| Objective:The cultivation of doctoral students is the highest level of higher education in the world.As the enrollment scale of doctoral students increases year by year,China’s education management department has introduced a series of reform measures,such as improving the quality of doctoral training;innovative ways to recruit doctoral students,and encourage admission methods such as master-doctor continuous study,bachelor-master-doctor continuous study and application examination system,increasing the requirements for doctoral degree.Although these measures have promoted the development of the cultivation of doctoral students in China,however,social competition is increasingly fierce,and doctoral students are facing increasing pressure in economy,family,study,employment and scientific research;PhD students need to manage the mentoring relationship and balance work,family and study.These are big challenges to psychological endurance of doctoral students undoubtedly.Therefore,the mental health of doctoral students and its related factors is an important topic worthy of concern.PhD students are in a state of sub-health because of great mental stress.Depression and anxiety are common mental disorders of doctoral students,and their incidence is high.A 2015 study from the university of California,Berkeley,found that forty-seven percent of PhD students are depressed and prone to depression.Many failed to graduate on time,with deferments of 5 to 10 years or more.Some students have abandoned their academic studies and given up pursuing a doctorate.According to a metaanalysis paper of JAMA,a world-renowned journal,the proportion of depressive symptoms among medical students is between 24% and 29%,and that among residents is between 25% and 33%.In addition,burnout was also higher among medical students,which may be associated with increased suicidal intention in the future.One study in the United States estimated that about 14 percent of medical students had symptoms of moderate to severe depression,and about 5 percent had suicidal thoughts during medical education and training.Medical students had a 2.4 times higher risk of depression than the general population.Medical doctoral students are higher level academic researchers in medical colleges,the pressure from academic studies,paper publishing,mentoring relationship,financial issues,family and work conflicts were all higher.The levels of depression and anxiety were higher than those of undergraduate and postgraduate students.While,there has been little reporting.The relationship between teachers and students refers to the degree of harmony between students and their tutors,the degree of guidance and the level of students’ identification with their tutors.From the perspective of social cognition,instructional efficiency or instructional function is of great significance to graduate programs.The supervisor is responsible for guiding the doctoral students to complete the doctoral program.Previous studies have shown that the mentoring relationship is related to students’ perceived selfefficacy,academic output and future academic development.In recent years,studies have shown that supervisor’s leadership style has a significant impact on graduate students’ mental health.Mentorship is important to the completion of doctoral programs,and nearly half of the dropouts’ report having not received adequate mentorship.A 2018 survey showed that a weak relationship with a mentor is a common feature of most graduate students experiencing depression and/or anxiety.Research self-efficacy refers to the students’ confidence in successfully completing various tasks of research projects and the students’ self-evaluation of their own level of research capability.Research self-efficacy is very important for students’ research training.Self-efficacy helps individuals decide how much effort they will put in when they are ready to complete a task,how long they will persist when they experience difficulties,and how resilient they will be in adverse situations.Studies have shown that there is a significant positive correlation between research self-efficacy and future research input and output.Schlosser et al.found that mentoring relationship has a significant impact on research self-efficacy.Other studies have shown that research self-efficacy is positively correlated with students’ interest in research.Research interest is the interest and attitude of students towards the completion of research activities.Research interest will influence individuals’ willingness to participate in research activities.Some studies have shown that interest in research may affect the level of research self-efficacy,and indirectly affect the psychological state of students in the process of completing research projects.Rigor is a necessary quality for doing a research.Individuals with rigorous personality traits may be more likely to be trusted by the tutor,meet the requirements of the tutor,and establish a good relationship with the tutor.A high level of willingness of lifelong learning is a necessary quality for medical students.Only when medical students have lifelong learning intention and enthusiasm,can they take the initiative to give play to their learning potential,effectively ensure that medical students master new knowledge and skills,to improve their professional,clinical and research ability,and ensure high post competence and competitive advantage.This study was conceived in this context.What is the prevalence of depression and anxiety among doctoral students in China? What are the risk factors for depression and anxiety? What are the factors that affect depression and anxiety level? What are the factors in descending order of contribution? How do these factors affect depression and anxiety? This study will provide the basic data of doctoral students’ mental health level for medical education and managers,identify risk factors for depression and anxiety symptoms,and help managers identify them in time.Screening the associated factors of depression and anxiety and the effect mechanism will provide certain support for future teaching reform and policy intervention.This paper is divided into four parts: the first part is to design a questionnaire to investigate the prevalence of depression and anxiety among medical doctoral students;the second part is to study the risk factors of depression and anxiety;the third part is to examine the mediating effect of the mentoring relationship in the association between research self-efficacy and depression/anxiety;the fourth part is the qualitative analysis of the factors affecting depression and anxiety of doctoral students.Methods:In the first part,according to the domestic and foreign literature review and semi-structured interview,the indicators and scales in the questionnaire were determined and the questionnaire was designed.From November to December 2017,we recruited 379 doctoral students who were studying in a medical university.After obtaining the informed consent of the respondents,self-filled questionnaires were used to collect the sociodemographic and doctoral characteristics of respondents.We used the corresponding scales to measure the depression,anxiety,research self-efficacy,interest in research,rigorous personality,lifelong learning intention and mentoring relationship.The data was statistically analyzed by SPSS19.0 with the input information of Epidata3.1 software,and the test level was 0.05.In the second part,frequency and its distribution are used to represent the distribution characteristics of count data.The measurement data are expressed as mean plus or minus standard deviation.The reliability test of the scale used Alpha coefficient for internal reliability evaluation.In terms of the analysis of potential risk factors,univariate analysis was carried out first: chisquare test was used for counting data,and t test or one-way analysis of variance was used for measurement data.The variables with statistical significance in univariate analysis were taken as independent variables,and the depression and anxiety status of doctoral students was taken as dependent variables.We performed the binary logistic multivariate regression analysis to determine the independent risk factors for the occurrence of depression and anxiety symptoms.In the third part,one-way ANOVA was used to compare the differences in depression and anxiety scores between different sociodemographic and doctoral characteristics.Pearson correlation analysis was used to test the association of research self-efficacy,interest in research,rigorous personality,lifelong learning intention,mentoring relationship with the depression and anxiety;Stepwise hierarchical regression analysis was used to determine the associated factors of depression and anxiety and how much variation the variables have explained.P < 0.05 was taken as the criterion of the significance.Tolerance and VIF are used to determine whether there is collinearity problem between variables.When tolerance < 0.1(VIF > 0.5),it indicates that collinearity problem may exist.The significance of the mediating effect and the magnitude of the interpretation were judged by multivariate hierarchical regression analysis.The mediating effect was further tested by asymptotic and resampling methods.5,000 bootstrap samples were used for estimation.In the forth part,based on the idea of grounded theory,Nvivo software was used to conduct a qualitative analysis of the respondses to the open-ended questions in the questionnaire.Factors affecting depression and anxiety of doctoral students were summarized and analyzed through three-level coding.Types,themes and concepts were sorted out and extracted from the data.According to the number of reference points,core influencing factors,subcore influencing factors and non-core influencing factors are divided.We constructed the theoretical model of the interaction of influencing factors.We also put forward some suggestions on prevention and intervention of depression and anxiety from three levels: doctoral students,doctoral supervisors and doctoral management institutions.Results:The first part: through literature review analysis and semi-structured expert interview,four types of sociodemographic characteristic indicators are collected and summarized,including basic information,economic pressure,child-rearing burden,work and employment.There are ten kinds of doctoral characteristic indicators including doctoral type,basic information of PhD’s studies,doctoral program progress,relationship with the mentor,guidance from the mentor,paper publishing pressure,feeling of PhD’s studies,expectation for graduation time,role in the mentor team,difficulty in balancing work,family and PhD’s studies.Six research variables are rigorous personality,proactive personality,interest in research,mentoring relationship,lifelong learning tendency and research self-efficacy.By the questionnaire survey,among 379 doctoral candidates,we found 87(23%)doctoral students with positive depression.Of these,45(11.9%)were moderately depressed;moderate severe depression was reported in 28 patients(7.4%);fourteen(3.7%)were severely depressed.We found 70(18.5%)doctoral students with positive anxiety,among which 44(11.6%)were moderately anxious;26(6.9%)had severe anxiety.The depression level of the PhD students was 6.99 ± 5.86,and the anxiety level was 5.50 ± 5.38.The second part: With univariate analysis it has been shown that pressure of promotion,clinical doctoral students,the frequency of meeting with the mentors,unpleasant experience with the mentors,mentor type,the difficulty in publishing doctoral qualification papers,realizing of the meaning of doing a PhD,expectation for graduation time,the difficulty in balancing work,family and PhD are the common potential risk factors of depression and anxiety disorders.The specific risk factors of depression are assisting the tutor to apply for the project or apply for the award,assisting and guiding thesis writing,and participating in the mentor projects.Parenting and the number of doctoral students supervised by the mentors are specific risk factors for anxiety disorders.After Logist regression analysis,we found that the risk of depression for doctoral students who meet their supervisors less than or equal to one time per semester is 0.088 times higher than that of doctoral students who meet their supervisors twice per semester.The risk of depression for doctoral students who meet their supervisors less than or equal to one time per semester is 0.151 times higher than that of doctoral students who meet their supervisors once a week.Doctoral students who meet with their supervisors less than or equal to once a semester are 0.189 times more likely to suffer from depression than those who meet their supervisors twice a week.The risk of depression for doctoral students who meet their mentors less than or equal to one time per semester is 0.214 times higher than that of doctoral students who meet their mentors every day.The risk of depression for doctoral students with unpleasant or conflicting experiences with their mentors was 3.111 times higher than that for doctoral students without unpleasant experiences.The risk of depression of doctoral students with difficulty in balancing work,family and doctoral education is 2.738 times higher than that of doctoral students with little difficulty;the risk of depression is reduced by 0.976 times for every unit of mentoring relationship;and the risk of depression is reduced by 0.995 times for every unit of scientific self-efficacy.After Logist regression analysis,we found that doctoral students who meet with their mentors less than or equal to one time per semester are 0.166 times more likely to suffer from anxiety disorder than those who meet with their mentors twice per semester;Doctoral students who meet with their mentors less than or equal to one time per semester are 0.142 times more likely to suffer from anxiety disorder than those who meet with their mentors once a week.The risk of anxiety for doctoral students with difficulty in balancing work,family and study is 3.542 times higher than that of doctoral students with little difficulty in balancing work,family and study;the risk of anxiety is reduced by 0.973 times for every unit of mentoring relationship;and the risk of anxiety is reduced by 0.991 times for every unit of scientific self-efficacy.The third part: After the stepwise hierarchical regression analysis,it has been shown that mentoring relationship,the difficulty in publishing PhD qualification papers,the difficulty in balancing work,family and PhD,research self-efficacy,feeling of economic pressure,realizing the significance of the PhD program,frequency of group meetings together explained 26.6% of the variation of depression.The top three variables contributing the most are mentoring relationship,the difficulty in publishing PhD qualification papers,and the difficulty in balancing work,family and PhD.We found that mentoring relationship played partly mediating roles in the relationship between research self-efficacy and depression by Stepwise hierarchical regression analysis.The mediating role has been tested to be significant with asymptotic and resampling methods.After the stepwise hierarchical regression analysis,it has been shown that mentoring relationship,the difficulty in publishing PhD qualification papers,the difficulty in balancing work,family and PhD,research selfefficacy,expectation for graduation time,the frequency of meeting with the mentor,realizing the significance of the PhD program,feeling of economic pressure,clinical work together explained 30.9% of the variation of anxiety.The top three variables contributing the most are mentoring relationship,the difficulty in publishing PhD qualification papers,and the difficulty in balancing work,family and PhD.We found that mentoring relationship played partly mediating roles in the relationship between research self-efficacy and anxiety by Stepwise hierarchical regression analysis.The mediating role has been tested to be significant with asymptotic and resampling methods.The forth part: through the three-level coding analysis,we found that the factors affecting depression and anxiety among doctoral students in the medical college could be divided into ten categories: "Learning and research ability","tutor,team and laboratory","work,family and children","physical and mental pressure","economic pressure","time pressure","graduation pressure","doctoral training system","sense of significance of doctoral study" and "initiative and interpersonal skills".In the theoretical model of the interaction between the influencing factors of depression and anxiety for doctoral students,the interaction of "learning and research ability","tutor,team and laboratory",and "work,family and children" indirectly affects depression and anxiety through "physical and mental stress".Conclusion: 1.The results of the current status survey show that among the 379 doctoral students,23% of them are positive for depression symptoms and 18.5% for anxiety symptoms.2.The frequency of meeting with the mentors,the difficulty in balancing work,family and PhD,mentoring relationship,research self-efficacy are common risk factors for depression symptoms and anxiety symptoms among doctoral students.Having an unpleasant experience with the mentors is a specific risk factor for depression symptoms.3.(1)The influence factors associated with depression symptoms scores in descending order of contribution are “mentoring relationship”,“having difficulty in publishing PhD qualification paper”,“having difficulty in balancing work,family and PhD”,“research self-efficacy”,“sense of economic pressure”,“meaning of doing a PhD”,“frequency of holding group meeting”.(2)The influence factors associated with anxiety symptoms scores in descending order of contribution are “mentoring relationship”,“having difficulty in publishing PhD qualification paper”,“having difficulty in balancing work,family and PhD”,“research self-efficacy”,“time of graduation expectation”,“frequency of meeting with mentors”,“meaning of doing a PhD”,“sense of under economic pressure”,“clinical doctoral students”.(3)The mentoring relationship plays a partial mediating role in the relationship between research self-efficacy and depression/anxiety symptoms.4."Learning and research ability","tutors,teams and laboratories","work,family and children" and "physical and mental stress" are the core influencing factors of depression symptoms and anxiety symptoms.The prevention and intervention of depression and anxiety should be carried out jointly by doctoral students,supervisors and management institutions of doctoral students. |
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