Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis.

Objectives: Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms. Methods: We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic. Results: The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%). Conclusion: This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

University Students' Financial Situation During COVID-19 and Anxiety and Depressive Symptoms: Results of the COVID-19 German Student Well-Being Study (C19 GSWS).

Background: The COVID-19 pandemic has had a major impact on students' financial situation as well as on their mental health. Aim: To examine the reported change in the financial situation of German university students before and across two time points of the COVID-19 pandemic and to evaluate its associations with anxiety and depressive symptoms. Methods: We used data from the cross-sectional COVID-19 German Student Well-being Study conducted at five German universities (N = 7203). Linear regression models were used to analyze associations between a reported change in financial situation and anxiety and depressive symptoms. Results: Twenty-eight percent of the participants reported to have a worsened financial situation at the time of the survey compared to the time prior to the pandemic. A worsened financial situation at the time of the survey as compared to prior to the pandemic was associated with higher levels of anxiety and depressive symptoms reported in all three depression and anxiety scales [a 1.46 point increase on the CES-D 8 scale (95% confidence interval (CI): 1.19; 1.73), a 0.37-point increase in PHQ-2 (95% CI: 0.28; 0.46), and a 0.45-point increase in GAD-2 (95% CI: 0.35; 0.55)]. An improved financial situation, on the other hand, was associated with lower levels of anxiety and depressive symptoms. As for the second change, comparing the current financial situation with the situation during the first wave of the pandemic, the associations with anxiety and depressive symptoms were broadly similar. Conclusion: Our findings suggest that students are a vulnerable population in need of mental and financial support during times of crisis. Future research is needed to obtain insights into potential long-term effects of the pandemic on students' mental health.

Associations of loneliness with mental health and with social and physical activity among university students in Germany: results of the COVID-19 German student well-being study (C19 GSWS).

Introduction: University students are at high risk for loneliness with a potential negative impact on health. The COVID-19 measures disrupted students' academic routine and social life, which might have affected their perception of loneliness. This study investigated the prevalence of perceived loneliness among university students in Germany during the COVID-19 pandemic and its associations with mental health, behavioral outcomes, and sociodemographic characteristics. Methods: COVID-19 German student well-being study (C19 GSWS) collected data from five German universities from October 27th to November 14th, 2021, resulting in a sample of 7,203 respondents. Associations of loneliness with depressive symptoms, anxiety, social and physical activity, as well as sociodemographic characteristics, were analyzed using multivariable logistic regressions. Results: A total of 20.6% of students reported loneliness. Students with depressive or anxiety symptoms had more than eight- or sixfold odds, respectively, for reporting loneliness (depressive symptoms: OR = 8.29; 95% CI: 7.21-9.52; anxiety: OR = 6.48; 95% CI: 5.65-7.43) compared with students who did not report any symptoms. Students who were less physically active were more likely to experience loneliness compared with students who were more physically active (no moderate physical activity: OR = 1.39; 95% CI: 1.21-1.59; no vigorous physical activity: OR = 1.19; 95% CI: 1.04-1.36). We found no association between loneliness and social activity. However, loneliness was associated with being single (OR = 2.93; 95% CI: 2.55-3.36), living alone (OR = 1.31; 95% CI: 1.13-1.52), or having a temporary residency status in Germany (OR = 2.24; 95% CI: 1.65-3.04). Conclusion: Our findings highlight the importance of loneliness as a relevant factor associated with health. Further research is needed to determine potential protective factors to tackle loneliness and to investigate how study conditions at higher education institutions may affect students' perceived loneliness.

Study Conditions and University Students' Mental Health during the Pandemic: Results of the COVID-19 German Student Well-Being Study (C19 GSWS).

University students are generally vulnerable to mental health problems. This was exacerbated during the COVID-19 pandemic, when students experienced decisive changes and restrictions in their academic lives. Our study aimed at (a) analysing associations between study conditions and symptoms of depression and anxiety and (b) determining the extent of use and motivation to use student counselling services. The C19 GSWS is a cross-sectional study conducted at five universities in Germany (N = 7203). Descriptive analyses and linear regression models were performed to estimate the associations between study conditions and mental health outcomes. A total of 42.4% of the students felt down, depressed, or hopeless on several days over the past 14 days. Between a third and 44.1% of the students felt burdened by their study conditions. Worse perceived study conditions were associated with higher levels of depressive symptoms and anxiety. Only 7.1% indicated that they had utilised student counselling services, and female gender, enrolment in a bachelor's programme, and having more than 1 reason for utilisation were factors associated with use. The results of our research underline the need for universities to review their study conditions and to provide targeted intervention strategies and counselling services to promote students' mental well-being.

Anxiety and depressive symptoms of German university students 20 months after the COVID-19 outbreak - A cross-sectional study.

BACKGROUND: Given the long duration of the COVID-19 pandemic, monitoring mental health remains important. This study aimed to determine (1) the prevalence of anxiety and depressive symptoms among university students 20 months after the first COVID-19 restrictions and (2) which factors were associated with these outcomes. METHODS: The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) collected data of 7025 students at five German universities. Associations between anxiety and depressive symptoms with sociodemographic and other factors were analysed using multivariable logistic regression models. RESULTS: The mean age of the participants was 23.9 years (SD = 4.9), 67 % were female and 31 % male. The prevalence for depressive symptoms was 29 % (PHQ-2) and 12 % (CES-D 8) and 32 % for anxiety. A complicated relationship status, the lack of a trusted person, and financial difficulties were associated with anxiety and depressive symptoms. University students who were worried about (re-) infection with COVID-19 had a 1.37-times higher chance for reporting anxiety (GAD-2: OR, 95 % CI: 1.09-1.71). Those with pre-existing cardiovascular health conditions had an up to 3.21-times higher chance for reporting depressive symptoms (OR, CESD-D 8, 95 % CI: 1.44-7.14). LIMITATIONS: The study design is cross-sectional and uses self-reported outcomes. CONCLUSIONS: Concepts for prevention and counselling to tackle mental health problems in students are needed and programmes should take specific stressors related to the pandemic into account.

Determinants of vaccination behavior among university students 20 months after the COVID-19 outbreak: Results of the COVID-19 German Student Well-being Study (C19 GSWS).

Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of COVID-19 related complications compared to the general population in Germany. However, little is known about the other determinants of COVID-19 vaccination behavior for the population of German university students. This study aimed to investigate determinants of vaccination behavior in this population. The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities from October 27th to November 14th, 2021, via an online survey (n=7,267). Multiple logistic regressions were calculated to examine associations of psychological antecedents of vaccination (5Cs: confidence, complacency, constraints, calculation, collective responsibility), Critical Health Literacy in a Pandemic (CHL-P), and additional determinants (previous infection, trust in the health care system, feeling informed about the COVID-19 vaccine) and vaccination status (not vaccinated vs. fully vaccinated). All 5Cs were associated with reporting to be vaccinated, except for complacency. Regarding the CHL-P, students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had higher odds for reporting being vaccinated (OR=3.02; 95% CI: 2.26-4.04). Students who felt well informed about the COVID-19 vaccines were also more likely to report being fully vaccinated (OR=2.20; 95% CI: 1.51-3.21). Due to our finding that the 5Cs are associated with vaccination status among university students, we recommend that the different components of the 5Cs should be considered in future vaccination campaigns implemented in the university context.