Graduate student voices on stress and mental health: Narrative survey results from a Midsouth University in the United States

Abstract

Objective

Graduate students represent a uniquely vulnerable population, often navigating intense academic pressures with limited mental health resources. The objective of this exploratory study is to uncover experiences of stress and mental health, stressor management practices, and identify actionable steps universities can implement to improve mental health and well-being.

Methods

Between May and July 2025, graduate students (n = 101) at an urban university in the MidSouth U.S. completed an IRB-approved online survey. Demographic and narrative response data from six open-ended questions were collected. A grounded theory approach to study design was implemented and a three phase coding schema was applied to thematic analyses of participant narratives.

Results

Findings reveal graduate students are stressed; however, the meanings and management of stress varied. Most graduate students did not participate in campus activities promoting positive mental health, though they did seek mental healthcare. Narratives uncovered improvements the university can make to reduce stress and improve mental health among graduate students.

Conclusion

Experiences of stress and mental health are patterned by interpersonal and institutional factors. Management of academic and financial stressors, expansion of on-campus mental health services, and institutional mental health training and mentorship support are actionable steps toward promotion of well-being on campus.

Highlights

• •Graduate students represent a uniquely vulnerable population in higher education.
• •Study explored U.S. graduate student narratives about stress and mental health.
• •Graduate students are stressed; stressor meaning, chronicity, and management vary.
• •Universities can take actionable steps to reduce stress and improve mental health.

1. Introduction

Mental health and well-being of graduate students in the United States have become an increasingly urgent public health concern. Elevated rates of anxiety, depression, burnout, and psychological distress among graduate students compared to the general population, have been documented (Levecque et al., 2017). According to the American Physiology Summitt (SenthilKumar et al., 2023), between 20 and 30% of graduate students report symptoms of depression and anxiety while pursuing their education. These rates are nearly six times higher than those of the general population (Chi et al., 2023; Evans et al., 2018).

Pursuing graduate education involves balancing multiple demands, including coursework, research, teaching, employment, and family, while adapting to new academic and social environments (Evans et al., 2018). These overlapping stressors can proliferate and lead to mental health challenges, particularly when access to personal, social, and institutional resources are limited. Graduate students may struggle with financial insecurity, imposter syndrome, or lack of mentorship, all of which can heighten psychological distress (Al Lawati et al., 2025). Stressors that graduate students encounter, such as degree completion timeline, faculty-to-student ratios, and lower representation of women (among both faculty and students), have contributed to an increase in psychiatric medication use among students (Bergvall et al., 2025). This observation highlights the impactful nature of stressors facing students in higher academic institutions.

Although graduate education can be stressful for both domestic and international students, international students face additional burdens such as cultural adjustments, language barriers, visa restrictions, and limited employment opportunities (Anandavalli et al., 2021). Some may also experience subtle or overt discrimination and social isolation, further impacting their stress (Anandavalli et al., 2021). Additionally, graduate students may be exposed to stress and trauma stemming from instances of sexual harassment and sexual violence (Bloom et al., 2022; Bloom et al., 2021). More, graduate students belonging to marginalized groups based on sexual and gender identity, disability status, and neurodiversity status, may be uniquely exposed and more vulnerable to the effects of stress on mental health (Bloom et al., 2021; Gull et al., 2025; Syharat et al., 2023).

While recent literature has attempted to understand ways in which certain groups experience outcomes to mental health and well-being (Koo et al., 2021; Williams et al., 2018), fewer studies have explored what strategies or institutional actions, particularly those suggested by graduate students themselves, could effectively mitigate these challenges. To address this gap, the research team utilized a qualitative open-ended survey, constructed to explore graduate student experiences of stress and mental health, and to identify prospective university-level interventions.

2. Methods

2.1. Study design and population

The research team conducted an exploratory study at large, urban, public university in the MidSouth, United States. The primary aim of the study was to uncover meanings of stress and mental health, sources and management of stressors, and perceived recommended steps the university can consider toward improving mental health among graduate students. To ensure trustworthiness of study design, the team made efforts to reduce potential influence on study findings. These efforts included limiting influence of prior, related work on survey construction, triangulation of recruitment sites to reach a diverse participant pool, and reflexively analyzing emergent data themes. The composition of the research team, however, included graduate student research assistants and their position inspired the design and construction of survey questions. Participants included graduate students enrolled at the university who were at least 18 years old.

2.2. Data collection

We deployed multiple recruitment strategies, including flyers, email delivered to all enrolled graduate students from the Dean of the Graduate School, emails from the International Student Services and the Public Health Student Association, and posts to platforms including WhatsApp and GroupMe. Participation was incentivized with a chance drawing to win one of ten $50 Amazon gift cards. Surveys responses were collected in three waves, between May and July 2025. The survey was made available after the final exam period and prior to the beginning of the Fall semester. The survey release date was intentional to mitigate potential influence of academic event stressors, such as final exams. The study was approved by the University Institutional Review Board (ID: PRO-FY2025–502), and informed consent was obtained from all participants.

The survey (Table S1) consisted of two sections. First, participants responded to nine demographic questions pertaining to age, sex, race, degree, length of time in program, school or college, student status (domestic or international), first generation status, and employment status. Second, students responded to a series of six open-ended questions about stress, mental health, stressor management, participation in activities geared toward reducing stress and promoting positive mental health, and perceived recommendation strategies for the university to improve stress and mental health among graduate students. Before accessing the survey, participants were required to provide informed consent. Upon survey completion, responses were anonymized to protect confidentiality.

2.3. Data analysis

Survey responses were collected electronically with Microsoft Forms (Microsoft Corporation, 2025). A grounded theory approach to design and analysis of participant responses was applied. The emergent, inductive design was constructed to reveal the meaning of participant responses, rather than presupposing meaning based on prior knowledge about graduate student stress and mental health. As such, we followed a multi-step coding procedure characteristic of grounded theory, in analysis of survey response data. In the open coding phase, codes were grouped into categories based on the open-ended survey questions. Next, during the axial coding phase, sub codes were connected to the original codes as a tool to explore context and key factors informing responses. Finally, selective coding was applied, wherein main data themes were identified. At each stage of the coding process, an intercoder reliability check was performed by the research team to ensure an accurate coding schema.

3. Results

In total, there were 101 fully completed graduate student surveys. Demographic characteristics were collected prior to response from open-ended questions. The age of participants ranged between 21 and 55 years, with a mean age of 38 years. Participants self-identified as female (66%) and male (33%), and approximately 78% identified as non-White. Most participants (61%) were pursuing a master's degree, while 39% were pursuing a doctoral degree. Ten colleges or schools on campus were represented by the participants, including a professional nursing program. Many participants (26%) were affiliated with the College of Arts and Sciences, and approximately 33% were in their second year of study. Over half (52%) identified as international students, 55% as first-generation college students, and 65% reported being currently employed.

Participants provided responses to six open-ended questions (Table S1). Open and axial coding techniques were applied across all participant responses as a tool to identify common, recurring patterns in the narratives. During the selective coding phase, code categories were further organized into themes, piecing together student voices on stress and mental health. Through this multi-level analysis, findings indicated that students routinely experienced stress as feelings of being overwhelmed, pressure, and challenge tied to academic and role-related demands. Additionally, narrative responses suggest mental health was framed as the ability to adapt, cope, maintain balance, and regulate emotions. Students relied mostly on intentional self-care regimens to cope with commonly reported sources of stress like finances, uncertainty of governmental policy amendments, and academic work-life balance. In response to the stress, student participants disclosed having sought out mental health care from professional counselors, peer groups, and university faculty. However, narratives indicated utilization of mental health care services were contingent on cost and availability, and access to care didn't necessarily equate to satisfaction of care. Paradoxically, while participants narratives favored seeking mental health care, most shared they did not participate in activities, events, or other opportunities on-campus promoting stress reduction, positive mental health. For those participants who did engage however, self-care centered areas like diet, exercise, and mindfulness were popular. Table 1 summarizes the key themes and illustrative quotes derived from the respective participant narratives.

Table 1.

Stressor meaning and management based on a May–July 2025 graduate student survey at a MidSouth University in the U.S.

Question Topics	Key Themes		Illustrative Quotes
Stress & Mental Health Meaning	Stress Physical/mental Fatigue.	Mental Health Coping with challenges of life.	“Stress refers to the physical and mental pressure that one may feel from overexerting themselves in some capacity and mental health specifically refers to the mental disposition that one has, based on various other factors impacting their life.”
	Professional and personal life balance.	Struggling with positive emotion-regulation in everyday life.	“Stress is being overwhelmed by something, someone, or some situation physically, mentally, emotionally, psychologically, socially, spiritually, or financially. Stress impacts your menta l health because it impacts your thoughts and mental processes.”
Sources of Stress	Lack of financial compensation/support.		“Specific to graduate school is finances. I cannot afford a (used)car (or to fix my current car), but the city has terrible public transportation. In addition to this, I have several ongoing health concerns, including dental (not covered by university student health insurance). I also miss home! In addition to these new stresses, the political state of the country is a huge concern. I now worry about finding a job after school and have lost any sense of confidence regarding my future. These have been my biggest stressors outside of classes and personal/family stress.”
	Uncertainty/ fear of policy amendments affecting quality of life.
	Finding equilibrium between academic achievement and personal responsibilities.		“In my experience as a graduate student, the political climate has been one of the biggest sources of stress. It's hard to focus on academic growth when rights, safety, and funding feel uncertain. I also deal with imposter syndrome, especially in high-performing environments where everyone seems confident and accomplished. Being part of a global program can feel isolating at times. Connection matters, and without it, stress compounds quickly.”
Stressor Management	Intentional self-care regimen to cope with stress.		“I enjoy exercising to manage my stress but the support from friends, family, and classmates helps, too.”
			“Go outside in nature with my dog and attend dance classes/workouts and go for car rides.”
			“I try to exercise and eat well. However, my sleep is impacted. I have had to go on increased doses of anti-anxiety medication and ADHD medication.”
Seeking Mental Health Care	Personal resilience and peer-support groups.		“I have reached out to professors, who proved to be unsympathetic of my serious circumstances. I still need to find the right therapist for me, because the counseling center on campus only offers a limited number of free sessions per semester. The counseling provided by the psychology department apparently isn't that great either. Therapy is expensive so these are a couple of my minimal options.”
	Utilization and access constraints.
			“During my time as a graduate student, I've recognized that managing everything on my own wasn't always enough. I've sought support through off-campus counseling services when stress felt overwhelming or when I needed someone neutral to talk to. It was helpful to have a space to process my thoughts, especially during high-pressure periods like exams or major deadlines. I've also attended mental health workshops and used wellness apps recommended by the university for managing anxiety and improving focus. Seeking help reminded me that prioritizing mental health is a sign of strength, not weakness; it made a real difference in how I navigated challenges.”
Activities Promoting Stress Reduction	Wellness activities.		“No, I haven't participated in any so far [wellness activities]. Between classes and other responsibilities, I haven't made the time, but I know it's something I should prioritize more.”
	Self-care engagement.
			“I've attended a few mindfulness workshops and international student events and gatherings. They [gatherings] were small, but they helped me feel more connected and relaxed.”

Narrative results from the final question of the survey (Table S1) proved most elaborate, detailed in contrast from responses to questions prior. Participants were asked what institutional-level strategies they thought their university could consider toward improving stress and mental health among graduate students. A three-phase coding procedure was followed once more, to identify common patterns in response narratives. Findings centered on three thematic areas. First, providing services beyond the university counseling center; participants expressed concern over visibility, awareness, and options for mental health care on campus. Second, addressing financial strain; participant responses chronicled limitations in amount and type of funding sources available. Third, educating and preparing faculty on student mental health and mentorship; responses outlined a desire for an institutional and department-level culture shift in interactions, training, and advising pertaining to faculty-student relationships. Within context of these themes, responses highlighted the need for actionable steps toward improvement of outcomes on student mental health. Table 2 summarizes these key themes, illustrative quotes, and respective proposed institutional actions. Proposed institution-specific actions that were common among participants included: increasing advertisement of mental health resources and expansion of care services, both in-person and virtual; broader advertisement of internal and external funding opportunities and waste audits for reallocation, repurposing of available funds; and incorporation of mental health first aid training for faculty and student-faculty community building activities. Taken together, narrative responses unearthed apparent limitations with respect to dimensions of mental health on campus. Furthermore, responses signified students' interest and commitment to improving the overall health and well-being of their campus community.

Table 2.

Recommendations and proposed institutional actions based on a May–July 2025 graduate student survey at a MidSouth University in the U.S.

Key Themes	Illustrative Quotes	Proposed Institutional Actions
Provide services beyond the counseling center	“If there's one thing the University could do to improve stress and mental health among graduate students, it would be to normalize and expand access to mental health support—including regular workshops, peer support groups, and easily accessible counseling services specifically tailored to the graduate student experience. This matters because many graduate students silently struggle with unique pressures like isolation, impostor syndrome, and work-life imbalance. By creating a culture that prioritizes mental health and makes support a visible, routine part of academic life, the University can help reduce stigma, encourage early intervention, and build a healthier, more resilient student community.”	Increased targeted advertising for available mental health resources.
	“Expanding the care provided by the counseling center (by making the regular appointment/therapy schedule more frequent) would be great for students who cannot afford external help, due to financial and transportation concerns. Moreover, increased stress and exacerbated mental health may cause students, especially graduate students who believe they have to be adults and take care of everything themselves, to avoid reaching out in fear of being perceived as incompatible with the graduate level studies. So, it would be massively helpful if the counseling center took a proactive role in providing explanations about the resources available to students who come to the center, facilitate communication with their departments and professors, and reach out in possible red flag situations such as missing appointments if that was not the norm, as it may indicate an ongoing crisis.”	Advise graduate school to include a mental health promotion room, available in- office, for graduate students.
		Require campus graduate student organizations to host community engagement activities. For example, virtual sessions online and an in-person sessions, at least twice per academic year.
	“The University could improve stress and mental health among online graduate students by enhancing virtual mental health resources and creating more opportunities for online community-building. These changes would help foster a sense of connection and provide accessible support for students who may feel isolated while balancing academics with other responsibilities such as work and family.”
Addressing financial strain	“I am on the poverty line, with rising costs of living, especially rent and food. The center I receive my stipend through has a toxic work culture that creates more stress than I would experience in another program. The department I am part of is slowly deteriorating has reached the point that others and I have complained there are not enough classes offered to graduate students that pertain to the projects that we are working on.”	Audit graduate school funds to assess allocation of funds for each academic unit on campus.
	“The biggest source of stress is financial – concerns about paying for school each semester and repaying loans.”	Conduct a waste audit and repurpose available funds for graduate student professional development and achievement.
		Require office of experiential learning staff to advertise external scholarship funding opportunities.
	“Financial concerns are probably the primary source of stress for me. I am fortunate to have had a GA to provide a stipend and cover my tuition thus far, but the stipend is not enough to comfortably live off. I already have loans from undergraduate studies, so it can be stressful to budget with what I have to try and avoid taking out too many more.”
Educate and prepare faculty on student mental health and mentorship	“Ensure that students are treated as full human beings with lives, experiences, and diverse interests as opposed to focusing so heavily on the “productivity culture” that currently plagues our society	Appoint one faculty mentor per academic unit, to serve as the professional development mentor, with specific knowledge of mental health resources on campus
	.” “There needs to be better relationship building among students and professors, and there would need to be more activities that focus on inclusion for all.”
		Incorporate Mental Heath-Aid training per college/school on campus.
	“Training of faculty and staff.”	Conduct two faculty and student retreats per academic year.

It is important to note some disclaimers about these finding. First, while survey respondents were enrolled in different degree programs, the findings were not specific to those degree programs. Rather, these results are characteristic of more general stressors experienced by the students. Second, findings originating from the narratives are not intended to be generalizable to all graduate and professional students. While shared stressors among students both inside and out of the U.S. are sure to exist, the ways in which students experience stress will ultimately be patterned by access to resources, institutional services, and location, among other factors. Lastly, these findings do not serve as an evaluative metric on effectiveness of proposed institutional-level actions. Rather, responses concentrated on actions perceived as relevant to the university surveyed; actionable steps taken to improve stress and mental health at the university surveyed may not necessarily be effective at doing so or in the same ways, at other campuses.

4. Discussion

Narrative survey results indicate that meanings of stress and mental health experienced by graduate students are multifactorial. Intersecting factors such as perceived stressor chronicity, academic demands, financial strain, and limited institutional support pattern experiences of well-being. Consistent with prior research, participants identified academic culture and academic role obligations as impactful sources of stress; policy and financial uncertainty further exacerbate stressor burden (Evans et al., 2018; Levecque et al., 2017). Narratives additionally show that although students practice positive stressor management techniques and seek mental health care, the consistency of the behaviors is contingent on access to resources, like affordability. Incidentally, although many graduate students in this study did not engage in campus activities promoting stress reduction, those who did found them to be beneficial. This general observation aligns with work by Pearlin et al. (1981), which posits stress can lead to distress, though chronicity and duration of stress is determined by access and utilization of personal and social resources.

Findings from this study highlight stress does not occur in a vacuum; place (e.g. university), may shape experiences of stress and mental health on campus. For study participants, stress affects their academic life, personal life, and mental health care seeking pursuits. Incidentally, institutional-level constraints such as limited mental health care services, financial strain, and faculty and department resources and training, likewise, can affect student well-being. Participant responses captured prospective institutional strategies for improving well-being. Among strategies identified, many called for expansion of mental health services beyond traditional on-campus counseling services; audit of financial resources to better tailor to graduate student financial insecurities; and provide mental health training for faculty and academic units. Broadening resource opportunities, enhancing visibility of mental health activities and programs, and integrating peer support initiatives at the institutional and departmental level, could help bridge the gap between student need and service utilization. More, narratives emphasized the role faculty mentorship and departmental culture play in influencing stress and mental health. Students described strained advisor-advisee relationships as an impactful stressor. Existing work by Hermanstyne et al. (2022) and Taylor et al. (2018) documents the positive impact effective mentorship can have on outcomes to well-being for students. As such, incorporation and availability of mentorship training, as well as basic mental health first aid training for faculty can foster stronger, more supportive faculty-student interaction.

Overall, survey responses point to the need for a multilevel approach to mental health promotion in graduate education; one that addresses both personal and institutional contexts in which stress occurs. The prominence of stressor burden experienced by participants in this study mirror that of national data, which indicates graduate students experience disproportionally high rates of mental health challenges compared to the general population (Chi et al., 2023; Evans et al., 2018). Notably unique to this study was that more than half of respondents were international and first-generation students. Marginalized student groups like these, as well as others, are typically underrepresented in research and yet are uniquely exposed and vulnerable to stress and mental health (Baldwin-SoRelle and McDonald, 2024; Bloom et al., 2022). Consistent with work by Roberts and Plakhotnik (2009), these findings suggest that mental health inequities among graduate students may reflect broader structural disparities within higher education, reinforcing the need for culturally responsive, inclusive, and accessible interventions.

5. Conclusion

In summary, participant narratives reveal that graduate student stress is driven by interconnected academic, financial, and relational factors, compounded with unequal access to mental health resources. Addressing these challenges demands systemic, institutional solutions rather than solely individual efforts. Universities that adopt student-informed strategies, are those that aim to create healthier academic environments that promote student well-being and academic success. While study results presented here are exploratory, future work can benefit from a richer ethnographic deep dive, including focus groups, to probe for nuance in sources and factors patterning stress and mental health experienced by graduate and professional students. Future work should also concentrate on the effectiveness of institutional interventions on stress and mental health outcomes as well as service utilization on campus, over time.

CRediT authorship contribution statement

Alex R. Parkhouse: Writing – review & editing, Writing – original draft, Supervision, Project administration, Methodology, Investigation, Formal analysis, Conceptualization. Prada House: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Conceptualization. Dennis Tsegah: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Conceptualization. Chitra Ghosh: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Conceptualization.

Ethical approval

This study was approved by the University Institutional Review Board (ID: PRO-FY2025–502) and informed consent was obtained from all study participants.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Supplementary data

Supplementary material