The results reveal the predominance of negative elements in the representation of the PhD studies among PhD students and young doctors. Starting with the three themes regrouped under Node 1 (health), we can distinguish several aspects of mental health issues among which Theme 1 (“Physical, mental health and impostor syndrome”) and Theme 2 (“Stress and malaise at work”) seem to oppose one another. While Theme 2 refers to a certain level of stress, it also refers to tasks and expected difficulties, considered as intrinsically part of PhDs and research: competitiveness, high levels of complexity, pressure to perform... On these questions, research teams, labs and institutions have little room to maneuver. Most of this stress is related to the amount of work and difficulties to maintain a high level of competence to carry out these tasks over the long term but it should be noted that it concerns mainly the 1st year of PhD. A lack of skill, work organization, experience or self-efficacy could explain the predominance of this topic at the beginning of PhDs.
On the other hand, the first theme depicts a psychopathological picture. It regroups terms associated with the impostor syndrome which relates to a mental state of self-doubt. Despite evident abilities and academic success, those suffering from this condition are unable to feel competent and accomplished as they live in a persistent fear of being discovered as intellectual frauds 12,13. In addition, a certain number of psychological and behavioral symptoms linked to anxiety and depression are also regrouped in this theme (physical pain, sleeping problems, sick leaves…). In this regard, it should be noted that this early detection of anxious or depressive symptoms can be especially difficult if we consider the stress associated with research (as previously identified in Theme 2). Care should therefore take different forms. When possible, it seems necessary to provide more information to doctoral students and their supervisors on anxiety and depressive symptoms, as well as information on the impostor syndrome which seems to be associated with these symptoms. Though, it is known that students are unwilling to seek or receive help from health services because they perceive emotional distress as a potential threat for a successful career progression if psychiatric issues are revealed, especially among students who belong to minorities 14–19. It is accompanied by poor knowledge of these services and the type of support they can provide 17,20. However, it seems essential to work on the representations and the lack of knowledge associated with these services to promote care and limit the long-term repercussions on physical and mental health, and at a broader level on general functioning and the ability to maintain activities, work and avoid drop-out.
The same could be said for inability to maintain a satisfying work-life balance 2,21. This challenge is often difficult to achieve in research and it cannot be considered as a part of PhD experience solely. However, acting at this level can limit personal and professional exhaustion and reduce the guilt and negative feelings associated with the inability to maintain this balance. In most cases, supervision focuses on methodological aspects or the research field and leaves aside work organization and support. Universities can intervene on this topic and train doctoral students in efficient work methods and project management to reduce this inability. Such training should not only have a positive impact on the short-term but also it should help PhD students to maintain their motivation and ability to work despite highly demanding tasks.
With regard to the factors linked to the work (Node 2), one of the key factors related to the doctorate experience seems to be the social environment (Theme 4) within which the doctoral student evolves, as well as the professional identity and the feeling of belonging he develops. The intellectual stimulation, the institution and the level of responsibility associated with his work are positive aspects which encourage the pursuit of the doctorate. In a way, these aspects reward the high level of demand and investment required. In fact, it appears more than ever necessary to take these aspects into consideration to promote the reduction of mental health problems among PhD students. In a nutshell, cognitive behavior therapy already demonstrated that dysfunctional thinking (such as the impostor syndrome) can alter mood, behavior and has a negative effect on health and general functioning 22. It can also produce an underestimation of one’s ability or a belief of incompetence. By emphasizing positive aspects of PhD studies (skills developed, feeling of belonging, intellectual stimulation…) it would be possible to reduce these dysfunctional beliefs and produce positive effects at these different levels.
Finally, the lack of security and confidence regarding post-doctorate and professional career (Theme 5) is another key element that needs to be addressed 21,23. The integration of young doctors into society is more than ever necessary, whether in the public or private fields. Concrete actions to develop and support the post-thesis projects could benefit at several levels: reduce anxiety, increase well-being (and therefore reduce drop-out probability), establish new bridges between research and society. Unsurprisingly, this theme is associated with the end of the thesis. Especially if we consider the large number of ancillary tasks that seems intrinsically associated with PhD studies, among which we found tasks related to events, communication, teaching, etc. and leads PhD students to develop skills in a large number of fields outside of their field of expertise. An approach of their professional career in terms of skills rather than expertise seems to be an interesting way to develop self-efficacy, confidence and to reduce anxiety.
Although this is a convenience sample the extensive amount of qualitative data should prompt both academia and policy makers to consider intervention strategies. This study highlights a need to intervene at different levels, in terms of instruction, prevention, care and follow-up to reduce mental health problems among PhD students. It also highlights the perceived importance of the university and feeling of belonging to a community as possible factors to reduce these problems and reduce drop out probability.