The Effects of Cumulative Stressful Educational Events on the Mental Health of Doctoral Students During the COVID-19 Pandemic

 Dear Editor, 

Thank you for taking the time to allocate our paper “The effects of cumulative stressful educational events on the mental health of doctoral students during the COVID-19 pandemic” for review. We  have now addressed both the reviewers’ and your comments and made respective changes in the  manuscript. The changes are indicated by tracked changes below.  

Best wishes, 

Dr. Maria Kambouri 

m.kambouri@ucl.ac.uk 

1. The response to the reviewers seems thorough in terms of what has been said in the response  BUT the text showing changes has only been marked in different colours to indicate changes in  the first part of the revised manuscript and there appears to be at least one example around  original line 222 where the changed alluded to in the response to reviewers has not been made to the text. Please provide a manuscript appropriately marked-up because the changes are quite important.

Response: We have now marked-up the manuscript appropriately to reflect all the important changes and to provide clarity

2. Some parts of the revised manuscript appear very rushed and need clarification although they are useful in pointing up the learning environment is at the heart of the study. Response: We have now clarified/rephrased the parts that seemed rushed. The changes are highlighted in red and we have also expanded on the idea of the learning environment that plays an important part in the paper.

3. The Discussion lacks any mention of the learning environment that was a prominent part of the rationale for the paper as set out in the revised manuscript. Some comment on this is needed in the Discussion - perhaps a remark as to the need to attend to the whole learning environment at times of emergency but also perhaps at other times. Response: We have highlighted the idea about the learning environment throughout the study and have expanded on the parts that were pointed out. The comments in the pdf document were also taken into account and you can see all the changes in red.

4. There are several grammatical issues that may have been introduced as a result of the errors present in software - for example there are misplaced commas that break up the text sufficiently to destroy the meaning of the sentence. This is a fault that has persisted for years in all Microsoft packages for example. Response: Thank you for pointing this out. We have now fixed this.

The comments below correspond to the comment attached to the pdf document.

5. Line 61 & 63: This insert has been rushed. It should read something like:

The lead question for this study was: how has the Covid-19-altered environment in which research students had to work affected their wellbeing, health and relationships? During Covid-19, learning environments altered in various ways so that for some projects access to resources became more difficult and some projects ground to a halt and others were moved into the virtual world.

Response: We have now rephrased according to your recommendation.

6. Line 146: phrasing wrong here.

This should read something like access to resources became limited and in some cases research student projects ground to a halt.

Response: We added the suggested phrase at the end of the sentence.

7. Line 219: add at end ... and associated changes to the learning environment

Response: We have marked-up the changes that seemed to stop happening after that point. Please also see the first comment.

8. Line 262: The importance of the learning environment was stressed in the introduction but no mention of this broad concept is made in the Discussion. Presumably given the finding that CSEE are major factors in the aspects of mental health studied then the learning environment during any future pandemic or similarly disruptive event needs to be adapted more than was achieved in the case of Covid-19. Further, is this not a generalisable finding to other educational settings? It seems to me the research highlights that elements of the learning environment, encompassing both physical and interpersonal components, need to be adjusted in some cases to avoid negative impacts on the mental heath of PhD students. Ref 11 is very helpful to you in this respect.

Response: Thank you for noting this. We have updated the beginning and end of the Discussion to include mention of the importance of the learning and working environment, referencing Ref 11, and the point that universities should plan for mitigating the occurrence of cumulative stressful educational events that occur for research students in a time of societal upheaval in the first place. We do not wish to suggest that our findings are applicable to other learning environments (e.g. primary and secondary schools) given the unique learning components of a PhD and the developmental and age differences in the students.

9. Line 270: It is around here that changes to the text seem to stop happening

Response: We have now fixed this.

10. Line 273: reference 11 makes use of the term environment in just the way this paper is doing and this reference could provide a way for these authors to bring out aspects of the environment in the discussion in relation to their findings.

Response: We have elaborated on this. Please see the comments above about the working environment of the students.

11. Line 282: this comma is wrongly placed ... the Word editor constantly asks about commas. Over half the time it gets them wrong and destroys the meaning of the sentence, as here. The sentence does not need to be broken into phrases.

Response: We have fixe the issue with the commas throughout the manuscript.

12. Line 294: finances is not part of the paper avoid referring to it?

Response: We removed the term finances to avoid confusion.

13. Line 295: This is a change that has been made but it is not clear what is meant by the insertion. I think the reviewer's point was that some separate consideration of factors and some joint consideration was required and I think this insertion of new text is meant to answer that point. But it is poorly worded and looks hurried. Maybe this kind of phrasing is what is required: "Supplementary Table 2 indicates that some covariates are significant factors in either the depression or anxiety models when considered apart from the other CSEE factors. This suggests that it is the overall impact of all the CSEE factors that is the most important influence on mental health measures." Of course, I am guessing here but I hope the authors can see what I am suggesting.

Response: We have now rephrased for more clarity.

14. Line 301: all the data come from one Covid wave presumably so is this phrase needed?

Response: We have removed the phrase about the wave to avoid confusion.

15. Line 330: ref 11 is very pertinent for its use of the "working environment" meaning the totality of the physical and interpersonal elements -- i.e. it is not just the interpersonal necessarily.

Response: As noted, we have updated the Discussion to refer to the broader learning and working environment referencing Ref 11

Response: We changed the word “cited” to “accessed”. However, the link seems to be working when we tried to access it, so we have left it in there. Perhaps try a different browser?

The comments below correspond to the comment attached to the pdf document. Third Round

17. Line 77: Missing full stop

Response: We have now added the full stop to the sentence.

18. Line 81-82: Is this wording better for this sentence ... "Hence, it is vital, against the backdrop of the pandemic, to understand more about both the vulnerability of students and what factors might promote good mental health amongst them."

Response: We changed the wording as suggested: Hence, it is vital, against the backdrop of the pandemic, to understand more about both the vulnerability of doctoral students and what factors 118 might promote good mental health amongst them

19. Line 312-314: This sentence is very difficult to understand especially given the fact that the scoring system for attentional scores assigns a higher score to lower attentional skills. The findings on attentional skills seems key to the paper so getting this clear is important. You may need to rephrase around this area of text because you have anxiety, coping skills and attentional skills all in the mix. There are just too may "lower"s in this sentence. As it stands the science is not clear.

Response: We changed the wording to: Doctoral students with low attention scored lower on the anxiety scale. On the other hand, doctoral students with low coping skills experienced higher levels of anxiety. Both outcomes support past study findings (24,25).

High rates of psychological distress including anxiety and depression are common in the doctoral community and the learning environment has a role to play. With the COVID-19 pandemic taking a toll on mental health it is necessary to explore the risk and protective factors for this population. Using data from the Covid-19: Global Study of Social Trust and Mental Health, the present study examined the relationship between COVID-19-related stressful educational experiences and doctoral students’ mental health problems. Moreover, it assessed the role of attentional ability and coping skills in promoting good mental health.

155 doctoral students completed an online survey where micro-, meso- and macro-level educational stressors were measured. The Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire were used to measure depression and anxiety symptoms, respectively. We also measured coping skills using a 13-item scale and attentional ability using a questionnaire.

The results of multiple linear regression analyses showed that specific stressful educational experiences were unrelated but cumulative stressful educational experiences were related to increased depression symptoms (but not anxiety symptoms) in fully adjusted models. Additionally, higher coping skills and attentional ability were related to fewer depression and anxiety symptoms. Finally, no associations between demographics and other covariates and mental health problems were found.

The experience of multiple educational stressful events in their learning environment due to COVID-19 is a key risk factor for increased mental illness in the doctoral community. This could be explained by the uncertainty that the COVID-19 pandemic has caused to the students.