Exploring the mental health of doctoral students in Pakistan Open Access

The mental health (MH) ^[1] of postgraduate research (PGR) students ^[2], particularly those undertaking doctoral study, is a growing concern for institutions and supervisors globally (Hazell et al., 2020). Numerous studies have documented high levels of depressions, anxiety and stress (DAS) among doctoral students (DS) (Kulikowski et al., 2019; Levecque et al., 2017; Li et al., 2021; Volken et al., 2021). However, most of this research has focused on Western contexts, leaving a gap in understanding DSMH in countries like Pakistan.

This study addresses this gap by examining Pakistani DSMH, a demographic underrepresented in global PGR literature. Pakistan’s higher education sector has expanded rapidly since 2001, with the number of universities tripling and doctoral enrolments rising significantly (Baloch et al., 2020). Despite this growth, only 27% of Pakistani academics hold a doctoral degree, highlighting the strategic importance of doctoral education for national research capacity.

This research contributes new insights into the cultural, social and institutional factors shaping DSMH in Pakistan. It is the first systematic study to explore how these factors interact with MH outcomes, offering evidence to guide policy and institutional support strategies aimed at enhancing research productivity and student well-being.

DSMH challenges are not only personal but also affect academic performance, completion rates, and research quality (Evans et al., 2018). Calls for institutional responsiveness have emphasized the need for accessible MH services, robust social support and risk mitigation within academic environments (Evans et al., 2018; Hazell et al., 2020).

In Pakistan, the absence of comprehensive MH infrastructure at the tertiary level exacerbates these challenges (Bibi et al., 2019). While the link between DSMH and program outcomes has been explored internationally, it remains under-investigated in Pakistan. This study addresses this gap by analyzing associations between MH symptoms and DS performance outcomes within the Pakistani PGR context.

Pakistan’s postgraduate research (PGR) landscape presents a distinct context shaped by cultural and structural factors that influence DS’ experiences. Unlike Western models that integrate structured coursework with research, Pakistani doctoral education prioritizes independent research with minimal coursework. DS often face challenges related to funding, resources and institutional support, impacting their well-being and academic progress (Aman et al., 2024; Pakistan Today, 2024).

Despite growing global attention on student MH, it remains a taboo in Pakistan, with limited awareness and understanding of psychological well-being (Mashhood, et al., 2025). MH issues are stigmatized, leading to underreporting and reluctance to seek help. The niche nature of doctoral study may intensify these challenges. Additionally, extended family systems can shape social support networks, influencing MH outcomes (Ahmad and Koncsol, 2022).

Cultural norms and societal expectations significantly affect DS experiences. Comparative studies show countries like Germany and Australia benefit from greater MH literacy and institutional support, resulting in lower stigma and higher service utilization (Bibi and Khalid, 2023; Krendl and Pescosolido, 2020). In contrast, Pakistani cultural stigma and limited literacy hinder open dialogue and help-seeking (Husain, 2020; Rana and Jamil, 2022). These disparities highlight a need for context-specific interventions and increased MH awareness.

Stigma often prevents open discussion, with MH viewed as weakness or moral failing (Ejaz, 2025; Husain, 2020). This fear of labelling exacerbates distress among students. As doctoral enrolments grow, understanding and addressing these challenges is critical. This study aims to identify risk and protective factors affecting Pakistani DSMH.

Findings will inform targeted interventions and support mechanisms to enhance doctoral outcomes. By examining these factors within the Pakistani context, this study broadens the DSMH literature and underscores the importance of culturally responsive strategies.

DSMH concerns are increasingly recognised as a global issue in higher education. DS face elevated levels of DAS due to unique pressures such as research demands, publication expectations, funding uncertainties and supervisory relationships (Cho and Hayter, 2020; Woolston, 2019). Academic culture itself – high workload and performance expectation – further exacerbates these issues. Academic stress and anxiety are key risk factors for depressive symptoms among PGR students (Schofield et al., 2016), with DS experiencing mental disorders and suicidal ideation at rates significantly higher than the general population (Hazell et al., 2020). Addressing DSMH needs is essential for academic success and personal well-being.

DAS – though distinct constructs – often overlap in the PGR context (Evans et al., 2018). Stress typically reflects acute responses to pressure, while anxiety and depression are more chronic, linked to perceived lack of control or isolation (Turner et al., 2017). These symptoms often go unaddressed, as DS may normalize distress or avoid support services to maintain an image of academic competence (Oswalt et al., 2020). Studies consistently report elevated levels DAS among DS compared to general populations (Levecque et al., 2017).

MH is conceptualized here as emotional, cognitive and behavioural well-being, and the capacity to manage academic and life demands (WHO, 2025). Among PGR students, MH is shaped by psychological, social, institutional and relational factors (Levecque et al., 2017; Pyhältö et al., 2012). This study focuses on DAS, key indicators of psychological well-being – aligned with the Depression, Anxiety and Stress Scale framework (DASS-21, Lovibond and Lovibond, 1995) – which are empirically linked to academic disengagement, attrition and reduced life satisfaction (Barry et al., 2018; Stallman, 2010).

Various studies have highlighted widespread MH challenges among university students. In Australia, 13% reported high levels of depression, and 39.5% experienced mild to severe symptoms (Schofield et al., 2016). In Turkey, 27.1% were depressed, 47.1% anxious and 27% stressed (Bayram and Bilgel, 2008). South Asian studies show similar trends: in India, 51.3% of medical students reported depression, 53% anxiety and 66.9% stress (Iqbal et al., 2015); in Bangladesh, 69.5% experienced moderate to severe depression and 61% anxiety (Islam et al., 2020). A significant proportion of Pakistani students experience persistent MH challenges (Bukhari and Afzal, 2017) reinforced by recent empirical studies (Ahmed et al., 2023; Yasir et al., 2023). These findings underscore the urgency of investigating DSMH among under-researched and culturally distinct cohorts.

DS are particularly vulnerable to psychological distress due to the intellectual demands and prolonged uncertainty of doctoral study (Cantwell et al., 2017; Schmidt and Hansson, 2018). Life changes during the extended doctoral journey further intensify emotional strain (Rockinson-Szapkiw and Spaulding, 2014), often resulting in persistent DAS and a pervasive sense of urgency (Liu et al., 2019). Empirical evidence using tools like the DASS-42 shows DS report higher levels of psychological distress than general populations, especially those behind schedule (Barry et al., 2018). Depression among doctoral students is up to six times higher than in the general population (Evans et al., 2018), with 32% of Belgian DS at risk of psychiatric disorders—primarily depression - at rates over twice those of similarly educated peers (Levecque et al., 2017).

Studies reveal high prevalence of DAS among Pakistani university students. Bukhari and Afzal (2017) found 58% of students in Karachi experienced mild to severe DAS, with higher rates among females. Khan et al. (2021) reported depressive symptoms in 42% of students, while Asif et al. (2020) found high levels of DAS at a women’s university (75%, 88%, and 84% respectively). Bibi et al. (2019) highlighted widespread bullying and suicidal ideation. Yasir et al. (2023) reported over 55% of engineering and social sciences students showed clinical depression symptoms, and 63% experienced significant anxiety, driven by academic pressure, career uncertainty, and inadequate support. Among medical students, Ahmed et al. (2023) found over 70% experienced significant anxiety and more than 50% reported depressive symptoms, attributed to the dual demands of research and clinical responsibilities.

Multiple factors contribute to DSMH challenges, including demographic and candidature-related variables (e.g. gender, age, study mode and stage), work-life balance, financial stress, job insecurity, career uncertainty and supervisory relationships (Galle et al., 2021; Holbrook et al., 2012; Liu et al., 2019; Peterse et al., 2018). Dissertation writing and publication pressures further intensify these stressors (Wang, et al., 2024). Gender differences are notable, with female DS more likely to report emotional distress, while males may underreport due to stigma (Burt et al., 2017; Hyun et al., 2007). Older DS and those nearing submission often report heightened stress due to financial and career concerns (Peluso et al., 2011). Family and financial pressures are major predictors of depressive symptoms (Hish et al., 2019), while job insecurity and low satisfaction are linked to stress and anxiety – especially among those working full-time while officially part-time (Friedrich et al., 2023). In Pakistan, inconsistent supervisory quality has also been associated with negative MH outcomes (Friedrich et al., 2023).

Understanding these variables is essential for designing culturally relevant interventions. Social and supervisory support are widely recognised as protective factors (Panayidou and Priest, 2021). Interventions such as peer support groups and structured workshops – like The Researcher Toolkit – have shown promise in improving DS well-being and confidence (Homer et al., 2021). Despite the complex interplay between MH and life stressors (Liu and Alloy, 2010), there is a growing call for targeted research to identify specific risk factors and inform effective support strategies (Berry et al., 2020; Mackie and Bates, 2019).

Social support plays a critical role in buffering DSMH challenges, moderating the impact of academic and personal stressors (Ando, 2002; Lakey and Orehek, 2011). Jairam and Kahl (2012) identified three key sources of support – academic peers, family and faculty – emphasizing the importance of how well these sources meet DS needs. More recent studies reinforce the value of accessible support networks in reducing stress and anxiety (Farooq et al., 2023; Riaz et al., 2022). Support from peers, supervisors and institutions has been shown to mitigate academic and personal pressures (Panayidou and Priest, 2021; Peltonen et al., 2017), with emotional and informational support from academic peers and supervisors particularly beneficial. While direct evidence linking social support to DSMH is limited, it is widely regarded as protective against isolation and emotional distress (Hazell et al., 2020; Pappa et al., 2020).

In Pakistan, rising psychological distress among university students, including DS, is influenced by relationship difficulties, social adjustment issues and broader socio-political factors. Supervisory relationships are especially influential: poor supervision, marked by lack of guidance, increases stress and anxiety, while supportive supervision correlates with enhanced MH outcomes (Aslam et al., 2022). Cultural and societal expectations also contribute to stress, with pressure to secure prestigious post-PhD roles heightening anxiety (Niazi et al., 2023). Financial strain is another major factor, with inadequate funding linked to poor academic performance and well-being (Hussain et al., 2022).

Despite growing awareness, MH remains stigmatized in Pakistan, and institutional responses are often inadequate (Bibi et al., 2019; Irfan, 2016). A lack of coordination between education and health sectors has hindered effective support (Khan, 2013), and weak institutional structures contribute to low self-identification of MH issues (Bibi et al., 2020; Shafiq, 2020). With over 16,000 DS enrolled in Pakistani universities between 2015 and 2020 (HEC, 2021), the need for targeted MH interventions is urgent.

Coping mechanisms and support structures are essential. Peer networks offer emotional and practical support (Riaz et al., 2022), but institutional services remain underused (Farooq et al., 2023). Enhancing service visibility and accessibility is critical, as are specialised counselling services to address the high incidence of DAS among DS (Alvi et al., 2010; Asif et al., 2020; Bibi et al., 2019; Bukhari and Afzal, 2017; Kumar et al., 2019; Sohail, 2013). Accordingly, this study investigates the prevalence of DAS among DS in Punjab and Islamabad, examining the role of social support and the impact of stressful life events on their MH.

This study used a quantitative research design to assess the prevalence and determinants of DAS among DS in Pakistan. A quantitative approach was selected to enable structured measurement of DSMH status and its correlates across a large sample (Huczynski and Buchanan, 2007). Standardized instruments facilitated objective comparisons and identification of patterns and relationships within the data. Given the study’s aim to quantify DSMH outcomes and examine associations with demographic variables and social supports, this approach was deemed most appropriate for generating generalizable findings and informing targeted interventions.

The study was grounded in a post-positivist paradigm, which acknowledges objective reality can be imperfectly understood through empirical measurement and analysis (Creswell, 2014). This paradigm supports the use of structured instruments and statistical techniques to explore relationships between MH indicators and contextual variables such as demographics and support systems.

To ensure meaningful representation of the target population, a purposive sampling strategy was employed, as recommended by Polit and Beck (2006). Random sampling was not feasible due to access limitations: not all Pakistani universities offer doctoral programs (Higher Education Commission, Pakistan, 2021; Qureshi et al., 2019), and many DS return to their home regions after completing coursework, creating geographical barriers (Shah et al., 2020).

Moreover, doctoral coursework in Pakistan is often informal, conducted in faculty offices rather than structured classrooms, making access to DS during coursework challenging (Mahboob et al., 2017). Purposive sampling was selected for its effectiveness in identifying individuals with relevant experience and knowledge (Creswell and Clark, 2011), especially in resource-constrained settings and when studying hard-to-reach populations (Patton, 2002; Tongco, 2007).

Following Maxwell’s (1997) strategy for purposive sampling, universities in Punjab and Islamabad offering doctoral programs were identified based on program scope and researcher accessibility. Fifty-five universities with large doctoral enrolments across multiple disciplines were shortlisted, with 40 located in major urban centres. Of these, 22 institutions granted permission to participate. After institutional approval and participant consent, data collection was conducted using purposive sampling with elements of opportunistic sampling. A member of the research team visited each participating university during periods when DS were likely to be on campus, ensuring access to technology and minimizing barriers to participation.

A total of 248 DS were recruited from twenty-two universities located across Punjab and Islamabad. Demographic characteristics of the sample are presented in Table 1.

Most participants (98.4%) were Pakistani born, with ages ranging from 23 to 57 years (median age, 30). 69.5% of DS were aged 26–37 years, aligning with OECD data indicating 60% of doctoral candidates globally fall within this range, with median admission age at 29 (OECD, 2019). In total, 56.9% of participants were male and significantly older on average (M = 31.8 years) than female participants (M = 29.7 years, t = 2.92, p < 0.01). Marital status data showed 44.0% were married or divorced, and 75.0% had one or more children ^[3].

In terms of language proficiency, 92.2% of DS reported competent to superior English communication skills. Regarding candidature, participants represented a range of broad fields of study (BFOS): science (36.2%), engineering (29.7%), humanities, arts and social sciences (21.4%), and business (12.9%). Only 22.4% held a scholarship, while 47.5% were in the mid ^[4] -phase of their doctoral journey. Notably, 74.1% of DS reported no use of on-campus or off-campus health or counselling services. A minority (16.6%) lived alone or in hostel accommodation, whereas 80.0% indicated they had close friends or relatives nearby, suggesting potential access to informal social support networks.

For data collection a broad scan of the target population was generated using a battery of three instruments, of which the first two reported below (DASS-21 and Candidate Major Stressful Life Events Checklist) are previously used, and confirmed, instruments.

The DASS-21, developed by Lovibond and Lovibond (1995), was used to assess DSMH symptoms. This validated self-report instrument comprises three subscales, DAS, each containing seven items rated on a four-point Likert scale from 0 (“Did not apply to me at all”) to 3 (“Applied to me very much or most of the time”). Higher scores indicate greater symptom severity. The DASS-21 has demonstrated strong psychometric properties across diverse cultural contexts, including non-Western populations (Arab et al., 2019; Bibi et al., 2020). Cronbach’s alpha values reported by Arab et al. (2019) were 0.77 (depression), 0.79 (anxiety) and 0.78 (stress), indicating acceptable internal consistency.

The instrument functions as a screening tool, identifying individuals at risk of developing severe symptoms, regardless of clinical diagnosis. Participants were not excluded based on diagnostic status, allowing for assessment across both clinical and non-clinical groups. As shown in Table 2, each subscale score is categorized into five severity levels: normal ^[5], mild, moderate, severe and extremely severe. According to Lovibond and Lovibond (1995), scores in the “mild” range suggest elevated symptoms relative to the general population, though typically below clinical thresholds.

To assess exposure to significant stressors, a condensed checklist of thirteen major life events was developed, drawing on established instruments including the Social Readjustment Rating Scale (Holmes and Rahe, 1967) and the Life Event Scale for students (Linden, 1984). Linden’s findings indicate that students experiencing more life events are significantly more likely to report psychological distress, supporting the predictive validity of such measures.

The adapted checklist reflected stressors relevant to Pakistani DS, including bereavement, divorce, serious illness or injury (self or loved ones), financial crisis, job loss, increased family responsibilities, relocation and changes in academic supervision or environment. Item selection was informed by prior literature and refined through expert consensus among three academic psychologists with expertise in MH and PGR.

The checklist was pilot tested with ten DS to assess clarity and cultural relevance. While some participants suggested additional items, suggestions conceptually aligned with existing entries, confirming content coverage. Unlike the original SRRS, the checklist was not scored cumulatively; instead, the presence of one or more events was treated as a categorical variable in analysis. The instrument demonstrated face and content validity through expert review and pilot testing.

To capture the nature, source and adequacy of support available to DS, a study-specific Support Matrix was developed. This instrument was informed by prior research on doctoral well-being (Jairam and Kahl, 2012; Sverdlik et al., 2018) and aimed to address limitations in existing tools by mapping support type, source and perceived adequacy.

Support sources included family and friends (Haynes et al., 2012; Hunter and Devine, 2016), relatives and peers (Chirkov et al., 2005; Cotterall, 2013), supervisors (Zhou, 2015) and institutions (Ampaw and Jaeger, 2012; Devos et al., 2017). Support types included emotional, academic, financial, motivational and social. Participants indicated whether each source met their needs (yes/no). Two additional items assessed proximity of family/friends and living arrangements. The instrument was again reviewed by three experts and piloted with ten DS, resulting in minor wording adjustments. Internal consistency across support domains was acceptable (mean Cronbach’s α = 0.76), supporting their utility in mapping support experiences in this cohort.

Data were collected using paper-based surveys to maximize participation and mitigate barriers related to limited digital access. In Pakistan, DS are not issued university email accounts, and many return to their home regions after coursework, visiting campus infrequently (Mahboob et al., 2017).

Ethics approval was obtained from the University of Newcastle Human Research Ethics Committee (HREC). A researcher travelled to Pakistan, meeting with deans/directors, explaining the study and obtaining institutional and participant consent. On-campus DS were approached in class, offices, labs and libraries. Each participant received a Participant Information Statement (PIS), Consent Form (CF) and verbal outline of the study before completing the survey.

To reach off-campus doctoral students, supervisors and departmental staff assisted in identifying and contacting participants, notifying the researcher upon their return and facilitating survey distribution and collection. Data collection occurred over five months (September 2019 – January 2020), yielding a 62% response rate ^[6].

Survey responses were entered into Excel, cleaned for completeness and consistency, and imported into IBM SPSS Statistics (Version 25). Analyses included:

• descriptive statistics to summarize demographic, academic and MH characteristics;

• Pearson’s correlation and chi-square tests to examine associations between MH outcomes and demographic, academic and support variables; and

• independent samples t-tests to identify predictors of DAS, controlling for potential confounders.

Using the DASS-21, MH symptoms of 248 DS were assessed. Table 3 and Figure 1 show elevated symptoms were reported for depression (63.4%), anxiety (84.2%) and stress (41.2%). Severe to extremely severe symptoms were reported for depression (20.8%), anxiety (47.5%) and stress (11.8%). Mean scores were 6.68 (depression), 7.93 (anxiety) and 7.23 (stress), indicating moderate to high distress levels.

No significant associations were found between DASS-21 scores and demographic variables – gender, marital status, number of children, English proficiency, funding type, scholarship status, candidature stage, years enrolled or living arrangements. A weak but significant negative correlation was observed between age and anxiety (r = –0.153, p < 0.05), with DS aged ≤35 reporting severe anxiety, and those >35 reported moderate anxiety.

In total, 54 DS reported accessing counselling services in the past year. Table 4 shows these individuals had significantly higher anxiety (t = 2.00, p < 0.05) and depression (t = 2.36, p < 0.05) scores, suggesting help-seeking behavior was associated with greater symptom severity. No significant difference was found for stress. DS with family or friends nearby reported significantly lower levels of stress (t = 2.47, p < 0.05) and depression (t = 2.07, p < 0.05), indicating the protective role of proximal social support.

Figure 2 shows the most commonly reported stressful life events were as follows: increased family responsibilities (35.4%); personal/family health issues (28.8%); financial crises (28.0%); and marital separation (1.6%).

Significant positive correlations were found between the cumulative count for stressful life events and DASS-21 scores: depression (r = 0.147, p < 0.05); anxiety (r = 0.168, p < 0.05); and stress (r = 0.184, p < 0.01).

Table 5 shows specific life events were significantly associated with elevated symptoms:

• Personal or family health issues: all subscales (t = 2.90–3.08, p < 0.01).

• Loss of close friend(s): depression (t = 2.54), anxiety (t = 3.06), stress (t = 2.41), all p < 0.05.

• Changes in living arrangements: anxiety (t = 2.17, p < 0.05).

• Marital separation: stress (t = 2.79, p < 0.01).

Figure 3 illustrates primary support sources reported by DS^[7]. Most common were immediate family (91.9%), friends (80.6%), supervisors (79.4%) and institutions (62.5%).

Family was the leading provider of financial (66.1%), emotional (73.8%) and motivational (75.4%) support, but not academic support. Supervisors were the main source of academic support (68.5%), with institution providing perceived academic support to 49.5% of DS. Friends and family were equally important for social support (45.6% and 48%, respectively) and friends (60.5%) and supervisors (57.3%) were key for motivational support.

Significant gender-based differences were observed:

• Females received more academic support from family than males (36.9% vs 26.8%; Chi Sq, 4.23 (1) p < 0.05, N = 74).

• Males received more financial support from friends than females (14.3% vs 4.5%, Chi Sq 5.21 (1), p < 0.5, N = 20).

• Females received more emotional support from friends than males (72.7% vs 54.5%, Chi Sq 14.9 (1) p < 0.01, N = 115).

• Males received more social support from peers than females (58.6% vs 34.6%, Chi Sq 6.86 (1) p < 0.01, N = 122).

Support adequacy varied across sources. Approximately:

• 79% of DS felt family support met their needs;

• 64.9% reported adequate support from friends;

• 63.7% from supervisors; and

• Only 43% felt institutional support met their academic needs.

The most notable shortfalls were reported for peers and relatives, where support was available but often perceived as insufficient.

Perceived adequacy of support from institutions and supervisors was not significantly related to DASS-21 scores. However, support from friends was associated with lower stress levels when perceived as adequate (Mean = 6.87 vs 9.32).

Table 6 details significant relationships found between support adequacy from family, relatives, and peers and DASS-21 scores. DS who felt their support needs were met reported lower levels of DAS (p < 0.05), reinforcing the protective role of well-matched support.

This study investigated the prevalence of DAS among DS in Punjab and Islamabad, Pakistan, exploring associations between demographic variables, social supports and stressful life events. In a context where MH remains stigmatized, this research provides novel empirical insights into Pakistani DS psychological well-being and their perceived support needs. Use of the DASS-21 enabled standardized assessment and comparison with international studies.

The sample showed near-equal gender representation, aligning with national trends where male doctoral students slightly outnumber females (HEC, 2022). Elevated symptoms were reported across all three domains: depression (63.4%), anxiety (84.2%), and stress (41.2%), with 47.5% of DS experiencing severe to extremely severe anxiety, compared to 20.8% for depression and 11.8% for stress. Mean scores were 6.7 (depression), 8.0 (anxiety), and 7.2 (stress), comparable to Bibi et al.’s (2019) findings among Pakistani undergraduates.

International comparisons reinforce these findings. Evans et al. (2018) reported moderate to severe anxiety in 41% and depression in 39% of US PGR students. Levecque et al. (2017) found 33.3% of Belgian DS met criteria for common psychiatric disorders. Bernstein (2012) and Bacchi and Licinio (2015) identified elevated distress in engineering and medical DS, though the current study found no significant differences by field of study. Friedrich et al. (2023) similarly reported one-third of German DS exceeded depression thresholds, with stress and self-doubt key predictors.

Average age of participants was 30 years, with 47.5% in the mid-stage of candidature and 64.9% living with family. The sample was relatively homogeneous, perhaps explaining lack of significant subgroup differences. A weak but significant negative correlation was found between age and anxiety. Unlike Schofield et al. (2016), no significant differences were observed by candidature stage. Barry et al. (2018) found higher distress among Australian DS compared to general population norms, though their sample was older and predominantly female. Despite literature suggesting higher distress among females (Hazell et al., 2020), no gender-based differences were found in this study.

Consistent with Hazell et al. (2020), the study highlights the importance of MH interventions. DS who accessed counselling services reported higher levels of anxiety and depression, suggesting help-seeking behavior may be prompted by symptom severity. This is encouraging in a cultural context where MH stigma persists and awareness remains limited (Bibi et al., 2019; Jafar et al., 2013; Shah et al., 2010).

A significant positive correlation was found between the number of stressful life events in the past year and DASS-21 scores. Events such as personal or family health issues, loss of close friends, personal injury, changes in living conditions and marital separation were strongly associated with elevated symptoms across all subscales. These findings align with Parker (2018) and underscore consideration of recent life stressors when assessing MH and designing interventions.

A significant inverse correlation was found between support availability and DASS-21 scores for depression and stress. DS who received support from close family or friends reported lower symptom levels, consistent with Pakistan’s extended family system, where emotional and financial support from elders is culturally normative (Shaikh et al., 2008). These findings align with global evidence that financial stress is a key contributor to DSMH issues (Hazell et al., 2020), and proximity to family and friends offers protective emotional and motivational support.

Peer networks, mentorship and career development opportunities were identified as stress-reducing factors, though underrepresented groups may face unequal access to such resources (Nicholls et al., 2023). The study confirmed prior findings that social support buffers psychological distress (Hazell et al., 2020; Jairam and Kahl, 2012). Primary support sources included family, friends, supervisors and to a lesser extent, institutions. Female DS reported receiving more familial support, while friends were key providers of motivational support. Supervisors were the main source of academic support. Where support was perceived as adequate, DASS-21 scores were consistently lower.

Findings should be interpreted considering methodological constraints. While the DASS-21 has been validated in Pakistan, caution is advised in interpreting screening results (Bibi et al., 2020). The study was geographically limited to Punjab and Islamabad, and although participation and disciplinary diversity were strong, results may not generalize to all Pakistani DS.

Limited digital access meant surveys were administered in hardcopy format, restricting outreach to DS present on campus during scheduled visits. Sampling was purposive, targeting accessible students potentially excluding those with different experiences. Despite broader gender and geographic representation than comparable studies, a nationally representative investigation is needed to fully assess DSMH across Pakistan.

While qualitative methods have been used in prior studies exploring DS well-being, this study adopted a structured quantitative approach to capture the complexity of support networks (Waight and Giordano, 2018). The Support Matrix allowed participants to rank and describe support sources and adequacy, though some items were left incomplete – possibly due to time constraints or cultural sensitivities. Future studies should consider digital survey tools with built-in prompts to improve completion rates as access improves.

This study has important implications for research, academic practice and policy – particularly in developing PGR systems like Pakistan’s. The high prevalence of severe to extremely severe symptoms of DAS (20.8%, 47.5%, 11.8%, respectively), coupled with low support service utilization, highlights urgent need for institutional implementation of comprehensive well-being frameworks. These should include proactive MH education, competency-building programs and de-stigmatization efforts embedded within academic structures supporting both DS and supervisors.

Findings emphasize the multi-dimensional nature of support, with family, friends and supervisors playing distinct roles – financial, emotional, motivational and academic. Mismatches between perceived support and actual need were linked to increased distress, reinforcing the importance of tailored interventions. From a policy perspective, the study supports integrating DSMH into national PGR quality assurance agendas, urging the Higher Education Commission of Pakistan and universities to allocate resources accordingly.

Academically, findings support improved supervisor training to recognize and address student distress. Societally, the study challenges notions that advanced education ensures emotional resilience, advocating for greater public awareness of the psychological demands of doctoral study and the importance of supporting postgraduate researchers.

From a research standpoint, this study lays the foundation for longitudinal and comparative investigations into culturally specific support structures and their impact on DSMH. Future research should examine intervention efficacy and mechanisms by which social and institutional support buffer life stressors and enhance doctoral success.

MH among PGR students is increasingly recognized as a critical concern. This study contributes to that discourse by examining DAS prevalence among DS in one of Pakistan’s five regions, using the DASS-21. It also explored the role of social support and counselling service utilization in a context where MH remains stigmatized.

Findings revealed nearly half of DS experienced severe psychological distress, with one in four seeking counselling services – those with higher symptom severity being more likely to seek help. Family, friends and supervisors were identified as key support sources, each fulfilling distinct roles. Where support met perceived needs, distress levels were lower; conversely, exposure to multiple stressful life events increased vulnerability.

To advance understanding of DSMH in Pakistan, ongoing monitoring using tools like the DASS-21 is recommended. Future interventions should focus on support quality, task-related stress, and the intellectual demands of doctoral study. Expanding research to include learning context, dispositions and affective self-management will provide a more holistic view of the doctoral experience and inform more effective support strategies.

The authors acknowledge the contribution of Professor Allyson Holbrook and Mrs Hedy Fairbairn, Centre for the Study of Research Training and Impact (SORTI), The University of Newcastle to this paper.