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1. Introduction
PhD students are three times more likely to develop severe mental health problems compared to other highly educated people in the general population (Kismihók, McCashin, Mol, & Cahill, 2022). This is because doctoral students are exposed to specific stressors that increase their risk for developing mental health issues (Berry et al., 2021).
“More than 40% of PhD students met the criteria for moderate to severe depression or anxiety ... Just over a third of PhD students had considered ending their studies altogether for mental health reasons.”
– Cassie Hazell (2022), researcher on PhD mental health.
For International PhD students, the risk of developing mental health problems may be even higher because they have additional challenges, such as adapting to language and cultural differences.
This topic will help PhD supervisors and other student support staff at tertiary education providers understand the unique stressors that international PhD students experience and the types of barriers that can prevent them from seeking mental health support.
Supporting the non-academic side of life for international PhD students explains the impact of non-academic stressors on international PhD students not included in this topic, such as financial security, housing, and family.
2. Common mental health stressors
Covered in this section:
- Misaligned expectations
- Career pathway/development worries
- Cultural adaptation
- Language difficulties
- Loneliness
- Supervisor Relationships and power dynamics
2.1 Misaligned expectations
Research suggests that the more international students’ expectations are under-met, the lower their wellbeing will be (Geeraert et al., 2021). For example, a PhD scholarship may seem plentiful to students from countries with a lower cost of living and they may not understand that it will only just cover the very basics here. Realising this only after they have arrived can lead to a stressful experience, in terms of having to re-budget and find extra income to ensure they can afford to continue living here – especially if they have brought their family with them.
Hence, it is important to ensure that what students expect matches the reality of life in Aotearoa, so that they can have an enjoyable time pursuing their doctorate in this country.
Learn more:
Managing Expectations contains information that can help you identify and resolve international PhD students’ misaligned expectations before they set foot in the country, which will help reduce the risk of PhD disruptions and delays.
2.2 Career pathway/development worries
Receiving adequate support for professional development is particularly important for international PhD students, who can face greater challenges than domestic PhD students in getting ‘career ready’ for an academic or professional role in New Zealand or overseas.
Since most international PhD students face additional challenges that come with living abroad, it is easy for them to mistakenly put off getting themselves ‘career ready’ until near the end of their doctoral journey, at which point they find it extremely stressful. For example, students who are doing unskilled work just to keep their head above water while doing their PhD may find it difficult to extract themselves and focus on finding and securing skilled work relating to their PhD.
Learn more:
Supporting the professional development of international PhD students has more information about the challenges of getting ‘career ready’ and how best to help students overcome these challenges.
2.3 Cultural adaptation
A European survey (PhDnet Survey Group, 2020) reveals that as high as two thirds of international PhD students feel that they do not receive sufficient support to settle and establish in the new environment upon arrival. Yet research by Demes and Geeraert (2015) shows that stress levels are lower when students feel adapted to the host culture, such as accepting or adopting the new country’s cultural norms and having fewer experiences of feeling out of place.
This highlights how important it is for students to be well-supported while adapting to life in Aotearoa as part of pursuing a PhD here. Providing good support will help students avoid becoming overwhelmed by their move to a new country, and thus lower the risk of PhD disruptions and delays. This is particularly important for students with language difficulties (see below) as well as students with more differences between their home and host culture.
The Cultural Atlas website and the Hofstede Insights Country Comparison tool are two useful resources for identifying and understanding cultural differences between a student’s home culture and Aotearoa, and therefore which cultural aspects may require more guidance for some students.
In their research, Bethel, Ward, & Fetvadjiev (2020) looked into factors that affect international students’ ability to adapt to their host country’s culture. They found that the most influential factor is how well students make connections with locals, even more so than language proficiency (see below).
Learn more:
Supporting the mental health of International PhD students contains examples of how to facilitate students’ connections with locals and peers for greater belonging and therefore mental wellbeing.
2.4 Language difficulties
Research shows that language proficiency is linked to psychological wellbeing in international students (Bethel, Ward, & Fetvadjiev, 2020). The more comfortable students are with using the host country’s language, the less stressful it is for them to navigate and adapt to life there, and the less lonely they feel.
Meeting the language needs of international students contains general information that can help you identify specific language barriers and ensure students can fully understand important information communicated to them (e.g. about accessing support services) from your institution or department.
Lee (2021) shows that for international PhD students, seminars, and small group interactions may be especially stressful due to the pressure to engage in open debate with immediate verbal responses in little time to reflect and translate. For those teaching as part of doing their PhD, conveying course information and facilitating discussion can be especially challenging.
Bethel, Ward, & Fetvadjiev (2020) show that the negative effects of language difficulties on overall wellbeing can be counterbalanced through establishing relationships with locals – even for students who self-reported low proficiency.
Learn more:
Supporting the mental health of International PhD students provides details on how to encourage students to interact and build healthy connections with locals.
2.5 Loneliness
Feeling lonely is another key challenge for international students. Factors such as losing face-to-face contact with friends and family, missing out on networks in their host country because of not having any social connections, and/or a loss of same-culture peers can all contribute to loneliness.
“Satisfying social relationships are essential to psychological well-being while loneliness can have severe consequences on one’s mental and physical health if left untreated, including depression, anxiety, and disease” -- Lee, 2021.
Pursuing a PhD can be especially isolating, with a heavier emphasis on independent research and fewer opportunities to regularly interact with a wide range of peers. Students from Asia may also struggle more than others with intercultural friendships, especially with local peers.
However, Bethel, Ward, & Fetvadjiev (2020) indicate that connections with locals – rather than only international students as peers – significantly reduces loneliness and thus improves overall wellbeing.
Learn more:
Supporting the mental health of International PhD students provides suggestions on how to help reduce vulnerability to social isolation and loneliness through offering regular opportunities for students to forge relationships within their lab, cohort or across campus.
2.6 Supervisor relationship and power dynamics
The relationship an international PhD student has with their supervisor can make or break their experience in pursuing their doctorate. Postgraduate students at the University of Otago carried out research that identified a range of positive and negative aspects of PhD supervision, the details of which are on the Perspectives on quality supervision page of the University of Otago website.
A major stressor is the power dynamic and hierarchical nature of the supervisor-student relationship, and the inconsistent variety in how supervisors set boundaries within it (Metcalfe et al., 2018). Some supervisors try to flatten the hierarchy to create a closer, more supportive, reciprocal relationship, while others distance themselves from students and limit discussion to academic matters only.
The student’s low-power status in this relationship can lead to some students – especially those from cultures where they cannot speak up to those ranking higher – feeling that they are unable to say no to the supervisor’s requests, creating more stress as they accommodate a growing workload.
In addition, international PhD students’ heavy reliance on their supervisor compared to locals may make them especially vulnerable to mistreatment (Lee, 2021). Yet some students see asking to switch to another supervisor as causing ‘loss of face’ for the supervisor.
Similarly, others do not report inappropriate behaviour from supervisors – a known stressor contributing to mental unwellness – as they perceive it as potentially causing them to lose their scholarship, their ability to continue with their PhD, or even their visa.
Cultural differences in expectations can also create tensions between supervisors and students in navigating their relationship. The scenario below, based on research findings by Ding et al. (2018), is an example of what this can look like.
Scenario: Shu-Yi and Karen
Shu-Yi, like most Chinese PhD students, expects to develop emotional bonds and professional closeness with her supervisor in line with her Confucian-based cultural values. She hopes to undertake joint research together with her supervisor. However, her supervisor Karen expects Shu-Yi to conduct independent research and stick to purely academic subjects in their meetings.
However, because Karen has not informed Shu-Yi of what her expectations are, Karen is perplexed by Shi-Yi multiple attempts to engage her attention on topics outside of the PhD subject and outside office hours. Karen considers Shu-Yi’s attempts to bond as demanding and unprofessional. Exasperated, she says to a colleague: “One of my Chinese students told me about her personal life in Australia and sometimes she cried in meetings. I am not her mother.” (Ding et al., 2018)
Shu-Yi picks up on Karen’s frustration but can’t figure out what she’s doing that’s causing it. She now hesitates in approaching Karen for support, both academically and personally, and her mental health starts to wane as she continues with her PhD feeling excluded and unworthy.
Even in positive and constructive relationships, research by Metcalfe et al. (2018) showed that students were still reluctant in raising issues about their wellbeing with their supervisor, as they were either concerned that the supervisor would think them incapable of completing their doctorate or could see that the supervisor was also stressed and didn’t want to add to it.
However, positive supervisor-student relationships can quell students’ reluctance, doubts, and stress. Specifically, research by Hyun et al. (2007) found that international students who had better relationships with their advisors were less likely to report having a stress-related or emotional problem over the past year and thus were less likely to use mental health services. Additionally, of the students who did experience a problem, those with better advisor relationships were more likely to use counselling services when needed.
Learn more:
Supporting the mental health of International PhD students provides more information and examples of best practice in supervisor-student relationships.
3. Common barriers to getting mental health support
Greater awareness and better support can significantly reduce or even eliminate the stressors outlined above. However, international PhD students may be reluctant to make their problems known and seek help. According to one study (Lee, 2021), more than 40% of graduate students did not consider consulting with a therapist, counselor, or physician – even when they felt that their stress was negatively affecting their health.
A student’s reluctance to seek help may be related to:
- Individual barriers, mostly relating to students’ internal attitudes towards mental illness or seeking help, which are shaped and underpinned by their home culture’s values and norms;
- Institutional barriers, mostly relating to an institution’s/host culture’s values and practices around talking about and seeing help for mental health concerns.
3.1 Individual barriers
PhD students from certain nations or cultures may perceive drawing attention to themselves, talking about mental health, or seeking help as a negative attribute. For some there is intense shame and stigma associated with being mentally ill. They may also have a different cultural explanatory model of mental illness, which is not compatible with Western concepts and approaches (Metcalfe et al., 2018; Chow & Mulder 2017; Hyun et al., 2007).
For internationals with strong collectivist (over individualist) values, seeking mental health support might be viewed as “losing face”, shaming and dishonouring their family. Others might not feel comfortable speaking with someone outside of their culture (Lee, 2021).
PhD students from Asian countries
International students who identify themselves as ethnically Asian are significantly less likely to use counselling services than other ethnic groups and are more likely to seek help outside traditional mental health services (Chow & Mulder, 2017).
Research by Heggins & Jackson (2003) show that international students from Asia would prefer to seek help from older members of the Asian community rather than a professional mental health specialist, so having a relationship with this community locally is particularly important for their wellbeing.
Another facet to consider is a fear of others being told without their control/consent. Some students are especially afraid that word of them seeking help will reach home – potentially from student support staff or health professionals – and thus create negative perceptions of them and their family amongst people with whom they have enduring relationships of reciprocal respect. Hence, it is important to communicate clearly to international students that seeking help is fully confidential.
In addition, many international students simply don’t know that mental health support services exist. Research by Hyun et al. (2007) showed that as high as 40% of international students were unaware of on-campus counselling services, compared to less than a quarter of domestic students. This could be due to students not understanding the language of the information provided about these services. Similarly, language difficulties could affect students’ ability to understand or talk about any mental health concerns and articulate that they need help and what kind of help they would prefer.
A final aspect to consider is whether the student can recognise mental health issues in themselves or their peers and know when to seek help. For example, in some cultures, high pressure from parents and elders for students to achieve academic excellence is considered the norm. This means that PhD students from these cultures are more likely to consider experiencing anxiety, for instance, as part and parcel of achieving excellence. Institutional norms (see below) can also reinforce the idea that it is ‘standard’ for PhD students to experience mental health issues and not seek help for them.
Learn more:
Understanding mental health and wellbeing principles and tools provides more information around how to identify the signs of mental health concerns and how to respond appropriately as they increase in severity/urgency.
3.2 Institutional barriers
Academia has a culture of its own that is different, and sometimes less progressive, from the day-to-day culture that international PhD students experience when they arrive in a new country.
“Academia notoriously encourages a culture of overwork and under-appreciation. This mindset is present among PhD students… One student told us: ‘There is a common belief … you have to suffer for the sake of your PhD, if you aren’t anxious or suffering from impostor syndrome, then you aren’t doing it “properly”.’”
– Cassie Hazell (2022), researcher on PhD mental health.
Some tertiary education providers have a culture that implicitly encourages silence around mental health, Sometimes academic staff are even explicit in discouraging discussion about or seeking help for mental health concerns. For example, research by Lee (2021) revealed that graduates reported observing supervisors negatively judging students who sought care as being weak or inadequate.
“I went to a presentation by a PhD supervisor once, which was titled something like ‘How to get your PhD done’. At some point in the talk, the speaker gave us a long list of their responsibilities, elderly parents, siblings, income, animals, etc. and then they said. ‘And do you know how I got my PhD done? By shutting up and not complaining about it.’ I think that really encouraged everyone to consider any mental health concerns as weaknesses to be hidden and to bottle things up.”
– Freda, international PhD student at a New Zealand university
The perceived and/or actual responses from tertiary institution peers when seeking help and being ‘labelled’ with a mental illness is also a significant deterrent for many international PhD students. Are PhD students in your institution well-supported after they have been diagnosed with a mental illness and are receiving treatment for it? How do others in their faculty or department treat them once they have been diagnosed?
Case study: John
John is an international PhD student at a New Zealand university who sought professional help when he reached his mental capacity in his second year of pursuing his PhD.
“I tried to get support from the university first, but they only wanted to help me in a way that they could make sure that they could not be held responsible. They didn’t give me any information that could help me learn more about my own mental health concerns. Eventually, I managed to get professional help and was diagnosed with depression.
What really surprised me was the aftermath that I experienced. I felt like I was constantly being watched. I had to do things that probably weren’t needed if it wasn’t for my diagnosis, like having to get a doctor’s note for taking leave. I felt like I was being undermined all the time, and I regretted even raising concerns about my mental health in the first place because they treated me so differently.”
Finally, many student mental health services are not easy to access (e.g via other student support services). Many tertiary education providers have mental health services located separately from the student finance, career and immigration advice centres, for example. This makes it harder for international PhD students to access mental health support, as they may expect to find it with other services in the main student support hub. Additionally, having mental health services in a separate building/area of campus deters students from seeking help, due to the stigma of being seen entering a building/area that is obviously only for ‘the mentally unwell’ (Lee, 2021).
Learn more:
Supporting the mental health of International PhD students contains information on how to put supportive values and practices in place to counter these institutional barriers.
4. Conclusion
This topic has highlighted a range of stressors and barriers to seeking help for mental health issues in international PhD students. PhD supervisors and other staff at tertiary education providers should now be able to identify why some international PhD students might be experiencing high stress or overwhelm, and why they might not be seeking help.
Supporting the mental health of international PhD students – the second topic in this series of two – contains suggestions on how to help reduce students’ stressors and address the barriers preventing them from seeking help.
5. References
Berry, C., Niven, J., & Hazell, C. (2021). Personal, social and relational predictors of UK postgraduate researcher mental health problems. BJPsych Open. 7:6, E205. doi:10.1192/bjo.2021.1041
Bethel, A., Ward, C., & Fetvadjiev, V. H. (2020). Cross-Cultural Transition and Psychological Adaptation of International Students: The Mediating Role of Host National Connectedness. Frontiers in Education. 5:539950. Open access: https://doi.org/10.3389/feduc.2020.539950
Chow, C. S., & Mulder R. T. (2017). Mental health service use by Asians: a New Zealand census. New Zealand Medical Journal. 130:1461 . Retrieved from: https://journal.nzma.org.nz/journal-articles/mental-health-service-use-by-asians-a-new-zealand-census
Demes, K. A. & Geeraert, N. (2015). The highs and lows of a cultural transition: A longitudinal analysis of sojourner stress and adaptation across 50 countries. Journal of Personality and Social Psychology. 109:2, 316–337. http://dx.doi.org/10.1037/pspp0000046
Ding, Q. (2016). Understanding Chinese International Doctoral Students in New Zealand: A Literature Review of Contemporary Writings about Chinese Overseas Research Students. New Zealand Journal of Teachers’ Work. 13:2, 118-133. https://doi.org/10.24135%2Fteacherswork.v13i2.82
Kismihók, G., McCashin, D., Mol, S. T., & Cahill, B. (2022). The well-being and mental health of doctoral candidates. European Journal of Education, 57, 410-423. Retrieved from:
Hazell, C. (2022). ‘You have to suffer for your PhD’: poor mental health among doctoral researchers – new research. The Conversation. https://theconversation.com/you-have-to-suffer-for-your-phd-poor-mental-health-among-doctoral-researchers-new-research-174096
Heggins, W. J., & Jackson J. F. L. (2003). Understanding the collegiate experience for Asian international students at a midwestern research university. College Student Journal. 37:3, 379-391. Retrieved from: https://www.researchgate.net/publication/285860410_Understanding_the_collegiate_experience_for_Asian_international_students_at_a_midwestern_research_university
Hyun J, Quinn B, Madon T, Lustig S. (2007) Mental health need, awareness, and use of counseling services among international graduate students. J Am Coll Health. 56:2, 109-18. https://doi.org/10.3200/JACH.56.2.109-118
Lee, J. J. (2021). Unique challenges and opportunities for supporting mental health and promoting the wellbeing of international graduate students [Report]. Council of Graduate Schools. Retrieved from: https://cgsnet.org/graduate-student-mental-health-and-well-being/
Metcalfe, J., Wilson, S. & Levecque, K. (2018). Exploring wellbeing and mental health and associated support services for postgraduate researchers [report]. Vitae. Retrieved from: https://www.vitae.ac.uk/doing-research/wellbeing-and-mental-health/HEFCE-Report_Exploring-PGR-Mental-health-support/view
PhDnet Survey Group (2020). PhDnet Report 2019. Max Planck PhDnet. doi:10.17617/2.3243876. Retrieved from: https://www.phdnet.mpg.de/145081/2020-07-30_phdnet_survey
