Oby Ukadike: Content warning-- during this episode, we discuss experiences with depression and anxiety. We acknowledge this content may be difficult for listeners and encourage you to care for your safety and well-being if you choose to listen to this episode.

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From the campus of Harvard Medical School, this is ThinkResearch, a podcast devoted to the stories behind clinical research. I'm Oby, your host. ThinkResearch is brought to you by Harvard Catalyst, Harvard University's clinical and translational science center, and by NCATS, the National Center for Advancing Translational Sciences.

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Welcome to episode 3 of our series on mental health and medical training in graduate education in collaboration with The MIND Project at Harvard University. Today, we discuss the mental health crisis in graduate education, changes in the workforce due to the state of mental health, and work-life balance. We are joined by Dr. Teresa Evans, principal consultant for TiER1 Performance and former assistant professor at University of Texas Health Science Center of San Antonio.

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Hi, Dr. Evans. Welcome to the show.

Teresa Evans: Thank you for having me.

Oby Ukadike: So you have a very impressive and winding career path. Would you mind just giving us a walkthrough how you came to be where you are today?

Teresa Evans: Absolutely. I have a PhD in neuroscience from UT Health San Antonio here in San Antonio, Texas. I got to the idea of neuroscience because my undergrad is actually a double major chemistry and psychology.

So I guess if you smush those two together, you get neuroscience. I went to undergrad in Ohio. And often, people ask me, well, what got you from Ohio to San Antonio, Texas?

And a big piece of that not only was pursuing a degree in neuroscience-- they had a very strong program here-- but also that I am a military spouse. My now-husband-- at the time, boyfriend, fiance-- was becoming an Air Force pilot, which you can do in West Texas. So he moved to West Texas. And I came here to San Antonio.

And I've had the great fortune of being able to stay in San Antonio while his career has taken him around the state of Texas and overseas a few times. Following my graduate degree, I've had a pseudo-eclectic career, as you alluded to. It all started, though, with a interest in trying to figure out what could I be after graduate school and realizing that a lot of other graduate students at the time were asking the same question.

And so I started looking into all the resources that were and were not available to trainees for figuring out how to become the best professional they could be in whatever career that was, whether that was academic or otherwise. Through that exploration and doing work as a graduate student to bring those resources to my fellow colleagues, I laid the foundation to ultimately take on a role after graduate school that allowed me to start an office focused on career and professional development for scientists at UT Health San Antonio.

I worked in building that office and its infrastructure for a little over two years-- during that time, initiated the research that we're going to talk about today as a means to really start a conversation. I also wrote a book called Research-- A Career Guide for Scientists. And that book was also another way to keep the conversation going about how do we prepare folks for the career that they really want to pursue, all the while thinking I might stay in academia but also exploring other options, which got me excited about entrepreneurship.

So I decided, when an opportunity presented itself, to take my understanding of building programs and building kind of these resources to help folks pursue their passions and apply that to a B2B technology accelerator. I took the opportunity to do that. So that was, again, here in San Antonio. But I spent a little over a year working in the technology ecosystem learning from entrepreneurs what it means to be a CEO and how to navigate the world of venture capital.

And it was just a phenomenal opportunity. And also, because we were a accelerator in San Antonio, we interfaced with the city of San Antonio's economic development department a lot. Through those interactions, I was able to have conversations with leadership where they recognized that I had this now-unique, eclectic understanding of the city that included not only understanding our academic infrastructure but life sciences. And in particular, my research was TBI.

So I worked a lot with the veteran population and the DOD population here. And so I understood that landscape. And now I understood entrepreneurship, the technology landscape, and what was going on in the city. So they asked me to take on a project that would focus on cultivating military medical research and innovation in San Antonio as an independent consultant.

So for a year, I worked with the city and leadership here to put together a plan that would result in more economic development in the field of military medicine. And as you can tell from my story, it's all about meeting people and who you know. So I met a couple great individuals who asked me to help them start a clinical research organization.

And so they already had a very robust clinical research organization running clinical trials in cancer immunotherapy. But the interest was expanding that into running trials that had specific military relevance and so were more in the trauma space. And so I worked with them for a couple of years, really taking some of the things that I investigated in that consulting project with the city and applying that to running these clinical trials as a means to commercialize products that had military carry medical relevance.

All along the way, though, I will say-- and this is what having a PhD is just so great and opened so many doors. I was able to maintain an academic appointment with UTHealth and also gain an academic affiliation with Texas Biomedical Research Institute-- where, in both cases, I was able to still work with students to continue providing that career development that I am so passionate about and then also doing some work in K through 12 STEM education.

So I've continued to really spend time helping to get off the ground some NIH-funded work that focuses on helping students to understand all the careers that are available to them and be passionate about STEM. And so then people are like, well, yeah, but what are you doing right now? And so I ultimately am back in the consulting world but as a part of a firm, so not doing it independently but working with a group of amazing human beings at an organization called TiER1 Performance.

And TiER1 focuses on, as you hear in the title "Performance," human performance, but both in the area of commercial companies-- so helping companies to activate any strategy that they're looking to activate through the performance of their people, so learning and development, leadership training, and the like. And then also, we work with government clients, which is what I spend my time really thinking a lot about, and so bringing to government clients solutions around human performance, both in the research side and also in the delivery of a service side.

Again, I mentioned my passion about starting the conversation. And we're going to talk about it today in mental health. TiER1 Performance has been a great place to continue to work in that space. Because we really focus a lot on healthy cultures within various organizations that we work with and have a really robust portfolio of resources that we can provide the companies that we work with. And they also use the term, "starting the conversation around mental health," which is something that is great to continue to do.

Oby Ukadike: Thank you for giving us that background. And I know, even when we talked to you previously before this podcast, we talked about how we will have you back. Because we have so many things we can talk about. And so you co-wrote an article, "Evidence for a Mental Health Crisis in Graduate Education."

Teresa Evans: Yes.

Oby Ukadike: It was published in Nature Biotechnology in 2018. Can you talk through some of your findings in that article that you published?

Teresa Evans: Absolutely. As I mentioned before, I'm so grateful to have been a part of the conversation that resulted from this article. It was why we wanted to write it in the first place and why we were interested in this work. But it ultimately resulted in about-- I'm looking at the number-- 2,279 respondents to the survey.

And of those, the majority of them came within the first three months, which was amazing. We did a cross-sectional survey. That survey went out through social media and direct email. 90% of the respondents are PhD students, however.

And what we found is that 41% of the respondents had symptomatology on a scale called the GAD-07 that was aligned with having anxiety. And 39% of the respondents similarly had symptomatology on the PHQ-9 of depression. And so those numbers, 41% and 39% for anxiety and depression, are very high compared to what would be expected in, say, the general population.

The other key findings of the paper were that within those individuals that I described, so those that were high in anxiety and depression, those individuals were much more likely to indicate when asked that they did not have a good work-life balance. And secondarily to that, one of the findings that really stood out to myself and our co-authors was a body of questions that we asked about the mentor/mentee relationship.

Summing that together, there were several questions that asked about nuances of that relationship. But those who had higher levels of anxiety and depression in those populations, they were much less likely to have a strong mentor/mentee relationship, so just suggesting that there's a correlation there between the robustness of one's relationship in an academic setting with their mentor and their mental health status.

Oby Ukadike: As we've mentioned, your article was published in 2018, which was pre-COVID, pre-COVID-19 pandemic. Do you think the data has changed due to the pandemic?

Teresa Evans: Yeah, so great question. And I've been fortunate enough to be a part of some dissertation committees lately that are around that topic. And so I can say I imagine there will be some data coming out in the coming months, years to speak directly to that. But my quick answer would be absolutely.

What individuals who were in the graduate education world during the pandemic experienced definitely had an impact on mental health and wellness. And we know from the literature that isolation has grave impacts on one's mental health. And so if you add to that the ecosystem and landscape of mental health and wellness that often is seen as one goes through the process of graduate education, we can only expect that there were impacts.

Oby Ukadike: How do you see the workforce changing as more individuals are seeking out more accommodating career paths?

Teresa Evans: Yeah, that's a great question and one that many of the clients that we work with now at TiER1 in our commercial clients as well as government and across the board, folks are grappling with this. So it's, how is the workforce going to change? And how is the work arena going to change to accommodate?

And so I would say one way that I think that there will be a shift in how it applies to this particular conversation is likely that I see our workforce-- and in the case of graduate education, the trainees-- looking at education a little bit differently. So thinking about before I go into my PhD program, is this program going to afford me the lifestyle? Is this degree and this program-- and ultimately, the degree-- going to afford me the lifestyle that I'm looking for?

And one might also say, is this going to be a pandemic-proof career? That's something we never really had to think about before. But our workforce is thinking about that now. They're saying, well, if I need to go into the office today, that's fine.

But is this a job that I can do if I can't? Is this a job that'll still continue if we're faced with another situation like what we've been faced with in the past few years? And I would also say that I'm hearing a lot more-- this is something I heard a lot early on when I was working in career and professional development, this idea of transferable skills.

So one gains a certain set of skills in one environment. And how do they transfer to another work environment? But we're hearing that more and more across the board with the clients that we're working with, largely because there is a huge need for a workforce.

We're suffering to fill the positions that we need to fill. And that's true in almost every industry. And so then the question is, how do we take someone and take their skills at doing one task and apply them to another? And I think that's something, hopefully, we'll see our workforce in higher education starting to talk more about, that say, how do these skills transfer?

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Oby Ukadike: So we're specifically talking about, at least on this episode, graduate and post-graduate training programs. And even as someone who's gone through them and the work that you've done, thinking about it and the research that you've done, what do you think those programs can do to address this mental health crisis?

Teresa Evans: The first thing-- and I guess I should say, I feel like we've done a lot. I have been just so impressed and humbled by all of the conversations that I've been a part of and that my colleagues have been a part of. And then I can only imagine there are a bunch that have been around exactly this topic within higher education.

And so that's step one, just to make this something that we discuss, that we discuss often, and that is a part of not only leadership but also grassroots efforts within higher education. That's great. So talk about it. And make it something that is a part of the decisions that we're making. And then I would say-- I mentioned grassroots efforts.

I think that there is never enough support that can be given to graduate trainees who wish to create resources for themselves and for their colleagues. So supporting graduate student and postdoc associations, supporting efforts like this one to create venues for trainees to have these types of conversations-- so important.

And then as a faculty member and as someone who transitioned from graduate education into a leadership role within academia, no one really talked to me about this topic. I left graduate school. I took on a role where I was now mentoring trainees. And there was no training, no discussion about, well, what do you do if X, Y, or Z happens? And that was largely what fueled my interest in making sure that we asked the question in a academic way and started this conversation.

And so all that being said is, I do think that academia can ensure that the individuals who are in mentor relationships have access to training or resources that help them be the best version of themselves for their mentees and recognize the kind of support mentees need when it comes to mental health. It's different in every institution but something that we should all be asking as mentors.

Oby Ukadike: In these groups in particular, it seems that there's not a lot of research on the state of mental health challenges-- comparable to other research, maybe I'll say, that's happening. In your opinion, why do you think that is?

Teresa Evans: I think some of it is potentially resource driven. So the work that myself and my colleagues did was not funded. It was done as an extra project that we did on our free time.

Because we really felt it was important. I don't know if that has an impact. But I would imagine it does. But I say that. And then I also say I have had the fortune, like I said a minute ago, to be on some committees.

I know other people are starting to ask this question. And I think we're going to see more and more research out there. But it would be great. And maybe-- and I should always say-- maybe these things exist. And I haven't looked for them recently.

So I hope that they exist or that they will in the future, opportunities for individuals and scientists, researchers to gain the support they need to have the time and the resources to conduct work like this in a robust way. And I should say that this work is just the beginning. There is a lot that could be done to make this much more robust. We did what we could with the resources we had. If there are additional resources out there, that would be great.

And then along those lines, too, I will say making a call to folks who have done this kind of work to publish it-- you know, I can hear the person out there right now saying, well, I'm trying. So publishing this work isn't always easy. But that's a piece of it, that dichotomy of getting the work out there but then going through that peer review process and getting it published, making sure that we're doing every effort we can to share what we have found.

Oby Ukadike: On top of everything you do, you're also a parent. And something we don't often talk about is the balance of work and personal life and how it can impact mental health. Is there any advice you would give to someone who is struggling to keep the balance?

Teresa Evans: Thank you for asking this question. There's so many things I could say. But the advice part is most important. So my advice would be to always remember that you aren't alone and that there are individuals, whether in your family, your close friends, colleagues, or even people that you might not expect, like myself-- you can find me on the internet and reach out-- but individuals that you can talk to that can help you through whatever you're going through.

That would be one piece. The other thing, speaking from a personal experience, is that we all have our mental health struggles. No one is above the realities of life and of the challenges that we face.

And so being able to acknowledge when you're in a time that needs extra care and seek that support that you need is so important. And so you mentioned me being a parent. And I am. I think I can still say I'm a new parent.

My daughter will be two in a month. And so I'm going to stick to "I'm a new parent." And it is the hardest thing I've ever done in my life and maybe will always be. And I appreciated you asking me this question. Because I think we don't say that enough.

We don't share or speak openly enough about how hard it can be to balance work, and life, and family, and everything. I have some women in my work life that I look up to so much. But let me tell you, they made it look too easy. In hindsight, I'm like, why didn't you tell me this was so hard? So I'm trying really hard to honestly not make it look easy.

I think it's OK to say, it's not easy. It's OK to say, you know what? Today, I'm not going to get through all my emails. Or I just need a minute. And accept that.

And so to anyone out there who is struggling to balance whatever it is, it's OK to say you don't have it all together today. But you'll get it together tomorrow. And it's OK to show people that sometimes, too. They might need to see it. Because they might also be trying to keep it all on the inside like a winner.

Oby Ukadike: Now that's really a great point. And honestly, it made me want to ask you a bit of a follow-up question. And as you talked about earlier kind of the changing priorities, maybe, and how the workforce is changing, how does being a parent change even how you think about that in your career and how you think about moving forward? Especially as an entrepreneur, as a scientist, as an academic, I think that's a lot to think about.

Teresa Evans: Yeah, it absolutely changes everything. But at the same time, I have to remind myself that it doesn't have to, in some ways. I think the big thing I've had to grapple with myself is the speed. Those goals might still be there for me.

But they might not happen at the speed that I thought that they would. Or they might look a little bit different. But they don't have to be abandoned.

The other thing-- and I think this is true for a lot of people who pursue the kinds of work that you have and I have, which is the Type A personality of wanting to be perfect at everything. I have never wanted to be perfect at anything more than I've wanted to be perfect at being a mom and then a mom that works. And so I have to tell myself sometimes that my level of perfection is sometimes unnecessary, and can make it even harder on myself, and to focus on being perfect at the things that really matter.

It's OK if sometimes I forget the snack after school or whatever it may be. Those things are OK. At least I didn't forget to pick her up. I got that part. And you heard me say "mom that works." I read that once.

And it's really stuck with me, that the order of things is important. And I always put being a mom first and the work second. And it is a part of my identity. It's a part of who I am. And it was a part of my mom's identity and who she was.

And I think we need to just honor that and honor that, also, for dads. I think that's important, too. My husband, I'm so thankful he steps up and works as hard as I do to balance it all. And so it's parents, parents that work. And we just make it happen.

Oby Ukadike: I love what you talked about, the timing, that you can still have a goal. But maybe the timing is what's shifting. I think automatically sometimes-- at least for me, my brain goes to, well, can't do that.

Teresa Evans: And I can't say I wasn't there. There's been a time in this two-year journey of being a parent-- I guess it starts before then-- where I felt that way, where I said, well, I'm never going to be that vision of myself that I had. There's no way I can do it now.

And so I've really tried to shift my mindset to say, well, I'm still going to do that. It just might not be in the time that I thought. Or it might look a little bit different. But I'm still going to be that amazing version of myself that I want to be-- and all along the way, getting this amazing gift of sharing it with someone else.

Oby Ukadike: Now that is incredible. Thank you so much. It has been such a pleasure to have this conversation with you. And sincerely, we will have you back. We have more to talk about.

Teresa Evans: I can't wait. Yeah, absolutely. Thank you.

Oby Ukadike: Thank you for listening. If you enjoyed this episode, please rate us on iTunes. And help us spread the word about the amazing research taking place across the Harvard community and beyond. We are always looking to connect and collaborate with the research community and would like to hear from you. Please feel free to email us at onlineeducation.catalyst.harvard.edu to inquire about being a guest on the podcast.

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