Graduate and Professional Schools
Mental Health Task Force
December 9 2004
CONTENTS
| Introduction |
| Methods |
| Results |
| Conclusions |
| References |
EXECUTIVE SUMMARY
The Mental Health Task Force at UC Berkeley conducted a survey in April 2004, to collect data on graduate students’ mental health needs, their knowledge of health resources available on campus, and their satisfaction with department climate. This is the first survey of its kind at UC Berkeley, and it is one of very few in the nation to focus on graduate student well-being. The results of preliminary data analysis are summarized in this report. While some findings from the survey fit expectations (based on published reports of college mental health), other results were surprising. Highlighted findings include the following:
- In the last 12 months, 45.3% of respondents had experienced an emotional or stress-related problem that significantly affected their well being and/or academic performance.
- 9.9 % of respondents seriously considered suicide in the past 12 months.
- Less than 2% said they would first contact a mental health provider or a member of the faculty to discuss an emotional or stress-related problem.
- 52% of survey participants reported that they considered using psychological or counseling services provided by the university; less than a third actually reported using these services.
- Over 75% of students who have used campus counseling and psychological services reported feeling somewhat satisfied, satisfied, or very satisfied with their treatment.
- Almost 25% of graduate students in the survey were unaware of on-campus mental health services.
- International students were less aware of mental health services and less likely to use them.
- Female respondents met with their primary advisors less frequently than males, and they were less satisfied with their interactions with department faculty members.
- Female respondents were more likely to report feeling hopeless, exhausted, sad, or depressed in the last 12 months.
Further analysis of the data obtained from this survey will be released over the next year. Recommendations developed from research results will be shared with University Health Services, the Berkeley Division of the Academic Senate, campus administrators, and students and staff at other universities.
It is anticipated that this survey will provide relevant information to the campus; we hope that it additionally motivates action. Graduate students contribute significantly to the academic mission of UC Berkeley, by performing cutting-edge research, teaching undergraduate students, and publishing in scholarly journals. Maintenance of strong academic performance within the university requires social support and emotional well being; therefore it is in the university’s best interests to prioritize graduate student mental health.
Contributions:
This research project was funded by the Berkeley Graduate Assembly and sponsored by Steve Lustig (Assistant Vice Chancellor, UHS). Background research for the survey and the survey instrument were developed by Jenny Hyun and Brian C. Quinn, in consultation with members of the 2003-2004 Mental Health Task Force and UHS staff. Research protocol development and data analysis were conducted by Temina Madon* with Jenny Hyun, Brian C. Quinn, and Nicole Bellows. The survey report was written by Temina Madon; executive summary and press materials were written by Dan Handwerker. Revisions were carried out by Dan Handwerker with Nicole Bellows, Erin Becker, Thais da C.L. Alves, Deborah Aruguete, and Jenny Hyun. Many helpful comments were contributed by Steve Lustig, Sue Bell (CPS Outreach Coordinator) and Jeff Prince (CPS Director). Survey administration was conducted by Ken Wahl of the Office of Student Research.
*To whom correspondence should be addressed: temina@berkeley.edu or gmhealth@ocf.berkeley.edu
INTRODUCTION
Recent reports in the media, medical and public health literature, and elsewhere have highlighted the increasing incidence and identification of clinical depression and other complex mental disorders in college-aged populations over the last three decades [1]. However, most studies of student mental health have focused on undergraduate students; relatively few examinations of graduate student welfare and emotional well-being have been undertaken.
Graduate students are a distinct population from undergraduate students. They are older and often have family responsibilities; they have complex relationships with faculty members; and unlike undergraduate students, they tend to work in isolation and are disconnected from campus support services and staff.
To remedy the lack of data about graduate student mental health at UC Berkeley, the Berkeley Graduate Assembly established a Mental Health Task Force (MHTF) at the start of the Fall 2003 semester. The MHTF was charged with the following tasks:
A subgroup of the MHTF partnered with Steve Lustig (Executive Director, University Health Services) to conduct a survey of graduate students on the Berkeley campus. The study examines three areas of interest: graduate students’ perceived mental health and need for mental health services; awareness of and satisfaction with on-campus psychology and counseling services; and academic environment and work relationships. The resulting data are described here.
- Conducting a survey and needs assessment of graduate students
- Providing graduate student feedback to University Health Services
- Creating greater awareness of graduate student mental health needs amongst the faculty and university administration
METHODS
The research protocol for this study was reviewed and exempted by the UC Berkeley Committee for the Protection of Human Subjects in March 2004. An email invitation to participate in a survey was sent to approximately 9000 graduate students at UC Berkeley. All registered students in graduate or professional programs with email addresses on file with the University Registrar were invited to participate. The survey was distributed and data were collected during the month of April 2004.
Demographic information was collected to assess whether the responding population represented the total population of graduate students at UC Berkeley. Our response rate was 34.5 percent (3121 respondents from a pool of 9023 subjects). Data were broken down by sex, nationality, and department.
We used an anonymous, online survey instrument and recruited subjects into the study by email contact only. We had little control over a recruited subject’s completion of the study. This sampling technique creates bias in the response set. However, we did not correct or weight any of the data reported in this document.
RESULTS
Sample Statistics
The response population is fairly representative of the total graduate student population, using variables such as department, year in school, sex, and nationality to determine representation. Differences between the total student population and the sample were not significant for school or college (Figure 1, excluding the professional schools which were undersampled; Kolmogorov-Smirnov two-sample test, p<=0.03), ethnic identity (Figure 2; K-S test, p<=0.0001), or citizenship. However, 51.5% of respondents were female, which represents a slight over-sampling of women. The median age was 27 years, with an average of 28.4 + 5.4 years. Age distribution of the sample is given in Figure 3.
Figure 1: Composition of sample by academic school or college, compared with total graduate student population data reported by the Graduate Division for Fall 2003 [2]. X-axis shows school or college by name; y-axis shows percentage of graduate students in the total population or in the survey sample.
Figure 2: Composition of sample by ethnicity, compared with total graduate student population data reported by the Office of Student Research for Fall 2003 [3]. X-axis shows ethnic identity category selected by students; y-axis show percentage of graduate students in the total population or in the survey sample.
Figure 3: Composition of graduate student survey sample, by age. X-axis shows categories from which respondents could select; y-axis gives percentage of respondents in the survey sample who selected each age group.
It is notable that the ethnic identification “other” is remarkably under-represented in our sample, whereas “asian” and “white” are over-represented. These discrepancies may result from inconsistencies in self-reporting: students who identified as “other” in the administrative Office of Student Research survey may have felt more comfortable identifying as “white” or “asian” in this survey, which was conducted by fellow graduate students.
Mental Health Need
Perceived need for mental health services or emotional support was assessed using students’ reported experience with the following emotions: feeling things are hopeless; feeling overwhelmed by workload and responsibilities; feeling exhausted (not from physical activity); feeling very sad; and feeling so depressed that it is difficult to function. No diagnostic tests or depression screening tools were used; therefore, reported mental health reflects perceived rather than diagnosed health.
59.2 percent of all respondents reported having experienced at least one of the surveyed emotions “frequently” or “all of the time”. Figure 4 displays the percent of graduate student respondents who experienced each of the surveyed emotions.
Frequency with which Berkeley graduate students felt overwhelmed or exhausted is much greater than that reported by first-year college students in the 2003 study by the UCLA Higher Education Research Institute (HERI) [4]. The authors of the HERI study found that 26.8 percent of undergraduates frequently felt overwhelmed by all they had to do. In contrast, 39 percent of surveyed UC Berkeley graduate students report feeling frequently overwhelmed.
A 2003 study by the American College Health Association [5] reported that 61 percent of college students felt hopeless at least one or more times in the last twelve months. 45 percent said they had felt so depressed they could barely function, and 9.4 percent felt suicidal. In our sample, 67 percent of graduate student respondents felt hopeless at least once in the last twelve months, 54 percent reported feeling so depressed that it was difficult to function, and 9.9 percent reported that they had considered suicide. These results are summarized in Table 1.
Figure 4: Respondents’ experience with queried emotional states. Percentages indicate the proportion of respondents reporting experience with a particular emotion either “frequently” or “all of the time”.
| Reported Concern | Undergraduates | Survey Respondents |
| Felt overwhelmed | ||
| Felt depressed | ||
| Considered suicide |
Table 1: Perceived undergraduate mental health [5], compared with graduate students participating in 2004 Berkeley survey.
In addition to the finding that 9.9 percent of respondents reported seriously considering suicide, 18 of 3121 Berkeley graduate students reported at least one suicide attempt in the last 12 months. From the number of suicide attempts reported in our study, we can estimate the expected number of completed suicides in our survey population. Published values for the number of suicide attempts per completed suicide vary by study and authorship, but the National Institute of Mental Health has estimated that there are 8 to 25 attempts for every death from suicide [6].
Using this range, we would expect a suicide rate of 2.3-7.2 per 10,000 survey respondents, suggesting that the survey population is at high risk for suicide.
Our estimated suicide rate compares with suicide completion rates of 1.48 per 10,000 in the general population, as reported by Kuo et al in 2000; 1.07 per 10,000 for students over the age of 25; and 2.41 per 10,000 for male students aged 30-39 (both reported by Silverman et al in 1997). In comparison, the rate of suicide completion in college students (i.e. for undergraduates) is estimated at 0.75 per 10,000 by Silverman et al [7].
When asked about particular problems faced in the last twelve months, 45.3 percent of graduate students in our sample reported that they had experienced emotional or stress-related problems that significantly affected their well being or academic performance. Interestingly, 57.7 percent of students reported knowing a fellow Berkeley graduate student who had experienced such a problem in the last twelve months.
We asked who a student would first contact to discuss an emotional or stress-related problem. The contact preferred by the majority of students was a spouse or partner (51.2%), followed by a friend (29.5%) or family member (14.6%). Very few students (less than 2%) would first contact a mental health provider or member of the faculty. Just 8 percent of students identified a mental health provider as the second person they would contact to discuss an emotional or stress-related concern.
Use of and Satisfaction with Services
Nearly 25 percent of graduate students in our sample (24%) were unaware of the mental health services available on campus through Counseling and Psychological Services (CPS), a unit of the University Health Services. Of the graduate students who were aware of these services, most had located information via the University Health Services (UHS) website, orientation information, or UHS flyers.
Even though 51.7 percent of respondents reported that they had considered using on-campus psychological or counseling services in the previous twelve months, less than a third (27%) of respondents actually reported using these services. Reported reasons for not accessing services are given in Figure 5. Surprisingly, the most commonly cited reasons were a perceived lack of need for services or lack of time, suggesting that respondents may have difficulty assessing the seriousness of their mental health concerns.
Figure 5: Reasons cited by respondents for not accessing on-campus Counseling and Psychological Services, even when they know that these services are offered. X-axis shows reasons listed in the survey; y-axis shows the number of respondents who selected these reasons. Respondents could select multiple responses.
Overall, the graduate students who had experience with on-campus mental health services reported satisfaction (Figure 6). When students cannot be effectively or efficiently treated by staff at CPS, they are referred to a mental health professional in the community. Over 25 percent of graduate students referred to off-campus providers did not follow-up with referrals. Lack of time and cost constraints were the major reported barriers to accessing off-campus providers for graduate students who did not follow-up with referrals.
Figure 6: Respondents’ satisfaction with the health services they received from CPS, the on-campus mental health services provider at UHS. 844 of 3121 respondents (27%) chose to answer this question.
Interestingly, the percent of surveyed students reporting that they are “very satisfied” with off-campus psychologists and psychiatrists is greater than the percent of students who are “very satisfied” with on-campus mental health services provided by CPS (Figure 7). Students also report greater satisfaction overall with mental health care provided by medical (clinical) staff at the UHS, compared with psychological care and counseling provided by CPS.
Figure 7: Graduate student satisfaction with on-campus mental health services, off-campus mental health providers, and mental health care offered by on-campus medical providers at the Tang Center. Respondents were more satisfied with off-campus mental health providers.
International Students
We find that surveyed international students are less likely to have used on-campus counseling services than students who are US citizens and permanent residents. Likewise, international students are less aware of psychological and counseling services available on campus (see Figure 8). This is of particular concern given that international students have unique stressors and pressures in graduate school, as reported in a 2004 Graduate Division study at UC Berkeley [8].
Figure 8: International students are much less likely to have used on-campus mental health services and less likely to be aware that these services are available. Bars at left plot the percent of respondents aware of mental health services available through CPS. Bars at right show the percent that have used CPS at least once.
Gender Difference
We also observed a difference between men and women, in the reporting of depression and sadness. Figure 9 displays students’ perceived mental health, broken down by sex. As in Figure 4, the graph displays the percent of respondents reporting experience with surveyed emotions either “frequently” or “all the time”.
Gender differences in self-reported mental health concerns and help-seeking behavior have been documented elsewhere and may result from biological or social differences between the sexes. For example, a 2004 National College Health Assessment survey found that 50% of female students reported feeling overwhelmed at least once in the last year, compared with 40% of male students [9].
However, we observe an even greater disparity between female and male graduate students in Figure 9. It is possible that this disparity results from an academic climate which is selectively hostile to female graduate students, as has been reported in studies of women in academia [10].
Figure 9: Measures of perceived mental health, charted by sex. Female graduate students are more likely than males to report feeling hopeless, overwhelmed, exhausted, sad, and depressed “frequently” or “all the time”. Y-axis indicates percentages of women and men, respectively, reporting each of the surveyed emotions.
Faculty and Department Factors
In all schools and colleges, masters and doctoral students show consistent levels of satisfaction with their primary advisors and their interactions with other faculty members. However, professional students (particularly in the Schools of Law and Business) report lower overall satisfaction with primary advisors, possibly as a result of under-sampling. Also, professional students are less likely to work directly with members of the faculty on coursework or research projects; as a result, they may receive less time, attention, and career advice from professors in their programs.
Figure 10 (dark bars) plots the percent of surveyed students in each school or college who are “very satisfied”, “satisfied”, or “somewhat satisfied” with their primary faculty advisor. The academic advisor is defined in the survey as the single member of the faculty with whom a student has most contact.
Also displayed in Figure 10 (light bars) is the percent of students in each school or college who are “very satisfied”, “satisfied”, or “somewhat satisfied” with their interactions with other departmental faculty (excluding the primary advisor). Interestingly, surveyed students from academic (i.e. non-professional degree granting) schools and colleges report greater satisfaction with other faculty members, compared with the primary advisor.
Figure 10: Respondents’ overall satisfaction with their interaction with other members of the faculty (i.e. excluding the primary advisor) is charted with dark bars. Satisfaction with primary faculty advisor, by school or college, is displayed using light bars. Note that the professional schools were under-sampled in this study, and their low level of satisfaction with the faculty overall may reflect bias.
Female students reported less satisfaction with their relationships (or interactions) with faculty members other than the primary advisor (Figure 11). However, no large differences between female and male students were observed for satisfaction with the single faculty member with whom they have most contact.
Figure 11: Satisfaction with interactions with the department’s faculty members, by sex. Female graduate student respondents are less satisfied overall.
Female respondents also appear to meet less frequently with their primary advisors, compared with male survey respondents (Figure 12). This may be an artifact of the greater numbers of female graduate students enrolled in masters and humanities degree granting programs, which (compared with engineering and science research fields) generally require less contact between students and their faculty advisors.
Figure 12: Frequency of meetings with the primary academic advisor, by sex. Female respondents are more likely than males to meet with their professors monthly or once per semester; male respondents are more likely to meet once per week.
CONCLUSIONS
Perceived Mental Health of Graduate Students
Almost half of all graduate students participating in this survey reported an emotional or stress-related problem that significantly affected their well-being and/or academic performance in the last twelve months. Graduate students who responded to our survey also reported higher levels of stress and perceived mental distress than undergraduate student populations surveyed previously.
In spite of these high levels of reported mental distress, respondents commonly perceived no need and no time to use mental health services. This suggests that education for graduate students about the common symptoms of and treatment options for mental health problems should be a high priority. Students should be able to assess the seriousness of their problems and seek appropriate help. It also suggests that outreach to graduate students is essential for maintenance of academic success, productivity, and quality of life.
The high self-reported rate of suicide attempts in our sample population indicates that surveyed graduate students may face an extremely high risk of suicide. Accurate measures of suicides and suicide attempts, as well as an interdisciplinary approach to suicide prevention, should be implemented on the Berkeley campus. Likewise, the campus should increase awareness of common symptoms of mental distress and the health services available to students. A suicide prevention campaign conducted through departments, with participation of faculty members and graduate students peers, could be particularly effective.
Academic and Departmental Factors
Although students are unlikely to contact a faculty member with a mental health concern, the faculty should be educated on graduate student mental health concerns, to foster an academic environment that is more satisfactory to the graduate population, particularly female students. Surveyed graduate students report lower satisfaction with primary faculty advisors; this may reflect the frequency or intensity of dysfunctional relationships between graduate students and their faculty mentors.
Faculty members and departments can also be instrumental in reducing the stigma attached to depression, bipolar disorder, and other mental health concerns common on college campuses. Departmental policies should be reviewed with attention focused on how policy outcomes impact student mental health. Departments can appoint a liaison with the campus health services, so that preventive health information is shared freely between graduate students, faculty members, and departmental administrative staff.
Campus Mental Health Services
Greater advertisement of student health services would improve graduate student awareness of available health care and preventive education. It would also correct misperceptions about the quality of healthcare available on campus: while nearly 10 percent of students cited perceived quality of on-campus health services as a reason for not visiting CPS, over 75 percent of respondents who had used services at CPS reported that they were somewhat satisfied, satisfied, or very satisfied with their appointments.
Graduate students are more likely to access information via impersonal means (e.g. web, flyers) and they are most likely to contact a spouse, partner, or friend with a mental health concern. As such, peer health education and outreach by email or the internet are essential. Greater integration of health services with academic departments would improve student exposure to health education.
Respondents reported higher satisfaction with off-campus (community) mental health providers. Those who did not follow up with the off-campus mental health professionals to whom they were referred cite lack of time and cost constraints as major barriers. We recommend that UHS review its referral system and expand the pool of affordable, local community mental health providers to whom graduate students may be referred. Alternately, mental health providers with particular expertise in handling the mental health concerns of graduate student populations should be hired into the on-campus health services staff.
Future Work
This report represents the initial, first-pass analysis and summary of data collected from the Spring 2004 survey of UC Berkeley graduate students. Ongoing analysis, statistical modeling, and qualitative analysis of survey comment data are currently under way. These results will be released as they become available.
Recommendations based on our initial survey results have been shared with directors and staff of University Health Services. Last month, in response to the efforts of the graduate student Mental Health Task Force, members of the Academic Senate approved the formation of a campus-wide committee on mental health. Committees similar to this have been established at several other universities. We recommend that the Berkeley committee identify and implement improvements in campus climate, support of mental health services, and preventive health education. We anticipate that survey research such as this will be a useful contribution to future committee work.
REFERENCES
[1] JAMA Editorial, “Mounting Student Depression Taxing Campus Mental Health Services”, April 23/30 2003; New York Times, “In College and in Despair”, October 26, 2003.
[2] UC Berkeley Graduate Division graduate and professional student enrollment data, Fall 2003.
[3] UC Berkeley Office of Student Research student enrollment data, Fall 2003
[4] LJ Sax, JA Lindholm, AW Astin, WS Korn and KM Mahoney (2001) "The American Freshman: National Norms for Fall 2001". Higher Education Research Institute, UCLA Graduate School of Education & Information Studies.
[5] Reference Group Executive Summary (2003) National College Health Assessment, American College Health Association.
[6] Moscicki EK. (2001) Epidemiology of completed and attempted suicide: toward a framework for prevention. Clinical Neuroscience Research 1: 310-23.
[7] Kuo WH, Gallo JJ, Tien AY. (2001) Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland. Psychol Med 31(7):1181-91; Silverman MM, Meyer PM, Sloane F, Raffel M, Pratt DM. (1997) The Big Ten Student Suicide Study: a 10-year study of suicides on midwestern university campuses.Suicide Life Threat Behav. 27(3):285-303.
[8] UC Berkeley Graduate Division International Students Survey, Spring 2004.
[9] Reference Group Report (2004) National College Health Assessment, American College Health Association.
[10] Women in the Chemical Workforce: A Workshop Report to the Chemical Sciences Roundtable (2000) Commission on Physical Sciences, Mathematics, and Applications, National Academies of Science; Nelson DJ and Rogers DC (2000) National Analysis of Diversity in Science and Engineering Faculties at Research Universities, National Organization for Women.