded”; stress is a cognitive process related to one’s ability to cope, while anxiety is an unpleasant affective state associated with biological responses’ Van Laethem et al. (2017) ‘subjective and physiological state characterized by a combination of displeasure and high arousal’ Ayala et al. (2017) ‘stress occurs when environmental demands exceed a person's resources or threaten well-being’ Open in new tab Table 3. Definitions of Stress Employed in the Literature. Publication . Definition of stress . Brown (2008) ‘Stress is considered to be a generalised physiological and psychological state brought about by the experience of stressors in the environment, identified as having their source in the process of acculturation’ Stubb et al. (2011) ‘Stress means a situation in which a person feels tense, restless, nervous, or anxious or is unable to sleep because his/her mind is troubled all the time’ Jungbluth et al. (2011) ‘One widely-used definition of stress derives from Folkman and Lazarus’ (1985) transactional model. They define stress as “a relationship between the person and the environment that is appraised [emphasis added] by the person as relevant to his or her well-being and in which the person’s resources are taxed or exceeded”; stress is a cognitive process related to one’s ability to cope, while anxiety is an unpleasant affective state associated with biological responses’ Van Laethem et al. (2017) ‘subjective and physiological state characterized by a combination of displeasure and high arousal’ Ayala et al. (2017) ‘stress occurs when environmental demands exceed a person's resources or threaten well-being’ Publication . Definition of stress . Brown (2008) ‘Stress is considered to be a generalised physiological and psychological state brought about by the experience of stressors in the environment, identified as having their source in the process of acculturation’ Stubb et al. (2011) ‘Stress means a situation in which a person feels tense, restless, nervous, or anxious or is unable to sleep because his/her mind is troubled all the time’ Jungbluth et al. (2011) ‘One widely-used definition of stress derives from Folkman and Lazarus’ (1985) transactional model. They define stress as “a relationship between the person and the environment that is appraised [emphasis added] by the person as relevant to his or her well-being and in which the person’s resources are taxed or exceeded”; stress is a cognitive process related to one’s ability to cope, while anxiety is an unpleasant affective state associated with biological responses’ Van Laethem et al. (2017) ‘subjective and physiological state characterized by a combination of displeasure and high arousal’ Ayala et al. (2017) ‘stress occurs when environmental demands exceed a person's resources or threaten well-being’ Open in new tab Interestingly, most articles reviewed in this study avoid defining stress and instead rely on instrumental measures (discussed below) to understand stress levels. Doing so illustrates that ‘researchers have tended to avoid the problem of defining stress, choosing to study stress without reference to a clear framework’ (Hobfoll 1989: 513) often due to the lack of consensus around ‘a satisfactory definition of this concept [stress]’ (Segerstrom and Miller 2004: 2). 3.2 Methods used In terms of methodology, most studies (67.6%) employ quantitative methods, including regression analysis (e.g. Divaris et al. 2012), ANOVA (e.g. Gutierrez et al. 2017), structural equation model analysis (e.g. Caesens et al. 2014), and Pearson correlations (e.g. Nelson et al. 2001). Approximately one-quarter of the articles reviewed (26.5% ) use qualitative methods, especially interviews, to understand stress and its impact among graduate students. The remaining studies employ mixed-method approaches (5.9%) (See Fig. 2). To collect quantitative data, authors relied primarily on surveys using a myriad of scales to understand and measure stress. Specifically, eight studies utilize different versions of the Perceived Stress Scale (Cohen et al. 1983), which seeks to understand participants’ general levels of stress (Denovan et al. 2019) by measuring how often they ‘experience feelings of stress’ (Ayala et al. 2017: 20). Other scales, such as Lent et al. (2009)’s perceived academic stress scale (e.g. Rice et al. 2016), Mena et al. (1987)’s social, attitudinal, family, and environmental acculturative stress scale (e.g. Suh et al. 2016), and Stanton et al. (2001)’s stress in general scale (e.g. Swords and Ellis 2017), are other examples of how scholars have instrumented stress. A few studies develop their own stress-related survey questions (e.g. Jungbluth 2011; El-Ghoroury 2012). For qualitative studies, participants are asked open-ended questions designed to understand the degree to which they experience stress—and how frequently (e.g. De Meis et al. 2003; Brown 2008). 3.3 Year of publication A majority of the thirty-four articles published between 2000 and 2018 are relatively recent demonstrating growing scholarly interest in the topic of stress among graduate students. Specifically, twenty-seven of the reviewed articles (about 79.4%) were published after 2010; fifteen studies were published within the past five years (five in 2016, six in 2017, two in 2017, and two in 2018). Only four publications were published during the first six years of the scope of the study (from 2000 to 2005) (See Fig. 3). Figure 2. Open in new tabDownload slide Year of publication. Figure 2. Open in new tabDownload slide Year of publication. 3.4 Journals While this study screened hundreds of publications, the articles reviewed come mostly from journals in the disciplines of psychology, health, and higher education. Specifically, ten publications (29.4%) come from psychology journals, including Training and Education in Professional Psychology, Counseling Psychologist, and Psychological Reports. Medical and health-related journals (29.4%) include European Journal of Dental Education and Journal of Professional Nursing. Seven articles (20.6%) were published in higher education journals such as Studies in Higher Education and Higher Education Research & Development. The remaining journals come from fields such as career counseling, communication, sociology, evaluation, and tourism. There is little overlap among journals indicating interest from a wide variety of disciplines but little depth within a single discipline or journal concerning stress among graduate students (See Fig. 4). Figure 3. Open in new tabDownload slide Journal discipline. Figure 3. Open in new tabDownload slide Journal discipline. 3.5 Samples and settings About half (52.9%) of the studies reviewed examine stress among doctoral students, while five publications (14.7%) examine stress among master’s students. Other studies examine stress among both (8.8%) or do not differentiate between the two (23.5%) (See Fig. 5). Studies focus on students within specific academic programs, such as psychology (17.6%), medicine (17.6%), counseling (5.9%), sociology, biochemistry, and occupational therapy (2.9% each). Thirteen studies discuss and compare stress among graduate students from a variety of fields (38.2%). Sample size among these articles range from two students (Devonport and Lane 2014) to 1,076 students (Rice et al. 2016) with an average sample size of 243.4. Figure 4. Open in new tabDownload slide Student population—Degree program. Figure 4. Open in new tabDownload slide Student population—Degree program. With regard to the geographic focus of studies in the review, most examine stress among graduate students located in North America (USA [eighteen], Canada [one], and Jamaica [one]), whereas rest of the student populations include students in European countries (UK [four], Finland [two], Netherlands [two], and Belgium [one]), South America (Brazil [two]), Oceana (Australia [one]), and Asia (Japan [one]). This summary shows that USA-focused studies (followed by the UK as a distant second) constitute a plurality of the studies that focus on stress among graduate students (See Fig. 6). The predominant research focus on the USA and, to a lesser extent, European countries demonstrates that there exist few investigations of stress among graduate students located in other national contexts, especially within countries that are rapidly developing graduate education capacities, such India, China, and Korea. Figure 5. Open in new tabDownload slide Student population—Country. Figure 5. Open in new tabDownload slide Student population—Country. Figure 6. Open in new tabDownload slide Methods. Figure 6. Open in new tabDownload slide Methods. 3.6 Authors Save for one single-authored publication (Brown 2008), most publications (33 articles, 91.7%) reviewed in the study were co-authored. Among first authors, most are located at universities within North America (USA [nineteen], Canada [two], and Jamaica [one]), with the balance located in European countries (UK [three]; Finland [two], Netherlands [two], and Belgium [one]), South America (Brazil [two]), Oceana (Australia [two]), and Asia (Japan [one]). The respective national focus of publications discussed above can be explained by the corresponding distribution of authors; authors tend to focus on stress among graduate students located within their country of residence. However, in contrast to other fields, authorship is not concentrated among a small group of individuals but instead distributed widely.6 Among a total of 114 authors, including thirty-four first authors and their coauthors, only five authors (co)authored more than one article (Lorraine Brown [two], Michael V. Ellis [two], Kirsi Pyhältö[two], Kenneth G. Rice [two], and Hanna Suh [two]). Figure 3 and Appendix Table A.1 include the names of all authors in our review. 4. Findings The following sections summarize the specific findings from our review of the thirty-four publications described above. It does so by parsing findings into two categories: studies that focus on the impact of stress and those that focus on factors associated with stress. Figure 7 provides a conceptual representation of each category providing illustrative examples from each. Figure 7. Open in new tabDownload slide Conceptualization of graduate student stress with examples from the literature. Figure 7. Open in new tabDownload slide Conceptualization of graduate student stress with examples from the literature. 4.1 Impact of stress Fifteen studies employ stress as an independent variable that results in specific consequences for individuals, each of which are described in Table 4. For example, students who experience high levels of stress demonstrate higher levels of fatigue (Tanaka et al. 2009; Van Laethem et al. 2017), burnout (De Meis et al. 2003; Clark et al. 2009; Swords and Ellis 2017), and more frequently experience nightmares (Kroth et al. 2010). Stress can result in poor eating habits and nutrition (Hopwood and Paulson 2012) and diminished mindfulness (Greeson et al. 2015). Cumulative stress can also decrease quality of life among students (Brown and Watson 2010; Ayala et al. 2017) life satisfaction (Suh et al. 2016), and overall wellbeing (Zahniser et al. 2017; Barry et al. 2018). Interestingly, stress is also associated with higher levels of vigor and energy among some graduate students (Swords and Ellis 2017). Table 4. Consequences of stress Impact . Definition . Physical and psychological health The degree to which stress impacts physical and psychological wellbeing Career and program satisfaction The degree to which stress impacts satisfaction levels related to an individual’s academic program and/or career Productivity The degree to which stress impacts the productivity and quality of one’s academic work Relational maintenance behaviors The degree to which students are able to maintain good relationships with academic advisors Impact . Definition . Physical and psychological health The degree to which stress impacts physical and psychological wellbeing Career and program satisfaction The degree to which stress impacts satisfaction levels related to an individual’s academic program and/or career Productivity The degree to which stress impacts the productivity and quality of one’s academic work Relational maintenance behaviors The degree to which students are able to maintain good relationships with academic advisors Open in new tab Table 4. Consequences of stress Impact . Definition . Physical and psychological health The degree to which stress impacts physical and psychological wellbeing Career and program satisfaction The degree to which stress impacts satisfaction levels related to an individual’s academic program and/or career Productivity The degree to which stress impacts the productivity and quality of one’s academic work Relational maintenance behaviors The degree to which students are able to maintain good relationships with academic advisors Impact . Definition . Physical and psychological health The degree to which stress impacts physical and psychological wellbeing Career and program satisfaction The degree to which stress impacts satisfaction levels related to an individual’s academic program and/or career Productivity The degree to which stress impacts the productivity and quality of one’s academic work Relational maintenance behaviors The degree to which students are able to maintain good relationships with academic advisors Open in new tab Of course, stress can also affect the academic experience of graduate students. Specifically, high levels of stress impact academic productivity, including their ability to conduct research, write, and publish (Barry et al. 2018). Stress thus results in increasing program dissatisfaction (Yang et al. 2016) and higher intentionality for students to leave their academic program (Volkert et al. 2018). Long-term stress may result in dissatisfaction with one’s career choice (Clark et al. 2009), thus decreasing levels of commitment to that professional path (Ulku-Steiner et al. 2000). 4.2 Factors associated with stress While the previous section discusses the consequences of stress, this section highlights factors, illustrated in Table 5, associated with (higher or lower) stress levels. The most common factors associated with higher levels of stress include course assignments and homework (Nelson et al. 2001; Pfeifer et al. 2008; El-Ghoroury et al. 2012; Brown et al. 2016), examination preparation (Brown et al. 2016a,b), and meeting project and assignment deadlines (Devonport and Lane 2014; Barry et al. 2018). Other demands relate to the ongoing requirement to present their research graduate research seminars and conferences (Divaris et al. 2012), as well as general pressures to publish and teach (Waaijer et al. 2016). Graduate students are especially stressed as they transition from an educational setting to more of an applied environment, for example during internships, clinical practicums, and part-time employment (Nelson et al. 2001; Divaris et al. 2012). Caesens et al. (2014) find that when students are committed to their academic work and feel engaged, they experience less stress, though higher levels of engagement can lead to workaholism or over-commitment. While some anecdotal descriptions exist (e.g. Jungbluth et al. 2011), scholars have yet to systematically investigate how stress differs among disciplines, much less among different institutional and international contexts. Table 5. Factors associated with stress. Factors . Definition . Demands, workload, and commitment University or job-related demands associated with academic publication, work hours, academic employment, internships or off-site jobs, or a dissertation or thesis Personal characteristics and circumstances An individual’s demographic characteristics such as gender, ethnicity, and marital status and personal circumstances such as number of children at home and family crises Financial issues The degree to which a graduate student experiences financial difficulty Academic position and status Specific type of academic position and its associated status Academic community and environment The extent to which an academic environment provides psycho-social support; supportive culture; healthy work environment Personal well-being The extent to which an individual is psychologically well, including their work–life balance and the degree to which they participate in extracurricular activities Coping strategies The extent to which an individual possesses mechanisms that enable them to cope with stress Intervention programs The role and effectiveness of programs that seek to enable individuals to cope Relationship with advisors The extent to which relationships with advisors, committees, and mentors are responsive, supportive, and amicable Career and job uncertainty Ambiguity and related insecurity relating to professional future Factors . Definition . Demands, workload, and commitment University or job-related demands associated with academic publication, work hours, academic employment, internships or off-site jobs, or a dissertation or thesis Personal characteristics and circumstances An individual’s demographic characteristics such as gender, ethnicity, and marital status and personal circumstances such as number of children at home and family crises Financial issues The degree to which a graduate student experiences financial difficulty Academic position and status Specific type of academic position and its associated status Academic community and environment The extent to which an academic environment provides psycho-social support; supportive culture; healthy work environment Personal well-being The extent to which an individual is psychologically well, including their work–life balance and the degree to which they participate in extracurricular activities Coping strategies The extent to which an individual possesses mechanisms that enable them to cope with stress Intervention programs The role and effectiveness of programs that seek to enable individuals to cope Relationship with advisors The extent to which relationships with advisors, committees, and mentors are responsive, supportive, and amicable Career and job uncertainty Ambiguity and related insecurity relating to professional future Open in new tab Table 5. Factors associated with stress. Factors . Definition . Demands, workload, and commitment University or job-related demands associated with academic publication, work hours, academic employment, internships or off-site jobs, or a dissertation or thesis Personal characteristics and circumstances An individual’s demographic characteristics such as gender, ethnicity, and marital status and personal circumstances such as number of children at home and family crises Financial issues The degree to which a graduate student experiences financial difficulty Academic position and status Specific type of academic position and its associated status Academic community and environment The extent to which an academic environment provides psycho-social support; supportive culture; healthy work environment Personal well-being The extent to which an individual is psychologically well, including their work–life balance and the degree to which they participate in extracurricular activities Coping strategies The extent to which an individual possesses mechanisms that enable them to cope with stress Intervention programs The role and effectiveness of programs that seek to enable individuals to cope Relationship with advisors The extent to which relationships with advisors, committees, and mentors are responsive, supportive, and amicable Career and job uncertainty Ambiguity and related insecurity relating to professional future Factors . Definition . Demands, workload, and commitment University or job-related demands associated with academic publication, work hours, academic employment, internships or off-site jobs, or a dissertation or thesis Personal characteristics and circumstances An individual’s demographic characteristics such as gender, ethnicity, and marital status and personal circumstances such as number of children at home and family crises Financial issues The degree to which a graduate student experiences financial difficulty Academic position and status Specific type of academic position and its associated status Academic community and environment The extent to which an academic environment provides psycho-social support; supportive culture; healthy work environment Personal well-being The extent to which an individual is psychologically well, including their work–life balance and the degree to which they participate in extracurricular activities Coping strategies The extent to which an individual possesses mechanisms that enable them to cope with stress Intervention programs The role and effectiveness of programs that seek to enable individuals to cope Relationship with advisors The extent to which relationships with advisors, committees, and mentors are responsive, supportive, and amicable Career and job uncertainty Ambiguity and related insecurity relating to professional future Open in new tab Individual characteristics also often impact stress levels. Studies show that graduate students experience higher levels of stress when they are younger (Clark et al. 2009; Gutierrez et al. 2017), single (Brown et al. 2016a,b), female (Nelson et al. 2001; Caesens et al. 2014), and/or an international student (Rice et al. 2016). Background as a racial or ethnic minority is also positively correlated with stress levels (El-Ghoroury et al. 2012). Personal circumstances and events, such as the number of children at home (Nelson et al. 2001; Brown et al. 2016a,b), family crises (El-Ghoroury et al. 2012), or personal trauma (Waaijer et al. 2016) also increase stress levels. The degree to which a graduate student faces financial difficulties is also related to higher levels of stress. Graduate programs generally depend on departmental funding thus funding availability (Grady et al. 2014) and related uncertainty as to whether or not a graduate student will receive funding is a driver of stress (Grady et al. 2014). Even when graduate students receive funding, the amounts may be inadequate to cover program costs (De Meis et al. 2003; Acker and Haque 2015), including course fees (Brown et al. 2016a,b), thus students may find themselves saddled with substantial debt, a relatively common source of stress (El-Ghoroury et al. 2012). The source of students’ funds also matters: PhD students from the Netherlands, for example, may receive full funding, while foreign students at the same university tend to rely upon other sources that may not adequately cover the total cost of their doctoral program (Waaijer et al., 2016). The type of graduate program in which students are enrolled also influence stress levels. Specifically, full-time students experience more stress compared to part-time students (Brown et al. 2016a,b). Furthermore, students experience greater stress levels during the beginning of their academic program and less as they progress through their program (Brown 2008), though preparation for the dissertation defense among doctoral students is associated with higher stress levels (Van Laethem et al. 2017). Academic community and environment impact student stress in positive or negative ways. Studies show that when graduate students receive continuous advising (Rice et al. 2016), mentoring from other graduate students (Grady et al. 2014), perceive high levels of organizational (university) support (Caesens et al. 2014), view the broader academic community as supportive (Stubb et al. 2011), and feel a sense of belonging (Reilly and Fitzpatrick 2009), they tend to experience less stress. A graduate student’s study environment can also elevate stress levels, especially when they experience interruption during work (Waaijer et al. 2016; Cornér et al. 2017), work in a shared work space (Nogueira-Martins et al. 2004), or are in a department with high student-faculty ratio (Acker and Haque 2015). Attending graduate school in another country drives stress levels among student not used to educational environments where they are evaluated based on their active participation and communication in another language (Brown 2008). As mentioned, we also know very little about how these environmental aspects may vary within and among a myriad of national contexts beyond the USA and Europe. Three factors are shown to consistently decrease stress levels among graduate students, including personal wellbeing, coping strategies, and intervention programs. Personal well-being, especially work-life balance, which indicates the ability to enjoy leisure time or time with friends and family (Pfeifer et al. 2008) lowers stress levels. In contrast, if graduate students frequently experience work-life conflicts (Brown and Watson 2010; El-Ghoroury et al. 2012; Devonport and Lane 2014), lack time for leisure activities and personal life (Divaris et al. 2012), or have problems managing their time (Nelson et al. 2001; Pfeifer et al. 2008), they experience higher levels of stress. In addition, an interrelationship exists between anxiety and stress: individuals with higher levels of anxiety experience relatively higher levels of stress, just as stress can drive anxiety (El-Ghoroury et al. 2012), while confidence levels have the opposite effect (Clark et al. 2009). Individual coping strategies are also shown to enable students to manage stress. Doing exercise (Pfeifer et al. 2008) and managing responsibilities, maintaining realistic expectations, and optimizing living arrangements help graduate students lower stress levels (Jungbluth et al. 2011). In addition, Greeson et al. (2015) found that medical students experienced reduced levels of stress after they participated in a month-long program—a so-called mind-body skills group—that provided them with tools for self-care and stress management. However, there is little discussion about coping strategies among graduate students and the efficacy within other institutional and national contexts.7 Two additional stress-related factors emerged from the review. When students are dissatisfied with their relationships with advisors, committee, and mentors (Waaijer et al. 2016; Cornér et al. 2017) and lack mentoring or have had negative mentoring experiences (Ulku-Steiner et al. 2000; Grady et al. 2014), they experience higher levels of stress. Also, uncertainty and ambiguity associated with professional future, income generation, and career seems to drive stress levels as well (Divaris et al. 2012; Devonport and Lane 2014). The myriad of stressors described above demonstrate significant conceptual and substantive variations in the literature. Furthermore, scholars (e.g. Greeson et al. 2015) recommend that policymakers design and implement interventions to enable graduate students to reduce and manage stress. Yet, these studies are not well-linked in a way that would enable effective implementation of these recommendations, nor do they focus on how interventions might differ by institutional or national context, points discussed in the next section. 5. Discussion The purpose of this article is to review empirical studies that investigate factors associated with stress levels as well as the impact of that stress among graduate students. The review is motivated by studies and reports that illuminate reported spikes in mental illness among graduate students (e.g. Levecque et al. 2017) and its causal link to stress (Wang 2015; Evans et al. 2018). Despite numerous calls to address stress-related health problems in academia (Evans et al. 2018; Woolston 2018; Nature 2019a,b), scholarly interest in the topic has developed only recently; a plurality of articles in our range of focus (2000–8) were published during the last five years. Interestingly, these studies represent a wide range of authors, disciplines, and journals. While scholarly breadth provides heterogeneity in thought, it also helps explain challenges related to the development of robust theory (Swords and Ellis 2017) and the effectiveness of sophisticated interventions (Greeson et al. 2015) meant to reduce and manage stress within a myriad of contexts. These challenges may also stem from a lack of conceptual consensus within and among disciplines, especially psychology, around how stress is defined. Many stress studies focus on the instrumentation of stress while neglecting its definitional and theoretical underpinnings (Segerstrom and Miller 2004), a phenomenon observed among publications in our study. In practical terms, the proliferation of stress definitions limits the ability of scholars to produce generalizable findings that can be used to understand and address significant stress-related problems among specific populations, such as graduate students (Nelson 2007; Brown et al. 2016a,b). Scholars and policymakers unfamiliar with this underlying context would thus be wise to proceed with conceptual caution. Definitional challenges aside, our review demonstrate the growing interest in stressors and stress-related impacts among graduate students. Several reviewed publications contribute to the extant literature by focusing on stress impact, the most significant of which relates negatively to their physical and mental health. Other impacts include diminished productivity, quality of life, and relationships. Stress and the interaction of these impacts not only help explain decreasing levels of academic program satisfaction, they may also offer a partial explanation for the 50 per cent dropout rate among doctoral students (Patterson 2016). A relatively large proportion of studies in our review center on graduate student stressors, including academic demands, position and funding sources, personal circumstances, and levels of emotional support from fellow students and advisors. Recent media reports (e.g. Kovacs 2016; Luberecki 2017) illuminate the financial challenges of graduate students, which can consequently elevate stress levels. In contrast, factors such as (positive) work–life balance, coping strategies, and ex ante physical and mental health help lower stress levels. Given the strong link between factors associated with the academic responsibilities and experiences of graduate student, most scholars recommend that future research focus on structural changes and interventions in academia that might reduce student stress levels while providing them with the emotional tools to cope better. In addition to examining the extent to which formal graduate education milestones (e.g. coursework, dissertation, publications, internship, etc.) impact stress among students, future research could also delve into the impact of informal social processes and dynamics in graduate programs. Studies in our review show that while students experience high levels of stress when they are interrupted by others or work in a shared workspace (Nogueira-Martins et al. 2004; Waaijer et al. 2016; Cornér et al. 2017), isolation can also exacerbate student stress (Jungbluth et al. 2011; Grady et al. 2014). Relationships with specific individuals and groups, such as PIs, dissertation committees, and student-led peer groups also represent a potential area of inquiry. For instance, future research can attempt to understand how theory and concepts of socialization may account for formal and informal ways that graduate students are prepared to join the professoriate and/or the scientific profession generally, as well as to examine the degree to which such socialization processes affect stress among the students. In the literature, a common theme is that students experience high levels of stress during their initial transition and adaptation to graduate school (Brown 2008; Grady et al. 2014). In particular, graduate education is a new environment requiring new skills in response to new expectations and can be especially traumatic for foreign students (Brown 2008). Liminality and high stress levels during specific educational transitions (De Meis et al. 2003), from undergraduate school to graduate school and from master’s program to PhD program, may help explain a decline in students matriculating to doctoral programs (Okahana and Zhou 2018) and increasing dropout rates (Patterson 2016). Future studies can examine how stress during these educational transitions may be related to specific matriculation and persistence outcomes. While Fig. 7 provides a conceptual representation of the extant research findings, several new areas of research are vital for motivating further and informing future policy action within the context of graduate education. Specifically, research has yet to focus on the long-term impact of stress and how this evolves (if at all) throughout the graduate school experience and beyond. For example, how does stress manifest differently among students in different types of degree programs (Masters and Doctoral) with different disciplinary foci?8 Furthermore, how does stress differ among students of different genders, racial, and ethnic backgrounds? Another promising area of inquiry includes dynamics associated with the pursuit of graduate education by individuals from rapidly developing countries. Our review shows that international students generally experience higher levels of stress. For many students from countries, such as China and India, graduate education in Europe or North America offers the opportunity for upward mobility, especially if they obtain post-program jobs in academia or industry. However, family expectations, hyper-competitive research environments (that include other graduate students from all over the world), and uncertainties surrounding academic job markets likely generate high stress levels among these students (Wingfield 2017). How has this influx of foreign students affected academic culture, post-degree employment, and stress levels among students native to the receiving countries? Given that most of the studies in this review focus on graduate students in the USA and Europe, scholars might also examine how stressors and the impact of stress differs among graduate students located within rapidly developing countries. We believe that two research areas of research are especially ripe for study and consequent policy action. Two reviewed studies (Divaris et al. 2012; Devonport and Lane 2014) highlight the relationship between elevated stress levels and uncertainties associated with pursuing, succeeding, and generating income in a satisfying career. A myriad of studies highlights the existence of educational mismatch that PhD graduates fail to find an adequate job placement to utilize the knowledge and skills that they acquired during doctoral education (Bowlus 1995; Stenard and Sauermann 2016), especially among PhDs within the STEM disciplines (Cyranoski et al. 2011; Stephan 2012; Stenard and Sauermann 2016). These studies highlight the paradox between education mismatch and the sustained advocacy for ever increasing numbers of STEM PhD students (and funding). However, scholars have yet to empirically investigate the macro–micro link between educational mismatch and its impact on individual graduate students, including their stress levels and overall physical and mental health. A recent empirical study is illustrative. Hayter and Parker (2019) examine factors that impact the transition of university postdocs to nonacademic careers. The study is motivated by studies that show fewer than 15–20 per cent of university postdocs will obtain tenure-track faculty positions in research universities (e.g. Puljak and Sharif (2009)), generally the stated objective of these positions. Hayter and Parker (2019) find that many postdocs experience ‘incidence[s] of chronic stress’ and recommend that scholars ‘…investigate the nature and incidence of stress and related symptoms as well as their specific impact on postdoc wellbeing, including their career search’ (p. 567). The spirit of the authors’ discussion might also be applied to graduate STEM education writ large: a significant opportunity exists to understand the link between educational mismatch and stress levels, in addition to other micro-level factors, among graduate students. A second promising area of research is the specific role of fellow students and faculty as well as policy and programs in enabling graduate students manage stress, especially within the context of their professional development. For example, while Hayter and Parker (2019) attribute stress among postdocs to an ‘existential crisis’, they also focus on other interrelated factors such as unsupportive behavior among PIs and the lack of supportive university policies. As noted, several studies in this review (e.g. Ulku-Steiner et al. 2000; Caesens et al. 2014; Grady et al. 2014; Rice et al. 2016; Cornér et al. 2017) focus on the important role of academic culture, especially graduate student relationships with other students and faculty. However, following recently announced efforts to understand and combat mental illness among graduate students,9 we also lack a clear understanding of the specific social and cultural barriers that exist to identifying and treating stress within academia and how they may differ among countries. Similarly, several studies in our review (e.g. Nogueira-Martins et al. 2004; Acker and Haque 2015) highlight the role of university programs that enable coping and other stress management skills. For instance, only one study included in our review (Greeson et al. 2015) examines the direct linkage between participation in an intervention program and stress levels. By paying closer attention to how and the degree to which intervention programs help graduate students deal with stress-related issues, future studies can articulate implications for operating stress-related interventions at graduate schools (Divaris et al. 2012; El-Ghoroury et al 2012; Gutierrez et al. 2017; Suh et al. 2016; Barry et al. 2018), as well as how these interventions fit into a broader organizational strategy (Hayter and Cahoy 2018). Future research might catalog such programs, creating a typology of program type and focus within different higher education contexts, as well as explore factors responsible for their efficacy. Scholars might also focus on organizational contexts and higher education and science policy that exacerbate or reduce stress levels among graduate students, including those related to educational mismatch. For example, to what extent do the practices and policies of national research funding agencies impact how graduate students are selected, reimbursed for tuition, and employed as research assistants? Despite the increasing need for public policy and guidance addressing mental wellness and stress among graduate students, there is a limited number of national-level resources available to institutions. Theoretical and empirical studies that provide the groundwork for developing comprehensive public policy and guidance to tackle the issue of mental health and stress among graduate students would be a potential area of future inquiry. Graduate students play a critical role in the social and economic development of society and we are thus incumbent to protect and nurture their physical and emotional well-being is in our interest. Following Stephan (2012), there is far too often a disconnect between the observations and recommendations of August groups such as the National Academies within the USA (e.g. National Research Council 2018) and the focus of systematic empirical research. This review has identified an emerging albeit modest body of research that focuses on stressors and the impact of stress among graduate students. It is our hope that scholars can build upon and help focus and scale this work to inform and guide policy interventions that can reduce stress among graduate students and enable them to cope better. Conflict of interest statement None declared. Footnotes 1 Graduate education is otherwise referred to as postgraduate education in the UK, among other countries. (Post)graduate education refers to formal levels of academic or professional education generally after completing a four-year undergraduate degree. 2 The literature review began in 2019, thus 2018 was the latest year available for a complete publication search. 3 Additional keywords considered during the inductive search include: doctor*; postdoc*; postdoctoral; post-doc; ‘occupational stress’; ‘psychological stress’; ‘work stress’; ‘job stress’; ‘work related stress’; ‘job related stress’; anxiety; ‘social dysfunction’; ‘loss of confidence’; ‘depression’; ‘mental health’; wellbeing; ‘well-being’. We excluded the additional keywords from the final search command for the following rationale: First, we excluded ‘doctor*’ because it mostly results in irrelevant publications whose sample consists of professional medical doctors, whereas ‘doctoral’, one of our final terms, captures articles related to doctoral students. Second, postdoc-related terms were excluded because we found very few articles directly discussing stress among postdoctoral researchers and thus we decided to focus only on articles exploring stress among graduate students. Finally, we excluded terms regarding specific kinds of stress (‘occupational stress’; ‘psychological stress’; ‘work stress’; ‘job stress’; ‘work related stress’; ‘job related stress’), factors of stress (‘anxiety’, ‘social dysfunction’, ‘loss of confidence’) (Graetz 1991), and derivative concepts of stress (‘depression’, ‘mental health’, ‘wellbeing’, ‘well-being’) to more comprehensively find articles discussing ‘stress’. 4 For example, in Web of Science: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Arts & Humanities Citation Index (A&HCI), and Emerging Sources Citation Index (ESCI). 5 As an IF approximation, we used SCImago Journal Rank’s indicator of average citations per document during the preceding 2 years (Butler 2008; Falagas et al. 2008). 6 For example, a recent review of the academic entrepreneurship literature (See Figure 4 in Hayter et al. 2018) shows that one author, Mike Wright, accounts for 28 (14%) of the 209 articles in the study, followed by Andy Lockett with 11 articles. 7 In comparison, previous studies have examined different types of strategies for emotional regulation employed by college students and young people and how the levels of emotional regulation are associated with the levels of stress (Seligowski et al. 2015; Chacón-Cuberos et al. 2019). 8 Some studies include multiple disciplines within their sample but do not offer a systematic explanation of why stress levels may differ. 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TI - Under pressure: A systematic review of stress and its impact among graduate students
JF - Science and Public Policy
DO - 10.1093/scipol/scaa053
DA - 2020-12-07
UR - https://www.deepdyve.com/lp/oxford-university-press/under-pressure-a-systematic-review-of-stress-and-its-impact-among-GEgqmMzh4J
SP - 1
EP - 1
VL - Advance Article
IS - 
DP - DeepDyve
ER -