Depression – let's call it by its name

• Long-term stress among students can lead to professional burnout in the future.
• Aleksandra Zimmer: – People often think that depression is just a worse mood. You couldn’t be further from the truth.
• People struggling with mental health also face feelings of guilt – because these illnesses are not visible.
• Justyna Załuska: – I was helped by a professor who recommended a doctor to me. I was supported by my tutors, who gave me the opportunity to make up in three subjects.
• Medication, although taken daily, doesn't guarantee recovery. Some people with depression opt for psychotherapy, others choose helpful publications.
• Centre for Support and Accessibility at the Wrocław University of Environmental and Life Sciences – find help here.
• Patients Rights Advocate's Office report on student mental health.

According to the World Health Organisation more than 350 million people worldwide suffer from depression. In Poland – approximately 1.5 million. Projections made by WHO experts, based on pre-pandemic incidence data, indicated that by 2020, depression would be in second place among the most common diseases, and by 2030, it would take the first place.

Students more susceptible

An article in 2019 in the Natural Sciences journal (authors: Maria Całka and Paweł J. Pawlica, Silesian Medical University) reported that, according to available research, students report more mental problems than an age-matched non-student group, and that the incidence of mental problems among students is higher than in the general population (from 19.2 to 67.4%). In 2022, the Warsaw Medical University reported that an average of 250 students - 2% of all students studying at the university – make annual contact with the University Psychological Counselling Service, which has been operating at the university since 2018. As many as 15% of them are foreign students. At the Wrocław University of Environmental and Life Sciences, where the Personal Development Counselling Centre was established in 2015, 2020 and the pandemic proved to be a turning point – the number of students and doctoral students coming for help increased immensely.

A report compiled by Agata Igielska from the Personal Development Counselling Centre of UPWr showed that after several months into the pandemic, i.e. living under several months of greater or lesser stress, the university students’ mental health state raised many concerns. – At the forefront are doubts and considerations about the magnitude of the possible long-term effects of the pandemic. Currently it is impossible to predict when the crisis will end, it is also impossible to predict exactly what the long-term consequences of the current pandemic situation will be. We can certainly expect a significant increase in various types of difficulties and mental functioning disorders, similar to post-traumatic stress disorder (PTSD) – informed the report.

Całka and Pawlica write straightforwardly: “Long-term stress among students can have an adverse effect on mental health and lead to professional burnout in the future. Often, the consequences of poor mental health are experienced as troublesome, fostering unfairly unequal treatment or considered a source of significant disruption to relationships with family and friends. In addition, among socio-demographic factors, a greater role can be attributed to those affecting social support”.

It’s not just a bad mood

Aleksandra Zimmer is in the third year of her PhD, she is working on her thesis under the supervision of Prof. Krzysztof Lech and her assistant supervisor is Dr Klaudia Masztalerz. The topic of her PhD is the influence of raw material and solution pretreatment on the physicochemical properties and kinetics of osmotic dehydration and drying of garlic. She qualified for the prestigious Top Minds programme in this year's edition. This is her second attempt – the first was interrupted by depression

Today, Ola talks openly about her illness, but before she was hospitalised, she used to take on the mask of a happy girl every day, which she automatically does until today. This is how she is seen by her friends at university, her fellow students and her lecturers. She herself says that before she became ill, she had a task-oriented approach to life – no problems, just challenges.

– First came the panic attacks when, for example, I received an email from the supervisor of one of my PhD subjects with a simple message that the deadline for a dissertation was approaching. That was all it took, but for me it was the start of an avalanche. A new thing to do. And panic – says Ola, in whom, after the panic attacks, powerlessness began to build up.

A healthy person isn't capable of understand what it means not to be able to answer an email, get out of bed, get dressed and go to class. Every day became a challenge.

– For a long time I tried to ignore this pain. I coped with it, hoping it was temporary. I didn't want to tell my parents about it. I knew they would be horrified, but they were the ones who realised something was wrong with me. So they took me to the hospital – says Ola.

It was in the hospital, in the ward for patients like her, young, with advanced depression... that it dawned on her how long and hard she would have to work to get well again, adding that among 'her own', she was able to joke about depression.

A feeling of guilt

– We used to laugh that jokes about suicide attempts were the best. I know how it sounds, but it was only there that I met people who see the world in a similar way, who don't see any sense in themselves, in life, in what they do. And it's really not sadness, despondency or a bad mood – says Ola and immediately adds that a big problem with mental illness is guilt.

Because you can't see the illness, and you hear comments such as "do something about yourself", "get yourself together", "maybe take up a sport?", even though you can't concentrate on the simplest things.

Long-term stress among students can have an adverse effect on mental health and lead to burnout in the future

– It's just that with depression you can’t just get yourself together or go for a walk. You wouldn’t tell a person who has cancer to pull themselves together – explains Ola, who was afraid to talk about what was happening to her also because of her PhD. On the one hand, she wasn't able to work, on the other hand, she had the guilt of not being in control of her doctorate, which at one point went down the drain altogether. At the hospital, she even wondered whether she should leave to do something else.

Such an idea gained intensity especially after she submitted a request to the Doctoral School from a psychiatrist to extend her doctorate by six months due to her inability to work because of her health condition. – Unfortunately, I found out that the only reason to extend the studies according to the regulations is pregnancy, and that I can only resign from the doctorate and then apply for a renewal, which doesn’t give the certainty of continuation – says Aleksandra Zimmer and hopes that after the scale of the problem of depression among doctoral students is revealed, the Doctoral School will make some changes to the regulations.This in turn, in the event of a PhD student's health failing, even as a result of a car accident, will make it possible for the sufferer to continue their doctorate after getting better and the time to complete the doctorate will be extended.

– I'm glad that UPWr makes it possible to get councelling, but it doesn't change the fact that my condition deteriorated a lot at that time. I had two options: either I'd pick myself up immediately or I'd fail my PhD. If it hadn't been for the help of the promoters at the time, I don't know if I would have made it to the evaluation at all – admits Ola, who was on sick leave after leaving hospital. She was learning everyday life from scratch at the time.

– The doctor on the ward told me: “Ola, you have many difficult years ahead of you”. And I know that it's a struggle to cope with everyday life, work, study, responsibilities despite everything – says Ola, who takes medication, goes to therapy, has great support from her PhD supervisors, yet meeting a random person at university and simply hearing "How are you?" can trigger an avalanche.

Virus outbrake and downhill slide

Justyna Załuska is a PhD student – first year of the UPWr Doctoral School – with Prof Kulczycki. She is working on abiotic stress factors, their effects on crop plants and mitigation options. She has a master's degree in agriculture, but completed her engineering degree in applied plant biotechnology.

– I decided to get a PhD because I started to do well in my studies. I didn't have a clear idea of what I wanted to be and what I wanted to do in life, but when I came to this university, I felt I had found my place. I felt good here. I felt bad about leaving and, above all, I started to associate my future with my studies – says Justyna, who has been treated for depression for a year.

It started during the pandemic. Studying was her passion, and then the lockdown was announced. Her passion slowly turned into a sad obligation. Everyone stayed at home. The standard of teaching dropped, not everyone cared about learning as much as she did. Justyna left for a summer house so she wouldn't sit in Wrocław.

– And then it started to sink in. A lot of people were happy to listen to lectures in bed, no need to go anywhere. And I felt there was something wrong with me – at first Justyna thought she wasn't going out enough or meeting with people. But gradually she lost her strength, and after a while it became apparent that she was no longer motivated to do anything.

She sat with the professor for two hours.

– She offered to pay for my visit, as long as I fought for myself. She recommended a wonderful psychiatrist. In the end, I didn't take up the offer, but the totally unexpected help and understanding gave me a huge kick in the ass – says Justyna.

Constant work. On myself and with myself

At the time, she didn't have a scholarship and she couldn't get an in-person-appointment with a psychiatrist through the National Health Service, so when she got a call, she didn't manage to tell the doctor everything in 10 minutes over the phone.

– It was only privately that the doctor listened to me – That first visit lasted an hour and a half. The diagnosis: an acute depressive episode. Justyna makes no secret of the fact that she was afraid of the medication. That they would make her lethargic, dull, unable to study. None of her fears were confirmed.

– The psychiatrist also suggested therapy, to which I went. I didn't feel it though. Instead I read books on cognitive behavioural therapy and rational behaviour therapy. I tried to work on myself and with myself – emphasises Justyna. Closer friends know that she is ill. She doesn't like or know how to lie, and everyone has seen how she has changed.

– There are a lot of people who have been supportive in many areas of my life, but when it comes to depression, they mostly didn’t understand. They would start takling about themselves. That they too are sometimes sad, that they too sometimes don't have the strength to get out of bed, that everyone has problems, such as a neighbour's son who has just been diagnosed with multiple sclerosis, so you have to pick your head up, smile and move on. The advice comes from the fact that we don't know about depression, people really think it's just a worse mood, not a serious illness – admits Justyna, adding after a while that the tutors have given her the confidence to make up for the shortcomings in three subjects. And she is grateful to them for that.

– The Doctoral School is definitely a success, although I had a lot of hesitation. I seriously considered whether it would be better to change my environment, to start all over again, but I felt sorry for the work I had already put in. All the time I remembered that I had done well at university. After the first month at the Doctoral School, I felt like not going back there. For years I had idealised what it would be like, that since I had fulfilled my dreams I would just be happy, carefree. That some burden would fall. But the world is different and I'm trying to face it – says Justyna and immediately adds that it's not like taking a pill makes you healthy. There are still dark days and challenges.

– My brain still manages to turn a small thing into an impossible problem. But I'm fighting – admits Justyna.

First aid

Ewa Grzechnik, psychologist at the Centre for Support and Accessibility at the Wrocław University of Environmental and Life Sciences: – Students who come to the Centre present a wide range of problems. There are those who have psychiatric illnesses and disorders and ask for help in adjusting to the realities of university and the possibility of pursuing their studies. There are also those in whom the first symptoms of such disorders are just appearing – in which case they are referred for specialist help. But there are also people in different, difficult life situations, with problems in relationships, with peers, with any of the lecturers, with their studies.

A large proportion of those seeking support saw the beginning of their difficulties in 2020, the outbreak of the pandemic and the associated changes. And it is the pandemic that has led to universities in Poland giving students not only education and skills, but also increasing support. At the Wrocław University of Environmental and Life Sciences, it's psychological consultations – free of charge. From one to seven.

– When I see a problem, I first help the student to solve it. I refer them to a specialist when I run out of competence. Let's remember, however, that the student is an adult and it is up to them to decide whether to go to a psychiatrist or a psychotherapist – admits Ewa Grzechnik, a psychologist from the Centre for Support and Accessibility.  

Paradoxically, the fewest people come for help during exam sessions. This is when problems freeze. Their intensity increases just right before or after the exams.

TheCentre for Support and Accessibility is located in building C3, room 413, contact: psycholog@upwr.edu.pl.

Patients Rights Advocate's Office

In 2021, the Patients Rights Advocate's Office presented a report on mental health in academia. He combined it with an address to the Minister of Education and Science about the need for mental health support for students .

The report was prepared on the basis of information collected from dozens of universities from all over Poland – it took a closer look at the mental problems students face and the forms of help they receive at their universities. Among the former, the universities mentioned eating disorders, addictions, exhaustion, lack of concentration, lack of perspectives and opportunities for development. Difficulties in finding a first job, bullying or stalking were mentioned among the triggers of the crisis. The report also outlined the scale and forms of help a student can count on.

These are primarily mental health counselling centres aimed at students and academics – free of charge. They are often the first point of contact for a person in crisis with specialist psychological and psychiatric help. At the same time such units do not offer long-term therapy. Three consultations are usually held, on the basis of which the patient's situation is assessed. A diagnosis and a referral is made for further therapy or inpatient hospitalisation. Among the HEIs that responded to the Patients Rights Advocate's Office in 2020, 15 have a mental health counselling service within their structure and one planned to establish a counselling service.

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