Determinants of climate anxiety and willingness for climate-friendly behavioral change in German students: a quantitative study

Determinants of climate anxiety and willingness for climate-friendly behavioral change in German students: a quantitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of climate anxiety and willingness for climate-friendly behavioral change in German students: a quantitative study Timothy Mc Call, Gloria Düllberg, Michel Rinderhagen, Jonas Rickermann, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8193439/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2026 Read the published version in BMC Psychology → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Young people are increasingly concerned about climate change, which can have a negative impact on their mental health. Course content about the health consequences of climate change, as found in students of health-related subjects, is associated with increased climate anxiety. Climate anxiety can be both an understandable reaction to a real crisis that leads to climate-friendly behavior and a functional impairment that undermines the ability to act. The aims of the study are to identify risk and protective factors of students for functional impairment due to climate anxiety and factors that promote the willingness of students to climate-friendly behavioral change. Methods: Students of health-related subjects were surveyed using a quantitative online questionnaire. Age, gender, trait anxiety, personality, nature connectedness, climate-specific health literacy, and climate anxiety were recorded. Multiple linear regression analyses were used to analyze the data. Results: Neuroticism, trait anxiety, connectedness to nature, female gender, knowledge of the consequences of climate change, perceived relevance of climate change, and the belief that climate change poses a personal health risk are all positively and significantly associated with climate anxiety. Significantly positive associated with the willingness for climate-friendly behavioral change are climate anxiety, openness, and perceived action efficacy. Adding a quadratic term for climate anxiety suggests that the relationship between climate anxiety and willingness may not be linear and decreases as climate anxiety increases. Conclusions: As our results do not indicate any protective factors against impairment due to climate anxiety, this topic should be researched further. Future work should give special consideration to young female students, whose anxiety, neuroticism, and nature connectedness are more pronounced, as a potential risk group. Interventions that promote climate-friendly behavioral changes should appeal to open-minded students and reinforce their belief that their behavior impacts climate change. Additionally, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change. climate anxiety climate-friendly behavior climate-specific health literacy students Germany Figures Figure 1 1. Introduction With the increasing visibility of the negative consequences of climate change, the number of people reporting mental health problems related to climate change has increased worldwide (1). Young people in particular are concerned about climate change (2), as expressed in initiatives such as Fridays for Future. For students studying health-related subjects, courses often include information about climate change and its health consequences, which can be associated with higher levels of climate anxiety (3). It is important not to pathologize climate-related concerns, as climate change is a real threat (4). Climate-associated fears can serve to increase the willingness for climate-friendly behavioral change in order to avert the source of danger (5). However, climate anxiety can be associated with functional impairment (6,7) and thus undermine one's own ability to act. It is important to understand the risk factors for these negative effects to target interventions. It is also essential to identify protective factors against pathological climate anxiety to strengthen the resilience of vulnerable groups. One potentially protective, new construct here is climate-specific health literacy according to Reismann et al. (8). This study aims to find out which factors can be used to examine (1) pathological climate anxiety and (2) the willingness for climate-friendly behavioral change in German students, particularly those studying health-related subjects, to analyze risk and protective factors for climate anxiety, as well as the importance of climate anxiety and other factors for promoting climate-friendly behavior. Among other measures, the applicability of a new questionnaire to assess climate-specific health literacy (9) will be tested. 2. Background 2.1 Climate anxiety among students 2.1.1 Climate anxiety The term eco-anxiety is used to describe the anxiety caused by ecological crises. The form of eco-anxiety specifically related to anthropogenic climate change is called climate anxiety ( 10 ). Because climate change is a real threat and it is reasonable to be concerned ( 4 ), anxiety about climate change is not necessarily pathological ( 11 ). Clayton and Karazsia ( 6 ) developed the Climate Anxiety Scale (CAS) to assess clinically relevant climate anxiety, which is associated with cognitive-emotional and functional impairment. According to a meta-analysis, this type of impairment is negatively correlated with mental well-being ( 12 ), which emphasizes its relevance in the context of advancing climate change. In addition to anxiety, there are other emotional reactions to climate change (e.g., anger, guilt, contempt), which are differentiated for example in the Inventory of Climate Emotions (ICE) by Marczak et al. ( 13 ). 2.1.2 Students as risk group for climate anxiety? The current state of research suggests that young people in particular are affected by negative emotions respectively anxiety in connection with climate change. An international study by Hickman et al. ( 2 ) shows that 59% of participating adolescents and young adults aged 16 to 25 from ten different countries are very or extremely worried about climate change. These feelings about climate change have a negative impact on the daily lives and functioning of 45% of respondents. In addition, international studies have come to the conclusion that there is a significant negative correlation between climate anxiety and age ( 14 – 17 ), according to which a younger age is associated with higher levels of climate anxiety. Two German studies confirm this negative correlation between climate anxiety and age ( 18 , 19 ), while another German study found no correlation between age and climate anxiety ( 7 ). A German study by Söder et al. ( 20 ) showed that worries about climate change are prevalent among students: on a scale of one (no worry) to five (great worry), the average level of worry about climate change was 2.8. There is evidence that the level of climate anxiety in students depends on the content of their studies: A study of UK students also found rather low average levels of climate anxiety in the overall sample; but students with an environmental degree reported higher levels of climate anxiety than students without an environmental degree ( 21 ). A study of Mexican university students also showed that students whose courses included information about climate change had higher levels of climate anxiety ( 3 ). 2.2 Factors associated with climate anxiety 2.2.1 Gender and climate anxiety In order to identify potential risk groups for the negative consequences of climate anxiety, it is important to know what factors are associated with these consequences. As mentioned above, these include being young, but also being female: Several studies have shown that climate anxiety tends to be more prevalent among women than men ( 7 , 15 , 16 ), including among university students in Mexico ( 3 ). 2.2.2 Personality traits and climate anxiety It is possible that the level of climate anxiety depends on students’ personality traits. According to a meta-analysis by Cipriani et al. ( 22 ), concern about climate change is positively correlated with openness and neuroticism. In a study by Tucholska et al. ( 23 ) with adults from Poland, a significant positive correlation was found between climate anxiety and neuroticism as well as between climate anxiety and openness. While neuroticism was identified as a significant positive predictor of climate anxiety associated with cognitive and emotional impairment (the higher the level of neuroticism, the higher the level of cognitive and emotional impairment), conscientiousness was identified as a significant negative predictor of climate anxiety associated with functional impairment (the lower the level of conscientiousness, the higher the level of functional impairment) ( 23 ). 2.2.3 Trait Anxiety and climate anxiety In addition to the personality traits mentioned above, studies indicate that trait anxiety can also be associated with the extent of climate anxiety in students. Numerous studies suggest a significant positive correlation between functionally impairing climate anxiety and general anxiety or anxiety disorder symptoms ( 7 , 14 , 17 , 24 , 25 ), including among US students ( 26 ) and among a young (≥16 years) and educated sample from Germany ( 27 ). Another German study showed that the extent of functionally impairing climate anxiety is associated with general anxiety and depression, as well as with a diagnosis of depression and/or anxiety disorder ( 28 ). 2.2.4 Nature connectedness and climate anxiety Another potential factor influencing the extent of climate anxiety among students is their connection to nature. In a study by Curll et al. ( 29 ), a significant positive correlation was found between connectedness to nature and worry about climate change among Australian adults surveyed after a severe bushfire season. This finding is also confirmed in Canadian and UK studies, which found a significant positive correlation between climate anxiety and either connectedness to nature ( 25 ) or nature relatedness ( 17 ) in adults. These findings from international research are also reflected in a German study: Wullenkord et al. ( 30 ) identified connectedness to nature as a possible risk factor for impairment due to climate anxiety. 2.2.5 Climate-specific health literacy and climate anxiety While environmental literacy is defined as the process that forms or strengthens an individual's environmental values and competencies in problem-solving for environmental issues ( 31 ), climate-specific health literacy is characterized by knowledge about the health risks of climate change and the health co-benefits of climate-friendly behavior, as well as the emotional integration of knowledge and feelings of concern about climate change and health and the ability to translate this knowledge into climate-friendly actions ( 8 ). In an exploratory study Albrecht et al. ( 9 ) attempted to capture climate-specific health literacy using a self-constructed questionnaire, which in addition to the elements proposed by Reismann et al. ( 8 ), also included the barriers and enabling factors of climate-specific health literacy. To our knowledge, the relationship between climate anxiety and climate-specific health literacy among students has not yet been investigated. However, there are indications in the literature that suggest that this correlation should be analyzed. While studies with adults from the general population have shown a negative correlation between climate anxiety and climate knowledge ( 14 , 25 ), a study with Mexican university students found that knowledge about climate change was significantly positively related to climate anxiety scores ( 3 ). In a quasi-experimental pretest-posttest study with nursing students at a university in Istanbul, the effects of a course containing information about the causes and consequences of climate change and proposals to mitigate climate change were investigated. After participating in the course, there was a statistically significant increase in knowledge and attitudes towards global warming as well as in eco-anxiety ( 32 ). 2.3 Factors associated with the willingness for climate-friendly behavioral change 2.3.1 Gender, age, and willingness to change behavior In addition to the level of climate anxiety, the characteristics described above can also be associated with the willingness to make climate-friendly behavioral changes. With regard to demographic factors, it should be noted that, according to current studies, pro-environmental behavior is significantly positively associated with gender ( 1 ) and age ( 17 ), meaning that being female and older is associated with more pro-environmental behavior. However, it is important to note that the willingness to engage in environmentally friendly behavior does not always go hand in hand with actual behavior ( 33 ). 2.3.2 Personality traits and willingness to change behavior Personality traits could also be associated with students’ willingness to change behavior regarding climate friendly actions. A meta-analysis by Cipriani et al. ( 22 ) shows a positive correlation between proactivity towards climate change and openness, extraversion, agreeableness, and neuroticism. In a Polish study by Tucholska et al. ( 23 ), a significant positive association of openness on behavioral engagement in pro-environmental activity as well as with the planned pro-environmental activity was demonstrated. In addition, a significant association of neuroticism with planned pro-environmental activity was found. Significant positive correlates of current pro-environmental activity were openness, extraversion and conscientiousness ( 23 ). In a British birth cohort study, longitudinal data were analyzed to identify associations between personality traits and pro-environmental behaviors. Strong positive associations were found between agreeableness, openness and the total number of pro-environmental actions taken, a weaker positive association between extraversion and the total number of pro-environmental actions taken and a little to no association between conscientiousness and the total number of pro-environmental behaviors taken ( 34 ). A meta-analysis by Soutter et al. ( 35 ) shows that openness and conscientiousness as well as agreeableness and extraversion correlate significantly positively with pro-environmental behavior. 2.3.3 Climate anxiety and willingness to change behavior Climate anxiety can be understood as an adaptive reaction to a real threat, which is accompanied by behaviors to mitigate the source of danger ( 5 , 36 ). For some people, therefore, climate anxiety may act as a driver to take climate action ( 37 ). Numerous studies have found a significant positive correlation between climate anxiety and pro-environmental behavior in adults ( 1 , 15 – 17 , 23 , 25 , 38 , 39 ). Current studies with German adults confirm this association ( 7 , 27 , 40 ). 2.3.4 Climate-specific health literacy and willingness to change behavior In addition to anxiety, knowledge and competence in the field of climate change and health can also lead to meaningful responses to protect the climate. For example, a study of physicians and nurses from Germany found that participants who rated their knowledge of the consequences of climate change higher were more willing to eat a vegetarian diet or volunteer for sustainability than participants who rated their knowledge lower ( 9 ). This trend was not only among medical practitioners, but also among patients: In a study by Reismann et al. ( 8 ), the majority of participating patients stated that they would be willing to adopt climate-friendly behavior if they were informed by their physician about the health risks associated with climate change. In addition to the medical setting, this connection is also evident among students: A study with German university students revealed that students who were well informed about the health consequences of climate change were more willing to adopt climate-friendly behavior. This willingness also manifested itself in actual behavior, for example in the choice of environmentally friendly means of transport or a sustainable diet that offered health co-benefits ( 41 ). 2.4 Problem definition and aims To our knowledge, there are no studies that investigate climate anxiety associated with cognitive-emotional and functional impairments, as well as the factors influencing the extent of these impairments in German students, especially those studying health-related subjects. Against the background of possible risk factors such as a young age ( 18 , 19 ) and a high level of climate knowledge ( 3 ), it is important to find out to what extent they are affected by clinically relevant climate anxiety. Students may need help dealing with their climate-related emotions. In addition, it should be determined which factors make students vulnerable to clinically relevant climate anxiety and which protect against them in order to be able to specifically prevent the negative effects of climate anxiety. Therefore, the aim of the study is to identify potential risk and protective factors for the cognitive-emotional and functional impairments due to climate anxiety in this target group. To this end, the relevance of personality traits, trait anxiety, connectedness to nature and parts of climate-specific health literacy for the impairment caused by climate anxiety will be analyzed. Another aim of the study is to examine the factors associated with German students’ willingness to change their behavior toward more climate-friendly practices, in order to identify potential starting points for promoting climate-friendly behavior in this target group. To this end, we examine the association of climate anxiety, personality traits and the belief that one's own behavior has an impact on climate change with the extent to which students are willing to change their behavior. These aims translate into the following two research questions: How are personality traits, trait anxiety, connectedness to nature, and climate-specific health literacy associated with climate anxiety? How are climate anxiety, personality traits, and the belief that one's own behavior has an impact on climate change related to the willingness for climate-friendly behavioral change? 3. Methods 3.1 Participants The study was open to all students who were aged 18 or over and were attending a German higher education institution at the time of the invitation. To recruit students, we sent a call for participation to 572 health-related faculties at universities and other higher education institutions across Germany, who then forwarded the study invitation to their students. Based on an a priori power calculation using G*Power (Version 3.1.9.7) we identified a target sample size of 435 for the planned regression analysis with the most predictors (see Appendix A ). We oversampled to account for potential missing data. Of the total 528 eligible students who participated, 365 identified as female, 153 as male, and 10 as neither/diverse. The students ranged in age from 18 to 50 + years, but most were between 21 and 30 years old on average. Taking part in the study was voluntary. All participants consented to participate in the study after being informed of its objectives and procedures. No financial or other compensation was provided. 3.2 Materials and Procedure Interested students followed the invitation link to the online study in an environment and on a device of their choice. After reading through the study information and giving their informed consent, participants filled out the questionnaire. In a first block of questions participants provided information on whether they were studying at a German higher education institution (yes/no), how old they were (18–20 years; 21–25 years; 26–30 years; … or 50 + years old), and with which gender they identified (female; male; or diverse). A second block of questions assessed the participants’ trait anxiety, personality, and nature connectedness using the German-language versions of the short form of the State-Trait-Anxiety Inventory (STAI) ( 42 ) the 10-item short version of the Big Five Inventory (BFI-10) ( 43 ) and the Connectedness to Nature Scale for Adolescents (CNS-A) ( 44 ) respectively. The STAI has ten items in which participants rate anxiety-related statements on an 8-point Likert scale ranging from 1 “almost never” to 8 “almost always” (e.g. “I get tired quickly.”). The BFI-10 has ten items in which participants rate statements on a 5-point Likert scale ranging from 1 “not at all applicable” to 5 “fully applicable” (e.g. “I see myself as someone who is reserved.”), which allow inferences about the participants’ personality on five subscales describing their degree of extraversion, agreeableness, conscientiousness, neuroticism, and openness. Lastly, in answering the CNS-A, participants rated 14 nature-related statements on a 7-point Likert scale ranging from 1 “strongly disagree” to 7 “strongly agree” (e.g. “I feel one with nature.”). The third block of questions concerned the participants’ climate-specific health literacy which was assessed using the exploratory questionnaire developed by Albrecht et al. ( 9 ). The questionnaire assesses different aspects of climate-specific health literacy, of which we utilized five single 5-point Likert scale items addressing the participants self-rated knowledge of the consequences of climate change (knowledge), their perceived relevance of climate change (relevance), whether participants feel their actions have an impact on climate change (action efficacy), and whether participants believe climate change poses a personal (personal risk) or global health risk (global risk). We also used six 5-point Likert scale items to assess the participants willingness to engage in different climate-friendly behaviors: using a bicycle instead of a car, using public transportation instead of private transportation, switching to a vegetarian diet, switching to a vegan diet, getting involved in a community or organization that promotes sustainability or environmental protection, and paying more for sustainable products. Finally, participants answered questions about their level of climate anxiety using the German version of the CAS ( 7 ). The scale has 13 items in which participants rate statements describing their emotional impairment due to climate anxiety on a 7-point Likert scale ranging from 1 “strongly disagree” to 7 “strongly agree” (e.g. “Thinking about climate change makes it difficult for me to concentrate.”). The STAI (α = 0.88), CNS-A (α = 0.81), and CAS (α = 0.90) scales showed good internal consistency, while the items assessing the willingness for climate-friendly behavioral change showed acceptable internal consistency (α = 0.76). In contrast, the internal consistency of the five BFI-10 subscales was mixed: Extraversion (α = 0.77), Agreeableness (α = 0.27), Conscientiousness (α = 0.47), Neuroticism (α = 0.66), and Openness (α = 0.59). Students were able to participate for three weeks from late May to early June 2024. The questionnaire was exclusively administered online using evasys ( https://evasys.de/ ). Preceding the data collection the study was assessed and then approved by the Ethics Committee of Bielefeld University (Application No. 2024 − 119). 3.3 Data Analysis Before analyzing the data, we calculated aggregate scores for the personality subscales (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), nature connectedness, climate anxiety, and the willingness for climate-friendly behavioral change by calculating mean scores after recoding reversed items. As per the scale instructions, we calculated the total percentage of agreement for the STAI items (0–100), with higher scores indicating higher trait anxiety. We also created dummy variables for gender (female and diverse) for use in the regression analyses. Additionally, for Likert-type items that served as independent variables, the two lowest response categories were merged, as only a small proportion of participants selected them. This was done to ensure sufficient statistical power for their use as reference categories. In analyzing our data, we conducted several multiple linear regression analyses (MLRA) to answer our research questions. Because a first MLRA indicated that none of the personality subscales were significantly associated with climate anxiety, but trait anxiety was, and because trait anxiety and neuroticism had a high correlation (0.70), we conducted two separate MLRAs to answer the first research question, how are personality traits, trait anxiety, connectedness to nature, and climate-specific health literacy associated with climate anxiety. One MLRA with trait anxiety as the independent variable and one MLRA with the five personality subscales as the independent variables. Both MLRAs also included age, gender, climate-specific health literacy (knowledge, relevance, action efficacy, personal risk, and global risk), and connectedness to nature as additional independent variables and climate anxiety as the dependent variable. Because the assumption of homoscedasticity was not met for both MLRAs, we used bootstrapping with 5000 samples for the analyses. All other assumptions (normally distributed residuals, multicollinearity, autocorrelation, and extreme outliers) were satisfied. We then conducted another MLRA, using the willingness for climate-friendly behavioral change as the dependent variable, to answer the second research question, how climate anxiety, personality traits, and the belief that one's own behavior has an impact on climate change are associated with the willingness for climate-friendly behavioral change. Age, gender, climate anxiety, the personality subscales, and action efficacy were used as independent variables. All assumptions were fulfilled for this analysis. Finally, we estimated the same MLRA with an additional quadratic term added for climate anxiety. This way a possible non-linear relationship between climate anxiety and willingness for climate-friendly behavioral change was assessed. The model fulfilled all assumptions as well. 4. Results In total 528 students answered the survey. Excluding those with missing values in the analytical sample resulted in an analytical sample size of N = 470. Table 1 provides an overview over the sample characteristics. Most of the participants identified as female (n = 321; 68 %), while 30 % identified as male (n = 140) and 1.9 % (n = 9) as other than male or female, respectively. The majority were between the ages of 21 and 25 (n = 254; 54 %); 23 % were aged between 26 and 30 years (n = 108); 8.7 % between 18 and 20 years (n = 41), 6.8 % between 31 and 35 years (n = 32), 4.7 % between 36 and 40 years (n = 22), and lastly, 1.3 % were aged older than 40 years (n = 13). Regarding their knowledge of climate change consequences, more than 70 % of the participants assessed their knowledge as high (n = 242; 51 %) or very high (n = 97; 21 %); 21 % assessed their knowledge as medium (n = 99), and less than 10 % as low or very low (n = 32; 6.8 %). Nearly 90 % viewed the relevance of climate change as very urgent (n = 348; 73 %) or urgent (n = 69; 15 %). Conversely, less than 5 % viewed the relevance as rather insignificant (n = 24; 4.5 %). Regarding their action efficacy, 77 % of the participants answered that they feel their actions have an impact on climate change, with 48 % answering “Yes” (n = 224), and 29 % answering “Yes, very” (n = 138). 8.3 % stated that they do not feel that their actions have an impact on climate change (8.3 %, n = 39). 77 % of the participants stated that they see climate change as a cause for global health problems (climate change as a global risk). Specifically, 34 % (n = 160) answered "Yes" and 43 % (n = 204) answered "Yes, very." Meanwhile, 11% (n = 51) stated that they do not see climate change as such. Regarding the question whether participants see climate change as a risk factor for their own health, 33 % answered “Yes” (n = 154) and 36 % answered "Yes, very” (n = 171), while 17 % do not see it as a risk factor (n = 81). In terms of personality traits, the sample demonstrated the following mean scores for each trait: Extraversion 3.12 (SD = 0.99), Agreeableness 3.29 (SD = 0.81), Conscientiousness 3.61 (SD = 0.80), Neuroticism 3.05 (SD = 0.96), and Openness 3.64 (SD = 1.00). The mean for connectedness to nature in this sample is 5.04 (SD = 0.82), for trait anxiety it is 43 (SD = 17), and for climate anxiety, it is 2.38 (SD = 1.14). Regarding the willingness for climate friendly behavioural change, the sample presents a mean of 3.93 (SD = 0.74). Table 1. Sample characteristics To analyze whether age, gender, climate-specific health literacy (knowledge, relevance, action efficacy, personal risk, and global risk), trait anxiety, personality (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), and connectedness to nature are associated with climate anxiety, we conducted two MLRAs with bootstrapping. Both the model including trait anxiety ( F (24, 445) = 13.58, p < .001, adjusted R 2 = .39, AIC = 1.254) and the model including personality ( F (28, 441) = 9.31, p < .001, adjusted R 2 = .33, AIC = 1.302) were significant and explained 39% and 33% of the variance, respectively. Female gender, knowledge, relevance, personal risk, trait anxiety, neuroticism, and connectedness to nature were significantly associated with climate anxiety in the two models. Age was only significant in the personality model: On average participants aged 36-40 reported a 0.42 lower score (95 CI [-0.84, -0.01]) in climate anxiety than those 18-20 years old. Both models showed that being female, perceiving oneself as very knowledgeable about the consequences of climate change, perceiving climate change as highly relevant, believing that climate change poses a threat to personal health, and feeling connected to nature were associated with increased climate anxiety among students. The personality model showed similar results for participants that reported being a more neurotic person. Table 2. Multiple linear regression models for the outcome of climate anxiety In order to analyze whether age, gender, climate anxiety, personality (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and perceived action efficacy are associated with the willingness for climate-friendly behavioral change, we conducted another MLRA. The model used was significant ( F (16, 453) = 15.35, p < .001, adjusted R 2 = .33) and explained 33% of the variance. Climate anxiety ( B = .27, 95% CI [0.22, 0.33], p < .001), openness ( B = 0.10, 95% CI [0.04, 0.15] , p = .001) and higher values in perceived action efficacy (all: p < .001) were significantly associated with the willingness for climate-friendly behavioral changes. This means that students who feel more emotionally affected by climate anxiety, who are more open to new experiences, and who feel that their actions have an impact on climate change, were overall more willing to change their climate-friendly behavior. Additionally, on average those aged 26-30 reported 0.28-point higher willingness ( 95% CI : [0.06, 0.50], p = .012) to change their behavior in such a way, compared to 18–20-year-olds. Table 3 . Multiple linear regression models for the outcome of willingness for climate-friendly behavioral change Adding a quadratic term for climate anxiety to account for a possible non-linear relationship between climate anxiety and the willingness for climate-friendly behavioral change resulted in an improved model fit ( F (17, 452) = 16.00, p = < .001, adjusted R 2 = 0.35, AIC = 872). While the coefficient for climate anxiety ( B = 0.71, 95% CI [0.50, 0.93], p = < .001) indicates an even stronger positive association with said willingness, the quadratic term implies that this association is not linear and weakens with an increase in climate anxiety ( B = -0.07, 95% CI [-0.11, -0.04], p = < .001). Figure 1 showcases this non-linear association in comparison to the single linear term from model 3. Additionally, the improved model resulted in a significant coefficient for the “Neuroticism” personality: An increase in this variable is associated with a 0.09-point decrease in the willingness for climate-friendly behavioral change ( 95% CI [-0.15, -0.02], p = .011). Figure 1. Predicted values of the linear and non-linear marginal effects of climate anxiety on the willingness for climate-friendly behavioral change. Discussion 5.1 Discussion of results In answer to our first research question, we found that neuroticism, trait anxiety, connectedness to nature, female gender, knowledge of the consequences of climate change, perceived relevance of climate change, and belief that climate change poses a personal health risk all significantly and positively associated with climate anxiety. Age was only significant in the personality model. The finding that participants aged 36–40 reported on average a 0.42 lower score (95 CI [-0.84, -0.01]) in climate anxiety than those 18–20 years old aligns with numerous studies ( 14 – 19 ), indicating that a younger age is associated with higher clinically relevant climate anxiety. Consistent with this, the mean climate anxiety score of German students in the present study (M = 2.38) is higher than the mean climate anxiety scores of 1.81 ( 7 ) and 2.0 ( 18 , 19 ) in the general German population. Looking only at the 18–29 age group, the mean climate anxiety score is similar (M = 2.4) ( 18 ). Following on from this, student status may make no difference in this age group regarding climate anxiety. The finding that being female is significantly positive associated with climate anxiety in both regression models ( B = 0.29; B = 0.31) is also consistent with the results of other studies ( 7 , 15 , 16 ), including a study of Mexican university students ( 3 ). In our first regression model, trait anxiety has a very weak but significantly positive association with climate anxiety ( B = 0.02). This finding is consistent with a French study by Parmentier et al. ( 24 ), which found that trait anxiety is associated with cognitive emotional ( B = 0.18) and functional impairment ( B = 0.22) due to climate anxiety more strongly than in this study, but also significantly positively. Another also significantly positive association of general anxiety and depression with pathological climate anxiety ( B = 0.10) was demonstrated in a study of the general German population ( 7 ). Links between climate-associated worries and mental health problems in German students were also shown in another study: Söder et al. ( 20 ) found a significant positive association of depressive symptoms ( B = 0.272), sleep difficulties ( B = 0.184) and self-reported somatic symptoms ( B = 0.304) with climate change worry. Medical students in Germany mainly experience considerable stress in connection with climate change, although this is not (yet) reflected in depressive, anxious or traumatic symptoms. However, it is negatively related to resilience factors that prevent mental disorders ( 45 ). In both regression models, connectedness to nature is a weak but significantly and positively associated with climate anxiety ( B = 0.22; B = 0.21). In a study by Whitmarsh et al. ( 17 ), a comparably strong, significantly positive association of connectedness to nature with climate anxiety was demonstrated ( B = 0.14), albeit using the Nature Relatedness Scale (NR-6) ( 46 ). In line with these findings, Wullenkord et al. ( 30 ) found a significant positive correlation between climate anxiety and connectedness to nature among a German-speaking sample that was stratified by age, gender, and level of education. In our second regression model, neuroticism is significantly and positively associated with climate anxiety ( B = 0.26). This finding is consistent with the results of a Polish study by Tucholska et al. ( 23 ), which identified neuroticism as a weaker yet significant positive association with cognitive-emotional impairment due to climate anxiety ( B = 0.15). The following subscales of climate-specific health literacy are weakly but positively associated with climate anxiety in both regression models: knowledge of the consequences of climate change, perceived relevance of climate change, and belief that climate change poses a personal health risk. In contrast to our findings, studies have shown that knowledge of climate change and climate anxiety are negatively correlated among the general adult population in the USA and Canada ( 14 , 25 ). These differences could be due to the type of target group. When we consider only the target group of students, our results are consistent with the current state of research: There is a significant positive correlation between climate anxiety and climate knowledge among Mexican students ( 3 ). It should be noted that these studies examined additional dimensions of knowledge of climate change rather than only the consequences of it. Since the subscales of climate-specific health literacy in our study range from non-significant to significantly positive effects on the level of climate anxiety, our results do not indicate that climate-specific health literacy as an overall construct protects against pathological climate anxiety. However, a study with nursing students from Egypt indicates that the association of a similar concept, environmental literacy, with climate anxiety is gender-specific: While environmental literacy alone had no significant effect, the significant interaction between environmental literacy and gender indicated that higher environmental literacy in women was associated with lower climate anxiety scores ( 47 ). In answer to our second research question, we found that climate anxiety, openness, and the belief that one's own behavior impacts climate change are significantly and positively associated with the willingness for climate-friendly behavioral change. The association of climate anxiety with the willingness to engage in climate-friendly behavioral change is consistent with another German study by Wagner and Witthöft ( 27 ), conducted among young adults (≥16 years), where climate anxiety associated with cognitive-emotional and functional impairment, was also identified as the strongest predictor of pro-climate behavior in a multiple regression analysis ( B = 0.58). Although the results are not fully comparable because willingness does not always align with actual behavior ( 33 ), they are consistent. However, the direction and type of relationship between climate anxiety and pro-environmental behavior is controversial. For example, a study from Germany by Wullenkord et al. ( 7 ) identified pro-environmental intentions as the strongest predictor of climate anxiety ( B = 0.43, p < 0.001). In addition, previous studies have examined whether there is an inverted U-shaped relationship between climate anxiety and pro-environmental behavior, according to which a moderate level of climate anxiety is associated with more pro-environmental behavior and a very high level of climate anxiety with less pro-environmental behavior. While two Australian studies support this hypothesis ( 48 , 49 ), a German study rejects it ( 27 ). The present study found only a very slight inverted U-shaped relationship between climate change and the willingness for climate-friendly behavior change among German students of health-related subjects when a quadratic term for climate anxiety was added to the analysis. As briefly mentioned above, it must be taken into account that willingness does not always correspond to actual behavior ( 33 ), which is why this relationship can only be tested to a limited extent in this study. Nevertheless, it should be noted that Maduneme ( 50 ) found an inverted U-shaped relationship between climate anxiety and pro-environmental behavioral intentions among students from the USA. In line with our results, Tucholska et al. ( 23 ) identified a significant positive association of openness with planned pro-environmental behavior in Polish adults ( B = 0.27), which is stronger than the association of openness with willingness for climate-friendly behavioral change in the present study ( B = 0.10; B = 0.09). While Tucholska et al. ( 23 ) used an instrument comparable to our study to assess personality traits ( 51 ), they developed their own instrument to operationalize planned pro-environmental behavior, thus the comparability of the results is limited. Other studies have also demonstrated a positive correlation between openness and pro-environmental behavior ( 34 , 35 ). 5.2 Strengths and limitations To our knowledge, this is the first study in a German context that aimed to investigate both risk and protective factors for functional impairment due to climate anxiety, as well as factors influencing the willingness of students in health-related subjects to adopt climate-friendly behavioral change. However, the study has some limitations. Due to its cross-sectional design, no causal relationships can be inferred. Additionally, bias resulting from self-reported data and a potential overrepresentation of students particularly interested in climate change cannot be ruled out. Nevertheless, the climate anxiety score obtained in this study is comparable to that in an earlier study from Hajek and König ( 18 ). The 10-item short version of the Big Five Inventory ( 43 ) used showed mixed internal consistency, while it is considered an established assessment tool. When using the CAS ( 7 ) to measure climate anxiety, it should be noted that it is based on a rather pathological understanding. According to Wullenkord et al. ( 7 ), the scale primarily measures climate-related emotional impairments; however, the authors also recommend placing greater emphasis on milder forms of climate anxiety. Chan et al. ( 52 ) also showed in a longitudinal study that initially negative emotions towards climate change can develop into cognitive-emotional and functional impairments. Early identification and targeted interventions for milder forms of climate anxiety could therefore prevent a later worsening of symptoms. In light of the methodological criticisms outlined above, it is advisable to use more differentiated instruments to measure climate anxiety in future studies. The newly developed ICE ( 53 ) compromises eight categories of emotional response to climate change, offering a promising approach for this purpose. Furthermore, longitudinal studies examining the development of climate-specific health literacy in relation to climate anxiety throughout the course of studies are recommended. We also have collected data from people who identified as diverse. Due to the small sample size (n = 10), we cannot make any valid statements in this regard. Nevertheless, our data suggests that this group has the highest average level of climate anxiety (female = 2.57, male = 1.93, diverse = 2.81), although the difference is not significant. Although we asked about the willingness for climate-friendly behavioral changes, we did not inquire about their prior climate-friendly actions. Consequently, the results are limited as individuals already demonstrating climate-friendly behavior can barely adapt their behavior further. 5.3 Recommendations for action One of the aims of our study was to identify risk and protective factors for emotional impairment due to climate anxiety in students, particularly among students of health-related subjects. To this end, we tested a questionnaire on climate-specific health literacy ( 9 ) as a potential protective factor. As the climate-specific health literacy subscales had either a significant positive effect or no significant effect on the level of climate anxiety, our results do not suggest that climate-specific health literacy protects against clinically relevant climate anxiety overall. Other studies suggest that gender should also be considered when analyzing this relationship ( 47 ), which we confirmed with our results. Future research should continue to identify protective factors in order to develop a basis for intervention development to protect against clinically relevant climate anxiety associated with cognitive-emotional and functional impairment, so that students learn to deal with climate emotions appropriately and use them for climate action. Since our results show that young age, female gender, connectedness to nature, trait anxiety, and neuroticism are possible risk factors for clinically relevant climate anxiety, students with these characteristics in particular should be surveyed or involved in a participatory manner when developing interventions to reach them in the best possible way with the interventions developed. Nevertheless, it should not be overlooked that non-pathological concern about climate change is reasonable and that there is a fundamental need for appropriate and effective societal climate protection measures ( 4 ). Another aim of the study was to examine the association between students' willingness to adopt climate-friendly behavioral changes in order to identify potential starting points for promoting sustainable behavior. Since our results reveal a significant association between openness and behavioral change, students exhibiting this trait should be specifically targeted through interventions aimed at fostering climate-friendly actions. The trait of openness should be considered when developing and evaluating appropriate interventions. In addition, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change. Those interventions could incorporate the promotion of the belief that one's own behavior has an impact on climate change, as our results indicate that this belief is significantly positive associated with the willingness of students to engage in climate-friendly behavioral change. Given that our results indicate climate anxiety as having a strong significantly positive association with climate-friendly behavioral change (see Table 3 ), and considering the controversial nature and direction of this relationship (see Section 5.1 ), future research should further explore this connection to clarify the extent to which climate anxiety serves as a motivator for climate action among students, as well as the extent to which it acts as a barrier, potentially impairing their capacity to engage in such behaviors. 5.4 Conclusion Our study identified possible risk factors for climate anxiety impairment in students, including young age, female gender, anxiety, neuroticism, and connectedness to nature. Interventions should target students with these characteristics. Our study could not identify climate-specific health literacy as a potential protective factor, but rather the opposite, which is why possible protective factors should be researched further. Factors that may promote climate-friendly behavioral changes among students include climate anxiety, openness, and perceived efficacy of action. Therefore, behavioral change measures should particularly focus on open-minded students and emphasize the idea that one's behavior impacts climate change. Additionally, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change. The nature and direction of the relationship between climate anxiety and climate-friendly behavior should be further explored. The need for comprehensive societal strategies to mitigate and adapt to climate change is not undermined by these considerations but rather emphasized. Abbreviations BFI-10 Big Five Inventory CAS Climate Anxiety Scale CNS-A Connectedness to Nature Scale for Adolescents ICE Inventory of Climate Emotions MLRA Multiple linear regression analyses NR-6 Nature Relatedness Scale STAI State-Trait-Anxiety Inventory Declarations Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Bielefeld University (EUB, Bielefeld University, Germany) (Application No. 2024-119). All participants voluntarily consented to take part in the study after being informed of the objectives and procedure. Consent for publication: Not Applicable Availability of data and materials: The datasets generated and analyzed during the current study are included in this published article supplementary material (Additional file 1.sav). Competing Interests: The authors have no relevant financial or non-financial interest to disclose. Funding: The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the German Stifterverband Peter Beate Heller Foundation [Grant/Award number: T0160/33738/2019/kln]. The publication costs were supported by the Open Access Publication Fund of Bielefeld University and the Deutsche Forschungsgemeinschaft (DFG). Other than funding, the supporters were not involved in the study. Authors’ contributions: T.M. was responsible for conceptualization, project administration, supervision, provided resources, writing – original draft, and writing – review and editing and was involved in methodology and investigation. M.R. was responsible for methodology, formal analyses, visualization, writing – original draft, and writing – review and editing. G.D. was involved in conceptualization, validation, writing – original draft, and writing – review and editing. 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Supplementary Files Additionalfile1.sav AppendixA.docx Tables.docx Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2026 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 20 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviews received at journal 16 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Editor invited by journal 18 Dec, 2025 Submission checks completed at journal 10 Dec, 2025 First submitted to journal 27 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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07:48:24","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":198477,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/3505de8a1987ab6ac6b49096.html"},{"id":100362429,"identity":"58e5a347-b3f7-4422-9cab-2f156ed4eda7","added_by":"auto","created_at":"2026-01-16 07:46:44","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":119469,"visible":true,"origin":"","legend":"\u003cp\u003ePredicted values of the linear and non-linear marginal effects of climate anxiety on the willingness for climate-friendly behavioral change.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/6e6858efcbb8d8e5792411c5.jpg"},{"id":106344452,"identity":"76dd8a1d-6354-4366-9295-00ecb7d4803c","added_by":"auto","created_at":"2026-04-07 16:14:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1172287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/f2d868c2-e85b-4aaf-a0e6-f0926ab9c211.pdf"},{"id":100026829,"identity":"7f4c836f-b4b7-4eee-a74e-497a3a49f70a","added_by":"auto","created_at":"2026-01-12 08:40:48","extension":"sav","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":361355,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.sav","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/2c623a6a1e126d9890f7080a.sav"},{"id":100026827,"identity":"7fdfa97c-2d8b-4aef-aa49-7fd3c0b58e0c","added_by":"auto","created_at":"2026-01-12 08:40:48","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14141,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/29689077a84e81cf70a80ea5.docx"},{"id":100362576,"identity":"e44cad64-23e9-4ecb-949e-e893e99c57cd","added_by":"auto","created_at":"2026-01-16 07:47:15","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":34772,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8193439/v1/7bb85c345c1b4c27afc80fbb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of climate anxiety and willingness for climate-friendly behavioral change in German students: a quantitative study","fulltext":[{"header":"1.\tIntroduction","content":"\u003cp\u003eWith the increasing visibility of the negative consequences of climate change, the number of people reporting mental health problems related to climate change has increased worldwide (1). Young people in particular are concerned about climate change (2), as expressed in initiatives such as Fridays for Future. For students studying health-related subjects, courses often include information about climate change and its health consequences, which can be associated with higher levels of climate anxiety (3). It is important not to pathologize climate-related concerns, as climate change is a real threat (4). Climate-associated fears can serve to increase the willingness for climate-friendly behavioral change in order to avert the source of danger (5). However, climate anxiety can be associated with functional impairment (6,7) and thus undermine one's own ability to act. It is important to understand the risk factors for these negative effects to target interventions. It is also essential to identify protective factors against pathological climate anxiety to strengthen the resilience of vulnerable groups. One potentially protective, new construct here is climate-specific health literacy according to Reismann et al. (8). This study aims to find out which factors can be used to examine (1) pathological climate anxiety and (2) the willingness for climate-friendly behavioral change in German students, particularly those studying health-related subjects, to analyze risk and protective factors for climate anxiety, as well as the importance of climate anxiety and other factors for promoting climate-friendly behavior. Among other measures, the applicability of a new questionnaire to assess climate-specific health literacy (9) will be tested.\u0026nbsp;\u003c/p\u003e"},{"header":"2. Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Climate anxiety among students\u003c/h2\u003e \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Climate anxiety\u003c/h2\u003e \u003cp\u003eThe term eco-anxiety is used to describe the anxiety caused by ecological crises. The form of eco-anxiety specifically related to anthropogenic climate change is called climate anxiety (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Because climate change is a real threat and it is reasonable to be concerned (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), anxiety about climate change is not necessarily pathological (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Clayton and Karazsia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) developed the Climate Anxiety Scale (CAS) to assess clinically relevant climate anxiety, which is associated with cognitive-emotional and functional impairment. According to a meta-analysis, this type of impairment is negatively correlated with mental well-being (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), which emphasizes its relevance in the context of advancing climate change. In addition to anxiety, there are other emotional reactions to climate change (e.g., anger, guilt, contempt), which are differentiated for example in the Inventory of Climate Emotions (ICE) by Marczak et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Students as risk group for climate anxiety?\u003c/h2\u003e \u003cp\u003eThe current state of research suggests that young people in particular are affected by negative emotions respectively anxiety in connection with climate change. An international study by Hickman et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) shows that 59% of participating adolescents and young adults aged 16 to 25 from ten different countries are very or extremely worried about climate change. These feelings about climate change have a negative impact on the daily lives and functioning of 45% of respondents. In addition, international studies have come to the conclusion that there is a significant negative correlation between climate anxiety and age (\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), according to which a younger age is associated with higher levels of climate anxiety. Two German studies confirm this negative correlation between climate anxiety and age (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), while another German study found no correlation between age and climate anxiety (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA German study by S\u0026ouml;der et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) showed that worries about climate change are prevalent among students: on a scale of one (no worry) to five (great worry), the average level of worry about climate change was 2.8. There is evidence that the level of climate anxiety in students depends on the content of their studies: A study of UK students also found rather low average levels of climate anxiety in the overall sample; but students with an environmental degree reported higher levels of climate anxiety than students without an environmental degree (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). A study of Mexican university students also showed that students whose courses included information about climate change had higher levels of climate anxiety (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Factors associated with climate anxiety\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Gender and climate anxiety\u003c/h2\u003e \u003cp\u003eIn order to identify potential risk groups for the negative consequences of climate anxiety, it is important to know what factors are associated with these consequences. As mentioned above, these include being young, but also being female: Several studies have shown that climate anxiety tends to be more prevalent among women than men (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), including among university students in Mexico (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Personality traits and climate anxiety\u003c/h2\u003e \u003cp\u003eIt is possible that the level of climate anxiety depends on students\u0026rsquo; personality traits. According to a meta-analysis by Cipriani et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), concern about climate change is positively correlated with openness and neuroticism. In a study by Tucholska et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) with adults from Poland, a significant positive correlation was found between climate anxiety and neuroticism as well as between climate anxiety and openness. While neuroticism was identified as a significant positive predictor of climate anxiety associated with cognitive and emotional impairment (the higher the level of neuroticism, the higher the level of cognitive and emotional impairment), conscientiousness was identified as a significant negative predictor of climate anxiety associated with functional impairment (the lower the level of conscientiousness, the higher the level of functional impairment) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3 Trait Anxiety and climate anxiety\u003c/h2\u003e \u003cp\u003eIn addition to the personality traits mentioned above, studies indicate that trait anxiety can also be associated with the extent of climate anxiety in students. Numerous studies suggest a significant positive correlation between functionally impairing climate anxiety and general anxiety or anxiety disorder symptoms (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), including among US students (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and among a young (\u0026ge;16 years) and educated sample from Germany (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Another German study showed that the extent of functionally impairing climate anxiety is associated with general anxiety and depression, as well as with a diagnosis of depression and/or anxiety disorder (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4 Nature connectedness and climate anxiety\u003c/h2\u003e \u003cp\u003eAnother potential factor influencing the extent of climate anxiety among students is their connection to nature. In a study by Curll et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), a significant positive correlation was found between connectedness to nature and worry about climate change among Australian adults surveyed after a severe bushfire season. This finding is also confirmed in Canadian and UK studies, which found a significant positive correlation between climate anxiety and either connectedness to nature (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) or nature relatedness (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) in adults. These findings from international research are also reflected in a German study: Wullenkord et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) identified connectedness to nature as a possible risk factor for impairment due to climate anxiety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5 Climate-specific health literacy and climate anxiety\u003c/h2\u003e \u003cp\u003eWhile environmental literacy is defined as the process that forms or strengthens an individual's environmental values and competencies in problem-solving for environmental issues (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), climate-specific health literacy is characterized by knowledge about the health risks of climate change and the health co-benefits of climate-friendly behavior, as well as the emotional integration of knowledge and feelings of concern about climate change and health and the ability to translate this knowledge into climate-friendly actions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In an exploratory study Albrecht et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) attempted to capture climate-specific health literacy using a self-constructed questionnaire, which in addition to the elements proposed by Reismann et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), also included the barriers and enabling factors of climate-specific health literacy. To our knowledge, the relationship between climate anxiety and climate-specific health literacy among students has not yet been investigated. However, there are indications in the literature that suggest that this correlation should be analyzed.\u003c/p\u003e \u003cp\u003eWhile studies with adults from the general population have shown a negative correlation between climate anxiety and climate knowledge (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), a study with Mexican university students found that knowledge about climate change was significantly positively related to climate anxiety scores (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In a quasi-experimental pretest-posttest study with nursing students at a university in Istanbul, the effects of a course containing information about the causes and consequences of climate change and proposals to mitigate climate change were investigated. After participating in the course, there was a statistically significant increase in knowledge and attitudes towards global warming as well as in eco-anxiety (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Factors associated with the willingness for climate-friendly behavioral change\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Gender, age, and willingness to change behavior\u003c/h2\u003e \u003cp\u003eIn addition to the level of climate anxiety, the characteristics described above can also be associated with the willingness to make climate-friendly behavioral changes. With regard to demographic factors, it should be noted that, according to current studies, pro-environmental behavior is significantly positively associated with gender (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and age (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), meaning that being female and older is associated with more pro-environmental behavior. However, it is important to note that the willingness to engage in environmentally friendly behavior does not always go hand in hand with actual behavior (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Personality traits and willingness to change behavior\u003c/h2\u003e \u003cp\u003ePersonality traits could also be associated with students\u0026rsquo; willingness to change behavior regarding climate friendly actions. A meta-analysis by Cipriani et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) shows a positive correlation between proactivity towards climate change and openness, extraversion, agreeableness, and neuroticism. In a Polish study by Tucholska et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), a significant positive association of openness on behavioral engagement in pro-environmental activity as well as with the planned pro-environmental activity was demonstrated. In addition, a significant association of neuroticism with planned pro-environmental activity was found. Significant positive correlates of current pro-environmental activity were openness, extraversion and conscientiousness (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a British birth cohort study, longitudinal data were analyzed to identify associations between personality traits and pro-environmental behaviors. Strong positive associations were found between agreeableness, openness and the total number of pro-environmental actions taken, a weaker positive association between extraversion and the total number of pro-environmental actions taken and a little to no association between conscientiousness and the total number of pro-environmental behaviors taken (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). A meta-analysis by Soutter et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) shows that openness and conscientiousness as well as agreeableness and extraversion correlate significantly positively with pro-environmental behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Climate anxiety and willingness to change behavior\u003c/h2\u003e \u003cp\u003eClimate anxiety can be understood as an adaptive reaction to a real threat, which is accompanied by behaviors to mitigate the source of danger (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). For some people, therefore, climate anxiety may act as a driver to take climate action (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Numerous studies have found a significant positive correlation between climate anxiety and pro-environmental behavior in adults (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Current studies with German adults confirm this association (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4 Climate-specific health literacy and willingness to change behavior\u003c/h2\u003e \u003cp\u003eIn addition to anxiety, knowledge and competence in the field of climate change and health can also lead to meaningful responses to protect the climate. For example, a study of physicians and nurses from Germany found that participants who rated their knowledge of the consequences of climate change higher were more willing to eat a vegetarian diet or volunteer for sustainability than participants who rated their knowledge lower (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This trend was not only among medical practitioners, but also among patients: In a study by Reismann et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), the majority of participating patients stated that they would be willing to adopt climate-friendly behavior if they were informed by their physician about the health risks associated with climate change. In addition to the medical setting, this connection is also evident among students: A study with German university students revealed that students who were well informed about the health consequences of climate change were more willing to adopt climate-friendly behavior. This willingness also manifested itself in actual behavior, for example in the choice of environmentally friendly means of transport or a sustainable diet that offered health co-benefits (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Problem definition and aims\u003c/h2\u003e \u003cp\u003eTo our knowledge, there are no studies that investigate climate anxiety associated with cognitive-emotional and functional impairments, as well as the factors influencing the extent of these impairments in German students, especially those studying health-related subjects. Against the background of possible risk factors such as a young age (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and a high level of climate knowledge (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), it is important to find out to what extent they are affected by clinically relevant climate anxiety. Students may need help dealing with their climate-related emotions. In addition, it should be determined which factors make students vulnerable to clinically relevant climate anxiety and which protect against them in order to be able to specifically prevent the negative effects of climate anxiety.\u003c/p\u003e \u003cp\u003eTherefore, the aim of the study is to identify potential risk and protective factors for the cognitive-emotional and functional impairments due to climate anxiety in this target group. To this end, the relevance of personality traits, trait anxiety, connectedness to nature and parts of climate-specific health literacy for the impairment caused by climate anxiety will be analyzed. Another aim of the study is to examine the factors associated with German students\u0026rsquo; willingness to change their behavior toward more climate-friendly practices, in order to identify potential starting points for promoting climate-friendly behavior in this target group. To this end, we examine the association of climate anxiety, personality traits and the belief that one's own behavior has an impact on climate change with the extent to which students are willing to change their behavior. These aims translate into the following two research questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow are personality traits, trait anxiety, connectedness to nature, and climate-specific health literacy associated with climate anxiety?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow are climate anxiety, personality traits, and the belief that one's own behavior has an impact on climate change related to the willingness for climate-friendly behavioral change?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Methods","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants\u003c/h2\u003e \u003cp\u003eThe study was open to all students who were aged 18 or over and were attending a German higher education institution at the time of the invitation. To recruit students, we sent a call for participation to 572 health-related faculties at universities and other higher education institutions across Germany, who then forwarded the study invitation to their students. Based on an a priori power calculation using G*Power (Version 3.1.9.7) we identified a target sample size of 435 for the planned regression analysis with the most predictors (see Appendix \u003cspan refid=\"Sec27\" class=\"InternalRef\"\u003eA\u003c/span\u003e). We oversampled to account for potential missing data. Of the total 528 eligible students who participated, 365 identified as female, 153 as male, and 10 as neither/diverse. The students ranged in age from 18 to 50\u0026thinsp;+\u0026thinsp;years, but most were between 21 and 30 years old on average. Taking part in the study was voluntary. All participants consented to participate in the study after being informed of its objectives and procedures. No financial or other compensation was provided.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Materials and Procedure\u003c/h2\u003e \u003cp\u003eInterested students followed the invitation link to the online study in an environment and on a device of their choice. After reading through the study information and giving their informed consent, participants filled out the questionnaire. In a first block of questions participants provided information on whether they were studying at a German higher education institution (yes/no), how old they were (18\u0026ndash;20 years; 21\u0026ndash;25 years; 26\u0026ndash;30 years; \u0026hellip; or 50\u0026thinsp;+\u0026thinsp;years old), and with which gender they identified (female; male; or diverse).\u003c/p\u003e \u003cp\u003eA second block of questions assessed the participants\u0026rsquo; trait anxiety, personality, and nature connectedness using the German-language versions of the short form of the State-Trait-Anxiety Inventory (STAI) (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) the 10-item short version of the Big Five Inventory (BFI-10) (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and the Connectedness to Nature Scale for Adolescents (CNS-A) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) respectively. The STAI has ten items in which participants rate anxiety-related statements on an 8-point Likert scale ranging from 1 \u0026ldquo;almost never\u0026rdquo; to 8 \u0026ldquo;almost always\u0026rdquo; (e.g. \u0026ldquo;I get tired quickly.\u0026rdquo;). The BFI-10 has ten items in which participants rate statements on a 5-point Likert scale ranging from 1 \u0026ldquo;not at all applicable\u0026rdquo; to 5 \u0026ldquo;fully applicable\u0026rdquo; (e.g. \u0026ldquo;I see myself as someone who is reserved.\u0026rdquo;), which allow inferences about the participants\u0026rsquo; personality on five subscales describing their degree of extraversion, agreeableness, conscientiousness, neuroticism, and openness. Lastly, in answering the CNS-A, participants rated 14 nature-related statements on a 7-point Likert scale ranging from 1 \u0026ldquo;strongly disagree\u0026rdquo; to 7 \u0026ldquo;strongly agree\u0026rdquo; (e.g. \u0026ldquo;I feel one with nature.\u0026rdquo;).\u003c/p\u003e \u003cp\u003eThe third block of questions concerned the participants\u0026rsquo; climate-specific health literacy which was assessed using the exploratory questionnaire developed by Albrecht et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The questionnaire assesses different aspects of climate-specific health literacy, of which we utilized five single 5-point Likert scale items addressing the participants self-rated knowledge of the consequences of climate change (knowledge), their perceived relevance of climate change (relevance), whether participants feel their actions have an impact on climate change (action efficacy), and whether participants believe climate change poses a personal (personal risk) or global health risk (global risk). We also used six 5-point Likert scale items to assess the participants willingness to engage in different climate-friendly behaviors: using a bicycle instead of a car, using public transportation instead of private transportation, switching to a vegetarian diet, switching to a vegan diet, getting involved in a community or organization that promotes sustainability or environmental protection, and paying more for sustainable products.\u003c/p\u003e \u003cp\u003eFinally, participants answered questions about their level of climate anxiety using the German version of the CAS (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The scale has 13 items in which participants rate statements describing their emotional impairment due to climate anxiety on a 7-point Likert scale ranging from 1 \u0026ldquo;strongly disagree\u0026rdquo; to 7 \u0026ldquo;strongly agree\u0026rdquo; (e.g. \u0026ldquo;Thinking about climate change makes it difficult for me to concentrate.\u0026rdquo;).\u003c/p\u003e \u003cp\u003eThe STAI (α\u0026thinsp;=\u0026thinsp;0.88), CNS-A (α\u0026thinsp;=\u0026thinsp;0.81), and CAS (α\u0026thinsp;=\u0026thinsp;0.90) scales showed good internal consistency, while the items assessing the willingness for climate-friendly behavioral change showed acceptable internal consistency (α\u0026thinsp;=\u0026thinsp;0.76). In contrast, the internal consistency of the five BFI-10 subscales was mixed: Extraversion (α\u0026thinsp;=\u0026thinsp;0.77), Agreeableness (α\u0026thinsp;=\u0026thinsp;0.27), Conscientiousness (α\u0026thinsp;=\u0026thinsp;0.47), Neuroticism (α\u0026thinsp;=\u0026thinsp;0.66), and Openness (α\u0026thinsp;=\u0026thinsp;0.59). Students were able to participate for three weeks from late May to early June 2024. The questionnaire was exclusively administered online using evasys (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://evasys.de/\u003c/span\u003e\u003cspan address=\"https://evasys.de/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Preceding the data collection the study was assessed and then approved by the Ethics Committee of Bielefeld University (Application No. 2024\u0026thinsp;\u0026minus;\u0026thinsp;119).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Data Analysis\u003c/h2\u003e \u003cp\u003eBefore analyzing the data, we calculated aggregate scores for the personality subscales (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), nature connectedness, climate anxiety, and the willingness for climate-friendly behavioral change by calculating mean scores after recoding reversed items. As per the scale instructions, we calculated the total percentage of agreement for the STAI items (0\u0026ndash;100), with higher scores indicating higher trait anxiety. We also created dummy variables for gender (female and diverse) for use in the regression analyses. Additionally, for Likert-type items that served as independent variables, the two lowest response categories were merged, as only a small proportion of participants selected them. This was done to ensure sufficient statistical power for their use as reference categories.\u003c/p\u003e \u003cp\u003eIn analyzing our data, we conducted several multiple linear regression analyses (MLRA) to answer our research questions. Because a first MLRA indicated that none of the personality subscales were significantly associated with climate anxiety, but trait anxiety was, and because trait anxiety and neuroticism had a high correlation (0.70), we conducted two separate MLRAs to answer the first research question, how are personality traits, trait anxiety, connectedness to nature, and climate-specific health literacy associated with climate anxiety. One MLRA with trait anxiety as the independent variable and one MLRA with the five personality subscales as the independent variables. Both MLRAs also included age, gender, climate-specific health literacy (knowledge, relevance, action efficacy, personal risk, and global risk), and connectedness to nature as additional independent variables and climate anxiety as the dependent variable. Because the assumption of homoscedasticity was not met for both MLRAs, we used bootstrapping with 5000 samples for the analyses. All other assumptions (normally distributed residuals, multicollinearity, autocorrelation, and extreme outliers) were satisfied.\u003c/p\u003e \u003cp\u003eWe then conducted another MLRA, using the willingness for climate-friendly behavioral change as the dependent variable, to answer the second research question, how climate anxiety, personality traits, and the belief that one's own behavior has an impact on climate change are associated with the willingness for climate-friendly behavioral change. Age, gender, climate anxiety, the personality subscales, and action efficacy were used as independent variables. All assumptions were fulfilled for this analysis.\u003c/p\u003e \u003cp\u003eFinally, we estimated the same MLRA with an additional quadratic term added for climate anxiety. This way a possible non-linear relationship between climate anxiety and willingness for climate-friendly behavioral change was assessed. The model fulfilled all assumptions as well.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Results","content":"\u003cp\u003eIn total 528 students answered the survey. Excluding those with missing values in the analytical sample resulted in an analytical sample size of N = 470. Table 1 provides an overview over the sample characteristics. Most of the participants identified as female (n = 321; 68 %), while 30 % identified as male (n = 140) and 1.9 % (n = 9) as other than male or female, respectively. The majority were between the ages of 21 and 25 (n = 254; 54 %); 23 % were aged between 26 and 30 years (n = 108); 8.7 % between 18 and 20 years (n = 41), 6.8 % between 31 and 35 years (n = 32), 4.7 % between 36 and 40 years (n = 22), and lastly, 1.3 % were aged older than 40 years (n = 13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding their knowledge of climate change consequences, more than 70 % of the participants assessed their knowledge as high (n = 242; 51 %) or very high (n = 97; 21 %); 21 % assessed their knowledge as medium (n = 99), and less than 10 % as low or very low (n = 32; 6.8 %). Nearly 90 % viewed the relevance of climate change as very urgent (n = 348; 73 %) or urgent (n = 69; 15 %). Conversely, less than 5 % viewed the relevance as rather insignificant (n = 24; 4.5 %).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding their action efficacy, 77\u0026nbsp;% of the participants answered that they feel their actions have an impact on climate change, with 48\u0026nbsp;% answering \u0026ldquo;Yes\u0026rdquo; (n\u0026nbsp;=\u0026nbsp;224), and 29\u0026nbsp;% answering \u0026ldquo;Yes, very\u0026rdquo; (n\u0026nbsp;=\u0026nbsp;138). 8.3\u0026nbsp;% stated that they do not feel that their actions have an impact on climate change (8.3\u0026nbsp;%, n\u0026nbsp;=\u0026nbsp;39). 77\u0026nbsp;% of the participants stated that they see climate change as a cause for global health problems (climate change as a global risk). Specifically, 34\u0026nbsp;% (n\u0026nbsp;=\u0026nbsp;160) answered \u0026quot;Yes\u0026quot; and 43\u0026nbsp;% (n\u0026nbsp;=\u0026nbsp;204) answered \u0026quot;Yes, very.\u0026quot; Meanwhile, 11% (n\u0026nbsp;=\u0026nbsp;51) stated that they do not see climate change as such. Regarding the question whether participants see climate change as a risk factor for their own health, 33\u0026nbsp;% answered \u0026ldquo;Yes\u0026rdquo; (n\u0026nbsp;=\u0026nbsp;154) and 36 % answered \u0026quot;Yes, very\u0026rdquo; (n\u0026nbsp;=\u0026nbsp;171), while 17\u0026nbsp;% do not see it as a risk factor (n\u0026nbsp;=\u0026nbsp;81).\u003c/p\u003e\n\u003cp\u003eIn terms of personality traits, the sample demonstrated the following mean scores for each trait: Extraversion 3.12 (SD\u0026nbsp;=\u0026nbsp;0.99), Agreeableness 3.29 (SD\u0026nbsp;=\u0026nbsp;0.81), Conscientiousness 3.61 (SD\u0026nbsp;=\u0026nbsp;0.80), Neuroticism 3.05 (SD\u0026nbsp;=\u0026nbsp;0.96), and Openness 3.64 (SD\u0026nbsp;=\u0026nbsp;1.00). The mean for connectedness to nature in this sample is 5.04 (SD\u0026nbsp;=\u0026nbsp;0.82), for trait anxiety it is 43 (SD\u0026nbsp;=\u0026nbsp;17), and for climate anxiety, it is 2.38 (SD = 1.14). Regarding the willingness for climate friendly behavioural change, the sample presents a mean of 3.93 (SD\u0026nbsp;=\u0026nbsp;0.74).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eSample characteristics\u003c/p\u003e\n\u003cp\u003eTo analyze whether age, gender, climate-specific health literacy (knowledge, relevance, action efficacy, personal risk, and global risk), trait anxiety, personality (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness), and connectedness to nature are associated with climate anxiety, we conducted two MLRAs with bootstrapping. Both the model including trait anxiety (\u003cem\u003eF\u003c/em\u003e(24, 445) = 13.58, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003eadjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = .39, \u003cem\u003eAIC\u003c/em\u003e = 1.254) and the model including personality (\u003cem\u003eF\u003c/em\u003e(28, 441) = 9.31, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003eadjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = .33, \u003cem\u003eAIC\u003c/em\u003e = 1.302) were significant and explained 39% and 33% of the variance, respectively. Female gender, knowledge, relevance, personal risk, trait anxiety, neuroticism, and connectedness to nature were significantly associated with climate anxiety in the two models. Age was only significant in the personality model: On average participants aged 36-40 reported a 0.42 lower score (95 CI [-0.84, -0.01]) in climate anxiety than those 18-20 years old. Both models showed that being female, perceiving oneself as very knowledgeable about the consequences of climate change, perceiving climate change as highly relevant, believing that climate change poses a threat to personal health, and feeling connected to nature were associated with increased climate anxiety among students. The personality model showed similar results for participants that reported being a more neurotic person.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Multiple linear regression models for the outcome of climate anxiety\u003c/p\u003e\n\u003cp\u003eIn order to analyze whether age, gender, climate anxiety, personality (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and perceived action efficacy are associated with the willingness for climate-friendly behavioral change, we conducted another MLRA. The model used was significant (\u003cem\u003eF\u003c/em\u003e(16, 453) = 15.35, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001, \u003cem\u003eadjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = .33) and explained 33% of the variance. Climate anxiety (\u003cem\u003eB\u003c/em\u003e = .27, \u003cem\u003e95% CI\u0026nbsp;\u003c/em\u003e[0.22, 0.33], \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), openness (\u003cem\u003eB\u003c/em\u003e = 0.10, \u003cem\u003e95% CI [0.04, 0.15]\u003c/em\u003e, \u003cem\u003ep\u003c/em\u003e = .001) and higher values in perceived action efficacy (all: \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) were significantly associated with the willingness for climate-friendly behavioral changes. This means that students who feel more emotionally affected by climate anxiety, who are more open to new experiences, and who feel that their actions have an impact on climate change, were overall more willing to change their climate-friendly behavior. Additionally, on average those aged 26-30 reported 0.28-point higher willingness (\u003cem\u003e95% CI\u003c/em\u003e: [0.06, 0.50], \u003cem\u003ep\u003c/em\u003e = .012) to change their behavior in such a way, compared to 18\u0026ndash;20-year-olds.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Multiple linear regression models for the outcome of willingness for climate-friendly behavioral change\u003c/p\u003e\n\u003cp\u003eAdding a quadratic term for climate anxiety to account for a possible non-linear relationship between climate anxiety and the willingness for climate-friendly behavioral change resulted in an improved model fit (\u003cem\u003eF\u003c/em\u003e(17, 452) = 16.00, \u003cem\u003ep\u003c/em\u003e = \u0026lt; .001, \u003cem\u003eadjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.35, \u003cem\u003eAIC\u003c/em\u003e = 872). While the coefficient for climate anxiety (\u003cem\u003eB\u003c/em\u003e = 0.71, \u003cem\u003e95% CI\u003c/em\u003e [0.50, 0.93], \u003cem\u003ep\u003c/em\u003e = \u0026lt; .001) indicates an even stronger positive association with said willingness, the quadratic term implies that this association is not linear and weakens with an increase in climate anxiety (\u003cem\u003eB\u003c/em\u003e = -0.07, \u003cem\u003e95% CI\u003c/em\u003e [-0.11, -0.04], \u003cem\u003ep\u003c/em\u003e = \u0026lt; .001). Figure 1 showcases this non-linear association in comparison to the single linear term from model 3. Additionally, the improved model resulted in a significant coefficient for the \u0026ldquo;Neuroticism\u0026rdquo; personality: An increase in this variable is associated with a 0.09-point decrease in the willingness for climate-friendly behavioral change (\u003cem\u003e95% CI\u003c/em\u003e [-0.15, -0.02], \u003cem\u003ep\u003c/em\u003e = .011).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1.\u003c/strong\u003e Predicted values of the linear and non-linear marginal effects of climate anxiety on the willingness for climate-friendly behavioral change.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Discussion of results\u003c/h2\u003e \u003cp\u003eIn answer to our first research question, we found that neuroticism, trait anxiety, connectedness to nature, female gender, knowledge of the consequences of climate change, perceived relevance of climate change, and belief that climate change poses a personal health risk all significantly and positively associated with climate anxiety.\u003c/p\u003e \u003cp\u003eAge was only significant in the personality model. The finding that participants aged 36\u0026ndash;40 reported on average a 0.42 lower score (95 CI [-0.84, -0.01]) in climate anxiety than those 18\u0026ndash;20 years old aligns with numerous studies (\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), indicating that a younger age is associated with higher clinically relevant climate anxiety. Consistent with this, the mean climate anxiety score of German students in the present study (M\u0026thinsp;=\u0026thinsp;2.38) is higher than the mean climate anxiety scores of 1.81 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and 2.0 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) in the general German population. Looking only at the 18\u0026ndash;29 age group, the mean climate anxiety score is similar (M\u0026thinsp;=\u0026thinsp;2.4) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Following on from this, student status may make no difference in this age group regarding climate anxiety. The finding that being female is significantly positive associated with climate anxiety in both regression models (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.29; \u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31) is also consistent with the results of other studies (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), including a study of Mexican university students (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our first regression model, trait anxiety has a very weak but significantly positive association with climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). This finding is consistent with a French study by Parmentier et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), which found that trait anxiety is associated with cognitive emotional (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.18) and functional impairment (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22) due to climate anxiety more strongly than in this study, but also significantly positively. Another also significantly positive association of general anxiety and depression with pathological climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10) was demonstrated in a study of the general German population (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Links between climate-associated worries and mental health problems in German students were also shown in another study: S\u0026ouml;der et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) found a significant positive association of depressive symptoms (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.272), sleep difficulties (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.184) and self-reported somatic symptoms (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.304) with climate change worry. Medical students in Germany mainly experience considerable stress in connection with climate change, although this is not (yet) reflected in depressive, anxious or traumatic symptoms. However, it is negatively related to resilience factors that prevent mental disorders (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn both regression models, connectedness to nature is a weak but significantly and positively associated with climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22; \u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.21). In a study by Whitmarsh et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), a comparably strong, significantly positive association of connectedness to nature with climate anxiety was demonstrated (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.14), albeit using the Nature Relatedness Scale (NR-6) (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In line with these findings, Wullenkord et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) found a significant positive correlation between climate anxiety and connectedness to nature among a German-speaking sample that was stratified by age, gender, and level of education.\u003c/p\u003e \u003cp\u003eIn our second regression model, neuroticism is significantly and positively associated with climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.26). This finding is consistent with the results of a Polish study by Tucholska et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), which identified neuroticism as a weaker yet significant positive association with cognitive-emotional impairment due to climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.15).\u003c/p\u003e \u003cp\u003eThe following subscales of climate-specific health literacy are weakly but positively associated with climate anxiety in both regression models: knowledge of the consequences of climate change, perceived relevance of climate change, and belief that climate change poses a personal health risk. In contrast to our findings, studies have shown that knowledge of climate change and climate anxiety are negatively correlated among the general adult population in the USA and Canada (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These differences could be due to the type of target group. When we consider only the target group of students, our results are consistent with the current state of research: There is a significant positive correlation between climate anxiety and climate knowledge among Mexican students (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It should be noted that these studies examined additional dimensions of knowledge of climate change rather than only the consequences of it.\u003c/p\u003e \u003cp\u003eSince the subscales of climate-specific health literacy in our study range from non-significant to significantly positive effects on the level of climate anxiety, our results do not indicate that climate-specific health literacy as an overall construct protects against pathological climate anxiety. However, a study with nursing students from Egypt indicates that the association of a similar concept, environmental literacy, with climate anxiety is gender-specific: While environmental literacy alone had no significant effect, the significant interaction between environmental literacy and gender indicated that higher environmental literacy in women was associated with lower climate anxiety scores (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn answer to our second research question, we found that climate anxiety, openness, and the belief that one's own behavior impacts climate change are significantly and positively associated with the willingness for climate-friendly behavioral change. The association of climate anxiety with the willingness to engage in climate-friendly behavioral change is consistent with another German study by Wagner and Witth\u0026ouml;ft (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), conducted among young adults (\u0026ge;16 years), where climate anxiety associated with cognitive-emotional and functional impairment, was also identified as the strongest predictor of pro-climate behavior in a multiple regression analysis (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.58). Although the results are not fully comparable because willingness does not always align with actual behavior (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), they are consistent.\u003c/p\u003e \u003cp\u003eHowever, the direction and type of relationship between climate anxiety and pro-environmental behavior is controversial. For example, a study from Germany by Wullenkord et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) identified pro-environmental intentions as the strongest predictor of climate anxiety (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, previous studies have examined whether there is an inverted U-shaped relationship between climate anxiety and pro-environmental behavior, according to which a moderate level of climate anxiety is associated with more pro-environmental behavior and a very high level of climate anxiety with less pro-environmental behavior. While two Australian studies support this hypothesis (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), a German study rejects it (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The present study found only a very slight inverted U-shaped relationship between climate change and the willingness for climate-friendly behavior change among German students of health-related subjects when a quadratic term for climate anxiety was added to the analysis. As briefly mentioned above, it must be taken into account that willingness does not always correspond to actual behavior (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), which is why this relationship can only be tested to a limited extent in this study. Nevertheless, it should be noted that Maduneme (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) found an inverted U-shaped relationship between climate anxiety and pro-environmental behavioral intentions among students from the USA.\u003c/p\u003e \u003cp\u003eIn line with our results, Tucholska et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) identified a significant positive association of openness with planned pro-environmental behavior in Polish adults (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27), which is stronger than the association of openness with willingness for climate-friendly behavioral change in the present study (\u003cem\u003eB\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10; B\u0026thinsp;=\u0026thinsp;0.09). While Tucholska et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) used an instrument comparable to our study to assess personality traits (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), they developed their own instrument to operationalize planned pro-environmental behavior, thus the comparability of the results is limited. Other studies have also demonstrated a positive correlation between openness and pro-environmental behavior (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e5.2 Strengths and limitations\u003c/h2\u003e \u003cp\u003eTo our knowledge, this is the first study in a German context that aimed to investigate both risk and protective factors for functional impairment due to climate anxiety, as well as factors influencing the willingness of students in health-related subjects to adopt climate-friendly behavioral change.\u003c/p\u003e \u003cp\u003eHowever, the study has some limitations. Due to its cross-sectional design, no causal relationships can be inferred. Additionally, bias resulting from self-reported data and a potential overrepresentation of students particularly interested in climate change cannot be ruled out. Nevertheless, the climate anxiety score obtained in this study is comparable to that in an earlier study from Hajek and K\u0026ouml;nig (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 10-item short version of the Big Five Inventory (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) used showed mixed internal consistency, while it is considered an established assessment tool. When using the CAS (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) to measure climate anxiety, it should be noted that it is based on a rather pathological understanding. According to Wullenkord et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), the scale primarily measures climate-related emotional impairments; however, the authors also recommend placing greater emphasis on milder forms of climate anxiety.\u003c/p\u003e \u003cp\u003eChan et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) also showed in a longitudinal study that initially negative emotions towards climate change can develop into cognitive-emotional and functional impairments. Early identification and targeted interventions for milder forms of climate anxiety could therefore prevent a later worsening of symptoms. In light of the methodological criticisms outlined above, it is advisable to use more differentiated instruments to measure climate anxiety in future studies. The newly developed ICE (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) compromises eight categories of emotional response to climate change, offering a promising approach for this purpose. Furthermore, longitudinal studies examining the development of climate-specific health literacy in relation to climate anxiety throughout the course of studies are recommended.\u003c/p\u003e \u003cp\u003eWe also have collected data from people who identified as diverse. Due to the small sample size (n\u0026thinsp;=\u0026thinsp;10), we cannot make any valid statements in this regard. Nevertheless, our data suggests that this group has the highest average level of climate anxiety (female\u0026thinsp;=\u0026thinsp;2.57, male\u0026thinsp;=\u0026thinsp;1.93, diverse\u0026thinsp;=\u0026thinsp;2.81), although the difference is not significant.\u003c/p\u003e \u003cp\u003eAlthough we asked about the willingness for climate-friendly behavioral changes, we did not inquire about their prior climate-friendly actions. Consequently, the results are limited as individuals already demonstrating climate-friendly behavior can barely adapt their behavior further.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e5.3 Recommendations for action\u003c/h2\u003e \u003cp\u003eOne of the aims of our study was to identify risk and protective factors for emotional impairment due to climate anxiety in students, particularly among students of health-related subjects. To this end, we tested a questionnaire on climate-specific health literacy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) as a potential protective factor. As the climate-specific health literacy subscales had either a significant positive effect or no significant effect on the level of climate anxiety, our results do not suggest that climate-specific health literacy protects against clinically relevant climate anxiety overall. Other studies suggest that gender should also be considered when analyzing this relationship (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), which we confirmed with our results. Future research should continue to identify protective factors in order to develop a basis for intervention development to protect against clinically relevant climate anxiety associated with cognitive-emotional and functional impairment, so that students learn to deal with climate emotions appropriately and use them for climate action. Since our results show that young age, female gender, connectedness to nature, trait anxiety, and neuroticism are possible risk factors for clinically relevant climate anxiety, students with these characteristics in particular should be surveyed or involved in a participatory manner when developing interventions to reach them in the best possible way with the interventions developed. Nevertheless, it should not be overlooked that non-pathological concern about climate change is reasonable and that there is a fundamental need for appropriate and effective societal climate protection measures (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother aim of the study was to examine the association between students' willingness to adopt climate-friendly behavioral changes in order to identify potential starting points for promoting sustainable behavior. Since our results reveal a significant association between openness and behavioral change, students exhibiting this trait should be specifically targeted through interventions aimed at fostering climate-friendly actions. The trait of openness should be considered when developing and evaluating appropriate interventions. In addition, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change. Those interventions could incorporate the promotion of the belief that one's own behavior has an impact on climate change, as our results indicate that this belief is significantly positive associated with the willingness of students to engage in climate-friendly behavioral change. Given that our results indicate climate anxiety as having a strong significantly positive association with climate-friendly behavioral change (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and considering the controversial nature and direction of this relationship (see Section \u003cspan refid=\"Sec23\" class=\"InternalRef\"\u003e5.1\u003c/span\u003e), future research should further explore this connection to clarify the extent to which climate anxiety serves as a motivator for climate action among students, as well as the extent to which it acts as a barrier, potentially impairing their capacity to engage in such behaviors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e5.4 Conclusion\u003c/h2\u003e \u003cp\u003eOur study identified possible risk factors for climate anxiety impairment in students, including young age, female gender, anxiety, neuroticism, and connectedness to nature. Interventions should target students with these characteristics. Our study could not identify climate-specific health literacy as a potential protective factor, but rather the opposite, which is why possible protective factors should be researched further. Factors that may promote climate-friendly behavioral changes among students include climate anxiety, openness, and perceived efficacy of action. Therefore, behavioral change measures should particularly focus on open-minded students and emphasize the idea that one's behavior impacts climate change. Additionally, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change. The nature and direction of the relationship between climate anxiety and climate-friendly behavior should be further explored. The need for comprehensive societal strategies to mitigate and adapt to climate change is not undermined by these considerations but rather emphasized.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBFI-10\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Big Five Inventory\u003c/p\u003e\n\u003cp\u003eCAS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Climate Anxiety Scale\u003c/p\u003e\n\u003cp\u003eCNS-A\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Connectedness to Nature Scale for Adolescents\u003c/p\u003e\n\u003cp\u003eICE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Inventory of Climate Emotions\u003c/p\u003e\n\u003cp\u003eMLRA Multiple linear regression analyses\u003c/p\u003e\n\u003cp\u003eNR-6\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nature Relatedness Scale\u003c/p\u003e\n\u003cp\u003eSTAI State-Trait-Anxiety Inventory\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Bielefeld University (EUB, Bielefeld University, Germany) (Application No. 2024-119). All participants voluntarily consented to take part in the study after being informed of the objectives and procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during the current study are included in this published article supplementary material (Additional file 1.sav).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors have no relevant financial or non-financial interest to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the German Stifterverband Peter Beate Heller Foundation [Grant/Award number: T0160/33738/2019/kln]. The publication costs were supported by the Open Access Publication Fund of Bielefeld University and the Deutsche Forschungsgemeinschaft (DFG). Other than funding, the supporters were not involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e T.M. was responsible for conceptualization, project administration, supervision, provided resources, writing – original draft, and writing – review and editing and was involved in methodology and investigation. M.R. was responsible for methodology, formal analyses, visualization, writing – original draft, and writing – review and editing. G.D. was involved in conceptualization, validation, writing – original draft, and writing – review and editing. J.R., L.N., K.L., and M.L. contributed to\u0026nbsp;conceptualization, investigation, and writing - Review \u0026amp; Editing.\u0026nbsp;J.K., A.L.S., and C.L.W. were involved in investigation, methodology, formal analysis, visualization, and writing – review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We gratefully acknowledge the valuable support of Sophia Louisa Caputo, Jonathan Gelder, Tobias Herden, Lea Salome Klassen, Darlene Markowski, Franziska Masmeier, Andre Neudorf, Nadine Palitza, Maja Schwidop, Franziska Kerstin Seinsche, and Theresa Vos in the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOgunbode CA, Doran R, Hanss D, Ojala M, Salmela-Aro K, Van Den Broek KL, et al. Climate anxiety, wellbeing and pro-environmental action: correlates of negative emotional responses to climate change in 32 countries. 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Environ Behav. 2024;56(5\u0026ndash;6):408\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eWeber A, Kroiss K, Reismann L, Jansen P, Hirschfelder G, Sedlmeier AM, et al. Health-promoting and sustainable behavior in university students in Germany: a cross-sectional study. Int J Environ Res Public Health. 2023;20(7):5238. \u003c/li\u003e\n\u003cli\u003eGrimm J. State-Trait-Anxiety Inventory nach Spielberger. Deutsche Lang- und Kurzversion. Methodenforum der Universit\u0026auml;t Wien: MF-Working Paper 2009/02; 2009. \u003c/li\u003e\n\u003cli\u003eRammstedt B, John OP. Measuring personality in one minute or less: a 10-item short version of the Big Five Inventory in English and German. J Res Personal. 2007;41(1):203\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eG\u0026ouml;tting K, B\u0026ouml;hme T, Geiger SM. Connectedness to Nature Scale \u0026ndash; Adolescents (CNS-A) Entwicklung und Validierung einer Skala zur Erfassung von Naturverbundenheit bei Jugendlichen. 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Clarifying the nature of the association between eco-anxiety, wellbeing and pro-environmental behaviour. J Environ Psychol. 2024;95:102249. \u003c/li\u003e\n\u003cli\u003eMaduneme E. Some slice of climate anxiety \u0026hellip; is good: a cross-sectional survey exploring the relationship between college students media exposure and perceptions about climate change. J Health Commun. 2024;29(sup1):45\u0026ndash;56. \u003c/li\u003e\n\u003cli\u003eSchupp J, Gerlitz JY. Big Five Inventory-SOEP (BFI-S). Zusammenstellung Sozialwissenschaftlicher Items Skalen ZIS. 2008; https://doi.org/10.6102/zis54. \u003c/li\u003e\n\u003cli\u003eChan HW, Lin L, Tam KP, Hong Y yi. From negative feelings to impairments: A longitudinal study on the development of climate change anxiety. J Anxiety Disord. 2024;107:102917. \u003c/li\u003e\n\u003cli\u003eMarczak M, Wierzba M, Kossowski B, Marchewka A, Morote R, Kl\u0026ouml;ckner CA. Emotional responses to climate change in Norway and Ireland: a validation of the Inventory of Climate Emotions (ICE) in two European countries and an inspection of its nomological span. Front Psychol. 2024;15:1211272. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the supplementary files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"climate anxiety, climate-friendly behavior, climate-specific health literacy, students, Germany","lastPublishedDoi":"10.21203/rs.3.rs-8193439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8193439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Young people are increasingly concerned about climate change, which can have a negative impact on their mental health. Course content about the health consequences of climate change, as found in students of health-related subjects, is associated with increased climate anxiety. Climate anxiety can be both an understandable reaction to a real crisis that leads to climate-friendly behavior and a functional impairment that undermines the ability to act. The aims of the study are to identify risk and protective factors of students for functional impairment due to climate anxiety and factors that promote the willingness of students to climate-friendly behavioral change.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eStudents of health-related subjects were surveyed using a quantitative online questionnaire. Age, gender, trait anxiety, personality, nature connectedness, climate-specific health literacy, and climate anxiety were recorded. Multiple linear regression analyses were used to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eNeuroticism, trait anxiety, connectedness to nature, female gender, knowledge of the consequences of climate change, perceived relevance of climate change, and the belief that climate change poses a personal health risk are all positively and significantly associated with climate anxiety. Significantly positive associated with the willingness for climate-friendly behavioral change are climate anxiety, openness, and perceived action efficacy. Adding a quadratic term for climate anxiety suggests that the relationship between climate anxiety and willingness may not be linear and decreases as climate anxiety increases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAs our results do not indicate any protective factors against impairment due to climate anxiety, this topic should be researched further. Future work should give special consideration to young female students, whose anxiety, neuroticism, and nature connectedness are more pronounced, as a potential risk group. Interventions that promote climate-friendly behavioral changes should appeal to open-minded students and reinforce their belief that their behavior impacts climate change. Additionally, it should be investigated how to motivate students who are less open-minded to climate-friendly behavioral change.\u003c/p\u003e","manuscriptTitle":"Determinants of climate anxiety and willingness for climate-friendly behavioral change in German students: a quantitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 08:40:43","doi":"10.21203/rs.3.rs-8193439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-20T09:43:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T11:35:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232802372127545770671907580862536618161","date":"2026-01-27T20:36:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151207940167266761356146069913597572115","date":"2026-01-27T18:41:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T18:47:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T19:46:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311813516355667579188292383523295192480","date":"2026-01-07T18:17:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77682509133323028060939235508700092684","date":"2026-01-07T17:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T17:07:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T11:30:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-18T08:43:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-10T14:28:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-11-27T08:06:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f156dbd-a2d0-4714-a68e-a488cbd02a11","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:12:16+00:00","versionOfRecord":{"articleIdentity":"rs-8193439","link":"https://doi.org/10.1186/s40359-026-04438-0","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-04-01 16:00:09","publishedOnDateReadable":"April 1st, 2026"},"versionCreatedAt":"2026-01-12 08:40:43","video":"","vorDoi":"10.1186/s40359-026-04438-0","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04438-0","workflowStages":[]},"version":"v1","identity":"rs-8193439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8193439","identity":"rs-8193439","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}