Mental Health and Well-Being of Doctoral Students: A Systematic Review

1 Introduction

Doctoral students occupy a distinctive position within higher education. As the most highly trained group in their disciplines, they represent both an essential national intellectual resource and a key driving force in knowledge production [1]. Compared with undergraduates and master’s students, doctoral candidates encounter more complex and multifaceted pressures, including sustained academic demands, financial burdens, and uncertainties about future career prospects [2,3]. Consequently, their overall levels of mental health and well-being tend to be lower [4,5], with higher prevalence rates of depression and anxiety than in the general population [6]. Studies have shown that doctoral students report more frequent physical symptoms, anxiety, sleep disturbances, behavioral issues, and depressive symptoms than graduates who did not pursue further study [7,8,9,10].

Mental health challenges among doctoral students not only undermine their quality of life but may also exert long-term effects on their academic career trajectories, ultimately influencing the broader functioning of higher education systems. On one hand, psychological distress can lead to academic stagnation, dropout, and research burnout, directly weakening the effectiveness of doctoral training [11]. On the other hand, the resulting loss of talent and psychological imbalance may jeopardize research productivity and the sustainable development of academic human capital, thereby threatening the stability of the knowledge innovation system and the overall quality of higher education [12,13].

The World Health Organization defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being” [14]. Well-being, in contrast, reflects individuals’ overall evaluations of their lives [15]. Although conceptually distinct, mental health and well-being are closely intertwined and are often examined within a unified analytical framework. To provide a comprehensive synthesis of doctoral students’ psychological status, the present review includes studies addressing both mental health and well-being without making a strict conceptual distinction.

Existing research has primarily focused on two major domains: influencing factors and intervention strategies. Regarding influencing factors, economic strain, limited resources, academic workload, and career uncertainty have been consistently linked to deteriorations in mental health [1,11,16], whereas institutional support, high-quality supervision, and intrinsic motivation act as protective factors [5]. Meanwhile, well-being—an increasingly prominent topic—has been explored from multiple perspectives, including individual, interpersonal, and institutional contexts, emphasizing doctoral students’ overall life experiences and subjective satisfaction [12,15,17]. In terms of interventions, although empirical evidence remains limited, pilot programs have begun testing various approaches to enhance doctoral students’ mental health and well-being, such as psychological counseling and training, peer-support initiatives, improved supervisor–student interactions, and policy-level reforms [18].

Notably, recent studies have begun incorporating the Job Demands–Resources (JD-R) model to enhance explanatory power in examining doctoral students’ mental health and well-being. Originally developed to explain stress and performance outcomes in occupational settings, the JD-R model links work-related resources to positive well-being and productivity outcomes. In this context, the doctoral training environment can be conceptualized as a distinct form of “workplace”, where resources such as supervisory support and opportunities for skill development function as critical job resources. These resources can foster doctoral performance through enhanced well-being [19,20].

While the JD-R model offers a promising and integrative perspective, there remains a lack of systematic reviews applying this framework to doctoral student populations, and existing literature is still fragmented in its coverage. Some existing reviews focus primarily on the prevalence of specific psychological disorders, overlooking the underlying stress mechanisms, moderating factors, and multilevel influences; others pay limited attention to subjective well-being and positive psychological resources. Therefore, a comprehensive synthesis of current evidence is needed to identify key determinants and intervention approaches, thereby constructing a more integrated framework for understanding doctoral students’ mental health and well-being. Therefore, this review aims to address three key questions: (1) What factors influence doctoral students’ mental health and well-being? (2) What interventions have been proposed, and what are their effects? (3) How can future research further advance this field?

2 Methods

2.1 Search Strategy

To comprehensively capture studies on doctoral students’ mental health and subjective well-being, we conducted systematic searches in four databases: Web of Science, PubMed, Scopus, and EBSCO (including PsycINFO, PsycARTICLES, the Psychology and Behavioral Science Collection). The search period was restricted from 01 January 2010, to 19 September 2025. The search strategy was structured around three key dimensions: the study population (doctoral students), the study topic (mental health), and the outcome constructs (subjective well-being and quality of life). These dimensions were operationalized using relevant keywords and combined with Boolean operators (AND, OR) to ensure both comprehensiveness and precision. Full search terms, database-specific strategies, and inclusion/exclusion criteria are provided in Supplementary Material 1. Also, this study follows the PRISMA 2020 checklist (see Supplementary Material 2).

2.2 Screening Process and Results

The screening process included three stages: de-duplication in Zotero, title/abstract screening, and full-text review using Rayyan (version 1.6.3). Two researchers independently screened all studies, with disagreements resolved through discussion or consultation with a third reviewer. A PRISMA 2020 flow diagram was used to illustrate the study selection process (Fig. 1). The database search identified a total of 431 records. After removing duplicates, 247 articles remained. Title and abstract screening excluded 103 records, leaving 144 articles for full-text review. Following rigorous screening and evaluation, 56 studies met all eligibility criteria and were included in this systematic review.

Figure 1: Flowchart of included articles.

3 Results

3.1 Factors Influencing Doctoral Students’ Mental Health and Well-Being

Based on the inclusion and exclusion criteria, a total of 45 studies were identified for analysis. In terms of geographical distribution, the literature spans Europe, North America, Asia, and the Nordic countries. Among them, the United States accounts for the largest share with 11 studies, followed by the United Kingdom (n = 5), China (n = 3), Spain (n = 2), Italy (n = 2), Germany (n = 2), and India (n = 2), and Canada (n = 1), France (n = 1), and Norway (n = 1). This distribution highlights the cross-cultural relevance of doctoral students’ mental health and well-being as a global issue. Regarding methodological approaches, quantitative studies dominate the field (n = 26), while qualitative designs (n = 14) and mixed-methods studies (n = 5) are less common. In terms of measurement dimensions, research on mental health has primarily focused on anxiety, depression, stress, and burnout, whereas studies on well-being have examined life satisfaction, supervision quality satisfaction, sense of belonging, and loneliness. Overall, the literature remains weighted toward psychological distress, with relatively limited empirical evidence on well-being (see Table 1).

The determinants of doctoral students’ mental health and well-being span multiple levels, including individual psychological traits and behavioral choices, academic processes and supervisory relationships, interpersonal support systems, organizational and institutional contexts, and group-based differences. These factors intersect to shape doctoral students’ psychological experiences and overall quality of life. Synthesizing this evidence not only clarifies the mechanisms underlying doctoral students’ psychological risks but also informs the development of multi-level support and intervention strategies. The following sections summarize the literature across four major domains.

3.1.1 Individual-Level Factors

Doctoral students’ individual psychological characteristics are a key source of variation in their mental health and well-being. Research has shown that traits such as perfectionism, resilience, future anxiety, and intolerance of uncertainty significantly influence their adaptive capacity. Adaptive perfectionism and higher levels of resilience help alleviate stress and enhance life satisfaction, whereas maladaptive perfectionism and heightened future anxiety are associated with increased psychological distress [22,31]. In addition, positive psychological resources—such as psychological capital (hope, optimism, self-efficacy, and resilience), emotional intelligence, and mindfulness—have been shown to reduce academic stress and enhance psychological adaptability [48,54,64].

Beyond psychological traits, everyday behavioral practices also play a crucial role in shaping doctoral students’ mental health. Practices such as self-care, self-compassion, regular physical exercise, and healthy lifestyle habits have been linked to improved quality of life and reduced symptoms of anxiety and depression [29,31]. During the COVID-19 pandemic, these positive behaviors were especially emphasized as key resources for mitigating burnout and feelings of isolation [28]. Moreover, in the context of multiple roles and responsibilities, effective time management and structured daily routines have been shown to help students cope with stress and maintain a sense of well-being [36].

3.1.2 Academic-Level Factors

Supervisors are among the most critical sources of psychological and academic support for doctoral students. The supervisory relationship is widely regarded as one of the most decisive elements in doctoral education [3], and its effectiveness largely depends on the clarity of guidance and the quality of communication between the student and the supervisor. When supervision is unclear or when there are mismatched expectations regarding role division, research goals, or publication outcomes, doctoral students are more likely to experience elevated levels of depression, anxiety, and stress [40,57,61]. In contrast, high-quality and supportive supervision has been associated with greater life satisfaction and reduced psychological distress [24,58]. Moreover, a supervisor’s communication style and availability not only influence academic progress but also shape how students understand and manage their own psychological states [35].

Doctoral students are typically subject to intense academic demands, contributing to persistently high stress levels. While academic environments can promote meaningful engagement, they are also frequent sources of anxiety and exhaustion [66]. Key stressors include working conditions, job insecurity, and the pressures and uncertainties associated with dissertation writing, all of which have been linked to psychological distress [26]. Structural factors—such as heavy coursework, bureaucratic procedures, limited resources, and unpaid labor—further increase the risk of burnout [31,56,62]. A lack of control over academic progress has been found to correlate with reduced pro-gram satisfaction and increased dropout intentions [29,33]. The effort–reward imbalance (ERI) model helps explain these outcomes: high personal investment coupled with limited recognition or compensation significantly amplifies psychological stress among doctoral students [41].

3.1.3 Interpersonal-Level Factors

Support and a sense of belonging within the academic community are widely recognized as core contributors to doctoral students’ mental health and well-being. A strong sense of social belonging is associated with lower threat perception, better psychological functioning, and greater optimism about the future [29]. Conversely, a lack of belonging can lead to feelings of isolation and detachment, significantly increasing the risk of anxiety, depression, and dropout intentions [45]. Peer relation-ships play a critical role in this context. Collaborative and supportive peer environments can help reduce stress levels and enhance academic engagement, whereas competitive or exclusionary peer dynamics are closely linked to heightened psychological distress [47,62]. Furthermore, participation in academic social activities—such as seminars, writing groups, and informal gatherings—can strengthen social capital, alleviate loneliness, and foster opportunities for communication and collaboration, thereby indirectly promoting well-being and academic productivity [42].

Outside of academic settings, doctoral students also rely on broader social support networks, including family and partners, for emotional stability. Research has shown that dyadic coping strategies involving a partner can effectively alleviate academic stress, reduce negative emotional responses, and enhance psychological resilience [51]. For specific groups such as international doctoral mothers, partner and family support is especially vital in balancing academic responsibilities with caregiving demands. In the absence of such support, these students are more likely to experience emotional distress, guilt, and even consider program withdrawal [55]. Broader social networks have consistently been identified as protective factors. Students with higher levels of perceived social support report better quality of life and fewer symptoms of anxiety and depression [26]. During times of crisis, such as the COVID-19 pandemic, the combination of social support, resilience, and adaptive coping strategies has been shown to significantly improve doctoral students’ psychological functioning by mitigating stress, reducing emotional suffering, and enhancing life satisfaction [28].

3.1.4 Organizational and Environmental-Level Factors

Organizational support plays a critical role in doctoral students’ psychological well-being. When students perceive a lack of meaning in their research or insufficient institutional support, they are more likely to experience anxiety, depression, and intentions to withdraw from their programs [52]. Instrumental management styles may undermine students’ autonomy and academic identity, con-tributing to psychological distress and uncertainty about the future. Research also indicates that in some disciplines, the institutional environment is psychologically inadequate—over-relying on the supervisor as a single point of support while lacking diversified and formalized support systems—leaving students more vulnerable to mental health risks [38]. Additionally, gender equality studies have revealed systemic disparities: female doctoral students report significantly lower scores in career development, autonomy, and perceived safety compared to their male counterparts. These gaps not only reflect unequal resource distribution but also indicate that institutional and cultural biases may impose additional psychological burdens [39].

Resources and policy conditions. Financial stress and the instability of funding policies are significant determinants of doctoral students’ mental health. Insufficient economic support has been shown to intensify symptoms of anxiety and depression, reduce life satisfaction, and increase the likelihood of program attrition [54,56,62]. These issues are particularly pronounced during the early stages of doctoral training and among socioeconomically disadvantaged groups, who are more reliant on scholarships or external funding. In such cases, resource uncertainty places an even heavier psychological toll. The structure and reliability of funding systems at the policy level directly influence students’ ability to balance academic demands with financial and personal well-being.

External environmental disruptions. Doctoral students’ mental health is also shaped by broader sociopolitical contexts. During the COVID-19 pandemic, numerous studies documented significant increases in anxiety, depression, stress, feelings of isolation, and uncertainty among this population [3,23,46]. The pandemic disrupted access to laboratories and campus facilities and blurred the boundaries between work and personal life, compounding psychological distress [59]. Similarly, sociopolitical unrest and macro-level instability can heighten mental health risks by restricting aca-demic activities, altering social atmospheres, and undermining career outlooks.

3.2 Group Differences in Doctoral Students’ Mental Health and Well-Being

3.2.1 Gender and Identity Differences

Gender is among the most prominent factors underlying disparities in doctoral students’ mental health. Numerous studies have shown that female doctoral candidates face higher risks of anxiety and depression, and report disadvantages in organizational well-being indicators such as career development, autonomy, and perceived safety [25,39]. In addition, minority and LGBTQ+ doctoral students are more likely to report negative psychological experiences, suggesting that discrimination or lack of inclusivity in academic environments may constitute additional stressors [30]. For doctoral students who simultaneously bear maternal and international identities, conflicts between academic and family responsibilities are particularly pronounced, often accompanied by guilt, emotional distress, and heightened dropout intentions [54]. Collectively, these findings demonstrate that the psychological vulnerabilities of marginalized groups stem not only from academic pressures but also from their social identities and cultural contexts.

3.2.2 Disciplinary and Study-Stage Differences

Doctoral students’ mental health also varies significantly across disciplines. Students in the humanities and arts report higher levels of anxiety and depression compared with those in other fields, whereas medical and STEM doctoral students more frequently exhibit differing patterns of burnout and academic engagement [25,41]. These disciplinary variations may reflect differences in the nature of research work, clarity of career pathways, and availability of academic resources.

Study stage likewise shapes trajectories of mental health. Longitudinal research indicates that doctoral students’ psychological health tends to decline overall during the first years of enrollment, though individual trajectories differ markedly: some students maintain stability or even show improvement, while others experience persistent deterioration [45]. Stress levels and the extent to which basic psychological needs are met have been identified as critical predictors distinguishing these trajectories. This suggests that doctoral students’ mental health does not follow a linear course, but rather is co-determined by academic progress, need satisfaction, and resource availability.

3.2.3 Institutional Differences

Cross-national comparative studies emphasize that national and institutional contexts substantially alter the risk and protective mechanisms shaping doctoral mental health. In countries with more comprehensive funding systems and social security, doctoral students generally report lower levels of psychological distress; by contrast, in environments where funding is insufficient or institutional support is weak, stress and dropout intentions are far more prevalent [38,44,47]. Moreover, academic cultural differences also shape psychological experiences. For instance, institutional contexts that rely excessively on supervisors while lacking institutionalized mental health support channels render doctoral students more vulnerable to the adverse effects of poor supervisory relationships [38]. These cross-cultural findings underscore that doctoral students’ mental health cannot be addressed solely through individual- or interpersonal-level interventions; rather, institutional and policy design must account for cultural and contextual variations.

3.3 Interventions for Doctoral Students’ Mental Health and Well-Being

With the growing recognition of mental health concerns among doctoral students, both academia and practice have increasingly explored diverse intervention strategies aimed at alleviating elevated levels of stress, anxiety, and depression, while enhancing overall well-being. This review identified and analyzed 11 empirical studies focusing on interventions targeting doctoral students’ mental health and well-being. Geographically, most studies were conducted in the United States (n = 3), followed by the United Kingdom (n = 2), with the Netherlands, Spain, Canada, and France each contributing one study. Methodologically, the body of literature is diverse, encompassing randomized controlled trials (RCTs), mixed-methods research, qualitative interviews, and experimental designs. However, most interventions were tested in small-scale, short-duration studies. Despite these limitations, existing research suggests that interventions can be broadly categorized into three groups: psychology-based training (e.g., mindfulness, positive psychology, and self-compassion), practice-oriented behavioral and learning interventions (e.g., behavioral activation, structured writing retreats, and progress-oriented workshops), and relationship- and support-based approaches (e.g., peer support, reflective practice, and online group learning). These initiatives have enriched the repertoire of doctoral student support strategies and offer valuable insights for institutional policies and practices (see Table 2).

3.3.1 Psychology-Based Training

This category of interventions draws directly on established psychological approaches to enhance doctoral students’ mental health and well-being. Mindfulness interventions are among the most commonly applied, with studies demonstrating that daily mindfulness meditation and attention-focused practices effectively reduce symptoms of depression and anxiety while significantly improving psychological capital, including hope, resilience, and self-efficacy, thereby enhancing overall well-being [68,74]. The advantages of mindfulness lie in its high feasibility, low cost, and adaptability for online delivery. Positive psychology interventions have also shown promising outcomes. For example, the French CARE program reduced anxiety and improved well-being among doctoral students, while a Dutch self-compassion–based PsyCap intervention emphasized cultivating self-compassion to lower stress, enhance positive emotions, and sustain improvements in well-being over time [69,73]. In addition, multi-component psychoeducational programs, such as “The Third Half,” integrate stress management, emotion regulation, and health-promoting skills to provide doctoral students with a toolbox for self-care and coping. These programs have been found to significantly reduce negative emotions and psychological distress and demonstrate strong feasibility and scalability in practice [77]. Collectively, these interventions highlight the importance of strengthening psychological resources and equipping doctoral students with systematic frameworks for cognitive and emotional coping in high-pressure academic contexts.

3.3.2 Practice-Oriented Behavioral and Learning Interventions

A second category of interventions focuses on optimizing doctoral students’ daily study habits and behavioral routines to improve mental health and well-being. For instance, brief behavioral activation delivered via phone encouraged doctoral students to approach avoided but important goals and engage in rewarding activities, which significantly reduced burnout and enhanced well-being [67]. This flexible, remotely deliverable format makes it particularly suitable for institutions with limited resources. Structured writing retreats, including residential or online formats, have also proven effective in alleviating stress and improving psychological, emotional, and social well-being. Mechanisms underlying these effects include perceived gains in productivity and opportunities for socialization and networking, which emerged as key predictors of improved well-being [70]. Similarly, progress-oriented workshops that combine educational components, peer sharing, and self-monitoring of progress were shown to enhance students’ perceptions of academic advancement, reduce burnout and dropout intentions, and strengthen positive psychological capital and satisfaction with their programs [75]. Overall, such interventions work indirectly by improving doctoral students’ academic engagement and sense of progress, thereby mitigating psychological distress.

3.3.3 Relationship- and Support-Based Interventions

The third category emphasizes the role of social relationships and support networks in fostering doctoral students’ mental health. Evidence suggests that peer support is highly valued, providing flexible and informal spaces where students can alleviate loneliness, anxiety, and depression while exchanging experiences and practical advice [77]. These interventions are especially effective when peer groups are diverse and inclusive, accommodating the needs of students from different backgrounds. Reflective practice programs offer doctoral students structured opportunities to discuss challenges in supervisory relationships, academic pressures, and work–life balance in a safe environment, thereby strengthening self-awareness, coping strategies, and resilience [78]. Additionally, online group-based learning activities that gained prominence during the pandemic—such as virtual monthly meetings and writing retreats—were found to reduce isolation, enhance academic and leadership skills, alleviate stress, and improve self-efficacy, while reducing overreliance on supervisors [76]. By fostering greater connectivity and mutual support among doctoral students, these relationship-based interventions contribute to building more inclusive, secure, and supportive academic communities.

4 Discussion

This review systematically synthesizes the complex and multilayered factors influencing doctoral students’ mental health and well-being across four key domains: individual, academic, interpersonal, and organizational–environmental levels. It also categorizes the major intervention strategies targeted at improving psychological outcomes in this population. Building on these findings, it is necessary to more clearly highlight gaps in the existing literature to inform future research directions and propose specific, actionable recommendations for universities.

In terms of influencing factors, two critical gaps remain underexplored: cross-cultural comparisons and intersectional analyses of vulnerable subgroups. First, although existing studies have documented differences in doctoral students’ mental health and well-being based on demographic variables, academic disciplines, stages of study, and institutional settings, cross-cultural and policy-oriented comparative research remains limited. Most empirical studies have been conducted in Western contexts, while only a small number have focused on countries such as China or India. These studies tend to rely on single-nation or region-specific samples, with few adopting comparative perspectives. However, substantial variation exists in doctoral training models, academic cultures, funding structures, and mental health support systems across countries and institutional contexts. These systemic and cultural differences may exert heterogeneous effects on student psychological outcomes [38,44,47]. Future research should therefore undertake in-depth cross-cultural and cross-system comparative studies to examine how structural variations shape doctoral students’ mental health and well-being. Second, the differentiated psychological experiences of vulnerable populations within the doctoral student body require closer attention. Existing evidence indicates that female doctoral students are more prone to anxiety and depression, and students from ethnic minorities and LGBTQ+ groups frequently report negative psychological outcomes [33,60]. Moreover, intersecting identities—such as motherhood and international student status—introduce additional stressors and responsibilities that may heighten vulnerability to psychological distress. Future research should incorporate intersectional frameworks to examine how gender, ethnicity, caregiving roles, and institutional settings interact, identify which groups face the highest risks at specific academic stages, and propose tailored support mechanisms. Such analyses would not only advance understanding of risk stratification but also inform inclusive and equity-oriented policy development in higher education.

With regard to intervention strategies, although current research has demonstrated the effectiveness of approaches such as mindfulness training, writing retreats, and peer support in improving doctoral students’ mental health and well-being, there remains a lack of large-scale and longitudinal empirical validation [6,78,79,80]. Most existing interventions are characterized by short durations, small sample sizes, and voluntary participation, which limits their generalizability and scalability. Future studies should implement RCTs with larger, more diverse samples and incorporate extended follow-up periods to evaluate the comparative effectiveness and underlying mechanisms of different interventions across contexts [68]. In parallel, universities must take a more proactive role in promoting the psychological well-being of doctoral students. First, doctoral training programs should place greater emphasis on practical courses rooted in positive psychology. Integrating modules on emotion regulation, self-compassion, and mindfulness meditation into the formal curriculum may enhance students’ psychological resilience and their ability to cope with stress. Second, institutions should leverage artificial intelligence and big data technologies [81] to identify high-risk subpopulations and develop targeted, behavior- and learning-based interventions (e.g., structured writing retreats, time management coaching). Third, given that doctoral supervisors serve as critical sources of both academic and emotional support, universities should establish systematic mechanisms for assessing and improving supervision quality. This may include regular feedback sessions to explore supervisory style and communication patterns, evaluations of supervisor–student relationships, and early conflict resolution procedures to prevent the escalation of tensions.

Nevertheless, certain limitations remain. Despite following rigorous systematic review protocols, the number of included studies is constrained, especially with regard to intervention research, where existing evidence is largely limited to small-scale, short-term trials, lacking large-sample RCTs and long-term follow-up. Methodologically, many studies rely on cross-sectional data, limiting causal inference, while longitudinal and mechanism-focused analyses are relatively scarce. Additionally, heterogeneity across studies—in measurement tools, conceptual definitions, and analytical frameworks—complicates integration and comparison. Finally, this review excluded gray literature and unpublished studies, which may introduce publication bias.

5 Conclusions

Doctoral students’ mental health and well-being are not only central to their academic development and quality of life but also directly shape research productivity and the sustainability of higher education systems. This study is among the few systematic reviews to comprehensively synthesize research on doctoral students’ mental health and well-being, addressing both influencing factors and intervention strategies. It adopts a broad scope, including large-scale quantitative studies as well as qualitative and mixed-method research, and incorporates literature from diverse regions, including Europe, North America, and Asia, thereby reflecting both the universality and specificity of doctoral students’ psychological challenges in cross-cultural contexts. Moreover, this review systematically categorizes influencing factors across four dimensions: individual psychological traits and behaviors, academic processes and supervisory relationships, interpersonal support systems, and organizational and environmental conditions. It further highlights group-level differences related to gender, identity, discipline, stage of study, and institutional settings. In terms of interventions, it synthesizes three primary approaches: psychology-based training, practice-oriented behavioral interventions, and relationship- and support-based strategies. This multi-level, multidimensional integration enriches theoretical understanding and offers valuable insights for developing targeted support and intervention programs in practice.