Tag Archives: mental health

Routine Examination: Maintaining Good Mental Health During a Global Pandemic

As a 6th year student, I’ve benefitted quite a bit from listening to students before me when they talked about successful time management. This article is meant to be more than just an article on time management, though; it’s also an article about resilience, and coping strategies, and how all of it affects our work. And maybe how, when everything else fails, having a little bit of a routine can help.

In Man’s Search for Meaning, Victor Frankl wrote that “people have enough to live by, but nothing to live for; they have the means, but no meaning” [1]. We are taught as scientists that it is the science itself that should drive us, that if we are passionate enough about science, if we’re curious enough, we’ll succeed.  Anyone who fails must not have had enough passion, we’re told.

I don’t believe that’s true.

During this pandemic, it’s so easy for academia to continue with a mantra akin to “passion will drive science forward.” To me, it seems much more about resilience, defined in the social sciences as a measure of the ability to cope with stress [2]. People who are resilient recognize the limits of their control, have an action-oriented approach, are patient and flexible, and have goals (perhaps life goals?), among other things [2, 3]. While some of our reaction to stress can be attributed to genetics, there are certain skills that can be cultivated to increase our resilience [4]. One example is increasing the amount of active coping, such as exercise, looking for social support, mindfulness, or reframing stressors more positively [4-6].

I realize that this can sound strange to us as biomedical scientists rather than social scientists, but there is a body of literature (some of which is cited here), suggesting that resilience can protect employees from work-related stress, and that it could explain why some people thrive in environments where others burn out [7]. Right now, we’re in an environment where many of us will burn out—if not from the stress of graduate school, then from the added stress of a pandemic. It is critical, then, that we foster resilience in populations of graduate students who have been shown to experience higher levels of depression and anxiety than the larger population (I’ve written about this here).

The link between resilience and having a schedule/maintaining a routine may not be immediately obvious. It turns out that many of the predictors of resilience (goals, social support, personal reflection included in mindfulness study, etc.), as well as having a meaning in life, are also predictors of happiness [8]. Maintaining routine also gives us a sense of stability. Research on Post-Traumatic Stress Disorder (PTSD) has shown that avoidance coping strategies, including reducing routine activities to avoid triggering places, was a significant predictor for functional impairment [9]. Much research is devoted to the effects of family routines and daily routines on child development, but much less is discussed regarding the effects of these things on adult individuals [10]. I think, however, that some level of routine is good for all of us, even if that routine consists mainly of going to work and coming home again. Routines help us build healthy habits.

Perhaps that’s why so many of us have struggled during this pandemic. Academic science is by nature a flippy-floppy, unstructured business, and when COVID-19 took away the last piece of structure—going into the lab every day—many of us were left wondering what to do with all that new free time. The shutdown really gave me a chance to codify what works for me as a daily routine and what doesn’t. Give some of these a try!

Find a space to work that isn’t in your bedroom
Not all of us have the luxury of a personal home office, but it’s best to keep work things out of your sleep space. Associating your bedroom with work, especially stressful work, can blur the lines of work-life balance. Just because we’re working from home, that doesn’t mean we need to compromise our boundaries!

Make time to exercise
Personally, if I don’t exercise first thing in the morning, it doesn’t happen. Without exercise equipment at home, bodyweight exercises or outdoor cardio are going to be your best friend. Medicine in Motion has a nice workout library that’s worth checking out (as an added bonus, Tufts has its own chapter!).

Do your normal morning routine—even if you’re not going out
Shower, brush your teeth, get dressed, eat breakfast. Make it feel like you’re getting ready to work! It’s so tempting to stay in pajamas with a blanket and take Zoom calls from bed, but even if your camera is off and your labmates can’t see you, you won’t feel prepared to work and your brain won’t engage in it. Pretend that you’re going into the lab and bring your A-game to the zoom-room.

Normalize your sleep schedule
Wake up and go to bed at the same time each day. Keeping a consistent sleep schedule is referred to as “sleep hygiene.” Sleep hygiene is critical for maintaining your body’s circadian rhythm, which tells you when to wake up and when to wind down for the day. If you constantly switch what time you’re waking up or going to bed, your body won’t know when to help you wake up on any given day. This goes hand-in-hand with working outside your bedroom and breaking any association you may have between work and sleep. It’s actually best to do this every day, even when there isn’t a global pandemic (and yes, even on weekends!).

Find a little meaning (outside of work)
If you have a pet, it could be as simple as feeding your pet every morning and making sure they are getting the exercise and playtime they need. It might be caring for houseplants, or checking in with your parents or a close friend to make sure they are doing okay. Or perhaps living out your dreams of cooking eggplant in every possible style, just to say you’ve done it. Or crocheting baby hats for preemies in the NICU. Find something that, when you do a little bit each day, makes you feel like you accomplished something that impacts the world around you.

Expand your support network
Humans thrive on social interaction (even the most introverted of us enjoy the occasional chat). Reach out to some old friends, join a support group. Check in on people. If you’re looking to connect with people, CoronaBuddies is still available! It can be helpful to use the human inclination to follow a schedule here: set a weekly time to zoom with a friend, so that no matter how busy or isolated you otherwise feel, you’ve got that weekly visit waiting in the wings.

Cut yourself some slack…
Know that it’s totally okay if you aren’t as productive as you were before the pandemic. None of us are, especially with density restrictions and having to work around each other in a way that we didn’t have to before. Give yourself a mental health day and binge some of your favorite TV shows, talk to a friend, or cook some good food. Know that 100% effort at work may not give you 100% of the results you may have gotten pre-pandemic.

…But don’t let your guard down
This is a marathon, not a sprint. It’s so tempting to take your mask off—it’s hot, it’s itchy, it’s uncomfortable, it’s hard to breathe—but we’re still in the thick of the pandemic. The vaccine is coming, but until enough people have been vaccinated, it’s not over. Keep on keeping on with mask wearing, social distancing, and hand sanitizing.

And finally, know where to find help
Reach out to the Student Wellness Advisor, Sharon “Snaggs” Gendron, if you feel you could benefit from additional support. She can refer students struggling with mental health to clinicians who can help. Other places to find help are the Talk One2One Student Assistance Program, BetterHelp, iHope, and the University Chaplaincy.

In the event of a crisis, the National Suicide Prevention Lifeline is available 24/7 at 1 (800) 273-8255.

[1] Frankl, Victor. Man’s Search for Meaning. Beacon Press, Boston, 1946.

[2] Conner and Davison. (2003) Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety 18:76-82.

[3] Friborg et al. (2006) A new rating scale for adult resilience: what are the central protective resources behind healthy adjustment? International Journal of Methods in Psychiatric Research 12(2): 65-76.

[4] Southwick et al. (2005) The psychobiology of depression and resilience to stress: Implications for prevention and treatment. Annual Review of Clinical Psychology 1:255-91.

[5] Callaghan. (2004) Exercise: A neglected intervention in mental health care? Journal of Psychiatric and Mental Health Nursing 11: 476-483.

[6] Galante et al. (2018) A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomized controlled trial. Lancet Public Health 3:372-81.

[7] Grant and Kinman. (2012) Enhancing wellbeing in social work students: building resilience in the next generation. Social Work Education 31(5):605-621.

[8] Bailey and Fernando. (2012) Routine and project-based leisure, happiness, and meaning in life. Journal of Leisure Research 44(2):139-154.

[9] Pat-Horenczyk et al. (2006) Maintaining routine despite ongoing exposure to terrorism: a healthy strategy for adolescents? Journal of Adolescent Health 39:199-205.

[10] Schultz-Krohn. (2004) The meaning of family routines in a homeless shelter. American Journal of Occupational Therapy 58:531-542.

New Initiative on Campus Seeks to Tackle Mental Health Issues among Grad Students

For a long time, it was a generally accepted trope in academia that graduate students must endure harsh conditions, intellectual and emotional, before they are granted their PhD degrees. This is supposedly meant to build character, and weed out those who are not fit for the rigor and stress one encounters in academic research – a trial by fire of sorts. The ones who survive these conditions and emerge victorious, also internalize such hazing and come to think of it as just the regular pressure of working in academia.

It is therefore not surprising that the mental health of graduate students have not been discussed very much except in the recent years. While it has long been a subject of humor, such as PhD Comics and memes such as Shit Academics Say, it is only recently that the severity of the problem has been brought to light. In 2013, a series of articles regarding graduate students’ mental health was published on the GradHacker blog. In a guest post, Nash Turley, then a PhD candidate in evolutionary ecology at University of Toronto, looked at studies focusing on the major mental health issues graduate students face – anxiety, depression, suicidal thoughts, going as far back as 1997, and deduced that “mental health issues are the biggest barriers to success among graduate students.”

Earlier this year, a study published in the journal Nature Biotechnology by , described the mental health issues among graduate students as a “crisis”, highlighting the prevalence of anxiety and depression. After surveying 2,279 graduate students representing 26 countries and 234 institutions, the study found that graduate students are six times more likely to suffer from moderate-to-severe depression compared to the general population. The study also found that female, trans and gender-non conforming (GNC) students were significantly more likely to experience anxiety and depression than their cis male counterparts. Among the students with anxiety and depression, more than half did not felt valued by their mentors and half did not agree that mentors provided emotional support (only a third said yes). The study proposed some short term solutions, such as providing trainings to faculty and administrators by mental health professionals, similar to the NIH’s “train the trainers” program. For a longer term solution, the authors advocated for “a shift of the academic culture to eliminate the stigma and to ensure that students are not reluctant to communicate openly with PIs.” The notion of suffering has been internalized by graduate students to the point that in a latest study conducted among five hundred economics graduate students across eight institutions, the students who scored worse than average on a mental-health assessment tended to think that their mental health was better than average; among those who reported having suicidal thoughts, 26% assumed that their psychological well-being was better than the norm. In both studies, the major driver of such mental health issues seemed to be a combination of financial worries and the professional pressure to publish, both of which are products of the tight budget climate and the “publish or perish” nature that academia has recently taken on.

Alyssa DiLeo, a second-year graduate student in the Neuroscience program, is well aware of mental health issues graduate students face; she has faced them personally as well. “Graduate school is a hard transition for many people and even more difficult when they don’t have a support system. Mental health issues are also highly prevalent in graduate students. Levecque et al. published a study in May of 2017 reporting one in two PhD students experience psychological distress and 1/3 of graduate students are at risk for a psychiatric disorder. An online survey of graduate students in a recent March 2018 study by Evans et al. reported that graduate students are more than six times as likely to experience depression and anxiety compared to the general population. After taking a few years off before entering graduate school, I’ve definitely found myself struggling to transition from an employee to a graduate student and was finding it hard to find the right support.” She became aware of an initiative called Resources for Easing Friction and Stress (REFS) at MIT while attending a Graduate Women in Science & Engineering (GWiSE) event at Harvard, and was inspired to start a REFS program here at Sackler called sREFS (sackler Resources for Easing Friction and Stress).

The goal of the sREFS initiative is “to provide an easily accessible outlet for graduate students to talk about conflicts, issues, or stressors in their lab or personal life.” Currently, there are few options that Sackler students can peruse if they are having mental health issues – the Wellness Center which puts out events for the whole TUSM community, the Student Advisory Council of the Wellness center (which just got a Sackler rep on their board), or their friends and other graduate students at certain social events. Mentoring circles, another peer-based support system started by Sackler students and alumni for networking and career development, could be another option. However, Alyssa noted that while Mentoring Circles provided “a great networking resource with experienced mentors”, “sREFS aims to create a more one on one private conversation between students about mental health in graduate school.” This initiative also hopes to serve as the first contact for first year students who may have questions about the school or its programs, courses, etc. Additionally, sREFS will be trained on mediation and conflict management skills that may prove valuable in their own labs or workplaces post-graduation.

The sREFS initiative is a pilot program, proposed by Alyssa in conjunction with Sharon Snaggs from the Wellness Center, and has gained the support of the Dean’s Office and the Graduate Student Council. The process to become a sREF involves an 8-hour training spread out over 8 weeks, and is modeled after MIT’s REFS program. While the MIT program offers a certification after 40 hours of training provided by professionals, the sREFS initiative has a smaller scope and is more flexible given the student body size and available resources at Sackler. Once trained, sREFS will be expected to hold office hours for one-on-one conversations, and sREFS are also mandatory reporters and are liable to report any cases of harassment or similar incidents to the administration. At the inaugural meeting on Thursday, Nov 29, Alyssa mentioned that the only exclusionary criterion for becoming a sREF is enrollment as a PhD student, since continuity and consistency are important for this initiative to succeed. The sREFS will be allowed to keep anonymized and confidential notes only after getting consent from those who are speaking with them. These notes may also help identify the common issues prevalent among Sackler graduate students and help sREFS recommend programs to administration to tackle such issues. In case of any conflict of interest, sREFS may recuse themselves from certain cases; Alyssa would like to see at least one graduate student from each program volunteer as sREFS to avoid such conflicts. Given that this role incurs emotional stress on the volunteers, sREFS can also take time off from the initiative.

Interested students are asked to email Alyssa at Alyssa.DiLeo@tufts.edu to receive an application packet. The application deadline is Jan 15, but is also flexible since the initiative would like to be as inclusionary as possible. The sREFS initiative is also looking for volunteers to fill in positions on the executive board to help with logistics and planning. Unsurprisingly, all the current volunteers are female, as emotional labor most often falls on women in this patriarchy, and it would be great to see the male graduate students do their part as well in this timely, community-based initiative.

The Perks of Resting Your White Matter

All images used here are released under Creative Commons CC0. The author would like to thank her good friend E.C. for help in editing this article.

While the stigma of mental health issues has begun to lessen somewhat in recent years, it’s still very present in our society. Let’s take a moment to talk honestly about mental health and work/life balance.

Graduate students have a high risk of having or developing mental health issues
In a paper published in the Journal of Medical Education in 1984, Heins et al. studied perceived stress in medical, law, and graduate students. While the authors acknowledged that stress is related to doing graduate work regardless of program, they caution that overabundance of stress is, paradoxically, likely to be detrimental to the learning process (Heins et al. 1984). Even in the 80s, scientists were studying and acknowledging mental health issues resulting from too much stress, and the importance of its management in post-secondary education. So why has it taken so long to address this, even in everyday society?

Aside from the inertia created by social norms, there doesn’t seem to be a reasonable answer to this. Graduate students face an extraordinarily high amount of pressure, including the their own expectations and those of their peers, funding concerns, publishing, and finding a job once their degree is finally obtained (Hyun et al. 2006). A small study of Ph.D. students in Flanders, Belgium indicated that the risk having or developing a common psychiatric disorder, such as anxiety or depression, was 2.43 times higher in Ph.D. students than in the highly educated general population (Levecque et al. 2017). A similar pattern was published in the Graduate Student Happiness & Well-Being Report from University of California, Berkeley, where 28-64% of graduate students scored as being depressed (depending on the field of study; biological sciences scored 43-46%) (University of California, Berkeley 2014). This study’s top ten predictors of overall graduate student well-being are:

1. Career Prospects
2. Overall Health
3. Living Conditions
4. Academic Engagement
5. Social Support
6. Financial Confidence
7. Academic Progress & Preparation
8. Sleep
9. Feeling Valued and Included
10. Advisor Relationship

So, what does this mean?

Work-life balance is important
You may be protesting, “I am in graduate school. I am extremely busy and I simply don’t have time to do things outside of work.” Good news: studies show that taking breaks can boost your focus (Ariga and Lleras 2011; Finkbeiner et al. 2014; Zacher et al. 2016). There are lots of opportunities hidden within your day-to-day life that you can seize, if you know where to look. Not convinced? Try taking just one extra hour of time for yourself per week for a few months and see if your stress levels decrease. Here are some beneficial things to try during that hour:

Get some exercise
The gym in Sackler is free and readily accessible for students, but there are lots of other things you could do. Running is a great, rhythmic option that can double as a jam session to your favorite tunes. High-impact exercise not your style? Try taking a stroll with a friend to get some bubble tea and fresh air! Or take advantage of the weekly “Walk with the Dean” that Dean Jay recently implemented. The Student Advisory and Health Administration Office has also sponsored beginner’s level yoga and meditation, which will hopefully continue in future semesters.

Catch more zzz’s
Most of the time, caffeine does a passable job at convincing us that sleep isn’t all that important after all, right? As miraculous (and delicious!) as coffee is, the caffeine-induced buzz just isn’t a substitute for getting enough sleep. It’s very difficult to commit to a full 8 hours every night (and some of us may not even need quite that much), but if you are consistently running low on sleep, try committing to just an extra half hour each night. At the very least, you’ll get another 3.5 hours per week, which is a step in the right direction!

Start talking
Open a dialogue with your colleagues about mental health and well-being. You might be surprised by how many people have something to say on the topic, and by starting a conversation, you will play an active role in decreasing the stigma surrounding mental health. This can be a particularly helpful and important step if you are feeling alone, frustrated, helpless, or overwhelmed. If opening up to a friend is too daunting, you can also take advantage of peer-to-peer mentoring. Groups like Tufts Mentoring Circles aim to support students (and Postdocs!) through topics such as applying for jobs, time management, conflict resolution, and, of course, work/life balance.

Know where to go for help
Did you know that Tufts has a Student Wellness Advisor? This resource is available to all students on the Boston Health Science Campus. Our Wellness Advisor, Sharon “Snaggs” Gendron is here to help us manage the everyday stress of being graduate students. She can also refer students struggling with depression, anxiety, or other mental health challenges to clinicians who can help. You can read more about how to get in touch with the Wellness Advisor here.

If any of this sounds familiar and you want to try changing your habits, you’re in luck! There are two Wellness Gatherings coming up, one on November 15th from 3 PM – 4:30 PM and one on December 14th from 2:30 PM – 4 PM, in the Sackler 4th floor Reading Room. Take a few minutes to stop by and meet the Wellness Advisor (and a Canine Companion)!

A final note…
TL;DR? You are important and your health is paramount. Keep in mind that the definition of ‘health’ is not limited to the physical realm; you need to take care of your mind and feelings just as much as the rest of you.

Finally, and this cannot be emphasized enough, if you are struggling with mental health challenges like anxiety, depression, or suicidal thoughts, please seek help. You are not alone. In the event of a crisis, you can contact the National Suicide Prevention Lifeline 24/7 at 1 (800) 273-8255.

Literature Cited
Ariga A and Lleras A. (2011) Brief and rare mental ‘‘breaks’’ keep you focused: Deactivation and reactivation of task goals preempt vigilance decrements. Cognition 118:439-443.

Finkbeiner KM, Russell PN, and Helton WS. (2016) Rest improves performance, nature improves happiness: Assessment of break periods on the abbreviated vigilance task. Conscious Cogn 42:277-285.

Heins M, Fahey SN, and Leiden LI. (1984) Perceived stress in medical, law, and graduate students. J Med Educ 59:169-179.

Hyun JK, Quinn BC, Madon T, and Lustig S. (2006) Graduate student mental health: needs assessment and utilization of counseling services. J Coll Stud Dev 47(3):247-266.

Levecque K, Answeel F, De Beuckelaer A et al. (2017) Work organization and mental health problems in PhD students. Res Policy 46:868-879.

University of California, Berkeley. (2014) The Graduate Assembly: Graduate student happiness & well-being report. http://ga.berkeley.edu/wellbeingreport/. Accessed 31 October 2017.

Zacher H, Brailsford HA, and Parker SL. (2014) Micro-breaks matter: A diary study on the effects of energy management strategies on occupational well-being. J Vocat Behav 85:287-297.