Mental illness on the rise in academia

Universities are developing psychological care and prevention strategies for undergraduate and graduate students

PEDRO FRANZIn August 2017, a PhD student committed suicide in a laboratory at the University of São Paulo’s Institute of Biomedical Sciences (ICB-USP), igniting a discussion on the pressures faced by those pursuing an academic career and the psychological conditions related to graduate life. The subject is beginning to gain more attention in Brazil, but there are still few Brazilian universities investing in mental health clinics for their undergraduate and graduate students.

The problem is global. A study published in Research Policy in May 2017 found that one-third of 3,659 PhD students at universities in the Flanders region of Belgium were at risk of developing a mental illness. In 2014, a study from the University of California, Berkeley, found that of 2,500 graduate students, 785 (31.4%) showed signs of depression. The study was part of a larger piece of research that has been ongoing since 1994, when it was found that 10% of graduate students and post-doctoral researchers at the university had considered suicide.

In the United Kingdom, a study published in Educational Psychology in 2001 found that 53% of researchers at British universities suffered from mental illness, while in Australia the rate was found to be as much as four times higher in the academic world than among the general population. Despite the relatively small sample sizes, these studies contribute to a growing concern in the academic world: undergraduate and graduate students are subject to pressures that can lead to a series of mental health conditions.

Like other countries, there are still few studies, data, and initiatives on this subject in Brazil. São Paulo State University (UNESP) is planning to launch their “Bem viver para tod@s” (Well-being for all) program in early 2018. The initiative will include lectures and discussions with mental health experts from the university itself. “The objective is to guide students and professors on how to identify and deal with these problems,” explains Cleopatra da Silva Planeta, dean of university extension and coordinator of the project.

PEDRO FRANZSome universities already offer mental health services to their students. The University of Campinas (UNICAMP), for example, has a Psychological and Psychiatric Care program (SAPPE), which has been providing psychological and psychiatric care to undergraduate and graduate students for 30 years. According to psychiatrist and SAPPE coordinator Tânia Vichi Freire de Mello, about 40% of the university students using the service are studying master’s degrees or PhDs. “Most report symptoms of insomnia, stress, and anxiety, as well as panic attacks and depression,” she says. “Many try to evade these issues by drinking alcohol and using psychoactive drugs such as marijuana.”

These problems are usually the result of a convergence of factors, according to psychiatrist Neury José Botega, from the UNICAMP School of Medical Sciences (FCM). He believes that the dynamics of graduate schools involve tight deadlines, pressure to publish articles, excessive workloads, and fees. “Students often claim that they are unable to meet deadlines or cannot handle the demands of their professors and supervisors,” he says. Stress, anxiety, panic attacks, and depression are common. “Continuing studies is often unfeasible and students become anxious that they are unable to complete the required work.”

A report released by the Brazilian Association of Directors of Federal Higher Education Institutions (ANDIFES) in 2011 mapped the social, economic, and cultural background of nearly 20,000 undergraduate students at Brazilian federal universities, finding that 29% had already sought psychological care and 9% had sought psychiatric care—the latter involving more serious problems. The study also found that 11% had already taken or were taking psychiatric medication.

According to Tamara Naiz, president of the Brazilian Graduate Students Association (ANPG), a common problem among graduate students is the so-called burnout syndrome, when an individual reaches an extreme level of exhaustion through overworking and lack of rest. Another is impostor syndrome, which affects academics who cannot accept that they deserve success on their own merit. “The development of mental health issues during graduate studies is a reflection of the problems within academia, which offers few opportunities,” she says. “The situation is exacerbated by the demands and pressures of short deadlines for writing and defending theses and excessive or unfair fees for publishing in high impact journals.”

Bad relationships with supervisors can also contribute to the development of psychological disorders. ANPG has seen various cases of abusive or negligent attitudes reported by students who have been harassed during meetings or classes. The organization has also received numerous reports of supervisors who show no interest in the research of their students, or ask students to perform tasks unrelated to their research. Other cases involve students not receiving their funding or being given low grades for false or non-academic reasons. Sexual harassment and gender discrimination—which are still prevalent—are also highlighted as contributing factors to mental illness in academia, especially among women.

PEDRO FRANZMedical school
The vast majority of studies on psychiatric epidemiology in Brazilian academia are related to undergraduate students, especially those in medicine, a course that is often characterized by continuous pressure for good grades and many hours of study both in and out of class. The environment among the students themselves is also highly competitive, starting with the university entrance examination, which is usually heavily oversubscribed. A 2013 study published in Revista Brasileira de Educação Médica (Brazilian Journal of Medical Education) by researchers from the Federal University of Paraíba (UFPB) found that of 384 medical students, 33.6% had some type of mental health condition such as anxiety, depression, or somatic symptom disorder, which manifests as physical symptoms but cannot be explained by a physical medical condition.

According to psychiatrist Laura Helena Andrade from the Psychiatry Institute at the USP School of Medicine (FM-USP), factors such as difficulty managing time, daily contact with death, fear of contracting disease or making mistakes, and feelings of powerlessness in relation to certain illnesses make medical students more susceptible to mental illness. “Medical students need to be more resilient in order to maintain a high level of performance in their studies, research, and patient care,” she points out. At the Federal University of São Carlos (UFSCAR), there have been 22 suicide attempts involving medical students in the last five years alone, according to data published in the O Estado de S. Paulo newspaper in September 2017. At the Federal University of São Paulo (UNIFESP) and ABC Federal University (UFABC), five students took their own lives in the same period.

This has encouraged some Brazilian universities to invest in psychological care and prevention resources especially for these students, such as the Support Group for Residents and Students of Medicine and Speech-Language Therapy (GRAPEME) at UNICAMP. Since 1986, USP has been working with the Psychological Assistance for Students Group (GRAPAL), which aims to provide care to FM-USP physical therapy, speech-language therapy, medicine, and occupational therapy students, as well as residents. In August, the Federal University of Minas Gerais (UFMG) introduced two psychology clinics for undergraduate and graduate students.

The two institutions are also training professors to anticipate mental health issues. According to SAPPE’s Tania Vichi Freire de Mello, it is important to pay attention to sudden changes in student behavior or unexplained drops in academic performance. A survey conducted in 2016 analyzed the profile of 1,237 students who had contacted SAPPE, concluding that counseling or psychological treatment may prevent students from leaving their course. The study found that dropout rates were lower among those who used SAPPE services than those who did not.

Neury José Botega, from FCM-UNICAMP, believes it is important for professors to be more open with their students about mental health, without minimizing their problems. “In general, professors are more worried about the academic performance of their students, without considering that this itself is related to the student’s mental health,” says the psychiatrist. “We must act to accommodate these students, to help them, and if necessary, to refer them to care services.”