mental health social work dissertation

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Social Work Theses, Projects, and Dissertations

Theses/projects/dissertations from 2024 2024.

WHAT IS THE READINESS OF SOCIAL WORK STUDENTS TO WORK WITH AUTISTIC INDIVIDUALS? , Ignacio Aguilar Pelaez

EXAMINING EXPERIENCES AMONG SOCIAL WORKERS WORKING WITH PARENTS WHO SUFFER FROM SUBSTANCE USE DISORDER , Alicia Alvarado and Eleno Zepeda

COVID-19, SOCIAL ISOLATION, AND MSW STUDENTS’ MENTAL HEALTH , Cassandra Barajas

Through the Lens of Families and Staff in Emergency Shelters , Elizabeth Barcenas

MACHISMO: THE IMPACT IT HAS ON HISPANIC MALE COLLEGE STUDENTS RECEIVING MENTAL HEALTH SERVICES , Sara Barillas and Alexander Aguirre

THE DISPROPORTIONATE IMPACTS OF CERTAIN FACTORS THAT DIFFERENTIATE THE AMOUNT OF MENTAL HEALTH REFERRALS OF SCHOOL A COMPARED TO SCHOOL B , Jesus Barrientos

Correlation of Adverse Childhood Experiences and Somatic Symptoms in Adolescents , Shannon Beaumont

Caregivers of Dialysis Patients , Alyssa Bousquet and Amelia Murillo

Self-Care Habits and Burnout Among County Social Workers on the Central Coast of California , Jaclyn Boyd and Denise Ojeda

GENDER DYSPHORIA IN ADOLESCENCE AND THE MODELS OF CARE: A SYSTEMATIC LITERATURE REVIEW , Arnold Briseno

THE EFFECTS OF PARENTING STYLES ON COMMUNICATION AMONG ASIAN AMERICAN YOUNG ADULTS , Abigail Camarce

BARRIERS TO AND FACILITATORS OF CARE: EXPLORING HOW LOW-INCOME WOMEN ACCESS REPRODUCTIVE HEALTHCARE IN A RURAL COMMUNITY , Sydney Taylor Casey

CLIENT PERPETRATED VIOLENCE AND SAFETY CULTURE IN CHILD WELFARE: A SYSTEMATIC LITERATURE REVIEW , Amber Castro

ACCESSIBILITY OF SERVICES FOR TRANSGENDER ADOLESCENTS FROM A CHILD WELFARE PERSPECTIVE , Eduardo Cedeno

WHAT ARE THE BARRIERS TO SEEKING PSYCHOTHERAPY SERVICES ACROSS DIFFERENT RACIAL AND ETHNIC GROUPS? , Deysee Chavez and Elisa Rodarte

Homelessness In The Coachella Valley , Katrina Clarke

Challenges Veterans Encounter Receiving or Seeking Mental Health Services , Denise D. Contreras and Andrea Ramirez

EXAMINING THE EFFECTIVENESS OF PSYCHOSOCIAL INTERVENTIONS FOR OPIOID USE DISORDER: A SYSTEMATIC REVIEW , Elizabeth Ashley Contreras

IS A SOCIAL SUPPORT BASED MODEL BETTER FOR TREATING ALCOHOLISM? A SYSTEMATIC REVIEW , Jordan Anthony Contreras

SOCIAL WORKERS’ PREPAREDNESS FOR PRACTICE WITH PATIENTS EXPERIENCING PSYCHOTIC DISORDERS , Paula Crespin

INVESTIGATING THE LEVEL OF EVIDENCE OF ADVERSE CHILDHOOD EXPERIENCES AND PARENTING PRACTICES: A SYSTEMATIC REVIEW , Eloisa Deshazer

MENTAL HELP-SEEKING: BARRIERS AMONG AFRICAN AMERICANS: THE ROLE OF TECHNOLOGY IN ADDRESSING THOSE BARRIERS , Charneka Edwards

Treatment not Punishment: Youth Experiences of Psychiatric Hospitalizations , Maira Ferrer-Cabrera

THE BARRIERS TO NATURAL OUTDOOR SPACES: PERSPECTIVES FROM PEOPLE WITH MOBILITY DISABILITIES , Sierra Fields and Kailah Prince

IMPLEMENTATION OF MENTAL HEALTH SERVICES AND CURRICULUM FOR ELEMENTARY-AGED CHILDREN , Indra Flores Silva and Jason Kwan

POOR ACADEMICS FROM COLLEGE STUDENTS GRIEVING THROUGH COVID 19 , Sarah Frost

COMPASSION FATIGUE IN SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM SETTINGS , Sandra Gallegos

A SYSTEMATIC REVIEW ON THE EFFECTIVENESS OF THE GUN VIOLENCE RESTRAINING ORDER , Bonnie Galloway and Yasmeen Gonzalez-Ayala

STRESS AND HELP-SEEKING IN FARMWORKERS IN THE COACHELLA VALLEY , Alexis Garcia and Daniela Mejia

THE EFFECTIVNESS OF FEDERAL PELL GRANT PROGRAM , Maria Delcarmen Garcia Arias and Ashley Hernandez

PARENT INVOLVEMENT AND EDUCATIONAL OUTCOMES AMONG LATINO FAMILIES , Diana Garcia and Gabriela Munoz

IMPACT OF SCHOOL-BASED MENTAL HEALTH SERVICES ON STUDENT ATTENDANCE AT A SOUTHERN CALIFORNIA SCHOOL DISTRICT , Johanna Garcia-Fernandez and Morgan Stokes

BARRIERS TO GENDER-AFFIRMING CARE , Gloria Garcia

THE CONTRIBUTING FACTORS OF PLACEMENT INSTABILITY FOR PREGNANT FOSTER YOUTH , Amanda Garza and Shayneskgua Colen

PROGRESSION OF BLACK WOMEN IN TENURE RANKED POSITIONS , Unique Givens

Child Maltreatment Primary Prevention Methods in the U.S.: A Systematic Review of Recent Studies , Maria Godoy-Murillo

Assessing and Meeting the Needs of Homeless Populations , Mitchell Greenwald

Parity In Higher Education In Prison Programs: Does It Exist? , Michael Lee Griggs and Vianey Luna

SURROGACY AND IT'S EFFECTS ON THE MENTAL HEALTH OF THE GESTATIONAL CARRIER , DayJahne Haywood

SUBSTANCE USE TREATMENT WITHIN THE US PRISON SYSTEM , Timothy Hicks

LGBTQ+ College Students Hopeful Future Expectations , Savannah Hull

EFFECTS OF VOLUNTARY REMOVAL ON AN IMMIGRANT FAMILY , Miriam Jimenez

THE MOTIVATING FACTORS AFFECTING THE CONTINUANCE AND COMPLETION OF SUBSTANCE USE TREATMENT FOR MOTHERS , Jacquetta Johnson

FACTORS AFFECTING THE ENROLLMENT AND GRADUATION RATES AMONGST AFRICAN AMERICAN MALES IN THE UNITED STATES , Tracie Johnson

SUPPORTING FORMERLY INCARCERATED INDIVIDUALS IN HIGHER EDUCATION: A QUANTITATIVE STUDY , Lisa Marie Jones-Wiertz

PROTESTANT CHURCH WORKERS' KNOWLEDGE OF CHILD ABUSE REPORTING AND REPORTING BEHAVIOR , Rachel Juedes

Social Media Told Me I Have A Mental Illness , Kathleen Knarreborg

THE RELATIONSHIP BETWEEN ROLE MODELS, SOCIOECONOMIC MOBILITY BELIEFS, AND ACADEMIC OUTCOMES , Christian Koeu and Marisol Espinoza Garcia

CULTURAL AND STRUCTURAL BARRIERS OF UTILIZING MENTAL HEALTH SERVICES IN A SCHOOL-BASED SETTING FOR LATINX POPULATIONS , Silvia Lozano and Bridgette Guadalupe Calderon

EDUCATIONAL OUTCOMES FOR YOUTH THAT PARTICIPATED IN EXTENDED FOSTER CARE: A SYSTEMATIC REVIEW , Kassandra Mayorga and Roxana Sanchez

NON-BINARY IDENTITY WITHIN COMPETENCY TRAINING FOR MENTAL/BEHAVIORAL HEALTH PROVIDERS: A SYSTEMATIC REVIEW , Alexis McIntyre

Childhood Neglect and Incarceration as a Adult , Marissa Mejia and Diana Gallegos

IMPACT OF RESOURCE SCARCITY ON UNDOCUMENTED STUDENTS IN HIGHER EDUCATION , Sebastian Melendez Lopez

STUDY EXPLORING FEELINGS OF SELF-BLAME AND SHAME AMONG INDIVIDUALS RAISED BY SEVERELY MENTALLY ILL CAREGIVERS , Joanie Minion

THE OBSTACLES FACING HOMELESS VETERANS WITH MENTAL ILLNESS WHEN OBTAINING HOUSING , Melissa Miro

STUDENTS OF HIGHER EDUCATION RECEIVING SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM AND ITS IMPACT ON MENTAL HEALTH , Cristina Palacios Mosqueda

COMMERCIALLY SEXUALLY EXPLOITED CHILDREN TARGETED WITHIN SOCIAL SERVICES , Britny Ragland

ART THERAPY FOR BEREAVED SIBLINGS AFTER PEDIATRIC CANCER DEATH , Daniela Ramirez-Ibarra

HOW DID THE COVID-19 PANDEMIC IMPACT EXTENDED FOSTER CARE SOCIAL WORKERS WHILE PROVIDING SOCIAL SERVICES , Omar Ramirez and Victoria Lopez

A COMPARATIVE ANALYSIS OF BODY MODIFICATION BIASES IN THE MENTAL HEALTH FIELD , Lonese Ramsey

Bridging Training Gaps: Assessing Knowledge and Confidence of Mental Health Interns in Opioid Misuse Intervention for School-Aged Children and Adolescents , Carolina Rodriguez and Gabriela Guadalupe Gonzalez

PERCEPTIONS OF YOUTH ATHLETE SAFETY PARENTS VS DIRECTORS , Nicole Anais Rodriguez

SPIRITUALITY AND RECOVERY FROM ADDICTION: EXPERIENCES OF NARCOTICS ANONYMOUS MEMBERS , Elizabeth Romberger

ADVERSE CHILDHOOD EXPERIENCES AND ALTRUISM: THE IMPACT ON SOCIAL WORK AS A CAREER CHOICE , Nancy Salas and Brittany Altuna

MAJOR FACTORS OF SUSTAINING RECOVERY AFTER RELAPSE FROM A SUBSTANCE USE DISORDER , Amanda Tei Sandhurst

UNDERSTANDING THE PERSPECTIVES AND ATTITUDES OF 12-STEP PARTICIPANTS TOWARDS MEDICATION-ASSISTED TREATMENT , Christopher Scott

THE UTILIZATION OF MUSIC AND AUTONOMOUS SENSORY MERIDIAN RESPONSE IN REDUCING STRESS , Robert Scott

THE AFTERMATH OF THE PANDEMIC’S EFFECT ON COLLEGE STUDENT DEPRESSION , Lorena Sedano

Exploring the Experiences of Minority Former Foster Youths During and Post Care: A Qualitative Study , Caithlyn Snow

Factors that Contribute to Disparities in Access to Mental Health Services within Hispanic Adults , Jasmine Soriano

THE CHALLENGES TO THE IMPLEMENTATION OF ADMINISTRATION FOR CHILDREN AND FAMILIES MEMORANDUM: FOSTER CARE AS A SUPPORT TO FAMILIES , Rebecca Joan Sullivan-Oppenheim

RESILIENCE IN FATHERHOOD: EXPLORING THE IMPACT OF ABSENT FATHERS ON BLACK AMERICAN MEN'S PARENTING NARRATIVES AND PRACTICES , Ericah Thomas

FACTORS THAT IMPACT FOSTER YOUTHS’ HIGH SCHOOL GRADUATION , Esther Thomas

EXAMINING A RELATIONSHIP BETWEEN SEXUAL SATISFACTION AND CHILD MALTREATMENT , Amanda Titone

THE PRESENT STRUGGLES OF IMMIGRANT FARMWORKERS IN CALIFORNIA , Leslie Torres and Angelica Huerta

PROGRAM EVALUATION OF SCHOOL-BASED MENTAL HEALTH COUNSELING SERVICES , Yvette Torres and Emily Ann Rodriguez

Stressors, Caffeine Consumption, and Mental Health Concerns among College Students , Stacey Trejo

MENTAL HEALTH TREATMENT HELP SEEKING ATTITUDES AND BEHAVIORS AMONG LATINX COMMUNITY , Nancy Vieyra

JUSTICE-INVOLVED STUDENTS: EFFECTS OF USING SUPPORT SERVICES TO OVERCOME BARRIERS , Gabby Walker and Sofia Alvarenga

MANDATED REPORTERS’ KNOWLEDGE AND REPORTING OF CHILD ABUSE , Alexis Reilly Warye

THE COMMUNITY RESILIENCY MODEL (CRM) APPLIED TO TEACHER’S WELL-BEING , John Waterson

Addressing Rural Mental Health Crises: An Alternative to Police , Faith Ann Weatheral-block

Theses/Projects/Dissertations from 2023 2023

PROLONGED EXPOSURE TO CONGREGATE CARE AND FOSTER YOUTH OUTCOMES , Tiffany Acklin

YOU CALL US TREATMENT RESISTANT: THE EFFECTS OF BIASES ON WOMEN WITH BORDERLINE PERSONALITY DISORDER , Cassidy Acosta

EXAMINING SOCIAL DETERMINANTS OF HEALTH OF FORMERLY INCARCERATED CALIFORNIA STUDENTS WHO GRADUATED FROM PROJECT REBOUND , Ashley C. Adams

ALTERNATIVE APPROACHES TO POLICE INTERVENTIONS WHEN RESPONDING TO MENTAL HEALTH CRISES INCIDENTS , Karen Rivera Apolinar

Understanding Ethical Dilemmas in Social Work Practice , Arielle Arambula

IS THERE A RELATIONSHIP BETWEEN PROFESSORIAL-STUDENT RACIAL MATCH AND ACADEMIC SATISFACTION OF AFRICAN AMERICAN SOCIAL WORK STUDENTS , Ashlei Armstead

NON-SPANISH SPEAKING LATINOS' EXPERIENCES OF INTRAGROUP MARGINALIZATION AND THE IMPLICATIONS FOR ETHNIC IDENTITY , Marissa Ayala

SERVICES AVAILABLE IN THE MIXTEC COMMUNITY AND THE BARRIERS TO THOSE SERVICES , Currie Bailey Carmon

IMPACT OF OUTDOOR ADVENTURE ON THE SELF-ESTEEM, SELF-CONFIDENCE, AND COMFORT LEVEL OF BLACK AND BROWN GIRLS , Nathan Benham

THE ROLE UNDOCUMENTED STUDENT RESOURCE CENTERS PLAY IN SUPPORTING UNDOCUMENTED STUDENTS IN HIGHER EDUCATION , Cynthia Boyzo

Program Evaluation of Teen Parent Support Group , Brianne Yvonne Irene Brophy

THE IMPACT THE JOB STRESS OF A CHILD WELFARE SOCIAL WORKER HAS ON THE QUALITY OF THEIR RELATIONSHIP WITH THEIR INTIMATE PARTNER , Nadine Cazares

Adverse Effects for Siblings Who Witness Child Abuse , Leslie Chaires

ASIAN DISCRIMINATION: IN THE FIELD OF SOCIAL WORK , Sunghay Cho

PERCEIVED FINANCIAL STRAIN AND ITS EFFECTS ON COLLEGE STUDENTS’ WELFARE , Monica Contreras and Clarissa Adrianna Martinez

The Media and Eating Disorders , Diane Corey

INCREASING TEACHER AWARENESS OF MENTAL HEALTH IN CHILDREN , Sarah Alexis Cortes

The Investigation of Knowledge and Practice of Child Welfare Workers Providing Case Management to Children with Disabilities , Giselle Cruz

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Mental Health Dissertation Topics & Titles

Published by Carmen Troy at January 9th, 2023 , Revised On June 7, 2024

You probably found your way here looking for mental health topics for your final year research project. Look no further, we have drafted a list of issues, and their research aims to help you when you are brainstorming for dissertation or thesis topics on mental health.

PhD-qualified writers of our team have developed these topics, so you can trust to use these topics for drafting your dissertation.

You may also want to start your dissertation by requesting a brief research proposal or full dissertation service from our writers on any of these topics, which includes an introduction to the topic, research question , aim and objectives, literature review , and the proposed research methodology to be conducted. Let us know if you need any help in getting started.

Check our dissertation examples to understand how to structure your dissertation .

Also read: Psychology dissertation topics & nursing dissertation topics

List Of Trending Mental Health Research Topics & Ideas

• The Impact of Social Media on Body Image and Self Esteem in Youngsters. 
• How Does Loneliness Link to Depression in People Above the Age of 70
• The Effects of Israeli-Palestinian Conflicts on the Mental Health of Children in Gaza 
• The Impact of Posting Pictures From War on the Mental Health of Viewers
• The Effectiveness of Excercise Programs in Managing Symptoms of Depression 
• Role of Cultural Competency in Providing Effective Mental Healthcare for Diverse Populations
• The Impact of Social Stigma on Help-Seeking Behaviours for Mental Health Concerns
• The Effectiveness of Art Therapy Interventions in Managing Symptoms of Post-traumatic Stress Disorder (Ptsd)
• How Group Therapy Interventions Impacts Promoting Social Connection and Reducing Loneliness
• Animal-Assisted Therapy Interventions in Reducing Symptoms of Anxiety and Depression
• Psychedelic-Assisted Psychotherapy in Treating Eating Disorders

Latest Mental Health Dissertation Topics

Review the step-by-step guide on how to write your dissertation here .

Topic 1: An assessment of the Influence of Parents' Divorce or Separation on Adolescent Children in terms of long-term psychological impact.

Research Aim: This study aims to investigate the level of traumas experienced by the children of divorced or separated parents. The principal aim of this study is to explore the long-term psychological impacts of parents’ divorce on the life of children regardless of their gender and age in terms of mental wellbeing, academic performance, and self-worth.

Topic 2: An investigation of the impact of Trauma and Health-related quality of life on the Mental health and Self-worth of a child.

Research Aim: This study aims to assess the long-term impacts of the trauma children face in their early years of life on their overall mental health. Also, numerous studies have emphasised improving the quality of life for children who tend to experience multiple traumas and take them along in adulthood. Therefore, this study also proposed the impacts of traumatic childhood experiences on self-worth, mental health, and vitality of implementing firm intervention before the child reaches adulthood.

Topic 3: Assessing the effect of Psychological training on males suffering from Post-Surgery Anxiety in the UK.

Research Aim: Postoperative problems may occur as a result of surgical stress. This study aims to examine different approaches to control post-surgical anxiety and improve patients’ lives in the short and long term, focusing on male patients in the UK. It will also give us an understanding of how psychological training and interventions affect anxiety in male patients and help them overcome this through a systematic review.

Topic 4: Investigating the Relationship between Mental illness and Suicides- A case study of UK's Young Adults.

Research Aim: This study aims to find the relationship between mental illness and suicides and risk factors in the UK. This study will specifically focus on young adults. It will examine different mental disorders and how they have led to suicide and will analyse further studies of people who have died by suicide and find evidence of the presence or absence of mental illness.

Topic 5: Examining the behaviour of Mental Health Nurses taking care of Schizophrenia Patients in the UK.

Research Aim: Negative behaviours and discrimination have been usually reported as a reason for the inconvenience in the treatment of mentally ill or schizophrenia patients, which negatively impacts the patient’s results. Healthcare professionals’ attitudes have been regarded as being more negative than the general public, which lowers the outlook for patients suffering from mental illness. This study will examine the behaviour of mental health nurses regarding schizophrenia patients in the UK and also focus on the characteristics associated with nurses’ attitudes.

COVID-19 Mental Health Research Topics

Topic1: impacts of the coronavirus on the mental health of various age groups.

Research Aim: This study will reveal the impacts of coronavirus on the mental health of various age groups

Topic 2: Mental health and psychological resilience during COVID-19

Research Aim: Social distancing has made people isolated and affected their mental health. This study will highlight various measures to overcome the stress and mental health of people during coronavirus.

Topic 3: The mental health of children and families during COVID-19

Research Aim: This study will address the challenging situations faced by children and families during lockdown due to COVID-19. It will also discuss various ways to overcome the fear of disease and stay positive.

Topic 4: Mental wellbeing of patients during the Coronavirus pandemic

Research Aim: This study will focus on the measures taken by the hospital management, government, and families to ensure patients’ mental well-being, especially COVID-19 patients.

Best Mental Health Topics for Your Dissertation

Topic 1: kids and their relatives with cancer: psychological challenges.

Research Aim: In cancer diagnoses and therapies, children often don’t know what happens. Many have psychosocial problems, including rage, terror, depression, disturbing sleep, inexpiable guilt, and panic. Therefore, this study is designed to identify and treat the child and its family members’ psychological issues.

Topic 2: Hematopoietic device reaction in ophthalmology patient’s radiation therapy

Research Aim: This research is based on the analysis of hematopoietic devices’ reactions to ophthalmology radiation.

Topic 3: Psychological effects of cyberbullying Vs. physical bullying: A counter study

Research Aim: This research will focus on the effects of cyberbullying and physical bullying and their consequences on the victim’s mental health. The most significant part is the counter effects on our society’s environment and human behaviour, particularly youth.

Topic 4: Whether or not predictive processing is a theory of perceptual consciousness?

Research Aim: This research aims to identify whether or not predictive processing is a theory of perceptual consciousness.

Topic 5: Importance of communication in a relationship

Research Aim: This research aims to address the importance of communication in relationships and the communication gap consequences.

Topic 6: Eating and personality disorders

Research Aim: This research aims to focus on eating and personality disorders

Topic 7: Analysis of teaching, assessment, and evaluation of students and learning differences

Research Aim: This research aims to analyse teaching methods, assessment, and evaluation systems of students and their learning differences

Topic 8: Social and psychological effects of virtual networks

Research Aim: This research aims to study the social and psychological effects of virtual networks

Topic 9: The role of media in provoking aggression

Research Aim: This research aims to address the role of media in provoking aggression among people

Mental Health Topics for Your Dissertation For Research

Topic 1: what is the impact of social media platforms on the mental wellbeing of adults.

Research Aim: the current study aims to investigate the impact social media platforms tend to have on adults’ mental well-being with a particular focus on the United Kingdom. While many studies have been carried out to gauge the impact of social media platforms on teenagers’ mental well-being, little to no research has been performed to investigate how the health of adults might be affected by the same and how social media platforms like Facebook impact them.

Topic 2: The contemporary practical management approach to treating personality disorders

Research Aim: This research will discuss the contemporary practical management approach for treating personality disorders in mental health patients. In the previous days, much of the personality disorder treatments were based on medicines and drugs. Therefore, this research will address contemporary and practical ways to manage how personality disorders affect the mental state of the individuals who have the disease.

Topic 3: How is Prozac being used in the modern-day to treat self-diagnosed depression?

Research Aim: In the current day and age, besides people suffering from clinical depression, many teens and adults have started to suffer from self-diagnosed depression. To treat their self-diagnosed depression, individuals take Prozac through all the wrong means, which harms their mental state even more. Therefore, the current study aims to shed light on how Prozac is being used in the modern age and the adverse effects of misinformed use on patients.

Topic 4: Are women more prone to suffer from mental disorders than men: A Comparative analysis

Research Aim: There have been several arguments regarding whether women are more likely to suffer from mental disorders than men. Much of the research carried out provides evidence that women are more prone to suffer from mental disorders. This research study aims to conduct a comparative analysis to determine whether it’s more likely for men or women to suffer from mental disorders and what role biological and societal factors play in determining the trend.

Topic 5: The impact of breakups on the mental health of men?

Research Aim: Several studies have been carried out to discuss how women are affected more by a breakup than men. However, little research material is available in support of the impact the end of a relationship can have on men’s mental health. Therefore, this research study will fill out the gap in research to determine the impact of a breakup on men’s mental health and stability.

Topic 6: A theoretical analysis of the Impact of emotional attachment on mental health?

Research Aim: This research aims to analyse the theories developed around emotional attachment to address how emotional attachment can harm individuals’ mental health across the globe. Several theories discuss the role that emotional attachment tends to play in the mind of a healthy being, and how emotional attachment can often negatively affect mental well-being.

Topic 7: How do social media friendships contribute to poor mental health?

Research Aim: This research idea aims to address how social media friendships and networking can often lead to a lack of self-acceptance, self-loathing, self-pity, self-comparison, and depression due to the different mindsets that are present in today’s world.

Topic 8: What role do parents play in ensuring the mental well-being of their children?

Research Aim: It is assumed that parents tend to stop playing a role in ensuring that the mental health and well-being of their children are being maintained after a certain age. Therefore, this study will aim to put forward the idea that even after the children pass the age of 18, activities and their relationship with their parents will always play a role in the way their mental health is being transformed.

Topic 9: A study on the mental health of soldiers returning from Iraq?

Research Aim: This topic idea puts forward the aim that the mental health of soldiers who return from war-struck areas is always a subject of interest, as each of the soldiers carries a mental burden. Therefore, it is vital to understand the soldiers’ mental health returning from Iraq, focusing on what causes their mental health to deteriorate during the war and suggestions of what to do or who to call if they do become unwell.

Topic 10: How the contemporary media practices in the UK are leading to mental health problems?

Research Aim: The media is known to have control and influence over people’s mindsets who are connected to it. Many of the contemporary media practices developed in the UK can negatively impact the mental well-being of individuals, which makes it necessary to analyse how they are contributing to the mental health problems among the UK population.

Topic 11: What is the impact of television advertising on the mental development of children in the UK?

Research Aim: This topic aims to address how television advertising can negatively impact children’s mental development in the United Kingdom, as it has been observed in many studies that television advertising is detrimental to the mental health of children.

Topic 12: How deteriorating mental health can have an Impact on physical health?

Research Aim: This research aims to address the side-effects of deteriorating mental health on the physical health of individuals in society, as it is believed that the majority of the physical ailments in the modern-day age are due to the deteriorating mental health of individuals. The study can address the treatments for many ailments in our society due to deteriorating mental health and well-being.

Topic 13: The relationship between unemployment and mental health

Research Aim: How unemployment relates to concepts, such as a declining economy or lack of social skills and education, has been frequently explored by many researchers in the past. However, not many have discussed the relationship between unemployment and the mental health of unemployed individuals. Therefore, this topic will help address the problems faced by individuals due to unemployment because of the mental blocks they are likely to develop and experience. In the future, it will lead to fewer people being depressed due to unemployment when further research is carried out.

Topic 14: The mental health problems of prisoners in the United Kingdom

Research Aim: While prisoners across the globe are criticised and studied for the negativity that goes on in their mindsets, one would rarely research the mental health problems they tend to develop when they become prisoners for committing any crime. It is often assumed that it is the life inside the prison walls that impacts the prisoners’ mental health in a way that leads to them committing more crimes. Therefore, this research topic has been developed to study prison’s impact on prisoners’ mental well-being in the United Kingdom to eventually decrease the number of crimes that occur due to the negative environment inside the prisons.

Topic 15: Mental well-being of industry workers in China

Research Aim: While many research studies have been carried out regarding the conditions that the workers in China tend to be exposed to, there is very little supporting evidence regarding the impact such working conditions have on the mindset and mental health of the workers. Therefore, this study aims to address the challenges faced by industry workers in China and the impact that such challenges can have on their mental well-being.

Topic 16: Is the provision of mental health care services in the United Kingdom effective?

Research Aim: Many people have made different assumptions regarding the mental health care services provided across the globe. However, it seems that little to no research has been carried out regarding the efficiency and effectiveness of the provision of mental health care services in the United Kingdom. Therefore, this study aims to put forward research into the mental health care services provided in well-developed countries like the United Kingdom to gauge the awareness and importance of mental health in the region.

Topic 17: What are the mental health problems that minorities in the United Kingdom face?

Research Aim: It is believed that minorities in the United Kingdom are likely to experience physical abuse, and societal abuse and are often exposed to discrimination and unfair acts at the workplace and in their social circle. The study investigates the range of mental problems faced by minorities in the UK, which need to be addressed to have equality, diversity, and harmony.

Topic 18: The impact the Coronavirus has had on the mental health of the Chinese people

Research Aim: The spread of the deadly Coronavirus has led to many deaths in the region of China, and many of those who have been suspected of the virus are being put in isolation and quarantine. Such conditions tend to hurt the mental health of those who have suffered from the disease and those who have watched people suffer from it. Therefore, the current study aims to address how the Coronavirus has impacted the mental health of the Chinese people.

Topic 19: How to create change in mental health organisations in China?

Research Aim: Research suggests little awareness about mental health in many Asian countries. As mental health problems are on the rise across the globe, it is necessary to change mental health organisations. Therefore, the study aims to discuss how to create change in mental health organisations in the Asian region using China’s example.

Topic 20: Addressing the mental health concerns of the Syrian refugees in the UK

Research Aim: This research project would address the concerns in terms of the refugees’ mental health and well-being, using an example of the Syrian refugees who had been allowed entry into the United Kingdom. This idea aims to put forward the negative effects that migration can have on refugees and how further research is required to combat such issues not just in the United Kingdom but worldwide.

How Can ResearchProspect Help?

ResearchProspect writers can send several custom topic ideas to your email address. Once you have chosen a topic that suits your needs and interests, you can order for our dissertation outline service which will include a brief introduction to the topic, research questions , literature review , methodology , expected results , and conclusion . The dissertation outline will enable you to review the quality of our work before placing the order for our full dissertation writing service!

Important Notes:

As a mental health student looking to get good grades, it is essential to develop new ideas and experiment on existing mental health theories – i.e., to add value and interest in the topic of your research.

Mental health is vast and interrelated to so many other academic disciplines like civil engineering ,  construction ,  project management , engineering management , healthcare , finance and accounting , artificial intelligence , tourism , physiotherapy , sociology , management , project management , and nursing . That is why it is imperative to create a project management dissertation topic that is articular, sound, and actually solves a practical problem that may be rampant in the field.

We can’t stress how important it is to develop a logical research topic based on your entire research. There are several significant downfalls to getting your topic wrong; your supervisor may not be interested in working on it, the topic has no academic creditability, the research may not make logical sense, and there is a possibility that the study is not viable.

This impacts your time and efforts in writing your dissertation as you may end up in a cycle of rejection at the initial stage of the dissertation. That is why we recommend reviewing existing research to develop a topic, taking advice from your supervisor, and even asking for help in this particular stage of your dissertation.

While developing a research topic, keeping our advice in mind will allow you to pick one of the best mental health dissertation topics that fulfill your requirement of writing a research paper and add to the body of knowledge.

Therefore, it is recommended that when finalising your dissertation topic, you read recently published literature to identify gaps in the research that you may help fill.

Remember- dissertation topics need to be unique, solve an identified problem, be logical, and be practically implemented. Please look at some of our sample mental health dissertation topics to get an idea for your own dissertation.

How to Structure Your Mental Health Dissertation

A well-structured dissertation can help students to achieve a high overall academic grade.

• A Title Page
• Acknowledgements
• Declaration
• Abstract: A summary of the research completed
• Table of Contents
• Introduction : This chapter includes the project rationale, research background, key research aims and objectives, and the research problems. An outline of the structure of a dissertation can also be added to this chapter.
• Literature Review : This chapter presents relevant theories and frameworks by analysing published and unpublished literature available on the chosen research topic to address research questions . The purpose is to highlight and discuss the selected research area’s relative weaknesses and strengths whilst identifying any research gaps. Break down the topic, and key terms that can positively impact your dissertation and your tutor.
• Methodology : The data collection and analysis methods and techniques employed by the researcher are presented in the Methodology chapter which usually includes research design , research philosophy, research limitations, code of conduct, ethical consideration, data collection methods, and data analysis strategy .
• Findings and Analysis : Findings of the research are analysed in detail under the Findings and Analysis chapter. All key findings/results are outlined in this chapter without interpreting the data or drawing any conclusions. It can be useful to include graphs, charts, and tables in this chapter to identify meaningful trends and relationships.
• Discussion and Conclusion : The researcher presents his interpretation of results in this chapter and states whether the research hypothesis has been verified or not. An essential aspect of this section of the paper is to draw a linkage between the results and evidence from the literature. Recommendations with regard to the implications of the findings and directions for the future may also be provided. Finally, a summary of the overall research, along with final judgments, opinions, and comments, must be included in the form of suggestions for improvement.
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Childhood Trauma and Adolescent Mental Health: A Transdisciplinary Approach for Social Work Research and Practice

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• March 19, 2019
• Affiliation: School of Social Work
• This dissertation presents a transdisciplinary model to guide future social work research and practice with childhood trauma and adolescent mental health. The included studies aim to: 1) analyze and describe the transdisciplinary problem of childhood trauma in a vulnerable population 2) research associations between childhood trauma and transdisciplinary adolescent mental health outcomes, and 3) systematically review intervention approaches to a complex adolescent mental health outcome from a transdisciplinary perspective. Comprehensive transdisciplinary theoretical research informs the development of the transdisciplinary model of childhood trauma and adolescent mental health. Epidemiological methods are used to examine trauma prevalence in a sample of adolescent mothers and multivariate regression models are used to analyze trauma subtypes/polytraumatization as risk factors for adolescent perinatal depression. An amended Cochrane Collaboration protocol guides a systematic review of the literature for adolescent complex trauma intervention studies. The first paper confirms childhood trauma an epidemic problem with over 80% of adolescent mothers experiencing trauma, particularly those with perinatal depression. The second paper finds that childhood sexual abuse, childhood loss, and polytraumatization are significant risk factors of adolescent perinatal depression. The final paper finds complex trauma interventions for adolescents limited in number and methodological rigor, and that a trans-diagnostic approach may be helpful to evaluate intervention efficacy in complex populations. The studies presented illustrate the transdisciplinary nature of childhood trauma and adolescent mental health, specifically adolescent perinatal depression and complex trauma. They also demonstrate how transdisciplinary principles can be integrated into the way these problems are conceptualized, measured, interpreted and discussed. This work establishes a foundation for future research on the transdisciplinary model which may eventually help to guide transdisciplinary intervention research on childhood trauma and adolescent mental health.
• August 2016
• Perinatal Depression
• Social work
• Mental health
• Transdisciplinary
• Mental Health
• https://doi.org/10.17615/ejd7-c311
• Dissertation
• In Copyright
• Rizo, Cynthia
• Bledsoe, Sarah
• Guo, Shenyang
• Howard, Matthew O.
• Testa, Mark
• Belger, Aysenil
• Doctor of Philosophy
• University of North Carolina at Chapel Hill Graduate School

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185 Social Work Dissertation Topics: Creative List

If you are a student of social work, then there are so many subjects that you can write about in your dissertation topic. Social work, in simple terms, is a set of functions that allow you to improve the lives of others. Social workers help adults and children cope with everyday issues, relationship troubles, personal issues and family issues. Given the scope of work of a social worker, finding the right social work dissertation topics can be challenging as there are so many pressing issues to cover.

In order to write a good paper and choose a topic that interests you, here are a few things that you should consider:

Choose a topic that is close to your heart : If you have chosen social work as your field of study, then there must be some area of work that intrigues you. This could be related to child care, women’s rights or health. To write a good paper, choose a subject that is of interest to you and will help you in your line of work going forward. Make sure your topic is supported by data : Choose topics that have enough data to present strong arguments and discussions. The paper should be thought provoking : Once you have got an approval on your proposed social work dissertation topics, use as much information that is relatable. The readers should take back some ideas from your paper and also have questions about how the system can be improved to fulfill the purpose of social work. This means that you need to find loopholes in the system and address them in your paper effectively.

Now that you know what a good social work dissertation paper entails, here is a list of topics to help you start your journey. However if you have more interesting things to do, remember you have an opportunity to buy dissertation and get the best result.

Social Work Dissertation Ideas

These are good dissertation topics for social work students at all academic levels:

• Write an in-depth paper on the perception and attitude of oppression between the community and healthcare professionals.
• Write about the inherent perceptions related to social work among different cultures.
• A comprehensive review of different approaches to strengthen users of social services.
• The role of social workers in end-of-life decisions.
• Is evidence based learning an excellent way of learning for social workers?
• What are your views on the law of reflection and its role in social work?
• What are the challenges faced by social workers with respect to inter-professional practices?
• Is tutoring an integral part of social work training? Write your views.
• Social work and government policies: Write a detailed review.
• How social work interventions can protect vulnerable adults.
• The common security issues faced by personal social workers.
• Transitioning from employment to social work: Challenges and advantages.
• Substance abuse among young adults. The role of social workers in prevention and management.
• A review on why women choose to remain in abusive relationships.
• The contribution of social services in helping families cope with a member with dementia.
• The relationship between social work and communities of faith.
• The role of social workers in promoting ethnic minorities.
• The best ways in which social workers can improve the life of the elderly.
• Does social work impact the quality of life of senior citizens?
• Disparities in the society that can be resolved to improve the lives of ethnic minorities.
• The importance of being gender sensitive in addressing the issues faced by the LGBTQ community.
• Is rehabilitation of young offenders the new way of ensuring restorative justice?
• Laws that allow the representation of marginalized societies in the government.
• Can prohibition of alcohol preserve law and order in a community?
• The role of drug addiction in increasing relationship problems within families.
• The primary factors contributing to juvenile delinquency.
• Does imposing a curfew on minors lead to increased chances of premarital sex?
• The role of the media in determining the electoral process of any country.
• Provide great examples of good governance with respect to the recovery of a city or locality after being affected by a natural calamity.
• Provide a social work perspective on the growing popularity of political figures and icons.
• How does education contribute to the ability of leaders to shape the social and political structure of a country?
• Can reactivating the death penalty change the rate of crime in our society?
• Do individuals who are in illicit relationships perceive the norms of a marriage differently?
• Experiences with healthcare of people who have been diagnosed with fibromyalgia.
• Culture-based activism and its impact on the lives of Native Americans.

Easy Social Work Research Topics

These social work research topics cover a range of relatable and controversial subjects for you to write about.

• How can survivors of domestic violence get better employment opportunities?
• A study of women with sexual addiction.
• Reintegration of individuals who have survived abuse into the society.
• The primary causes and the best ways to prevent juveni;e recidivism.
• Examples of great women leaders in our community.
• Should immigrants be given health services?
• What are the best housing options to support young people?
• Medical care for the elderly: The challenges.
• A detailed study of the relationships of HIV positive individuals.
• Is customer satisfaction the most important goal for a business?
• The barriers in social work with respect to climate change.
• The experience of a home care worker in a caring relationship.
• Are voluntary tourism communities in Chile an example of social development?
• Why do we still hesitate to talk about sex?
• How does organizational culture contribute to marginalism?
• The role of leadership practices in eliminating new forms of marginalism.
• Graduate students and the attitude towards couples therapy.
• Review the employment services for domestic violence survivors in your region/ country.
• Evaluate eviction risks based on social and cultural perceptions.
• Write about the experiences of women who are in a relationship with an individual who is sexually addicted.
• Provide a qualitative study of resilience and risk associated with young people.
• How does health affect the employment of refugee and immigrant women?
• Does encouraging traveling among women promote community leadership?
• Humanities and the relationship with citizenship.
• The perspectives of youth and service providers on the impact of housing options for young adults.
• The role of arts in boosting healing processes.
• How has dance impacted society?
• How to improve medical facilities in rural areas?
• The experiences of rural individuals with social workers.
• How do the concepts of our society affect the lives of individuals with HIV and AIDs?
• Improving care for individuals with HIV and AIDS.
• Explore the nature of collaboration between individuals who suffer from poverty and various organizations in regions that are at a high economic and social risk.
• The importance of sexual health education for immigrant women.
• The social risks of gender identity.
• How can the theory of dynamic systems be applied to countries that are in a war situation?

Child Protection Dissertation Ideas

Here are some good dissertation topics for social work students who are interested in childcare services:

• The impact of agencies in protecting children: Provide a review of literature based on real practices.
• Will children who experience or witness abuse and violence within the family perpetuate the same type of behavior?
• Impact of family support and protection in child protection intervention by social workers.
• The health problems of adults who have survived child sexual abuse.
• The contribution of social workers in carrying out effective interventions for survivors of child sexual abuse.
• Factors that contribute to adopted children seeking out their biological parents.
• The impact of domestic violence on children and the resulting consequences for a social worker.
• Review the educational achievements with respect to childcare in your region.
• Review of literature of education and childcare in California and what the world can learn from it.
• The effect of gambling on the lives of children.
• The common factors that affect the socio-economic requirements of children.
• How can social workers aid the emotional growth of children?
• The impact of pornography in increasing the rate of crime and violence against chidlren.
• The views of sexual abuse victims on pedophilia.
• How do the physical changes during puberty affect the psyche of a child?
• The risks associated with child welfare decisions.
• How can education prevent violence against children?
• An analysis of the maternal experiences of victims of child sexual abuse.
• The experience of new social workers in child welfare.
• Secondary traumatic stress between young counselors and children.
• The best ways to protect a child in custody.
• Support strategies to prevent child poverty in your country.
• A study of resilience in individuals when building a strong future after emerging from a difficult childhood. Provide examples.
• Immigrant families and adolescent development.
• Is gender neutral upbringing overrated or is it the need of the hour?
• How does the environment in the school impact the self esteem of children?
• A case study to review the challenges of children with learning disabilities.
• The benefits of studying child development in improving the contributions of social services.
• The reason for the ignorance of child development for several years in history.
• Write a detailed paper on the formation of ego with respect to different stages of development.
• The effect of an absent parent on the developing years of a child.
• How does domestic violence affect the concept of self in a child?
• Child education and the impact of single parenting.
• Factors that contribute to the retention of employees in childcare.
• The causes and best strategies for the protection of runaway children.
• The role of gender differences in shaping the outlook of children.
• Why is play an important educational tool?
• The best policies to promote the rights of children.
• Factors that influence the quality of food in child care centers.
• The risk factors and effects of bullying.
• The best ways to reduce behavioral issues in children in foster care.
• The relationship between disability and the chances of a child ending up in foster care.
• The lack of child support and the effects on child care.
• How does group therapy help children in foster care?
• The impact of constant changes of family in orphaned toddlers.
• How does homelessness impact the psyche of a child?
• Recurring displacement and the effects on homeless children.
• Factors that contribute to an antisocial lifestyle in children in foster care.
• The effects of substance abuse on the lives of children.
• The trauma of child-parent separation on the lifestyle and health of children.

Social Work Dissertation Topics Mental Health

Mental health contributes to some of the most important dissertation topics for social work students.

• Why do individuals with obsessive compulsive disorders struggle to cope with society?
• The effects of living with bipolar parents on the health and lifestyle of a child.
• Why should we socially interrogate the stigma associated with mental health?
• The role of social workers in improving support for individuals with mental health issues.
• The occurrence of suicidal tendencies in military units and the best ways to address them.
• The impact of death on the collective well-being of any family unit.
• The positive impact of sponsors on the lives of recovering addicts.
• Provide a clinical study on the current anti-depressants and their effectiveness.
• How to stop social elimination of children suffering from Down Syndrome.
• The role of a family in exacerbating depression.
• The impact of alcoholism on personal lifestyle, family and society.
• Provide a detailed analysis of the similarities and differences between ADHD and Dyslexia.
• The best ways to improve awareness on degenerative mental health issues like Dementia.
• The need for more awareness among educators about learning disabilities.
• The most effective learning tools for children who suffer from ADHD, dyslexia and other learning disorders.
• A detailed evaluation of socio-sexual education programs for individuals with developmental disorders.
• Evaluation on the impact of developmental disabilities in the life events of an individual.
• Life with a spouse who has memory loss.
• Provide an exploratory study of different aids available to the primary caregivers of children with autism.
• The meaning of well-being based on the cultural and ethic backgrounds of individuals.
• Building resilience towards traumatic incidents using the mind-body connection of yoga.
• Is the stigma against mental health disorders greater for women? Conduct a comparative study.
• The perspectives of a woman living with mental illness and receiving assistance from community services.
• Investigate how smoking gives individuals with depression a sense of belonging or acceptance.
• Are mental health services equally accessible to minorities and other oppressed groups?
• Do mental health service providers avoid detention of young males in their psychiatric units?
• The relationship between government policies and effective mental health assistance.
• Common behavioral issues of children in dysfunctional families.
• The impact of foster care on the mental health of teenagers.
• The effect of poverty and scarcity on the psyche of young children.

Social Work Masters Dissertation Topics

If you are writing a dissertation paper for your master’s degree, here are some interesting topics for you to choose from:

• How is the lifestyle of a metropolitan city failed by the criminal justice system?
• What are some sure shot signs of trauma in the workplace?
• The effects of racial disparity on our society.
• The best ways to control substance abuse and addiction.
• How can the facilities at nursing homes for the elderly be improved?
• The negative impact of food banks.
• Government policies that have improved welfare conditions.
• The impact of homophobia on our community.
• Primary factors contributing to violence in a family.
• The effects of unemployment on society.
• Stigma and social issues faced by welfare mothers.
• Experiences of women who live in shelter homes.
• The inherent challenges of transracial adoption.
• How to make wellness therapy more sustainable?
• The impact of first-time menstrual experience on teenage girls living in foster homes.

Common Dissertation Topics For Social Work Students

If you wish to get top grades, here are some topics that give you a lot of literature and data to review.

• Birth control laws and their negative impact.
• The challenges of increasing housing costs on the youth.
• Workplace abuse and the relationship with paid labor.
• The impact of cultural belief on relationships.
• The negative impact of teenage pregnancy.
• Low income neighborhoods and the increasing cases of substance abuse.
• The hazards of confinement and why they need our attention.
• The need for therapy of poorly represented groups.
• Misdiagnosis of mental health issues and its impact.
• How can empathy improve social services?
• The need for qualitative examination of foster homes.
• The contributing factors for violence in correctional systems.
• Do therapists need therapy?
• How trafficking impacts societal well-being.
• The reasons for unreported abuse cases.
• The hidden trauma of survivors of natural calamities.
• Traumatic experiences of children in foster homes. A clinical study with measures to prevent them.
• Growing in a war zone and the psychological impact.
• Common myths about child services and foster care.
• Is there a disability disparity among social workers?

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Home > School, College, or Department > SSW > Dissertations and Theses

School of Social Work Dissertations and Theses

Theses/dissertations from 2024 2024.

Understanding the Other: Mentor Ethnocultural Empathy and Relationship Quality and Duration in Youth Mentoring , Miriam Miranda-Diaz

The Mirror Project: Reflections on the Experiences of African-American Female Adolescents Experiencing Foster Care , Bahia Anise-Cross DeGruy Overton

Theses/Dissertations from 2023 2023

Does Structural Racism Influence How Black/African Americans Define Memory Loss and Cognitive Impairment? An Africana Phenomenological Study , Andre Pruitt

Prosecutors or Helpers: An Institutional Ethnography of Child Protective Services Casework , Anna Maria Rockhill

Theses/Dissertations from 2022 2022

A Critical Discourse Analysis of How Youth in Care Describe Social Support , Jared Israel Best

Examining Demographic and Environmental Factors in Predicting the Perceived Impact of Cancer on Childhood and Adolescent Cancer Survivors , Nazan Cetin

Health Literacy and People Diagnosed with Mental Illness , Beckie Child

High School Persisters and Alternative Schools , Hyuny Clark-Shim

Examining the Role of Social Support and Neighborhood Deprivation in the Relationship Between Multiple ACEs and Health Risk Behaviors , Marin L. Henderson-Posther

A Typology of Foster Home Quality Elements in Relation to Foster Youth Mental Health , Paul Sorenson

"I'm Very Enlightened:" Assisting Black Males Involved in the Criminal Justice System to Deal With and Heal From Racism , Darnell Jackie Strong

The Mechanisms Connecting State Marijuana Policies to Parent, Peer, and Youth Drug Perception Leading to Youth Marijuana Use , Eunbyeor Sophie Yang

Theses/Dissertations from 2021 2021

E(Raced): Race and Use of Self Amongst BIPOC Social Workers , Anita Reinette Gooding

Theses/Dissertations from 2020 2020

A Colorless Nature: Exploring the Mental Health (Help-Seeking) Experiences of Pre-Adolescent Black American Children , Christopher Ashley Burkett

The Economically Disadvantaged Speak: Exploring the Intersection of Poverty, Race, Child Neglect and Racial Disproportionality in the Child Welfare System , Angela Gail Cause

Examining the Narratives of Military Sexual Trauma Survivors , Maria Carolina González-Prats

Theses/Dissertations from 2019 2019

Our Vision of Health for Future Generations: an Exploration of Proximal and Intermediary Motivations with Women of the Choctaw Nation of Oklahoma , Danica Love Brown

Interrogating the Construction and Representations of Criminalized Women in the Academic Social Work Literature: a Critical Discourse Analysis , Sandra Marie Leotti

Learning From Culturally Specific Programs and Their Impact on Latino Parent Engagement , Analucia Lopezrevoredo

Physical and Emotional Sibling Violence and Child Welfare: a Critical Realist Exploratory Study , Katherine Elizabeth Winters

Theses/Dissertations from 2018 2018

Is Therapy Going to the Dogs? Evaluating Animal Assisted Therapy for Early Identified At-Risk Children , Leah Faith Brookner

Investigating Time During Residential Program Until Transition for Adjudicated Youth: a Mixed Methods Study Using Event History Analysis with Follow-Up Interviews , Emily Carol Lott

Role of Spouse/Partner in Fertility Preservation Decision Making by Young Women with Cancer , Aakrati Mathur

Exploring the Association of Victimization and Alcohol and Marijuana Use among American Indian Youth Living On or Near Reservations: a Mixed Methods Study , Lindsay Nicole Merritt

The Intersections of Good Intentions, Criminality, and Anti-Carceral Feminist Logic: a Qualitative Study that Explores Sex Trades Content in Social Work Education , Meg Rose Panichelli

Latinas and Sexual Health: Correlates of Sexual Satisfaction , Christine Marie Velez

A Foucaultian Discourse Analysis of Person-Centered Practice Using a Genealogical Framework of Intellectual Disability , Nick Winges-Yanez

Theses/Dissertations from 2017 2017

Foundational Knowledge and Other Predictors of Commitment to Trauma-Informed Care , Stephanie Anne Sundborg

An Analysis of Oregon Youth Authority Populations: Who Receives Treatment and What Factors Influence Allocation of Treatment Resources? , Rebecca Arredondo Yazzie

Theses/Dissertations from 2016 2016

The Importance of Online Peer Relationships During the Transition to Motherhood: Do They Decrease Stress, Alleviate Depression and Increase Parenting Competence? , Bobbie Sue Arias

Bridging the Worlds of Home and School: a Study of the Relational Worlds of First-Generation Students in a School of Social Work , Miranda Cunningham

An Interpretive Phenomenological Analysis of Long-Term Mentoring Relationships from the Youth Perspective , Kevin Richard Jones

The Development and Validation of the Social Recovery Measure , Casadi "Khaki" Marino

Theses/Dissertations from 2015 2015

A Queer Liberation Movement? A Qualitative Content Analysis of Queer Liberation Organizations, Investigating Whether They are Building a Separate Social Movement , Joseph Nicholas DeFilippis

Got Hair that Flows in the Wind: The Complexity of Hair and Identity among African American Female Adolescents in Foster Care , Lakindra Michelle Mitchell Dove

Assessing the Impact of Restrictiveness and Placement Type on Transition-Related Outcomes for Youth With and Without Disabilities Aging Out of Foster Care , Jessica Danielle Schmidt

Fathers Caring for Children with Special Health Care Needs: Experiences of Work-Life Fit , Claudia Sellmaier

Investigating the Impact of Sibling Foster Care on Placement Stability , Jeffrey David Waid

Theses/Dissertations from 2014 2014

Understanding Sexual Assault Survivors' Willingness to Participate in the Judicial System , Mildred Ann Davis

The Relationship between Mindfulness and Burnout among Master of Social Work Students , Jolanta Maria Piatkowska

Out of the Way and Out of Place: An Interpretative Phenomenological Analysis of the Experiences of Social Interactions of Bisexually Attracted Young People , A. Del Quest

Strengths in Action: Implementing a Learning Organization Model in a Human Service Setting , Barbara Ann Whitbeck

Theses/Dissertations from 2013 2013

"Who Would Have Thought, With a Diagnosis Like This, I Would be Happy?": Portraits of Perceived Strengths and Resources in Early-Stage Dementia , Jutta Elisabeth Ataie

Lost in the Margins? Intersections Between Disability and Other Non-Dominant Statuses with Regard to Peer Victimization and Psychosocial Distress Among Oregon Teens , Marjorie Grace McGee

Teachers' Negative Comments Toward Youth in Foster Care with Disabilities: How Do They Relate to Youths' Problem Behaviors, School Attitudes, and School Performance? , Sunghwan Noh

Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO) , Peggy Nygren

Public Opinion and the Oregon Death with Dignity Act , Peggy Jo Ann Sandeen

The Role of Psycho-Sociocultural Factors in Suicide Risk Among Mong/Hmong Youth , TangJudy Vang

Theses/Dissertations from 2012 2012

Increasing Social Work Students' Political Interest and Efficacy: The Experience and Impact of a Social Welfare Policy Course from the Students' Perspective , Christie Dianne Bernklau Halvor

Exploring Support Network Structure, Content, and Stability as Youth Transition from Foster Care , Jennifer E. Blakeslee

Understanding the Experience of Air Force Single Parents: A Phenomenological Study , Samantha Everhart Blanchard

Implementer Perspectives: The Implementation of a School-Based Mentoring Program , Amanda Angela Fixsen

Risk Factors for Homelessness Among Community Mental Health Patients with Severe Mental Illness , Rupert Talmage van Wormer

Theses/Dissertations from 2011 2011

Gender, Culture, and Prison Classification: Testing the Reliability and Validity of a Prison Classification System , Aimée Ryan Bellmore

An Investigation of the Relationships between Violence Exposure, Internalizing and Externalizing Problems, and Adolescent Alcohol Use , Gregory Lloyd Forehand

Identifying Modifiable Factors associated with Depression across the Lifespan in Stroke Survivor-Spouse Dyads , Michael Joseph McCarthy

Investigating the Predictors of Postsecondary Education Success and Post-College Life Circumstances of Foster Care Alumni , Amy Michele Salazar

Runaway and Homeless Youth: Changing the Discourse by Legitimizing Youth Voice , Donald Dale Schweitzer

Theses/Dissertations from 2010 2010

Visions and Voices: An Arts-Based Qualitative Study Using Photovoice to Understand the Needs and Aspirations of Diverse Women Working in the Sex Industry , Moshoula Capous Desyllas

Somatization and Engagement in Mental Health Treatment , Teresa Chianello

Parental Differential Treatment (PDT) of Siblings: Examining the Impact and Malleability of Differential Warmth and Hostility on Children's Adjustment , Brianne H. Kothari

Understanding the Development of Self-determination in Youth with Disabilities in Foster Care , Jennifer L. Powers

Child Welfare Workforce Turnover: Frontline Workers' Experiences with Organizational Culture and Climate, and Implications for Organizational Practice , Melanie Dawn Sage

Theses/Dissertations from 2009 2009

Developing One's Self: Adoption and Identity Formation Through the Eyes of Transracially Adopted Native American Adults , Jody Becker-Green

Primary Care, Males, Masculinity, and Suicide : a Grounded Theory Study , John Thomas Casey

Dependent Care and Work-Life Outcomes : Comparing Exceptional Care and Typical Care Responsibilities , Lisa Maureen Stewart

Factors Associated with Inclusion of Spirituality in Secular Social Work Education , Leslie Grace Wuest

Theses/Dissertations from 2008 2008

Up a Creek : the Perilous Journey of Recently Uninsured Low-Income Adults in Oregon , Heidi Allen

Attributes of Effective Head Start Mental Health Consultants : a Mixed Method Study of Rural and Urban Programs , Mary Dallas Allen

Staying Within the Margins: The Educational Stories of First-Generation, Low-Income College Students , Diane Lyn Cole

Children with Incarcerated Parents : a Longitudinal Study of the Effect of Parental Incarceration on Adolescent Externalizing Behaviors , Jean Mollenkamp Kjellstrand

The Child Care Self-Sufficiency Scale: Measuring Child Care Funding and Policy Generosity across States , Karen Tvedt

Theses/Dissertations from 2007 2007

Family-Friendly Workplace Culture, Flexibility, and Workplace Support for Dependent Care : the Perspectives of Human Resource Professionals , Katherine June Huffstutter

Family Participation : Exploring the Role it Plays in Outcomes for Youth with Serious Emotional Disorders , Jodi Lee Kerbs

"Creative Interpretation and Fluidity in a Rights Framework": the Intersection of Domestic Violence and Human Rights in the United States , Karen Lynn Morgaine

Food Security and Hunger among Low income US Households: Relations to Federal Food Assistance Program Participation , Rebecca Elizabeth Sanders

Engaging Our Workforce: How Job Demands and Resources Contribute to Social Worker Burnout, Engagement and Intent to Leave , Sara Laura Schwartz

Theses/Dissertations from 2006 2006

Is It Just Me? Felt HIV -Related Stigma among Adults with HIV , Rebecca Gila Block

Social Workers Addressing Student-Perpetrated Interpersonal Violence in the School Context : Awareness and Use of Evidence-Supported Programs , Natalie Diane Cawood

Sons Providing Care at End-of-Life : Common Threads and nuances , Patricia Ebert

Theses/Dissertations from 2004 2004

Applying the Transtheoretical Model to Cigarette Smoking by Pregnant and Parenting Adolescent Females , Barbara Mary Sussex

Theses/Dissertations from 2002 2002

Identifying and Building on Strengths of Children With Serious Emotional Disturbances , Michael Orval Taylor

Theses/Dissertations from 2001 2001

A Dissertation on African American Male Youth Violence: "Trying to Kill the Part of You that Isn’t Loved" , Joy DeGruy Leary

Theses/Dissertations from 1999 1999

Voices of our past: the rank and file movement in social work, 1931-1950 , Richard William Hunter

The Assessment of Children with Attachment Disorder: The Randolph Attachment Disorder Questionnaire, the Behavioral and Emotional Rating Scale, and the Biopsychosocial Attachment Types Framework , Alice Myrth Ogilvie

Theses/Dissertations from 1997 1997

Grandmothers Laughing: Intergenerational Transmission of Cultural Beliefs About Pregnancy and Childbirth Among Native American Women , Claudia Robin Long

Theses/Dissertations from 1983 1983

The needs of older people as seen by themselves and support providers , Sarah Movius Schurr

Theses/Dissertations from 1981 1981

Non-work-related services at the workplace : an exploratory study , William Roland Adix, Elizabeth March Christie, James J. Christrup, Carol M. Kaulukukui, Jennifer Idris Lenway, Cynthia A. Nelson, Linda S. Rielly, Steven Sorlien, Kathleen A. Sweeney-Easter, Lynn Campbell Tate, Patricia Jones Warman, and Donn C. Warton

Assessment of Needs of Adolescent Mothers in Washington County , John L. Arnold, Jean C. Austin, Gary L. Brink, Jane Hall, Patricia C. Hanson, Valerie A. Ivey, April A. Moran, John P. Pank, Mark J. Skolnick, James A. Tarr, and Roberta B. Vaughn

Burnout: Multi-Dimensional Study of Alienation Among Social Service Workers in the Willamette Valley , Sally Carignan, John Deihl, Judy Harris, Jay Jones, Bonnie Rothman, Sabrina Ullmann, Beth Weinberg-Gordon, Phyllis Weter, Patricia Whitty, and Loretta Wilson

Alternative Agencies: An Exploratory Study , Linda Crane, Carolyn M. Curnane, Mike Echols, Mary Ann Hanson, Susan Kouns, Richard Ono, Mark Pierman, Susan K. Rademacher, Sara Weisberg, and Bea Zizlavsky

An Alumni survey of the School of Social Work, Portland State University , Stephen R. Fishack, Robert A. Forlenza, Susan D. Fredd, Gigi Gandy, William P. Goldsmith, Thomas L. Grier, and Sheila K. Lehto

A Description and Evaluation of the Self-Help Information Service , Cathy Tuma and John Wadsworth

The Portland, Oregon ASAP : an evaluation of treatment effectiveness , Joan M. Wildebush Berry, Stefani K. Cuda, Judi L. Edwards, Mary E. Ericson, Emilie Ford Frisbee, Steve Ernest Hand, Mary Anne Hannibal, Laurel M. Myers, Sharon Lee Perry, Loree Richards, Barbara Burns Schmidtke, Stephen Walker Voris, and Barbara M. Westby

Theses/Dissertations from 1980 1980

Multiple impact therapy : evaluation and design for future study , Jacqueline H. Abikoff, Dennis C. Anderson, Patricia C. Bowman, Carolyn Crawford Caylor, Nancy W. Freeland, Jan A. Godfrey, Marlene Graham, Kelly Ann Mason Hall, Mary J. Hatzenbeler, Susan C. Hedlund, Carol Lewis Kast, Gayle Matson Lansky, Janet M. Lewis, Kathleen Patricia Muldoon, Victoria A. G. Stoudt, and Anita Waage

Salem Teen Mother Program : a follow-up study , Frances L. Barton, Florence C. Berman, Sharon M. Bertoli-Nordlof, Marilyn L. Cooper, Claire K. Murray, Rosanne Peratrovich, Arlene M. Showell, and Julio C. Velazquez

Evaluative Styles of Clinicians in Private Practice , Daniel R. Brophy, Elliot M. Geller, Stephan L. Grove, Nancy E. Hedrick, A. Jill Nelson, and Babette A. Vanelli

Adaptation to dominant society : a self study of a woman of mixed race, black/Indian , Helen Marie Camel

A study of the crisis nature of the preparenthood period and implications for preventative social work practice , Julie Jean Colton

A Generalist approach to social work practice : model and synthesis , Chuck H. Johnson, Paul S. Knight, Michael W. Krumper, and John H. Rademaker

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Social Work thesis and dissertation collection

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Recent Submissions

Critiquing the presence and absence of children and young people's participation in policies for looked after children in scotland , interrogating the ethics of telecare services: a conceptual framework for dementia home care professionals , forever home the complexity of adoption breakdown in scotland , exploring experiences of children who migrate to delhi: understanding gender and space , looking after grandchildren: the motivation, pattern, and the impact of intergenerational engagements on grandparents in rural china , topping up the tank: enhancing the emotional resilience of social workers in local authority adult services , intergenerational transmission of the effects of maternal childhood adversities via poor infant outcomes , contributing to the development of social pedagogy in the uk: a case study at 'santiago 1' residential care home in spain , helping the 'problem child' become loveable again a discourse analysis on childhood adhd in switzerland and implications for social work , health needs and services for refugee women and children in uganda’s settlements: articulating a role for social work , unpicking social work practice skills: an interactional analysis of engagement and identity in a groupwork programme addressing sexual offending , turkish fathering today: an enquiry and discussion arising from the views of turkish fathers and turkish young people , twenty first century contact: young people in care and their use of mobile communication devices and the internet for contact , quickening steps: an ethnography of pre-birth child protection , low income employment in dhaka: women’s lives, agency and identity , partnership, power and policy: a case study of the scottish partnership on domestic abuse , feedback systems, interaction analysis, and counselling models in professional programmes , the participation of looked after children in permanency planning , everyday social work practice: listening to the voices of practitioners , quality of life experiences of parents of children with autism in scotland .

School of Social Work

Ph.D. Dissertations

Anna rockhill.

Prosecutors or Helpers: An Institutional Ethnography of Child Protective Services Casework

Andre Pruitt

 "Does Structural Racism Influence the way Black/African Americans Define Memory Loss and Cognitive Impairment? An Africana Phenomenological Study"

Henderson-Posther, Marin

Examining the Role of Social Support and Neighborhood Deprivation in the Relationship Between Multiple ACEs and Health Risk Behaviors

Strong, Darnell Jackie

"I'm Very Enlightened:" Assisting Black Males Involved in the Criminal Justice System to Deal With and Heal From Racism

Yang, Eunbyeor  

The Mechanisms Connecting State Marijuana Policies to Parent, Peer, and Youth Drug Perception Leading to Youth Marijuana Use

Clark-Shim, Hyuny

High school persisters and Alternative Schools

Best, Jared

A Critical Discourse Analysis of How Youth in Care Describe Social Support

Cetin, Nazan

Examining Demographics and Environmental Factors in Predicting the Perceived Impact of Cancer on Childhood and Adolescent Cancer Survivors

Sorenson, Paul

A Typology of Foster Home Quality Elements in Relation to Foster Youth Mental Health

Child, Beckie

Health Literacy and People Diagnosed with Mental Illness  

Gooding, Anita

E(Raced): Race and Use of Self Amongst BIPOC Social Workers   

Leotti, Sandra M.

Interrogating the Construction and Representations of Criminalized Women in the Academic Social Work Literature: A Critical Discourse Analysis  

Homan, Jesse

Attrition and Psychotherapy

Lazzari, Sarah

Support From Inside Out: Exploring Whether Various Social Supports Assist in Reducing Prison Rule Violations

Cause, Angela

The Economically Disadvantaged Speak: Exploring the Intersection of Poverty, Race, Child Neglect and Racial Disproportionality in the Child Welfare System 

Burkett, Christopher A. 

A Colorless Nature: Exploring the Mental Health (help-seeking) Experiences of Preadolescent Black American Children 

Gonzalez-Prats, Marina Carolina

Examining the Narratives of Military Sexual Trauma Survivors  

Brown, Danica Love

Our Vision of Health for Future Generations: An Exploration of Proximal and Intermediary Motivations with Women of the Choctaw Nation of Oklahoma »

Lott, Emily 

Investigating Time until Transition in a Residential Program for Adjudicated Youth: A Mixed Methods Study Using Event History Analysis with Follow-up Interviews. 

Winters, Katie

Physical and Emotional Sibling Violence and Child Welfare: A Critical Realist Exploratory Study »

Brookner, Leah

Is Therapy Going To The Dogs? Evaluating Animal Assisted Therapy for Early Identified At-Risk Children »

Mathur, Aakrati

Role of Spouse/Partner in Fertility Preservation Decision Making by Young Women with Cancer »

Merritt, Lindsay

Exploring Victimization and Alcohol and Marijuana Use Among American Indian Youth Living on or Near Reservations: A Mixed Methods Study »

Panichelli, Margaret

The Intersections of Good Intentions, Criminality, and Anti-Carceral Feminist Logic: A Qualitative Study That Explores Sex Trades Content in Social Work Education »

Velez, Christine

Latinas and Sexual Health: Correlates of Sexual Satisfaction »

Winges-Yanez, Nichole

A Foucaultian Discourse Analysis Using a Genealogical Framework of Intellectual Disability »

Sundborg, Stephanie

Foundational Knowledge and Other Predictors of Commitment to Trauma Informed Care »

Yazzie, Rebecca

An Analysis of Oregon Youth Authority Populations: Who Receives Treatment and What Factors Influence Allocation of Treatment Resources? »

Arias, Bobbie S.

The Importance of Online Peer Relationships during the Transition to Motherhood: Do They Decrease Stress, Alleviate Depression and Increase Parenting Competence? »

Cunningham, Miranda 

Bridging the Worlds of Home and School: A Study of the Relational Experiences of First-Generation Students in a School of Social Work »

Jones, Kevin R.

An Interpretive Phenomenological Analysis of Long-Term Mentoring Relationships from the Youth Perspective »

Marino, Casadi K.

The Development and Validation of the Social Recovery Measure »

Sellmaier, Claudia

Fathers Caring for Children with Special Health Care Needs: Experience of Work-Life Fit »

Mitchell Dove, Lakindra M. 

Got Hair that Flows in the Wind: The Complexity of Hair and Identity Among African American Female Adolescents in Foster Care »

DeFilippis, Joseph N. 

A Queer Liberation Movement?  A Qualitative Content Analysis of Queer Liberation Organizations, Investigating Whether They Are Building a Separate Social Movement »

Waid, Jeffrey D. 

Investigating the Impact of Sibling Foster Care on Placement Stability »

Del Quest, A. 

Out of the Way and Out of Place: An Interpretative Phenomenological Analysis of the Experiences of Social Interactions of Bisexually Attracted Young People »

Ann Davis, Mildred (Mandy)

Understanding Sexual Assault Survivors’ Willingness to Participate in the Judicial System »

Whitbeck, Barbara Allard 

Strengths in Action: Implementing a Learning Organization Model in a Human Service Setting »

Piatkowska, Jolanta  

The Relationship Between Mindfulness and Burnout Among Master of Social Work Students »

Nygren, Peggy

Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO) »

Ataie, Jutta Elisabeth

“Who Would Have Thought, with a Diagnosis Like This, I Would Be Happy?”: Portraits of Perceived Strengths and Resources in Early-Stage Dementia »

McGee, Marjorie Grace

Lost in the Margins? Intersections between Disability and Other Non-Dominant Statuses with Regard to Peer Victimization and Psychosocial Distress among Oregon Teens »

Noh, Sunghwan

Teachers’ Negative Comments Toward Youth in Foster Care with Disabilities: How Do They Relate to Youths’ Problem Behaviors, School Attitudes, and School Performance? »

Sandeen, Peg

Public Opinion and the Oregon Death with Dignity Act »

Vang, TangJudy  

The Role of Psycho-Sociocultural Factors in Suicide Risk Among Mong/Hmong Youth »

Blakeslee, Jennifer Elizabeth

Exploring Support Network Structure, Content, and Stability as Youth Transition from Foster Care »

Blanchard, Samantha Everhart

Understanding the Experience of Air Force Single Parents:  A Phenomenological Study »

Fixsen, Amanda Angela Marjorie

Implementer Perspectives: The Implementation of a School-Based Mentoring Program »

Halvor, Christie Dianne Bernklau

Increasing Social Work Students’ Political Interest and Efficacy: The Experience and Impact of a Social Welfare Policy Course from the Students’ Perspective »

van Wormer, Rupert

Risk Factors for Homelessness Among Community Mental Health Patients with Severe Mental Illness »

Bellmore, Aimee Ryan

Gender, Culture, and Prison Classification: Testing the Reliability and Validity of a Prison Classification System »

Forehand, Gregory Lloyd

An Investigation of the Relationships Between Violence Exposure, Internalizing and Externalizing Problems, and Adolescent Alcohol Use »

Kothari, Brianne H.

Parental Differential Treatment (PDT) of Siblings: Examining the Impact and Malleability of Differential Warmth and Hostility on Children’s Adjustment »

McCarthy, Michael Joseph

Identifying Modifiable Factors Associated with Depression Across the Lifespan in Stroke Survivor-Spouse Dyads »

Salazar, Amy Michele

Investigating the Predictors of Postsecondary Education Success and Post-College Life Circumstances of Foster Care Alumni »

Schweitzer, Donald Dale

Runaway and Homeless Youth: Changing the Discourse by Legitimizing Youth Voice »

Capous-Desyllas, Moshoula

Visions & Voices:  An Arts-Based Qualitative Study Using Photovoice to Understand the Needs and Aspirations of Diverse Women Working in the Sex Industry »

Chianello, Teresa

Somatization and Engagement in Mental Health Treatment »

Powers, Jennifer L.

Understanding the Development of Self-Determination in Youth with Disabilities in Foster Care »

Sage, Melanie Dawn

Child Welfare Workforce Turnover: Frontline Workers’ Experiences with Organizational Culture and Climate, and Implications for Organizational Practice »

Becker-Green, Jody

Developing One’s Self: Adoption and Identity Formation through the Eyes of Transracially Adopted Native American Adults »

Casey, John Thomas

Primary Care, Males, Masculinity, and Suicide:  A Grounded Theory Study »

Kjellstrand, Jean Mollenkamp

Children with Incarcerated Parents: A Longitudinal Study of the Effect of Parental Incarceration on Adolescent Externalizing Behaviors »

Stewart, Lisa Maureen

Dependent Care and Work-Life Outcomes: Comparing Exceptional Care and Typical Care Responsibilities »

Tvedt, Karen

The Child Care Self-Sufficiency Scale: Measuring Child Care Funding and Policy Generosity Across America »

Wuest, Leslie Grace

Factors Associated with Inclusion of Spirituality in Secular Social Work Education »

Allen, Heidi 

Up a Creek: The Perilous Journey of Recently Uninsured Low-Income Adults in Oregon »

Allen, Mary Dallas

Attributes of Effective Head Start Mental Health Consultants: A Mixed Methods Study of Rural and Urban Programs »

Cole, Diane Lyn

Staying Within the Margins: The Educational Stories of First-Generation, Low-Income College Students »

Cawood, Natalie Diane

Social Workers Addressing Student-Perpetrated Interpersonal Violence in the School Context: Awareness and Use of Evidence-Supported Programs »

Huffstutter, Katherine June

Family-Friendly Workplace Culture, Flexibility, and Workplace Support for Dependent Care: The Perspectives of Human Resource Professionals »

Kerbs, Jodi Lee

Family Participation: Exploring the Role it Plays in Outcomes for Youth with Serious Emotional Disorders »

McCormick, Andrew John

Training Social Workers in Palliative Care: Evaluation of a Self-Efficacy Model »

Morgaine, Karen Lynn

“Creative Interpretation and Fluidity in a Rights Framework”: The Intersection of Domestic Violence and Human Rights in the United States »

Sanders, Rebecca Elizabeth

Food Security and Hunger Among Low Income US Households: Relations to Federal Food Assistance Program Participation »

Schwartz, Sara Laura  

Engaging Our Workforce: How Job Demands and Resources Contribute to Social Worker Burnout, Engagement and Intent to Leave »

Zimmerman, Patricia Arlyne

Adolescent Mothers: Youth in Need of Developmentally Appropriate Services »

Block, Rebecca Gila

Is it Just Me? Felt HIV-Related Stigma Among Adults with HIV »

Ebert, Patricia

Sons Providing Care at End-of-Life: Common Threads and Nuances »

Ette, Ezekiel Umo

Transplants in the West: A Study of Settlement and Adjustment Issues Among Nigerian Immigrants in Portland, Oregon »

Patrick, William Robert

Exploring the Relationship of Anger, Sadness, and Men’s Violence »

Boland-Prom, Kimberly Wynn

Control and Social Support Variables During Pregnancy and the Development of Depressive Symptoms During the Postpartum Period »

Diehm, Thomas Michael

“That Relationship is Such an Important Piece": The Experience and Meaning of Graduate Social Work Education for Lesbian and Gay Students »

Maguire, Mary

The Environment of the Correctional Institution: An Exploratory Study of Staff Attitude and Institutional Characteristics »

Polen, Michael Robert

The Effects of Psychiatric Problem Severity on Substance Abuse Treatment Participation and Outcomes »

Sussex, Barbara Mary

Applying the Transtheoretical Model to Cigarette Smoking by Pregnant and Parenting Adolescent Females »

Cahn, Katharine Douglas Campbell

Getting There from Here: Variables Associated with the Adoption of Innovation in Public Child Welfare »

Knight, Karen Lea

Describing the Experience of Pregnant or Parenting Adolescents and Intimate Partner Abuse »

Ward, Ann Adora

Mental Health and HIV Risk Behaviors Among Homeless Youth »

Eggman, Susan Talamantes

Testimonios  from the Intersection of Mexican American Culture and an American Death »

Oschwald, Mary Martha

A Grounded Theory Study of the Processes of Resilience in Young Adults with Disabilities During their Transition into Adulthood »

Taylor, Michael Orval

Identifying and Building on Strengths of Children with Serious Emotional Disturbances »

Vegdahl, Sonja Bernice

Leaving Welfare: Stories of Struggle and Strength »

Douglas, Jane Patricia

Service Integration in HIV and Mental Health Care: Does it Predict Improved Outcomes? »

Hooper, Richard Ivan

Association Between Risk and Protective Factors and Mental Health Status of Youth in the Juvenile Justice System »

Leary, Joy DeGruy

A Dissertation on African American Male Youth Violence: “Trying to Kill the Part of You that Isn’t Loved” »

Yatchmenoff, Diane Kommers

Measuring Client Engagement in Non-Voluntary Child Protective Services »

Hunter, Richard William

Voices of Our Past: The Rank and File Movement in Social Work, 1931-1950 »

Morley, Evelyn Godbold

The Child Witness to Domestic Violence: The Relationship Among Battered Mothers’ Characteristics, Child Abuse, and Child Behavior Problems »

Ogilvie, Alice Myrth

The Assessment of Children with Attachment Disorder: The Randolph Attachment Disorder Questionnaire, the Behavioral and Emotional Rating Scale, and the Biopsychosocial Attachment Types Framework »

Ciliberti, Patricia

An Innovative Family Preservation and Support Program in an African American Community: Analysis of Six- and Twelve-Month Follow-up Data »

De Haan, Benjamin

Critical and Fatal Child Maltreatment in Oregon: Escalating Violence or Distinct Behavior? »

Long, Claudia Robin

Grandmothers Laughing: Intergenerational Transmission of Cultural Beliefs About Pregnancy and Childbirth Among Native American Women »

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• School of Social Work

Theses and Dissertations School of Social Work

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Full text for dissertations and theses included in this collection dates back to 2011. For older dissertations, check the library’s catalog CatalogUSMAI or Dissertations and Theses database .

Recent Submissions

Moving Beyond ‘A white Man’s Thing’: A Case Study of Urban Kenyan Youth Mental Health

Attitudes Toward Medical Aid in Dying in a National Sample of Hospice Clinicians

Push Factors, Moving, and Mental Health Among Older Adults: The Moderating Effects of Indicators of Social Support

Oral Histories of Black Women Advocates in the Civil Rights Era: Illuminating Perspectives of Black Healing, Wellness and Spirituality

Moving from Moral Distress to Moral Emotion: A Socioecological Model

Mindfulness, Self-Compassion, Emotion Regulation, and Parenting Stress in Mothers of Preschoolers

Exploring Child Welfare Placement Pathways to Residential Treatment Settings: A Three Paper Dissertation

Surviving High School Transfers: A Multilevel Study of Student and School Characteristics Related to School Transfer, Graduation, and College Entry

Perceived Need for Care and Mental Health Service Use: The Moderating Effect of Race/Ethnicity and Military Veteran Status among a Population-based Sample of U.S Adults

Understanding Financial Behavioral Health and Race (Racism), and their Association with Investment Risk Willingness

Time-Use and Well-Being in Family and Other Unpaid Caregivers of Older Adults

An Evaluation of the Effectiveness of Extended-Release Naltrexone

Centering Black Lives: Exploring Oral Histories of Legacy African American Women in the Black Belt to Heal the Wounds of Racialization as Justice

Examining depression and social and emotional development outcomes in parents and children in migrant and seasonal farmworker families

The Interplay of Home Visitors’ Personal and Professional Identities in Effectively Screening and Supporting Women around Sensitive Topics

Youth Worker Perspectives on Building and Maintaining Relationships with Older Adolescents and Emerging Adults in Strongport

Covariates Associated with Completing Short-Term Residential Treatment for a Substance Use Disorder Among Adults in the U.S.

Parents’ Experiences and Perspectives of Early Childhood Mental Health Services and Child Welfare

Comparing the impact of community-based mediation vs. prosecution on assault recidivism among adults

The Role of Self-efficacy, Technology Acceptance, and Support, in E-Learning for Child Welfare Workers

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• Open access
• Published: 26 August 2020

Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis

• Cassie M. Hazell   ORCID: orcid.org/0000-0001-5868-9902 1 ,
• Laura Chapman 2 ,
• Sophie F. Valeix 3 ,
• Paul Roberts 4 ,
• Jeremy E. Niven 5 &
• Clio Berry 6  

Systematic Reviews volume  9 , Article number:  197 ( 2020 ) Cite this article

14k Accesses

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Data from studies with undergraduate and postgraduate taught students suggest that they are at an increased risk of having mental health problems, compared to the general population. By contrast, the literature on doctoral researchers (DRs) is far more disparate and unclear. There is a need to bring together current findings and identify what questions still need to be answered.

We conducted a mixed methods systematic review to summarise the research on doctoral researchers’ (DRs) mental health. Our search revealed 52 articles that were included in this review.

The results of our meta-analysis found that DRs reported significantly higher stress levels compared with population norm data. Using meta-analyses and meta-synthesis techniques, we found the risk factors with the strongest evidence base were isolation and identifying as female. Social support, viewing the PhD as a process, a positive student-supervisor relationship and engaging in self-care were the most well-established protective factors.

Conclusions

We have identified a critical need for researchers to better coordinate data collection to aid future reviews and allow for clinically meaningful conclusions to be drawn.

Systematic review registration

PROSPERO registration CRD42018092867

Peer Review reports

Student mental health has become a regular feature across media outlets in the United Kingdom (UK), with frequent warnings in the media that the sector is facing a ‘mental health crisis’ [ 1 ]. These claims are largely based on the work of regulatory authorities and ‘grey’ literature. Such sources corroborate an increase in the prevalence of mental health difficulties amongst students. In 2013, 1 in 5 students reported having a mental health problem [ 2 ]. Only 3 years later, however, this figure increased to 1 in 4 [ 3 ]. In real terms, this equates to 21,435 students disclosing mental health problems in 2013 rising to 49,265 in 2017 [ 4 ]. Data from the Higher Education Statistics Agency (HESA) demonstrates a 210% increase in the number of students terminating their studies reportedly due to poor mental health [ 5 ], while the number of students dying by suicide has consistently increased in the past decade [ 6 ].

This issue is not isolated to the UK. In the United States (US), the prevalence of student mental health problems and use of counselling services has steadily risen over the past 6 years [ 7 ]. A large international survey of more than 14,000 students across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain and the United States) found that 35% of students met the diagnostic criteria for at least one common mental health condition, with highest rates found in Australia and Germany [ 8 ].

The above figures all pertain to undergraduate students. Finding equivalent information for postgraduate students is more difficult, and where available tends to combine data for postgraduate taught students and doctoral researchers (DRs; also known as PhD students or postgraduate researchers) (e.g. [ 4 ]). The latest trend analysis based on data from 36 countries suggests that approximately 2.3% of people will enrol in a PhD programme during their lifetime [ 9 ]. The countries with the highest number of DRs are the US, Germany and the UK [ 10 ]. At present, there are more than 281,360 DRs currently registered across these three countries alone [ 11 , 12 ], making them a significant part of the university population. The aim of this systematic review is to bring attention specifically to the mental health of DRs by summarising the available evidence on this issue.

Using a mixed methods approach, including meta-analysis and meta-synthesis, this review seeks to answer three research questions: (1) What is the prevalence of mental health difficulties amongst DRs? (2) What are the risk factors associated with poor mental health in DRs? And (3) what are the protective factors associated with good mental health in DRs?

Literature search

We conducted a search of the titles and abstracts of all article types within the following databases: AMED, BNI, CINAHL, Embase, HBE, HMIC, Medline, PsycInfo, PubMed, Scopus and Web of Science. The same search terms were used within all of the databases, and the search was completed on the 13th April 2018. Our search terms were selected to capture the variable terms used to describe DRs, as well as the terms used to describe mental health, mental health problems and related constructs. We also reviewed the reference lists of all the papers included in this review. Full details of the search strategy are provided in the supplementary material .

Inclusion criteria

Articles meeting the following criteria were considered eligible for inclusion: (1) the full text was available in English; (2) the article presented empirical data; (3) all study participants, or a clearly delineated sub-set, were studying at the doctoral level for a research degree (DRs or equivalent); and (4) the data collected related to mental health constructs. The last of these criteria was operationalised (a) for quantitative studies as having at least one mental health-related outcome measure, and (b) for qualitative studies as having a discussion guide that included questions related to mental health. We included university-published theses and dissertations as these are subjected to a minimum level of peer-review by examiners.

Exclusion criteria

In order to reduce heterogeneity and focus the review on doctoral research as opposed to practice-based training, we excluded articles where participants were studying at the doctoral level, but their training did not focus on research (e.g. PsyD doctorate in Clinical Psychology).

Screening articles

Papers were screened by one of the present authors at the level of title, then abstract, and finally at full text (Fig. 1 ). Duplicates were removed after screening at abstract. At each level of screening, a random 20% sub-set of articles were double screened by another author, and levels of agreement were calculated (Cohen’s kappa [ 13 ]). Where disagreements occurred between authors, a third author was consulted to decide whether the paper should or should not be included. All kappa values evidence at least moderate agreement between authors [ 14 ]—see Fig. 1 for exact kappa values.

PRISMA diagram of literature review process

Data extraction

This review reports on both quantitative and qualitative findings, and separate extraction methods were used for each. Data extraction was performed by authors CH, CB, SV and LC.

Quantitative data extraction

The articles in this review used varying methods and measures. To accommodate this heterogeneity, multiple approaches were used to extract quantitative data. Where available, we extracted (a) descriptive statistics, (b) correlations and (c) a list of key findings. For all mental health outcome measures, we extracted the means and standard deviations for the DR participants, and where available for the control group (descriptive statistics). For studies utilising a within-subjects study design, we extracted data where a mental health outcome measure was correlated with another construct (correlations). Finally, to ensure that we did not lose important findings that did not use descriptive statistics or correlations, we extracted the key findings from the results sections of each paper (list of key findings). Key findings were identified as any type of statistical analysis that included at least one mental health outcome.

Qualitative data extraction

In line with the meta-ethnographic method [ 15 ] and our interest in the empirical data as well as the authors’ interpretations thereof, i.e. the findings of each article [ 16 ], the data extracted from the articles comprised both results/findings and discussion/conclusion sections. For articles reporting qualitative findings, we extracted the results and discussion sections from articles verbatim. Where articles used mixed methods, only the qualitative section of the results was extracted. Methodological and setting details from each article were also extracted and provided (see Appendix A) in order to contextualise the studies.

Data analysis

Quantitative data analysis, descriptive statistics.

We present frequencies and percentages of the constructs measured, the tools used and whether basic descriptive statistics ( M and SD ) were reported. The full data file is available from the first author upon request.

Effect sizes

Where studies had a control group, we calculated a between-group effect size (Cohen’s d ) using the formula reported by Wilson [ 17 ], and interpreted using the standard criteria [ 13 ]. For all other studies, we sought to compare results with normative data where the following criteria were satisfied: (a) at least three studies reported data using the same mental health assessment tool; (b) empirical normative data were available; and (c) the scale mean/total had been calculated following original authors’ instructions. Only the Perceived Stress Scale (PSS) 10- [ 18 ] and 14-item versions [ 19 ] met these criteria. Normative data were available from a sample of adults living in the United States: collected in 2009 for the 10-item version ( n = 2000; M = 15.21; SD = 7.28) [ 20 ] and in 1983 for the 14-item version ( n = 2355; M = 19.62; SD = 7.49) [ 18 ].

The meta-analysis of PSS data was conducted using MedCalc [ 21 ], and based on a random effects model, as recommended by [ 22 ]. The between-group effect sizes (DRs versus US norms) were calculated comparing PSS means and standard deviations in the respective groups. The effect sizes were weighted using the variable variances [ 23 ].

Correlations

Where at least three studies reported data reflecting a bivariate association between a mental health and another variable, we summarised this data into a meta-analysis using the reported r coefficients and sample sizes. Again, we used MedCalc [ 21 ] to conduct the analysis using a random effects model, based on the procedure outlined by Borenstein, Hedges, Higgins and Rothstein [ 24 ]. This analysis approach involves converting correlation coefficients into Fisher’s z values [ 25 ], calculating the summary of Fisher’s z , and then converting this to a summary correlation coefficient ( r ). The effect sizes were weighted in line with the Hedges and Ollkin [ 23 ] method. Heterogeneity was assessed using the Q statistic, and I 2 value—both were interpreted according to the GRADE criteria [ 26 ]. Where correlations could not be summarised within a meta-analysis, we have reported these descriptively.

Due to the heterogenous nature of the studies, the above methods could not capture all of the quantitative data. Therefore, additional data (e.g. frequencies, statistical tests) reported in the identified articles was collated into a single document, coded as relating to prevalence, risk or protective factors and reported as a narrative review.

Qualitative data analysis

We used thematic analytic methods to analyse the qualitative data. We followed the thematic synthesis method [ 16 , 27 ] and were informed by a thematic analysis approach [ 28 , 29 ]. We took a critical realist epistemological stance [ 30 , 31 ] and aimed to bring together an analysis reflecting meaningful patterns amongst the data [ 29 ] or demi-regularities, and identifying potential social mechanisms that might influence the experience of such phenomena [ 31 ]. The focus of the meta-synthesis is interpretative rather than aggregative [ 32 ].

Coding was line by line, open and complete. Following line-by-line coding of all articles, a thematic map was created. Codes were entered on an article-by-article basis and then grouped and re-grouped into meaningful patterns. Comparisons were made across studies to attempt to identify demi-regularities or patterns and contradictions or points of departure. The thematic map was reviewed in consultation with other authors to inductively create and refine themes. Thematic summaries were created and brought together into a first draft of the thematic structure. At this point, each theme was compared against the line-by-line codes and the original articles in order to check its fit and to populate the written account with illustrative quotations.

Research rigour

The qualitative analysis was informed by independent coding by authors CB and SV, and analytic discussions with CH, SV and LC. Our objective was not to capture or achieve inter-rater reliability, rather the analysis was strengthened through involvement of authors from diverse backgrounds including past and recent PhD completion, experiences of mental health problems during PhD completion, PhD supervision experience, experience as employees in a UK university doctoral school and different nationalities. In order to enhance reflexivity, CB used a journal throughout the analytic process to help notice and bracket personal reflections on the data and the ways in which these personal reflections might impact on the interpretation [ 29 , 33 ]. The ENTREQ checklist [ 34 ] was consulted in the preparation of this report to improve the quality of reporting.

Quality assessment

Quantitative data.

The quality of the quantitative papers was assessed using the STROBE combined checklist [ 35 ]. A random 20% sub-sample of these studies were double-coded and inter-rater agreement was 0.70, indicating ‘substantial’ agreement [ 14 ]. The maximum possible quality score was 23, with a higher score indicating greater quality, with the mean average of 15.97, and a range from 0 to 22. The most frequently low-scoring criteria were incomplete reporting regarding the management of missing data, and lack of reported efforts to address potential causes of bias.

Qualitative data

There appeared to be no discernible pattern in the perceived quality of studies; the highest [ 36 , 37 , 38 , 39 , 40 ] and lowest scoring [ 41 , 42 , 43 , 44 , 45 , 46 ] studies reflected both theses and journal publications, a variety of locations and settings and different methodologies. The most frequent low-scoring criteria were relating to the authors’ positions and reflections thereof (i.e. ‘Qualitative approach and research paradigm’, ‘Researcher characteristics and reflexivity’, ‘Techniques to enhance trustworthiness’, ‘Limitations’, ‘Conflict of interest and Funding’). Discussions of ethical issues and approval processes was also frequently absent. We identified that we foregrounded higher quality studies in our synthesis in that these studies appeared to have greater contributions reflected in the shape and content of the themes developed and were more likely to be the sources of the selected illustrative quotes.

Mixed methods approach

The goal of this review is to answer the review questions by synthesising the findings from both quantitative and/or qualitative studies. To achieve our goal, we adopted an integrated approach [ 47 ], whereby we used both quantitative and qualitative methods to answer the same review question, and draw a synthesised conclusion. Different analysis approaches were used for the quantitative and qualitative data and are therefore initially reported separately within the methods. A separate synthesised summary of the findings is then provided.

Overview of literature

Of the 52 papers included in this review (Table 1 ), 7 were qualitative, 29 were quantitative and 16 mixed methods. Most articles (35) were peer-reviewed papers, and the minority were theses (17). Only four of the articles included a control group; in three instances comprising students (but not DRs) and in the other drawn from the general population.

Quantitative results

Thirty-five papers reported quantitative data, providing 52 reported sets of mental health related data (an average of 1.49 measures per study): 24 (68.57%) measured stress, 10 (28.57%) anxiety, 9 (25.71%) general wellbeing, 5 (14.29%) social support, 3 (8.57%) depression and 1 (2.86%) self-esteem. Five studies (9.62%) used an unvalidated scale created for the purposes of the study. Fifteen studies (28.85%) did not report descriptive statistics.

Of the four studies that included a control group, only two of these reported descriptive statistics for both groups on a mental health outcome [ 66 , 69 ]. There is a small (Cohen’s d = 0.27) and large between-group effect (Cohen’s d = 1.15) when DRs were compared to undergraduate and postgraduate clinical psychology students respectively in terms of self-reported stress.

The meta-analysis of DR scores on the PSS (both 10- and 14-item versions) compared to population normative data produced a large and significant between-group effect size ( d = 1.12, 95% CI [0.52, 1.73]) in favour of DRs scoring higher on the PSS than the general population (Fig. 2 ), suggesting DRs experience significantly elevated stress. However, these findings should be interpreted in light of the significant between-study heterogeneity that can be classified as ‘considerable’ [ 26 ].

A meta-analysis of between-group effect sizes (Cohen’s d ) comparing PSS scores (both 10- and 14-item versions) from DRs and normative population data. *Studies using the 14 item version of the PSS; a positive effect size indicates DRs had a higher score on the PSS; a negative effect size indicates that the normative data produced a higher score on the PSS; black diamond = total effect size (based on random effects model); d = Cohen’s d ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

To explore this heterogeneity, we re-ran the meta-analysis separately for the 10- and 14-item versions. The effect size remained large and significant when looking only at the studies using the 14-item version ( k = 6; d = 1.41, 95% CI [0.63, 2.19]), but was reduced and no longer significant when looking at the 10-item version only ( k = 3; d = 0.57, 95% CI [− 0.51, 1.64]). However, both effect sizes were still marred by significant heterogeneity between studies (10-item: Q = 232.02, p < .001; 14-item: Q = 356.76, p < .001).

Studies reported sufficient correlations for two separate meta-analyses; the first assessing the relationship between stress (PSS [ 18 , 19 ]) and perceived support, and the second between stress (PSS) and academic performance.

Stress x support

We included all measures related to support irrespective of whom that support came from (e.g. partner support, peer support, mentor support). The overall effect size suggests a small and significant negative correlation between stress and support ( r = − .24, 95% CI [− 0.34, − 0.13]) (see Fig. 3 ), meaning that low support is associated with greater perceived stress. However, the results should be interpreted in light of the significant heterogeneity between studies. The I 2 value quantifies this heterogeneity as almost 90% of the variance being explained by between-study heterogeneity, which is classified as ‘substantial’ (26).

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and perceived support. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Stress x performance

The overall effect size suggests that there is no relationship between stress and performance in their studies ( r = − .07, 95% CI [− 0.19, 0.05]) (see Fig. 4 ), meaning that DRs perception of their progress was not associated with their perceived stress This finding suggests that the amount of progress that DRs were making during their studies was not associated with stress levels.

Forest plot and meta-analysis of correlation coefficients testing the relationship between stress and performance. Black diamond = total effect size (based on random effects model); r = Pearson’s r ; Q = heterogeneity; Z = z score; I 2 = proportion of variance due to between-study heterogeneity; p = exact p value

Other correlations

Correlations reported in less than three studies are summarised in Fig. 5 . Again, stress was the most commonly tested mental health variable. Self-care and positive feelings towards the thesis were consistently found to negatively correlate with mental health constructs. Negative writing habits (e.g. perfectionism, blocks and procrastination) were consistently found to positively correlate with mental health constructs. The strongest correlations were found between stress, and health related quality of life ( r = − .62) or neuroticism ( r = .59), meaning that lower stress was associated with greater quality of life and reduced neuroticism. The weakest relationships ( r < .10) were found between mental health outcomes and: faculty concern, writing as knowledge transformation, innate writing ability (stress and anxiety), years married, locus of control, number of children and openness (stress only).

Correlation coefficients testing the relationship between a mental health outcome and other construct. Correlation coefficients are given in brackets ( r ); * p < .05; each correlation coefficient reflects the results from a single study

Several studies reported DR mental health problem prevalence and this ranged from 36.30% [ 54 ] to 55.9% [ 67 ]. Using clinical cut-offs, 32% were experiencing a common psychiatric disorder [ 64 ]; with another study finding that 53.7% met the questionnaire cut-off criteria for depression, and 41.9% for anxiety [ 67 ]. One study compared prevalence amongst DRs and the general population, employees and other higher education students; in all instances, DRs had higher levels of psychological distress (non-clinical), and met criteria for a clinical psychiatric disorder more frequently [ 64 ].

Risk factors

Demographics Two studies reported no significant difference between males and females in terms of reported stress [ 57 , 73 ], but the majority suggested female DRs report greater clinical [ 80 ], and non-clinical problems with their mental health [ 37 , 64 , 79 , 83 , 89 ].

Several studies explored how mental health difficulties differed in relation to demographic variables other than gender, suggesting that being single or not having children was associated with poorer mental health [ 64 ] as was a lower socioeconomic status [ 71 ]. One study found that mental health difficulties did not differ depending on DRs’ ethnicity [ 51 ], but another found that Black students attending ‘historically Black universities’ were significantly more anxious [ 87 ]. The majority of the studies were conducted in the US, but only one study tested for cross-cultural differences: reporting that DRs in France were more psychologically distressed than those studying in the UK [ 67 ].

Work-life balance Year of study did not appear to be associated with greater subjective stress in a study involving clinical psychology DRs (Platt and Schaefer [ 75 ]), although other studies suggested greater stress reported by those in the latter part of their studies [ 89 ], who viewed their studies as a burden [ 81 ], or had external contracts, i.e. not employed by their university [ 85 ]. Regression analyses revealed that a common predictor of poor mental health was uncertainty in DR studies; whether in relation to uncertain funding [ 64 ] or uncertain progress [ 80 ]. More than two-thirds of DRs reported general academic pressure as a cause of stress, and a lack of time as preventing them from looking after themselves [ 58 ]. Being isolated was also a strong predictor of stress [ 84 ].

Protective factors

DRs who more strongly endorsed all of the five-factor personality traits (openness, conscientiousness, extraversion, agreeableness and neuroticism) [ 66 ], self-reported higher academic achievement [ 40 ] and viewed their studies as a learning process (rather than a means to an end) [ 82 ] reported fewer mental health problems. DRs were able to mitigate poor mental health by engaging in self-care [ 72 ], having a supervisor with an inspirational leadership style [ 64 ] and building coping strategies [ 56 ]. The most frequently reported coping strategy was seeking support from other people [ 37 , 58 ].

Qualitative results

Meta-synthesis.

Four higher-order themes were identified: (1) Always alone in the struggle, (2) Death of personhood, (3) The system is sick and (4) Seeing, being and becoming. The first two themes reflect individual risk/vulnerability factors and the processes implicated in the experience of mental distress, the third represents systemic risk and vulnerability factors and the final theme reflects individual and systemic protective mechanisms and transformative influences. See Table 2 for details of the full thematic structure with illustrative quotes.

Always alone in the struggle

‘Always alone in the struggle’ reflects the isolated nature of the PhD experience. Two subthemes reflect different aspects of being alone; ‘Invisible, isolated and abandoned’ represents DRs’ sense of physical and psychological separation from others and ‘It’s not you, it’s me’ represents DRs’ sense of being solely responsible for their PhD process and experience.

Invisible, isolated and abandoned

Feeling invisible and isolated both within and outside of the academic environment appears a core DR experience [ 39 , 43 , 81 ]. Isolation from academic peers seemed especially salient for DRs with less of a physical presence on campus, e.g. part-time and distance students, those engaging in extensive fieldwork, outside employment and those with no peer research or lab group [ 36 , 52 , 68 ]. Where DRs reported relationships with DR peers, these were characterised as low quality or ‘not proper friendships’ and this appeared linked to a sense of essential and obvious competition amongst DRs with respect to current and future resources, support and opportunities [ 39 ], in which a minority of individuals were seen to receive the majority share [ 36 , 74 ]. Intimate sharing with peers thus appeared to feel unsafe. This reflected the competitive environment but also a sense of peer relationships being predicated on too shared an experience [ 39 ].

In addition to poor peer relations, a mismatch between the expected and observed depth of supervisor interest, engagement and was evident [ 40 , 81 ]. This mismatch was clearly associated with disappointment and anger, and a sense of abandonment, which appeared to impact negatively on DR mental health and wellbeing [ 42 ] (p. 182). Moreover, DRs perceived academic departments as complicit in their isolation; failing to offer adequate opportunities for academic and social belonging and connections [ 42 , 81 ] and including PGRs only in a fleeting or ‘hollow’ sense [ 37 ]. DRs identified this isolation as sending a broader message about academia as a solitary and unsupported pursuit; a message that could lead some DRs to self-select out of planning for future in academia [ 37 , 42 ]. DRs appeared to make sense of their lack of belonging in their department as related to their sense of being different, and that this difference might suggest they did not ‘fit in’ with academia more broadly [ 74 ]. In the short-term, DRs might expend more effort to try and achieve a social and/or professional connection and equitable access to support, opportunities and resources [ 74 ]. However, over the longer-term, the continuing perception of being professionally ‘other’ also seemed to undermine DRs’ sense of meaning and purpose [ 81 ] and could lead to opting out of an academic career [ 62 , 74 ].

Isolation within the PhD was compounded by isolation from one’s personal relationships. This personal isolation was first physical, in which the laborious nature of the PhD acted as a catalyst for the breakdown of pre-existing relationships [ 76 ]. Moreover, DRs also experienced a sense of psychological detachment [ 45 , 74 ]. Thus, the experience of isolation appeared to be extremely pervasive, with DRs feeling excluded and isolated physically and psychologically and across both their professional and personal lives.

It’s not you, it’s me

‘It’s not you, it’s me’ reflects DRs’ perfectionism as a central challenge of their PhD experience and a contributor to their sense of psychological isolation from other people. DRs’ perfectionism manifested in four key ways; firstly, in the overwhelming sense of responsibility experienced by DRs; secondly, in the tendency to position themselves as inadequate and inferior; thirdly, in cycles of perfectionist paralysis; and finally, in the tendency to find evidence which confirms their assumed inferiority.

DRs positioned themselves as solely responsible for their PhD and for the creation of a positive relationship with their supervisor [ 36 , 52 , 81 ]. DRs expressed a perceived need to capture their supervisors’ interest and attention [ 36 , 52 , 74 ], feeling that they needed to identify and sell to their supervisors some shared characteristic or interest in order to scaffold a meaningful relationship. DRs appeared to feel it necessary to assume sole responsibility for their personal lives and to prohibit any intrusion of the personal in to the professional, even in incredibly distressing circumstances [ 42 ].

DRs appeared to compare themselves against an ideal or archetypal DR and this comparison was typically unfavourable [ 37 ], with DRs contrasting the expected ideal self with their actual imperfect and fallible self [ 37 , 42 , 52 ]. DRs’ sense of inadequacy appeared acutely and frequently reflected back to them by supervisors in the form of negative or seemingly disdainful feedback and interactions [ 41 , 76 ]. DRs framed negative supervisor responses as a cue to work harder, meaning they were continually striving, but never reaching, the DR ideal [ 76 ]. This ideal-actual self-discrepancy was associated with a tendency towards punitive self-talk with clear negative valence [ 38 ].

DRs appear to commonly use self-castigation as a necessary (albeit insufficient) means to motivate themselves to improve their performance in line with perfectionistic standards [ 38 , 41 ]. The oscillation between expectation and actuality ultimately resulted in increased stress and anxiety and reduced enjoyment and motivation. Low motivation and enjoyment appeared to cause procrastination and avoidance, which lead to a greater discrepancy between the ideal and actual self; in turn, this caused more stress and anxiety and further reduced enjoyment and motivation leading to a sense of stuckness [ 76 ].

The internalisation of perceived failure was such that DRs appeared to make sense of their place, progress and possible futures through a lens of inferiority, for example, positioning themselves as less talented and successful compared to their peers [ 37 ]. Thus, instances such as not being offered a job, not receiving funding, not feeling connected to supervisors, feeling excluded by academics and peers were all made sense of in relation to DRs’ perceived relative inadequacy [ 36 ].

Death of personhood

The higher-order theme ‘Death of personhood’ reflects DRs’ identity conflict during the PhD process; a sense that DRs’ engage in a ‘Sacrifice of personal identity’ in which they feel they must give up their pre-existing self-identity, begin to conceive of themselves as purely ‘takers’ personally and professionally, thus experiencing the ‘Self as parasitic’, and ultimately experience a ‘Death of self-agency’ in relation to the thesis, the supervisor and other life roles and activities.

A sacrifice of personal identity

The sacrifice of personal identity first manifests as an enmeshment with the PhD and consequent diminishment of other roles, relationships and activities that once were integral to the DRs’ sense of self [ 59 , 76 ]. DRs tended to prioritise PhD activities to the extent that they engaged in behaviours that were potentially damaging to their personal relationships [ 76 ]. DRs reported a sense of never being truly free; almost physically burdened by the weight of their PhD and carrying with them a constant ambient guilt [ 37 , 38 , 44 , 76 ]. Time spent on non-PhD activities was positioned as selfish or indulgent, even very basic activities of living [ 76 ].

The seeming incompatibility of aspects of prior personal identity and the PhD appears to result in a sense of internal conflict or identity ‘collision’ [ 59 ]. Friends and relatives often provided an uncomfortable reflection of the DR’s changing identity, leaving DRs feeling hyper-visible and carrying the burden of intellect or trailblazer status [ 74 ]; providing further evidence for the incompatibility of their personal and current and future professional identities. Some DRs more purposefully pruned their relationships and social activities; to avoid identity dissonance, to conserve precious time and energy for their PhD work, or as an acceptance of total enmeshment with academic work as necessary (although not necessarily sufficient) for successful continuation in academia [ 40 , 52 , 77 ]. Nevertheless, the diminishment of the personal identity did not appear balanced by the development of a positive professional identity. The professional DR identity was perceived as unclear and confusing, and the adoption of an academic identity appeared to require DRs to have a greater degree of self-assurance or self-belief than was often the case [ 37 , 81 ].

Self as parasitic

Another change in identity manifested as DRs beginning to conceive of themselves as parasitic. DRs spoke of becoming ‘takers’, feeling that they were unable to provide or give anything to anyone. For some DRs, being ‘parasitic’ reflected them being on the bottom rung of the professional ladder or the ‘bottom of the pile’; thus, professionally only able to receive support and assistance rather than to provide for others. Other DRs reported more purposefully withdrawing from activities in which they were a ‘giver’, for example voluntary work, as providing or caring for others required time or energy that they no longer had [ 38 , 44 ]. Furthermore, DRs appeared to conceive of themselves as also causing difficulty or harm to others [ 81 ], as problems in relation to their PhD could lead them to unwillingly punishing close others, for example, through reducing the duration or quality of time spent together [ 38 ].

Feeling that close others were offering support appeared to heighten the awareness of the toll of the PhD on the individual and their close relationships, emphasising the huge undertaking and the often seemingly slow progress, and actually contributing to the sense of ambient guilt, shame, anger and failure [ 38 ]. Moreover, DRs spoke of feeling extreme guilt in perceiving that they had possibly sacrificed their own, and possibly family members’, current wellbeing and future financial security [ 49 ].

Death of self-agency

In addition to their sense of having to sacrifice their personal identity, DRs also expressed a loss of their sense of themselves as agentic beings. DRs expressed feeling powerless in various domains of their lives. First, DRs positioned the thesis as a powerful force able to overwhelm or swallow them [ 46 , 52 , 59 ]. Secondly, DRs expressed a sense of futility in trying to retain any sense of personal power in the climate of academia. An acute feeling of powerlessness especially in relation to supervisors was evident, with many examples provided of being treated as means to an end, as opposed to ends in themselves [ 39 , 42 , 62 ]. Supervisors did not interact with DRs in a holistic way that recognised their personhood and instead were perceived as prioritising their own will, or the will of other academics, above that of the DR [ 39 , 62 ].

Furthermore, DRs reported feeling as if they were used as a means for research production or furthering their supervisors’ reputations or careers [ 62 ]. DRs perceived that holding on to a sense of personal agency sometimes felt incompatible with having a positive supervisor relationship [ 42 ]. Thus whilst emotional distress, anger, disappointment, sadness, jealousy and resentment were clearly evident in relation to feeling excluded, used or over-powered by supervisors [ 37 , 42 , 52 , 62 ], DRs usually felt unable to change supervisor irrespective of how seriously this relationship had degraded [ 37 , 62 ]. Instead, DRs appeared to take on a position of resignation or defensive pessimism, in which they perceived their supervisors as thwarting their personhood, personal goals and preferences, but typically felt compelled to accept this as the status quo and focus on finishing their PhDs [ 42 ]. DRs resignation was such that they internalised this culture of silence and silenced themselves; tending to share litanies of problems with supervisors whilst prefacing or ending the statements with some contradictory or undermining phrase such as ‘but that’s okay’ [ 42 , 52 ].

The apparent lack of self-agency extended outward from the PhD into DRs not feeling able to curate positive life circumstances more generally [ 76 ]. A lack of time was perhaps the key struggle across both personal and professional domains, yet DRs paradoxically reported spending a lot of time procrastinating and rarely (if ever) mentioned time management as a necessary or desired coping strategy for the problem of having too little time [ 46 ]. The lack of self-agency was not only current but also felt in reference to a bleak and uncertain future; DRs lack of surety in a future in academia and the resultant sense of futility further undermined their motivation to engage currently with PhD tasks [ 38 , 40 ].

The system is sick

The higher-order theme ‘The system is sick’ represents systemic influences on DR mental health. First, ‘Most everyone’s mad here’ reflects the perceived ubiquity mental health problems amongst DRs. ‘Emperor’s new clothes’ reflects the DR experience of engaging in a performative piece in which they attempt to live in accordance with systemic rather than personal values. Finally, ‘Beware the invisible and visible walls’ reflects concerns with being caught between ephemeral but very real institutional divides.

Most everyone’s mad here

No studies focused explicitly on experiences of DRs who had been given diagnoses of mental health problems. Some study participants self-disclosed mental health problems and emphasised their pervasive impact [ 50 ]. Further lived experiences of mental distress in the absence of explicit disclosure were also clearly identifiable. The ‘typical’ presentation of DRs with respect to mental health appeared characterised as almost unanimous [ 39 ] accounts of chronic stress, anxiety and depression, emotional distress including frustration, anger and irritability, lack of mental and physical energy, somatic problems including appetite problems, headaches, physical pain, nausea and problems with drug and alcohol abuse [ 39 , 46 , 59 , 76 ]. Health anxiety, concerns regarding perceived new and unusual bodily sensations and perceived risks of developing stress-related illnesses were also common [ 46 , 59 , 76 ]. A PhD-specific numbness and hypervigilance was also reported, in which DRs might be less responsive to personal life stressors but develop an extreme sensitivity and reactivity to PhD-relevant stimuli [ 39 ].

An interplay of trait and state factors were suggested to underlie the perceived ubiquity of mental health problems amongst DRs. Etiological factors associated with undertaking a PhD specifically included the high workload, high academic standards, competing personal and professional demands, social isolation, poor resources in the university, poor living conditions and poverty, future and career uncertainty [ 36 , 41 , 43 , 46 , 49 , 76 ]. The ‘nexus’ of these factors was such that the PhD itself acted as a crucible; a process of such intensity that developing mental health problems was perhaps inevitable [ 39 ].

The perceived inevitability of mental health problems was such that DRs described people who did not experience mental health problems during a PhD as ‘lucky’ [ 39 ]. Supervisors and the wider academic system were seen to promote an expectation of suffering, for example, with academics reportedly normalising drug and alcohol problems and encouraging unhealthy working practices [ 39 ]. Furthermore, DRs felt that academics were uncaring with respect to the mental challenge of doing a PhD [ 39 ]. Nevertheless, academics were suggested to deny any culpability or accountability for mental health problems amongst DRs [ 39 , 59 , 74 ]. The cycle of indigenousness was further maintained by a lack of mental health literacy and issues with awareness, availability and access to help-seeking and treatment options amongst DRs and academics more widely [ 39 ]. Thus, DRs appeared to feel they were being let down by a system that was almost set up to cause mental distress, but within which there was a widespread denial of the size and scope of the problem and little effort put into identifying and providing solutions [ 39 , 59 ]. DRs ultimately felt that the systemic encouragement of unhealthy lifestyles in pursuit of academic success was tantamount to abuse [ 62 ].

A performance of optimum suffering

Against a backdrop of expected mental distress, DRs expressed their PhD as a performative piece. DRs first had to show just the right amount of struggle and difficulty; feeling that if they did not exhibit enough stress, distress and ill-health, their supervisors or the wider department might not believe they were taking their PhD seriously enough [ 40 ]. At the same time, DRs felt that their ‘researcher mettle’ was constantly being tested and they must rise to this challenge. This included first guarding against presenting oneself as intellectually inferior [ 36 ]. Yet it also seemed imperative not to show vulnerability more broadly [ 74 ]. Disclosing mental or physical health problems might lead not only to changed perceptions of the DR but to material disadvantage [ 74 ]. The poor response to mental health disclosures suggested to some DRs that universities might be purposefully trying to dissuade or discourage DRs with mental health problems or learning disabilities from continuing [ 74 ]. The performative piece is thus multi-layered, in that DRs must experience extreme internal psychological struggles, exhibit some lower-level signs of stress and fatigue for peer and faculty observance, yet avoid expressing any real academic or interpersonal weakness or the disclosure of any diagnosable disability or disease.

Emperor’s new clothes

DRs described feeling beholden to the prevailing culture in which it was expected to prioritise above all else developing into a competitive, self-promoting researcher in a high-performing research-active institution [ 39 , 42 ]. Supervisors often appeared the conduit for transmission of this academic ideal [ 74 ]. DRs felt reticent to act in any way which suggested that they did not personally value the pursuit of a leading research career above all else. For example, DRs felt that valuing teaching was non-conformist and could endanger their continuing success within their current institution [ 55 ]. Many DRs thus exhibited a sense of dissonance as their personal values often did not align with the institutional values they identified [ 74 ]. Yet DRs expressed a sense of powerlessness and a feeling of being ‘caught up’ in the values of the institution even when such values were personally incongruent [ 74 ]. The psychological toll of this sense of inauthenticity seemed high [ 55 ]. Where DRs acted in ways which ostensibly suggested values other than prioritising a research career, for example becoming pregnant, they sensed disapproval [ 76 ]. DRs also felt unable to challenge other ‘institutional myths’ for example, the perceived institutional denial of the duration of and financial struggle involved in completing a PhD [ 49 ]. There was a perceived tendency of academics to locate problems within DRs as opposed to acknowledging institutional or systemic inequalities [ 49 ]. DRs expressed strongly a sense in which there is inequity in support, resources and opportunities, yet universities were perceived as ignoring such inequity or labelling such divisions as based on meritocracy [ 36 , 74 ].

Beware the invisible and visible walls

DRs described the reality of working in academia as needing to negotiate a maze of invisible and visible walls. In the former case, ‘invisible walls’ reflect ephemeral norms and rules that govern academia. DRs felt that a big part of their continuing success rested upon being able to negotiate such rules [ 39 ]. Where rules were violated and explicit or implicit conflicts occurred, DRs were seen to be vulnerable to being caught in the ‘crossfire’ [ 36 ]. DRs identified academic groups and departments as being poor in explicitly identifying, discussing and resolving conflicts [ 37 ]. The intangibility of the ‘invisible walls’ gave rise to a sense of ambient anxiety about inadvertently transgressing norms and divides, such that some DRs reported behaving in ways that surprised even themselves [ 37 ].

Gendered and racial micropolitics of academic institutions were seen to manifest as more visible walls between people, with institutions privileging those with ‘insider’ status [ 36 ]. Women and people of colour typically felt excluded or disadvantaged in a myriad of observable and unobservable ways, with individuals able to experience both insider and outsider statuses simultaneously [ 36 , 37 ], for example when a male person of colour [ 36 ]. Female DRs suggested that not only must women prove themselves to a greater extent than men to receive equal access to resources, opportunities and acclaim but also are typically under additional pressure in both their professional and personal lives [ 37 , 52 , 76 ]. Women also felt that they had to take on more additional roles and responsibilities and encountered more conflicts in their personal lives compared to men [ 52 ]. Examples of professionally successful women in DRs’ departments were described as those who had crossed the divide and adopted a more traditionally male role [ 40 ]. Thus, being female or non-White were considered visible characteristics that would disadvantage people in the competitive academic environment and could give rise to a feeling of increased stress, pressure, role conflicts, and a feeling of being unsafe.

Seeing, being and becoming

The higher-order theme of ‘Seeing, being and becoming’ reflects protective and transformative influences on DR mental health. ‘De-programming’ refers to the DRs disentangling their personal beliefs and values from systemic values and also from their own tendency towards perfectionism. ‘The power of being seen’ reflects the positive impact on DR mental health afforded by feeling visible to personal and professional others. ‘Finding hope, meaning and authenticity’ refers to processes by which DRs can find or re-locate their own self-agency, purpose and re/establish a sense of living in accordance with their values. ‘The importance of multiple goals, roles and groups’ represents the beneficial aspects of accruing and sustaining multiple aspects to one’s identity and connections with others and activities outside the PhD. Finally, ‘The PhD as a process of transcendence’ reflects how the struggles involved in completing a PhD can be transformative and self-actualising.

De-programming

DRs reported being able to protect their mental health by ‘de-programming’ and disentangling their attitudes and practices from social and systemic values and norms. This disentangling helped negate DRs’ adopting unhealthy working practices and offered some protection against experiencing inauthenticity and dissonance between personal and systemic values.

First, DRs spoke of rejecting the belief that they should sacrifice or neglect personal relationships, outside interests and their self-identity in pursuit of academic achievement. DRs could opt-out entirely by choosing a ‘user-friendly’ programme [ 44 ] which encouraged balance between personal and professional goals, or else could psychologically reject the prevailing institutional discourse [ 40 ]. Rather than halting success, de-programming from the prioritisation of academia above all else was seen to be associated not only with reduced stress but greater confidence, career commitment and motivation [ 40 , 50 ]. It was also suggested possible to ‘de-programme’ in the sense of choosing not to be preoccupied by the ‘invisible walls’ of academia and psychologically ‘opt out’ of being concerned by potential conflicts, norms and rules governing academic workplace conduct [ 36 ]. Interaction with people outside of academia was seen to scaffold de-programming, by helping DRs to stay ‘grounded’ and offering a model what ‘normal’ life looks like. People outside of academia could also help DRs to see the truth by providing unbiased opinions regarding systemic practices [ 39 ].

A further way in which de-programming manifested was in DRs challenging their perfectionist beliefs. This include re-framing the goal as not trying to be the archetype of a perfect DR, and accepting that multiple demands placed on one individual invariably requires compromise [ 40 , 76 ]. DRs spoke of the need to conceptualise the PhD as a process, rather than just a product [ 46 , 82 ]. The process orientation facilitated framing of the PhD as just one-step in the broader process of becoming an academic as opposed to providing discrete evidence of worth [ 82 ]. Within this perspective, uncertainty itself could be conceived as a privilege [ 81 ]. The PhD was then seen as an opportunity rather than a test [ 37 , 46 ]. Moreover, the process orientation facilitated viewing the PhD as a means of growing into a contributing member of the research community, as opposed to needing to prove oneself to be accepted [ 82 ]. Remembering the temporary nature of the PhD was advised [ 45 ] as was holding on to a sense that not completing the PhD was also a viable life choice [ 76 ]. DRs also expressed, implicitly or explicitly, a decision to change their conceptualisation of themselves and their progress; choosing not to perceive themselves as stuck, but planning, learning and progressing [ 38 , 39 , 81 , 82 ]. This new perspective appeared to be helpful in reducing mental distress.

The power of being seen

DRs described powerful benefits to feeling seen by other people, including a sense of belonging and mattering, increased self-confidence and a sense of positive progress [ 37 ]. Being seen by others seems to provoke the genesis of an academic identity; it brings DRs into existence as academics. Being seen within the academic institution also supports mental health and can buffer emotional exhaustion [ 37 , 52 , 55 , 81 ]. DRs expressed a need to feel that supervisors, academics and peers were interested in them as people, their values, goals, struggles and successes; yet they also needed to feel that they and their research mattered and made a difference within and outside of the institution [ 42 , 52 , 81 ]. It was clear that DRs could find in their disciplinary communities the sense of belonging that often eluded them within their immediate departments [ 42 ]. Feeling a sense of belonging to the academic community seemed to buffer disengagement and amotivation during the PhD [ 81 ]. Positive engagement with the broader community was scaffolded by a sense of trust in the supervisor [ 81 ]. DRs often felt seen and supported by postdocs, especially where supervisors appeared absent or unsupportive [ 50 ].

Spending time with peers could be beneficial when there was a sense of shared experience and walking alongside each other [ 39 ]. Friendship was seen to buffer stress and protect against mental health problems through the provision of social and emotional support and help in identifying struggles [ 39 , 43 ]. In addition to relational aspects, the provision of designated physical spaces on campus or in university buildings also seemed important to being seen [ 37 ]. Peers in the university could provide DRs with further physical embodiments of being seen, for example, gift-giving in response to their birthdays or returning from leave [ 37 , 50 ]. Outside of the academic institution, DRs described how being seen by close others could support DRs to be their authentic selves, providing an antidote to the invisible walls of academia [ 50 ]. Good quality friendships within or outside academia could be life-changing, providing a visceral sense of connection, belonging and authenticity that can scaffold positive mental health outcomes during the PhD [ 39 ]. Pets could also serve to help DRs feel seen but without needing to extend too much energy into maintaining social relationships [ 50 ].

Finally, DRs also needed to see themselves, i.e. to begin to see themselves as burgeoning academics as opposed to ‘just students’ [ 81 ]. Feeling that the supervisor and broader academic community were supportive, developing one’s own network of process collaborators and successfully obtaining grant funding seemed tangible markers that helped DRs to see themselves as academics [ 37 , 81 ]. Seeing their own work published was also helpful in providing a boost in confidence and being a joyful experience [ 42 ]. Moreover, with sufficient self-agency, DRs can not only see themselves but render themselves visible to other people [ 37 ].

Multiple goals, roles and groups

In antidote to the diminished personal identity and enmeshment with the PhD, DRs benefitted from accruing and sustaining multiple goals, roles, occupations, activities and social group memberships. Although ‘costly’ in terms of increased stress and role conflicts, sustaining multiple roles and activities appeared essential for protecting against mental health problems [ 50 , 68 ].

Leisure activities appeared to support mental health through promoting physical health, buffering stress, providing an uplift to DRs’ mood and through the provision of another identity other than as an academic [ 44 , 50 , 76 ]. Furthermore, engagement in activities helped DRs to find a sense of freedom, allowing them to carve up leisure and work time and psychologically detach from their PhD [ 68 , 76 ]. Competing roles, especially family, forced DRs to distance themselves from the PhD physically which reinforced psychological separation [ 50 , 59 ]. Engaging in self-care and enjoyable activities provided a sense of balance and normalcy [ 39 , 44 , 68 ]. This normalcy was a needed antidote to abnormal pressure [ 59 ]. Even in the absence of fiercely competing roles and priorities, DRs still appeared to benefit from treating their PhD as if it is only one aspect of life [ 59 ]. Additional roles and activities reduced enmeshment with the PhD to the extent that considering not completing the PhD was less averse [ 40 ]. This position appeared to help DRs to be less overwhelmed and less sensitive to perceived and anticipated failures.

Finding hope, meaning and authenticity

Finding hopefulness and meaning within the PhD can scaffold a sense of living a purposeful, enjoyable, important and authentic life. Hopefulness is predicated on the ability to identify a goal, i.e. to visualise and focus on the desired outcome and to experience both self-agency and potential pathways towards the goal. Hopefulness was enhanced by the ability to break down tasks into smaller goals and progress in to ‘baby steps’ [ 38 , 59 ]. In addition, DRs benefitted from finding explicit milestones against which they can compare their progress [ 59 ], as this appeared to feed back into the cycle of hopeful thinking and spur further self-agency and goal pursuit.

The experience of meaning manifested in two main ways; first as the more immediate lived experience of passion in action [ 76 ]. Secondly, DRs found meaning in feeling that in their PhD and lives more broadly they were living in accordance with their values, for example, experiencing their own commitment in action through continuing to work on their PhD even when it was difficult to do so [ 76 ]. DRs who were able to locate their PhD within a broader sense of purpose appeared to derive wellbeing benefits. There was a need to ensure that values were in alignment, for example, finding homeostasis between emotional, intellectual, social and spiritual parts of the self [ 46 , 59 , 90 ].

The processes of finding hopefulness and meaning appear to be largely relational. Frequent contact with supervisors in person and social and academic contact with other DRs were basic scaffolds for hope and meaning [ 52 ]. DRs spoke of how a sense that their supervisors believed in them inspired their self-agency and motivation [ 42 , 62 , 76 ]. Partners, friends and family could also inspire motivation for continuing in PhD tasks [ 44 , 76 ]. Other people also could help instil a sense of motivation to progress and complete the PhD; a sense of being seen is to be beholden to finish [ 39 ]. Meaning appeared to be scaffolded by a sense of contribution, belonging and mattering [ 81 ] and could arise from the perception of putting something into the collective pot, inspiring hopefulness and helping others [ 39 , 42 ]. Moreover, hopefulness, meaning and authenticity also appeared mutually reinforcing [ 81 ]. Finding meaning and working on a project which is in accordance with personal values, preferences and interests is also helpful in completing the PhD and provides a feedback loop into hope, motivation and agentic thinking [ 39 , 81 ]. Furthermore, DRs could use agentic action to source a community of people who share their values, enabling them to engage in collective authenticity [ 39 ].

The PhD as a process of transcendence

The immense challenge of the PhD could be a catalyst for growth, change and self-actualisation, involving empowerment through knowledge, self-discovery, and developing increased confidence, maturity, capacity for self-direction and use of one’s own autonomy [ 44 , 82 ]. The PhD acted as a forge in which DRs were tested and became remoulded into something greater than they had been before [ 44 , 82 , 90 ]. The struggles endured during the PhD caused DRs to reconsider their sense of their own capacities, believing themselves to be more able than they previously would have thought [ 50 ]. The struggles endured added to the sense of accomplishment. A trusted and trusting supervisor appears to aid in the PhD being a process of transcendence [ 62 ].

More broadly, the PhD also helped DRs to transcend personal tragedy, allowing immersion in a meaningful activity which begins as a means of coping and becomes something completely [ 39 ]. The PhD could also serve as a transformative selection process for DRs’ social relationships, with some relationships cast aside and yet others formed anew [ 39 ]. Overall, therefore, the very aspects of the PhD which were challenging, and distressing could allow DRs to transcend their former selves and, through the struggle, become something more.

Summation of results

The findings regarding the risk and protective factors associated with DR mental health have been summarised in Table 3 in relation to (1) the type of research evidencing the factor (i.e. whether the evidence is quantitative only, part of the meta-synthesis only, or evident in both results sections); and (2) the volume of evidence (i.e. whether the factor was found in a single study or across multiple studies). The factors in the far-right column (i.e. the factors found across multiple research studies utilising both qualitative and quantitative methods) are the ones with the strongest evidence at present.

This systematic review summarises a heterogeneous research area, with the aim of understanding the mental health of DRs, including possible risk and protective factors. The qualitative and quantitative findings presented here suggest that poor mental health is a pertinent problem facing DRs; stress appears to be a key issue and significantly in excess of that experienced in the general population. Several risk and protective factors at the individual, interpersonal and systemic levels emerged as being important in determining the mental health of DRs. The factors with the strongest evidence-base (i.e. those supported by multiple studies using qualitative and quantitative findings) denote that being female and isolated increases the risk of the mental health problems, whereas seeing the PhD as a process, feeling socially supported, having a positive supervisor relationship and engaging in self-care is protective.

Results in context

Stress can be defined as (1) the extent to which a stimulus exerts pressure on an individual, and their propensity to bear the load; (2) the duration of the response to an aversive stimuli, from initial alert to exhaustion; or (3) a dynamic (im)balance between the demands and personal resource to manage those demands [ 91 ]. The Perceived Stress Scale (PSS) [ 18 , 19 ] used in our meta-analysis is aligned with the third of these definitions. As elaborated upon within the Transactional Model of Stress [ 92 ], stress is conceptualised as a persons’ appraisal of the internal and external demands put upon them, and whether these exceed their available resources. Thus, our results suggest that, when compared to the general population, PhD students experience a greater maladaptive imbalance between their available resources and the demands placed upon them. Stress in itself is not a diagnosable mental health problem, yet chronic stress is a common precipitant to mental health difficulties such as depression and posttraumatic stress disorder [ 93 , 94 ]. Therefore, interventions should seek to bolster DRs’ resources and limit demands placed on them to minimise the risks associated with acute stress and limit its chronicity.

Individual factors

Female DRs were identified as being at particular risk of developing mental health difficulties. This may result from additional hurdles when studying in a male-dominated profession [ 95 , 96 , 97 ], and the expectation that in addition to their doctoral studies, females should retain sole or majority responsibility for the domestic and/or caring duties within their family [ 52 , 76 ]. It may also be that females are more willing to disclose and seek help for mental health difficulties [ 98 ]. Nevertheless, the World Health Organisation (WHO) mental health survey results indicate that whilst anxiety and mood disorders are more prevalent amongst females, externalising disorders are more common in males [ 99 ]. As the vast majority of studies in this review focussed on internalising problems (e.g. stress, anxiety and depression) [ 37 , 64 , 79 , 80 , 83 , 89 ], this may explain the gender differences found in this review. Further research is needed to explore which perspective, if any, may explain gender gap in our results.

Perhaps unsurprisingly, self-care was associated with reduced mental health problems. The quantitative findings suggest that all types of self-care are likely to be protective of mental health (i.e. physical, emotional, professional and spiritual self-care). Self-care affords DRs the opportunity to take time away from their studies and nurture their non-PhD identities. However, the results from our meta-synthesis suggest that DRs are not attending to their most basic needs much less engaging in self-care behaviours that correspond to psychological and/or self-fulfilment needs [ 100 ]. Consequently, an important area for future enquiry will be identifying the barriers preventing DRs from engaging in self-care.

Interpersonal factors

Across both quantitative and qualitative studies, interpersonal factors emerged as the most salient correlate of DR mental health. That is, isolation was a risk factor, whereas connectedness to others was a protective factor. There was some variability in how these constructs were conceptualised across studies, i.e. (1) isolation: a lack of social support, having fewer social connections, feeling isolated or being physically separate from others; and (2) social connectedness: multiple group membership, academic relationships or non-academic relationships; but there was no indication that effects varied between concepts. The relationship between isolation and negative health consequences is well-established, for example both physical and mental health problems [ 101 ], and even increased mortality [ 102 ]. Conversely, social support is associated with reduced stress in the workplace [ 103 , 104 ]. Reducing isolation is therefore a promising interventional target for improving DRs’ mental health.

The findings regarding isolation are even more alarming when considered alongside the findings from several studies that PhD studies are consistently reported to dominate the lives of DRs, resulting in poor ‘work-life balance’ and losing non-PhD aspects of their identities. The negative impact of having fewer identities [ 105 ] can be mitigated by having a strong support network [ 106 ], and increasing multiple group memberships [ 107 ]. But for DRs, it is perhaps the absence of this social support, combined with identity impoverishment, which can explain the higher than average prevalence of stress found in our meta-analysis.

Systemic factors

DRs’ attitudes towards their studies may be a product of top-down systemic issues in academia more broadly. Experiencing mental health problems was reported as being the ‘norm’, but also appeared to be understood as a sign of weakness. The meta-synthesis results suggest that DRs believed their respective universities prioritise academic success over workplace wellbeing and encourage unhealthy working habits. Working in an unsupportive and pressured environment is strongly associated with negative psychological outcomes, including increased depression, anxiety and burnout [ 108 ]. The supervisory relationship appeared a particularly important aspect of the workplace environment. The quantitative analysis found a negative correlation between inspirational supervision and mental health problems. Meta-synthetic finding suggested toxic DR-supervisor relationships characterised by powerlessness and neglect, as well as relationships where DRs felt valued and respected—the former of these being associated with poor mental health, and the latter being protective. The association between DR-supervisor relationship characteristics needs to be verified using quantitative methods. Furthermore, DRs’ sense that they needed to exhibit ‘optimum suffering’, which appears to reflect a PhD-specific aspect of a broader academic performativity [ 109 ], is an important area for consideration. An accepted narrative around DRs needing to experience a certain level of dis/stress would likely contribute to poor mental health and as an impediment to the uptake and effectiveness of proffered interventions. Although further research is needed, it is apparent that individual interventions alone are not sufficient to improve DR mental health, and that a widespread culture shift is needed in order to prevent the transmission of unhealthy work attitudes and practices.

Limitations of the literature

Although we found a respectable number of articles in this area, the focus and measures used varied to the extent that typical review analysis procedures could not be used. That is, there was much heterogeneity in terms of how mental health was conceptualised and measured, as well as the range of risk and protective factors explored. Similarly, the quality of the studies was hugely variable. Common flaws amongst the literature include small sample sizes, the use of unvalidated tools and the incomplete reporting of results. Furthermore, for qualitative studies specifically, there appeared to be a focus on breadth instead of depth, particularly in relation to studies using mixed methods.

The generalisability of our findings is limited largely due to the lack of research conducted outside of the US, but also because we limited our review to papers written in English only. The nature of doctoral studies varies in important ways between studies. For example, in Europe, PhD studies usually apply for funding to complete their thesis within 3–4 years and must know their topic of interest at the application stage. Whereas in the US, PhD studies usually take between 5 and 6 years, involve taking classes and completing assignments, and the thesis topic evolves over the course of the PhD. These factors, as well as any differences in the academic culture, are likely to affect the prevalence of mental health problems amongst DRs and the associated risk and protective factors. More research is needed outside of the US.

‘Mental health’ in this review was largely conceptualised as a type of general wellbeing rather than a clinically meaningful construct. None of the studies were ostensibly focused on sampling DRs who were currently experiencing or had previously experienced mental health problems per se, meaning the relevance of the risk, vulnerability and protective factors identified in the meta-synthesis may be more limited in this group. Few studies used clinically meaningful measures. Where clinical measures were used, they captured data on common mental health problems only (i.e. anxiety and depression). Due to these limitations, we are unable to make any assertions about the prevalence of clinical-level mental health problems amongst DRs.

Limitations of this review

As a result of the heterogeneity in this research area, some of the results presented within this review are based on single studies (e.g. correlation data; see Fig. 5 ) rather than the amalgamation of several studies (e.g. meta-analysis/synthesis). To aid clarity when interpreting the results of this review, we have (Table 3 ) summarised the volume of evidence supporting risk and protective factors. Moreover, due to the small number of studies eligible for inclusion in this review, we were unable to test whether any of our findings are related to the study characteristics (e.g. year of publication, country of origin, methodology).

We were able to conduct three meta-analyses, one of which aimed to calculate the between-group effect size on the PSS [ 18 , 19 ] between DRs and normative population data. Comparing these data allowed us to draw some initial conclusions about the prevalence of stress amongst DRs, yet we were unable to control for other group differences which might moderate stress levels. For example, the population data was from people in the United States (US) in 1 year, whereas the DR data was multi-national at a variety of time points; and self-reported stress levels may vary with nationality [ 110 ] or by generation [ 111 , 112 ]. Moreover, two of the three meta-analyses showed significant heterogeneity. This heterogeneity could be explained by differences in the sample characteristics (e.g. demographics, country of origin), doctoral programme characteristics (e.g. area of study, funding status, duration of course) or research characteristics (e.g. study design, questionnaires used). However, due to the small number of studies included in these meta-analyses, we were unable to test any of these hypotheses and are therefore unable to determine the cause of this heterogeneity. As more research is conducted on the mental health of DRs, we will be able to conduct larger and more robust meta-analyses that have sufficient power and variance to statistically explore the causes of this heterogeneity. At present, our findings should be interpreted in light of this limitation.

Practice recommendations

Although further research is clearly needed, we assert that this review has identified sufficient evidence in support of several risk and protective factors to the extent that they could inform prevention and intervention strategies. Several studies have evidenced that isolation is toxic for DRs, and that social support can protect against poor mental health. Initiatives that provide DRs with the opportunity to network and socialise both in and outside of their studies are likely to be beneficial. Moreover, there is support for psychoeducation programmes that introduce DRs to a variety of self-care strategies, allow them to find the strategies that work for them and encourage DRs to make time to regularly enact their chosen strategies. Finally, the supervisory relationship was identified as an important correlate of DR mental health. Positive supervision was characterised as inspirational and inclusive, whereas negative supervision productised DRs or neglected them altogether. Supervisor training programmes should be reviewed in light of these findings to inform how institutions shape supervisory practices. Moreover, the initial findings reported here evidence a culture of normalising and even celebrating suffering in academia. It is imperative therefore that efforts to improve and protect the mental health of DRs are endorsed by the whole institution.

Research recommendations

First, we encourage further large-scale mental health prevalence studies that include a non-PhD comparison group and use validated clinical tools. None of the existing studies focused on the presence of serious mental health problems—this should be a priority for future studies in this area. Mixed-methods explorations of the experiences of DRs who have mental health problems, including serious problems, and in accessing mental health support services would be a welcome addition to the literature. More qualitative studies involving in-depth data collection, for example interview and focus group techniques, would be useful in further supplementing findings from qualitative surveys. Our review highlights a need for better communication and collaboration amongst researchers in this field with the goal of creating a level of consistency across studies to strengthen any future reviews on this subject.

The results from this systematic review, meta-analysis and meta-synthesis suggest that DRs reported greater levels of stress than the general population. Research regarding the risk and protective factors associated with the mental health of DRs is heterogenous and disparate. Based on available evidence, robust risk factors appear to include being isolated and being female, and robust protective factors include social support, viewing the PhD as a process, a positive DR-supervisor relationship and engaging in self-care. Further high-quality, controlled research is needed before any firm statements can be made regarding the prevalence of clinically relevant mental health problems in this population.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Confidence intervals

Doctoral researchers

Higher Education Statistics Agency

Perceived Stress Scale

Standard deviation

United Kingdom

United States

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Thank you to the Office for Students for their funding to support this work; and thank you to the University of Sussex Doctoral school and our steering group for championing and guiding the ‘Understanding the mental health of Doctoral Researchers (U-DOC)’ project.

The present project was supported by the Office for Students Catalyst Award. The funder had no involvement in the design of the study, the collection, analysis or interpretation of the data, nor the writing of this manuscript.

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CH contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. LC contributed to the data curation, investigation, project administration, validation and writing—review and editing of this paper. SV contributed to the data curation, formal analysis, investigation, project administration, validation and writing—review and editing of this paper. PR contributed to the funding acquisition, project administration, supervision and writing—review and editing of this paper. JN contributed to the conceptualisation, funding acquisition, methodology, project administration, supervision, validation, writing—original draft preparation and writing—review and editing of this paper. CB contributed to the conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualisation, writing—original draft preparation and writing—review and editing of this paper. The author(s) read and approved the final manuscript.

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Hazell, C.M., Chapman, L., Valeix, S.F. et al. Understanding the mental health of doctoral researchers: a mixed methods systematic review with meta-analysis and meta-synthesis. Syst Rev 9 , 197 (2020). https://doi.org/10.1186/s13643-020-01443-1

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• 1 Regional Alcohol and Drug Abuse Research Center, Ben Gurion University of the Negev, 84105 Beer Sheva, Israel.
• 2 Department of Social Psychology, Moscow State University of Psychology and Education, Moscow, Russia.
• 3 Department of General Psychology, Penza State University, Penza, Russia.
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ORIGINAL RESEARCH article

Relationships between cross-cultural adaption, perceived stress and psychological health among international undergraduate students from a medical university during the covid-19 pandemic: a moderated mediation model.

• 1 Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
• 2 China Medical University-The Queen's University of Belfast Joint College, China Medical University, Shenyang, China
• 3 International Education School, China Medical University, Shenyang, China
• 4 Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, Shenyang, China

International university students may be at greater risk for developing psychological problems due to the unique stressors in them, particularly during the COVID-19 pandemic. The purpose of present study is to propose and test a moderated mediation model that would illuminate the underlying relationships of cross-cultural adaption, perceived stress and psychological health as well as the moderating effect of optimism and resilience among international medical undergraduates in China during the COVID-19 pandemic. The study was conducted via a web-based survey in November 2020. Electronic informed consents were obtained from all participants. A total of 453 students including 233 males and 220 females aged 18 to 28 years with an average age of 22.09 ( SD = 2.73) completed the questionnaires. Symptom Checklist 90, the measurement of cross-cultural adaption, the Perceived Stress Scale, the Life Orientation Test-Revised and the Resilience Scale were used for the survey. Results for the moderated mediation model testing revealed that cross-cultural adaption significantly and negatively associated with the Global Severity Index (GSI) of the Symptom Checklist 90 (β = −0.24, P < 0.01), and perceived stress partially mediated the relationship. Optimism (β = −0.29, P < 0.01) and confidence in COVID-19 control (β = −0.19, P < 0.01) had direct negative effects on perceived stress. Furthermore, optimism and resilience negatively moderated the indirect effect of cross-cultural adaption on psychological health through perceived stress. Findings of this study suggest that university educators ought to promote or make use of programs that cope with stress and boost optimism and resilience in order to support students not only adapt well to a new culture, but also keep good psychological health during the period of COVID-19 pandemic.

Introduction

Along with the trend of globalization, more and more students choose to receive their higher education abroad. Proportion of international student within the campus has been recognized as one of the important indicators in various world university rankings, and the international students have already been an essential part of the higher education worldwide. With the rapid development of economy and the expanded international influence, China has attracted more and more international students since the twenty first century. In 2015, nearly 400,000 international students from 202 countries and regions were studying in China, an increase of 50% over in 2010 ( 1 ). Among them, the number of students specialized in medicine, engineering and science increased most remarkably ( 1 ). In 2018, this figure increased to 492,200, and China has become the largest destination for overseas study in Asia ( 1 ). However, for the international students, studying and growing up in another culture can be very challenging, and at the time of public crisis such as the COVID-19 pandemic, the challenge they are facing could be overwhelming.

During the COVID-19 pandemic, control and prevention measures such as lockdown, reduction of social contact and changes of teaching mode interrupted the students' daily life, hampered their studies and negatively impacted their psychological health ( 2 ). Moreover, previous studies revealed that the international students were more prone to psychological problems because, compared with their domestic peers, they lacked resources to counteract stress and had to cope with more challenges unique to them, such as the language barrier and culture shock ( 3 , 4 ). However, most of the previous studies were done in western countries, and the research in Asia has been limited, especially during the COVID-19 pandemic. According to the results of a recent survey to the international students, 73.4, 76.6, and 58.5% of the participants had depression, anxiety and stress symptoms, respectively, during the pandemic, and male students presented more symptoms of depression and anxiety than females due to their more risk-taking behaviors ( 2 ). As international medical students will be incorporated into the future work force safeguarding the health of mankind, their well-being especially their mental health during the pandemic should arouse our attention. Therefore, the purpose of this study is to investigate the psychological health and the related factors of this student population in order to provide proper help to them during the period of COVID-19 pandemic.

Cross-cultural adaption is one of the challenges that international students have to cope with. Many researchers have examined the cross-cultural adaption or other related concepts in the realm of acculturation and cultural shock. The term cross-cultural adaption has been used to indicate a wide range of definitions which include a host language ability, a feeling of acceptance, the nature and extent of interaction with host nationals, or the acquisition of culturally acceptable behaviors ( 5 ). Cross-cultural adaption is often described as a stressful process for international students ( 6 ). Previous studies showed that the international undergraduates had more psychological problems, and failure in cross-cultural adaption might be an important stressor ( 7 – 9 ). According to Berry's acculturative stress theory, high levels of acculturation stress exceeding the individual's coping capacity is considered detrimental and thought to be the main mechanism for psychological distress among the immigrant population ( 10 ). Thus, stress perception might be an essential contributor to the relationship between cross-cultural adaption and psychological health.

With the emergence of the scientific field of positive psychology ( 11 ), the interest in understanding individuals from a positive psychological perspective has become a current development in higher education practice ( 12 ). Although there is still limited research on positive psychological health among undergraduates in universities ( 13 ), strong evidence exists supporting the relationship between positive psychology and psychological health of employees in organizational settings ( 14 ).

As one of the important positive psychological resources, optimism is defined as positive expectation of future success that creates renewed efforts to attain goals despite of any adversity that may be anticipated or created by stressful experiences ( 15 ). Optimism has been linked to better psychological health ( 16 ) and physical health ( 17 ), and many studies have documented optimism's protective effects against stress, which suggests that optimism may moderate the development of psychological problems in response to stress ( 18 ). Furthermore, optimism has also been found to be useful in dealing with psychological stressors ( 19 ). A meta-analysis examining experimental studies found that optimism was a significant moderator of the effects of stressors on psychological health, such that individuals with lower optimism typically showed the greatest benefit from the intervention ( 20 ). Therefore, optimism may moderate the impact of both stressors and stress on psychological health.

On the other hand, as another important positive psychological resource, resilience has been characterized by the ability to bounce back from negative emotional experiences and by flexible adaption to the changing demands of stressful experience ( 21 ). Individuals who have the ability to adapt and bounce back in adverse situations tend to exhibit strength in making realistic plans and taking necessary actions. It is recognized that resilience was an important protective factor against the development of psychiatric disorders in the face of continued adversity ( 22 ). Previous studies revealed that resilience might help undergraduates coping effectively with the stress in university life ( 23 ). Thus, resilience may be a moderator in the relationship between stress and psychological health.

However, little research has been done to study the mechanisms of the relationship between cross-cultural adaption and psychological health including the mediating or moderating variables ( 24 ). Therefore, the present study aims to test a moderated mediation model that proposes the underlying relationships of cross-cultural adaption, perceived stress and psychological health among international medical undergraduates from a Chinese university during the COVID-19 pandemic. In addition, the moderating effect of optimism and resilience will also be explored. For that purpose and based on the literature review, we formulate the following hypotheses: (H1) Perceived stress mediated the relationship between cross-cultural adaption and psychological health; (H2) Optimism moderated the relationship between cross-cultural adaption and perceived stress; (H3) Optimism moderated the relationship between perceived stress and psychological health; (H4) Resilience moderated the relationship between perceived stress and psychological health. The proposed moderated mediation model is depicted in the conceptual diagram in Figure 1 .

Figure 1 . The conceptual diagram of moderated mediation model.

Materials and Methods

Study design and subjects.

The study was conducted via a web-based survey in November 2020. A cluster sampling was used and the international undergraduates enrolled at one Chinese university (China Medical University) were the target population for the study. The inclusion criteria required that each participant was under the period of study and could access to the internet. Ethics approval from the Research Ethics Committee at China Medical University (2020-25) was obtained on March 16th, 2020. There were a total of 945 international undergraduates who met the criteria, and the emails were sent to them for invitation to the survey. The email briefly detailed the purpose of the study and invited the students to participate with a link to the online survey. The first page of the online survey included a brief description of the study and an informed consent letter, in which the participants were informed about their rights to decline participation and measures to protect their confidentiality. If the students agreed to the informed consent, they could then begin the questionnaires. In the end, a total of 453 international medical undergraduates out of 500 responses completed the questionnaires, with a response rate of 47.94%. The sample consisted of 233 (51.43%) males and 220 (48.57%) females. Their ages ranged from 18 to 28 years, with an average age of 22.09 years (standard deviation = 2.73). The students were originally from 49 countries, of which 84.98% were from Asia, 7.95% from Africa, 3.09% from Europe, 2.21% from North America, and 1.77% from Oceania.

Measurements

Measurement of psychological health.

The Symptom Checklist 90 (SCL-90) has been widely used to assess the psychological functioning not only in psychiatric patients but also in non-clinical population ( 25 ). Therefore, it was used to evaluate the psychological health of international undergraduates in this study. The SCL-90 is a multidimensional symptom self-report clinical rating scale, and contains 90 items in which respondents are to rate their degree of distress on each item according to a five-point Likert scale ranging from not at all to extremely. Eighty-three items reflect nine symptoms dimensions, which are Somatization (12 items), Obsessive-Compulsive (10 items), Interpersonal Sensitivity (9 items), Depression (13 items), Anxiety (10 items), Hostility (6 items), Phobic Anxiety (7 items), Paranoid Ideation (6 items), and Psychoticism (10 items) ( 26 ). The Global Severity Index (GSI) of the SCL-90 is regarded as the best single indicator to reflect overall symptom severity, because it combines information on both numbers of symptoms and intensity of distress ( 26 ). The GSI and the dimension scores can be calculated by summing up all the distress scores or the ones belong to a specific dimension, and then divided by 90 or the number of items to the specific dimension. A number of studies have been conducted demonstrating the reliability and the validity of this instrument ( 27 , 28 ), and a Cronbach's alpha of 0.98 was found in this study.

Measurement of Cross-Cultural Adaption

Cross-cultural adaption of the international undergraduates was measured by 6 questions regarding the language barrier and its negative influence on their life and study, the negative impact of the cultural differences, and whether they were already adapted to the study and life at the university. Response options are presented along a four-point Likert-type scale ranging from not at all to very much, and a higher summative score (negative items are reverse-scored) represents a higher level of cross-cultural adaption. The Cronbach's alpha for this sample was 0.75.

Measurement of Confidence in COVID-19 Control

Confidence in COVID-19 control was measured by 5 questions regarding if the participant is taking personal protective measures and the confidence in the personal protective measures, the confidence in the knowledge and the ability to protect oneself from being infected, and if the participant is confident that the outbreak will eventually be contained. Participants answered 1 (not at all) to 4 (very much) to the questions, and a higher total score represented a higher level of confidence in the COVID-19 control. The Cronbach's alpha was 0.72 in this study sample.

Measurement of Perceived Stress

The Perceived Stress Scale (PSS) was used to obtain an indication of the extent to which the international undergraduates perceived situations in their life to be stressful. It is the most widely used psychological measurement for the perception of stress, and requires respondents to indicate how frequently in the past month they had perceived their life to be overwhelming ( 29 ). The scale consists of 10 items, and a five-point Likert scale ranging from 0 (never) to 4 (very often) is used for answering statements. The PSS is scored by reversing positively stated items and then summing up all items with a total score ranging from 0 to 40. The score indicates the degree of perceived stress; the higher the score, the more stressful the individual perceives his or her life is. Adequate reliability and validity was reported for the PSS ( 30 ), and the Cronbach's alpha for PSS in the present study was 0.85.

Measurement of Optimism

Optimism was assessed with the Life Orientation Test-Revised (LOT-R). The LOT-R is a self-report, 6-item questionnaire that measures generalized positive outcome expectancy or optimism ( 31 ), and has been the most commonly used instrument to measure optimism in psychological research ( 32 ). To complete the scale, respondents were asked to indicate on a 5-point scale (0 = strongly disagree and 4 = strongly agree) the extent to which they agree or disagree with each of the six items. The scale consists of three positive and three negative items, and an overall optimism score was computed by adding ratings of the positive and reversed-scored negative items, with higher scores indicating greater optimism. The LOT-R has previously shown acceptable validity and good reliability when used as a measure for optimism ( 33 ). When used in this study, it has shown moderate internal consistency with a Cronbach's alpha of 0.71.

Measurement of Resilience

The Resilience Scale measures the ability to cope with stress and adversity ( 34 ). In this study, we used the 14-item Resilience Scale (RS-14) to assess the resilience level of the international undergraduates. Respondents were asked to select a response on a seven-point Likert-type scale with anchoring statements from 1 (strongly disagree) to 7 (strongly agree) to indicate how well one is able to accept themselves and life in terms of adaptability, flexibility, a balanced perspective on life, determination, mastery, perseverance and so on ( 34 ). The sum of the responses on the 14 items was used to calculate the resilience scores of the participants, with higher scores indicating stronger resilience. This scale yielded a good overall reliability for different samples ( 34 ), with a Cronbach's alpha of 0.96 in the current study.

Statistical Analysis

Analyses were conducted using SPSS statistics 23. The instruments in the study were all validated for the sample through confirmatory factor analysis and showed good fits to the data. The data was analyzed using descriptive statistics which included the means and standard deviations along with correlation coefficients. Pearson Correlation test was used to measure the correlation between the variables. An independent samples t -test was conducted to determine if a significant difference exists between genders.

Mediation and moderated mediation model analyses were tested using ordinary least squares path analysis and bootstrapping methods ( 35 ). Bootstrapping drew a large number of samples from the dataset and calculated the direct and the indirect effect (via perceived stress) of the independent variable (cross-cultural adaption) on the dependent variable (psychological health), which were tested against the null hypothesis that the effect was zero. The 95% confidence interval produced by the bootstrapping procedure was examined and if zero was not included within the confidence interval, the effect was considered significant ( 36 , 37 ). When both the direct effect and the indirect effect were significant, partial mediating effect was proved, while full mediating effect was proved when only the indirect effect was significant ( 36 , 37 ).

In addition to testing the indirect effect of cross-cultural adaption on psychological health, mediated by perceived stress, path analysis was conducted to assess whether these relationships were conditional on values of the moderators (optimism and resilience). In these analyses, cross-cultural adaption, confidence in COVID-19 control, optimism, and the cross-cultural adaption × optimism interaction term were entered as predictors of perceived stress, and cross-cultural adaption, perceived stress, optimism, resilience, the perceived stress × optimism interaction term, and the perceived stress × resilience interaction term were included as predictors of psychological health. A statistically significant interaction implied a moderating effect which was then plotted, and the significance of the slopes was examined.

In the case of a significant interaction, further analyses were conducted to probe the indirect effect by estimating conditional indirect effects at different values of the moderators (optimism and resilience). The indirect effect of cross-cultural adaption on psychological health through perceived stress was calculated at values of the moderator one standard deviation below the mean, at the mean, and above the mean ( 35 ). If the 95% bootstrapping confidence interval did not contain zero, the conditional indirect effect at that value of the moderator was considered significant ( 35 ).

All mediation and moderated mediation analyses were conducted using Hayes' PROCESS macro for SPSS, a statistical tool for path analysis-based mediation, moderation, and conditional indirect effects analyses ( 35 ). For the mediation analysis, Model 4 of PROCESS was employed to test whether perceived stress mediated the effect of cross-cultural adaption on psychological health after controlling for the confidence in COVID-19 control. For the moderated mediation analysis, Model 64 of PROCESS was used in this study. In addition, bias-corrected bootstrapping procedures with 5,000 resamples were utilized to calculate 95% confidence intervals of the effects. To avoid the problem of multicollinearity, variables were mean-centered before performing the regression. A significance level of 0.05 was used for all analyses.

Descriptive Statistics

Means, standard deviations and correlations of the variables used in the analysis are presented in Table 1 . The average GSI of the SCL-90 was 1.51, and the dimension scores based on severity of symptoms in descending order were Obsessive-Compulsive, Depression, Interpersonal Sensitivity, Paranoid Ideation, Hostility, Phobic Anxiety, Psychoticism, Anxiety, and Somatization. Cross-cultural adaption, confidence in COVID-19 control, optimism and resilience were significantly negatively correlated with GSI and all the dimension scores of the SCL-90, while perceived stress was significantly positively correlated with GSI and all the dimension scores of the SCL-90. Age was not significantly correlated with any variable.

Table 1 . Correlations of variables in the analysis.

Differences of Psychological Health Between Genders

The tests found no significant differences on the GSI and all the dimensions of the SCL-90 between males and females. A summary of the results is shown in Table 2 .

Table 2 . Differences of psychological health between genders.

Mediation Model Testing Results

Since age was not significantly correlated to the GSI of the SCL-90 and gender didn't yield a significant effect on the GSI of the SCL-90 in the univariate analyses, they were not controlled in the models. After controlling for the confidence in COVID-19 control, the results for the mediation model testing are presented in Table 3 , from which the analysis indicated that cross-cultural adaption significantly and negatively associated with the GSI (β = −0.23, P < 0.01) and perceived stress (β = −0.24, P < 0.01), and perceived stress significantly and positively associated with the GSI (β = 0.51, P < 0.01). There was also a significantly negative association between confidence in COVID-19 control and perceived stress (β = −0.22, P < 0.01). The output showed that the direct effect of cross-cultural adaption on the GSI was significant, and the indirect effect through perceived stress on the GSI was also significant (Effect = −0.02, 95% confidence interval [−0.03, −0.01]), supporting the hypothesis (H1) that the perceived stress mediated the relationship between cross-cultural adaption and the psychological health of international medical undergraduates partially. These findings indicated that the stress perceived by the international medical undergraduates decreased when the cross-cultural adaption improved, and then the GSI decreased accordingly, which represented an improvement of the psychological health.

Table 3 . Results of the mediation model testing.

Moderated Mediation Model Testing Results

The results for the moderated mediation model testing are shown in Table 4 , and the final model with statistic values is shown in Figure 2 . Unfortunately, optimism did not moderate the relationship between cross-cultural adaption and perceived stress, as the cross-cultural adaption × optimism interaction term was not significant. However, it had a significant and negative effect (β = −0.29, P < 0.01) on perceived stress directly, whose strength was even stronger than the direct effect of cross-cultural adaption (β = −0.21, P < 0.01) and confidence in COVID-19 control (β = −0.19, P < 0.01) on perceived stress. Combination of the cross-cultural adaption, confidence in COVID-19 control and optimism explained 22% of the variance ( R 2 = 0.22, F = 31.30, P < 0.01) in perceived stress.

Table 4 . Results of the moderated mediation model testing.

Figure 2 . The final model with statistic values. * P < 0.05, ** P < 0.01.

In the moderated mediation model, the strength of the relationship between perceived stress and the GSI (β = 0.51) was stronger than the relationship between cross-cultural adaption and the GSI (β = −0.24). Although optimism and resilience did not significantly associate with the GSI, both interactions with perceived stress were significant. The combination of the variables above explained 43% of the variance in psychological health of international medical undergraduates.

The interaction between perceived stress and optimism (β = −0.09, P < 0.05), as well as the interaction between perceived stress and resilience (β = −0.16, P < 0.01), were all negative on the GSI, indicating that optimism and resilience negatively moderated the relationship between perceived stress and the GSI, supporting H3 and H4. In order to interpret the interaction term, the simple slopes of optimism and resilience predicting the GSI are presented in Figures 3 , 4 . For those who were low in optimism, higher perceived stress was associated with higher GSI (simple slope = 0.06, t = 11.48, P < 0.01). However, for those who were high in optimism, the association was weakened (simple slope = 0.04, t = 7.93, P < 0.01), which means optimism dampens the positive relationship between perceived stress and the GSI. Thus, when there is a high level of perceived stress with a high level of optimism, it is less likely to have a serious negative impact on psychological health. Similarly, the slope of the regression line of perceived stress predicting the GSI at low (simple slope = 0.07, t = 10.79, P < 0.01) and high (simple slope = 0.03, t = 6.02, P < 0.01) level of resilience were all significant, but the slope was smaller when the level of resilience was high. Therefore, resilience mitigated the positive relationship between perceived stress and the GSI, too.

Figure 3 . The moderation of optimism on the relationship between perceived stress and GSI of the SCL-90.

Figure 4 . The moderation of resilience on the relationship between perceived stress and GSI of the SCL-90.

Moderation of the indirect effect of cross-cultural adaption on the GSI was tested for low, medium and high levels of optimism, and at the corresponding levels of resilience as well. As shown in Table 5 , the indirect effects were significant for all the levels of optimism and resilience but differentiated at different levels. When optimism or resilience moved to higher levels, the indirect effect was seen to be smaller, which means that the indirect effect of cross-cultural adaption on the GSI via perceived stress becomes weaker as optimism or resilience improves. The high optimism and resilience subgroup was affected the least compared with other subgroups by the indirect effect of cross-cultural adaption associated with the GSI of the SCL-90.

Table 5 . Conditional indirect effects of cross-cultural adaption on psychological health at different levels of optimism and resilience.

The COVID-19 pandemic adversely impacts on the psychological health of university students worldwide. However, it's still possible that individuals can adjust to the pandemic through remaining positive ( 38 ). In our study, the average GSI of the SCL-90 among international medical undergraduates was mild (1.51), which is similar to that of previous studies in China ( 39 , 40 ). The possible reason may be related with a more stable psychological reaction that the medical undergraduates had, due to the knowledge and training from campus.

Our study proposed a mediation model first to identify the relationship between cross-cultural adaption and psychological health among international medical undergraduates during the COVID-19 pandemic, and to see whether the relationship was mediated by perceived stress. We found that cross-cultural adaption significantly and negatively associated with the GSI of SCL-90 (β = −0.23, P < 0.01) and perceived stress (β = −0.24, P < 0.01) with moderate effects; and perceived stress significantly and positively associated with the GSI of SCL-90 (β = 0.51, P < 0.01) with a strong effect. Consistent with previous studies, our findings support the positive relationship between cross-cultural adaption and psychological health among international medical undergraduates, which implies the students with better cross-cultural adaption adjust better to the new environment and are optimally functioning in social arenas ( 41 – 43 ). Furthermore, our findings revealed that in addition to the significant direct effect on the GSI of SCL-90, cross-cultural adaption also had a significant indirect effect on the GSI of SCL-90 by influencing the stress perceived by international medical undergraduates. This means that perceived stress partially mediated the relationship between cross-cultural adaption and psychological health among international medical undergraduates, which was in line with the previous research findings among immigrant and other populations ( 44 , 45 ). Consequently, international medical undergraduates with poor cross-cultural adaption were likely to perceive more stress, which was associated with increase of GSI in the current sample. Since perceived stress had a strong effect on psychological health, how to manage the stress effectively would be crucial for international medical undergraduates.

In the final moderated mediation model, our results revealed that although no moderating effect of optimism was found on the relationship between cross-cultural adaption and stress perceived by international medical undergraduates, optimism had a negative direct effect on perceived stress (β = −0.29, P < 0.01), which should also be considered as a useful resource to combat stress. Previous studies have proven that optimism could influence stress-perception ( 46 , 47 ), and the individuals who had higher level of optimism, as a consequence of the optimistic style of appraisal, were more likely to report active ways of coping with stressful situations, which in turn led to perceive less stress than those with lower level of optimism ( 48 ). Therefore, optimism is a protective factor of perceived stress for international medical undergraduates. Importantly, similar to one previous research finding ( 49 ), our study also revealed that the confidence in COVID-19 control was negatively correlated with perceived stress of international medical undergraduates (β = −0.19, P < 0.01). During the COVID-19 pandemic period, although the pandemic was a stressor for international medical undergraduates, the achievements in combating COVID-19 across different countries might encourage them to cooperate and abide by the various control measures, and their confidence in COVID-19 control might increase accordingly, which could alleviate the perception of stress ( 50 ). This finding suggests that during the pandemic of COVID-19, building confidence in COVID-19 control in the students may be a good strategy to make international medical undergraduates feel less stress and improve their psychological health. Therefore, the improvement of optimism and confidence in COVID-19 control could help international medical undergraduates to perceive less stress.

Moreover, in our moderated mediation model, optimism and resilience negatively moderated the relationship between perceived stress and the GSI of SCL-90, and the effects were differentiated for subgroups, which implied that the indirect effect of cross-cultural adaption on psychological health via perceived stress was dependent on the levels of optimism and resilience. Our findings showed that the indirect effect of cross-cultural adaption on psychological health via perceived stress was weaker for international medical undergraduates with high level of optimism and resilience compared with those with low or medium level of optimism and resilience. These findings are also in agreement with previous studies which revealed that higher level of optimism and resilience, as internal resources, would be valuable strategies to improve coping mechanisms for stress on psychological health ( 21 , 51 – 53 ). This indicates that an intervention of protection might be useful for international medical undergraduates, in particular for those with low level of optimism and resilience. Various positive psychology exercises have demonstrated that optimism and resilience could be taught, learned and developed over time ( 21 , 54 , 55 ). Findings of our study provide evidence for developing training programs that support fostering high levels of optimism and resilience. In this sense, we suggest this knowledge could be used by university educators and managers to build positive characteristics and improve strengths for international undergraduates under the circumstances of COVID-19 pandemic.

This study has several limitations. First of all, since our study population only included the international undergraduates at one medical university of China, caution should be noted in generalizing the findings from this study to other international undergraduates. This warrants a replication of this study inquiry across a number of universities in China before more robust conclusions can be drawn. Second, the data was obtained by self-report measurements and could have included both participant bias and dishonesty, so it is possible that data could be inaccurate. Third, due to the cross-sectional study design, causal inferences cannot be made regarding the relationships between variables in this study. A possible future research opportunity is to investigate through longitudinal approach study. Fourth, as only two integral components of psychological capital i.e., optimism and resilience are studied, other aspects of the psychological capital should be taken into account in future studies.

Despite the limitations, our study offers some positive findings and opportunities for further research in the area of psychological health of international medical undergraduates and enriches the literature of cross-cultural adaption and positive psychology in higher education research. Our findings are also potentially useful for psychological health intervention programs for international medical undergraduates to cope with stressful situations such as COVID-19 pandemic more effectively. Although the results and recommendations from this study cannot eliminate the stressors, they may help lessen the degree to which the international medical undergraduates are affected by the poor cross-cultural adaption. Since previous studies have developed a series of brief micro-training interventions that focused on improving individuals' optimism and resilience ( 56 – 58 ), it is worth implementing among the international medical undergraduates to counteract stress induced by cross-cultural adaption, and maintain their psychological health during the COVID-19 pandemic. University educators ought to promote and make use of programs such as the ones that cope with stress and boost optimism and resilience in order to support students not only adapt well to a new culture, but also keep good psychological health.

In the present study, we found a positive association between cross-cultural adaption and psychological health among international medical undergraduates, which was mediated by perceived stress. Optimism and confidence in COVID-19 control were negatively correlated with perceived stress. In addition, optimism and resilience negatively moderated the indirect effect of cross-cultural adaption on psychological health through perceived stress. Therefore, collaborations from multiple departments on campus are required to implement the training programs that cope with stress and foster high levels of optimism and resilience, in order to maintain psychological health among international medical undergraduates in China during the COVID-19 pandemic.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by the Research Ethics Committee at China Medical University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

XiW drafted the manuscript. LL helped analyzing the statistics. XuW and MQ collected the data. LY and YG helped with the study design and data analysis. BP provided the guidance of the study design and reviewed the manuscript. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors are grateful to the international students who participated in the study and the colleagues who helped contacting the students.

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Keywords: cross-cultural adaption, perceived stress, optimism, resilience, psychological health, international undergraduates, COVID-19

Citation: Wang X, Lu L, Wang X, Qu M, Yuan L, Gao Y and Pan B (2021) Relationships Between Cross-Cultural Adaption, Perceived Stress and Psychological Health Among International Undergraduate Students From a Medical University During the COVID-19 Pandemic: A Moderated Mediation Model. Front. Psychiatry 12:783210. doi: 10.3389/fpsyt.2021.783210

Received: 25 September 2021; Accepted: 12 November 2021; Published: 10 December 2021.

Reviewed by:

Copyright © 2021 Wang, Lu, Wang, Qu, Yuan, Gao and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Bochen Pan, panbochen@cmu.edu.cn

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Russia to build high-speed railway between Moscow and St. Petersburg

MOSCOW (Reuters) - Russia has approved a project to build the first high-speed passenger railway between its two biggest cities, Moscow and St. Petersburg, to be funded with billions of dollars from the state budget, a government directive showed on Thursday.

The government approved the construction of the 679 km railroad, which should allow Russian-made trains travelling at 360 km/hour per hour to get from Moscow to St. Petersburg in 2-2.5 hours instead of the current 4-5 hours, on the first business day of the St Petersburg International Economic Forum.

The railway, which will cost more than 2.3 trillion roubles ($25.97 billion), will be built by a Russian company, VSM Two Capitals, on concession terms using state and private money.

The Russian government plans to allocate at least 300 billion roubles of loans from the National Welfare Fund at 1% in 2025, and subsidies amounting to about 328 billion roubles between 2024 and 2038, the directive showed.

More than 580 billion roubles is needed for the project from the National Welfare Fund, with other funding coming from sources including Russian state-owned banks VTB, Sberbank and Gazprombank, the former minister of transport Vitaly Savelyev said in February.

The head of Russia's Sberbank German Gref said on Thursday it will participate in financing the project.

Russia has proposed to raise taxes for companies and the wealthy, which may add an extra $30 billion to next year's budget revenues and allow Moscow to increase spending, including on its war in Ukraine.

($1 = 88.5750 roubles)

(Reporting by Gleb Stolyarov; Editing by Jan Harvey)

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Russian propaganda in 2024 includes deepfakes, sham websites and social media swarms.

A deepfake video of a State Department official falsely claiming a Russian city is a legitimate target for Ukrainian strikes using U.S. weapons.

Pro-Russia social media accounts amplifying stories about divisive political topics such as immigration and campus protests over the war in Gaza.

Sham news sites spoofing real publications or posing as legitimate-sounding outlets with names like D.C. Weekly, the Boston Times and Election Watch.

Russian propaganda is ramping up in a busy global election year , targeting American voters as well as elections in Europe and the Paris Olympics, according to intelligence officials, internet researchers and tech companies.

“Russia remains the most active foreign threat to our elections,” Director of National Intelligence Avril Haines told senators last month at a briefing about election risks.

Influence operations linked to Russia take aim at a disparate range of targets and subjects around the world. But their hallmarks are consistent: attempting to erode support for Ukraine, discrediting democratic institutions and officials, seizing on existing political divides and harnessing new artificial intelligence tools .

"They're often producing narratives that feel like they're throwing spaghetti at a wall," said Andy Carvin, managing editor at the Atlantic Council's Digital Forensic Research Lab, which tracks online information operations. "If they can get more people on the internet arguing with each other or trusting each other less, then in some ways their job is done."

Some efforts have been linked directly to the Kremlin, including a network of fake accounts and phony news websites given the name Doppelganger , whose operators have been sanctioned by both the U.S. and the European Union.

The origins of others are still unknown, such as the fabricated video of State Department spokesman Matthew Miller, in which reporters' questions and Miller's response about U.S. policy in the Ukraine war were faked, likely with the help of artificial intelligence. The video circulated on Russian Telegram channels and was picked up by Russian state media and government officials, according to The New York Times .

Russia employed tactics such as exacerbating existing divisive issues and creating fake accounts posing as Americans in its 2016 and 2020 election-meddling efforts, researchers say. Since Russia invaded Ukraine in early 2022, discrediting Ukraine and amplifying voices in the U.S. and other countries that oppose aid to Ukraine and support for NATO has become a dominant theme of the Kremlin's efforts.

"What you can see is they are referencing politics in a certain country, and they are generally tying that to what is going on in Ukraine. The underlying message is, 'Here's why people should not support Ukraine,'" said Ben Nimmo, principal investigator on OpenAI’s intelligence and investigations team, who previously led global threat intelligence at Facebook's owner, Meta.

Fake accounts, phony websites

The Kremlin relies on what Haines called "a vast multimedia influence apparatus, which consists of its intelligence services, cyber-actors, state media proxies and social media trolls" to pump out propaganda, launder fake and misleading news articles and circulate conspiracy theories.

Since the invasion of Ukraine, the European Union has banned Russian media outlets including RT, Sputnik, Voice of Europe and RIA Novosti from publishing or broadcasting within the bloc. That hasn’t stopped RT articles from proliferating across hundreds of other websites widely available in Europe, according to a recent report from the German Marshall Fund of the United States, the University of Amsterdam and the Institute for Strategic Dialogue.

"We discovered RT articles reposted to third-party websites targeting audiences from Iraq to Ethiopia to New Zealand, often without any indication that the content was sourced from a Russian propaganda outlet," the researchers wrote.

Perhaps the most persistent and prevalent Russian online operation is Doppelganger. First identified by researchers at the EU DisinfoLab in 2022, the campaign has impersonated news outlets including the U.K.'s The Guardian , Germany's Der Spiegel , The Washington Post and Fox News, and it has posed as NATO, the Polish and Ukrainian governments, the German police and the French Foreign Ministry.

In addition to operating fake accounts and phony websites, the operation purchased Facebook ads targeting French and German audiences with messages about aid to Ukraine, farmers' protests and the war in Gaza, according to the European nonprofit AI Forensics .

Doppelganger has also set its sights on the Paris Olympics, Microsoft said in a report this week. It used fake French-language news sites to push claims of corruption in the Games' organizing body and to warn of potential violence.

In March, the U.S. Treasury sanctioned two Russian companies identified as being behind Doppelganger — Social Design Agency and Structura — as well as their founders, saying they carried out the campaign "at the direction of the Russian Presidential Administration."

The misinformation-tracking company NewsGuard has connected a separate network of 167 websites "masquerading as independent local news publishers in the U.S." to a former deputy sheriff from Florida who now lives in Moscow.

Using AI tools to create propaganda

The volume of posts, articles and websites that Russian-linked operations produce is being boosted by artificial intelligence — another new factor that sets 2024 apart from previous election cycles.

Covert influence campaigns based in Russia, as well as in China, Iran and Israel, have begun using AI in their attempts to manipulate public opinion and shape politics, according to recent reports from OpenAI, Meta and Microsoft .

A Russian operation that Microsoft calls Storm-1679 used AI to fake actor Tom Cruise's voice narrating a phony Netflix documentary disparaging the International Olympic Committee.

According to OpenAI, Doppelganger has used its AI tools, which include ChatGPT, to translate articles into other languages and generate social media posts and comments. Another Russian operation, dubbed Bad Grammar, used AI to debug code for a program that automatically posted on Telegram.

The question remains: How effective are Russia's attempts to influence public opinion and democratic elections?

Many online operations that have been publicly identified haven't reached large audiences of real people, researchers say, and AI hasn't made them any more convincing — at least not yet.

"It's absolutely true that when you look at an individual campaign, it's just as likely as not that it hasn't had a huge amount of influence, which is why Russia just does it again and again, or in a different form, or targeting a different group," the Digital Forensic Research Lab's Carvin said. "It's almost like producing cheaply manufactured goods and just getting it out there in the world, hoping that maybe one particular gadget ends up becoming the popular toy of the season, even if the others completely fail."

Many researchers who study disinformation warn against seeing the hand of Russia as an all-powerful puppeteer, especially since so much of what its mouthpieces amplify is homegrown.

"Any potential narrative that's being argued in a given political environment is fodder for Russian operations — which in itself can sound a little crazy and conspiracy-ish," Carvin said. "And in some ways you risk creating a … situation where absolutely everything that's happening online is all Russia's fault."

But, he added, "at the same time, Russia has a lot of resources at its disposal and it's willing to experiment in different ways to see which things stick. … Why not try all of the above and see where it takes you?"

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