What is the impact of social support on self-rated health and depressive symptoms in university students: a survey study in two German universities

What is the impact of social support on self-rated health and depressive symptoms in university students: a survey study in two German universities | 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 What is the impact of social support on self-rated health and depressive symptoms in university students: a survey study in two German universities Mira Tschorn, Kristin Koller-Schlaud, Darlene Heinen, Sarah Jane Böttger, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5863692/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Public Health → Version 1 posted 10 You are reading this latest preprint version Abstract Background : Mental health problems have been shown to be prevalent among university students, with stress, depression and anxiety symptoms having a strikingly negative impact. Factors such as gender and social support have been considered important factors for mental and self-rated health. The present study aims to report on the mental and self-rated health of students at two universities within the Berlin-Potsdam metropolitan area (Germany) and to investigate potential associations between social support, self-rated health and depressive symptoms in these two samples. Methods : Students from two universities and different faculties participated in an online-survey reporting on their self-rated health, depressive symptoms and social support. To analyse differences between the two samples we conducted chi square tests for categorical variables, t-tests for continuous variables, and Mann-Whitney U tests for non-normally distributed continuous variables. We also used multivariate linear regression models for the two samples separately to investigate the association of the two health indicators with social support while accounting for relationship status, living situation (living alone yes/no) and gender. Results : 31% of students (27% to 36% in our two samples) reported depressive symptoms above the clinically relevant threshold. Increased depressive symptoms (β=-.317, p<.001; β=-.326, p<.001) and lower overall health (β=.222, p=.003; β=.176, p=.008) were associated with fewer social support in both samples. Female gender was associated with higher depressive symptoms (β=.207, p<.001) and lower overall health (β=-.231, p<.001) in one sample; gender did not have a significant effect in the other sample. Relationship status and living situation did not show a significant effect. Conclusions : With roughly a third of students reporting depressive symptoms at both study sites, our data supports the notion that mental health difficulties are a critically relevant topic for universities. We recommend that universities actively provide the infrastructure needed and anchor them in the core budget in order to promote studyability, social support and mental health amongst their students. We also recommend acknowledging gender sensitive aspects in mental health promotion. self-rated health mental health depressive symptoms social support university students Introduction Students commencing their university education enter a transition phase. During that time, they are facing personal and developmental challenges including self-identity formation, intellectual and social development in the work context, high degrees of self-organization and autonomy as well as settling into the institutional context of academia ( 1 , 2 ). For many students, this transition phase is characterized by separation from home due to change of residence, relationship stressors, increased demands on time management skills and overall high levels of psychological stress ( 3 , 4 ). Moreover, the mean age for students starting university is known to be a peak risk period for the onset of mental disorders such as affective disorders ( 5 ). Students can thus be considered a particularly vulnerable population regarding mental illnesses. According to the Techniker Krankenkasse ( 6 ) and the Federal Ministry of Education and Research ( 7 ), mental health problems are particularly prevalent among university students, with stress, depression and anxiety symptoms having notably negative effects. These findings also reveal that in 2023, nearly two-thirds of students in Germany rated their overall health as good or very good, while approximately one-tenth rated it as fair or poor. Moreover, the proportion of students reporting negative health has more than tripled since 2015 (3% in 2015, 10% in 2023). One possible reason for this trend could be the COVID-19 pandemic. University closures and the shift to online learning led to increased isolation and lifestyle changes, while lockdowns and other restrictions negatively affecting students' health ( 8 , 9 ). This period of prolonged stress and reduced social interactions likely contributed to a decline in students' overall health perceptions, as they struggled with disrupted routines, financial uncertainties and fewer support networks ( 8 , 9 ). A study by Gewalt et al. ( 10 ) examined these effects on the physical and mental health of 1,246 German university students. The study found that 53% reported a decline in mental health, with 9% indicating a significant worsening. Similarly, Werner et al. ( 11 ) found an intraindividual increase in depression during the pandemic compared to pre-pandemic levels among 424 German students. Holm-Hadulla et al. ( 12 ) investigated the effects of 18 months of social restrictions and reported that 72% of students experienced significant impairments in well-being and 76% exhibited signs of at least one psychological syndrome, with 42% showing depressive symptoms. University and college centres had already been noting a shift from addressing benign developmental and informational needs to dealing with more severe psychological problems and mental illnesses ( 13 ). A study conducted by the German health insurance BARMER ( 14 ) reported that 17% of student clients were affected by a professionally diagnosed mental illness. Among these, 5% of students were diagnosed with an affective disorder, with depressive episodes being the second most common diagnosis affecting 4% of students. This prevalence has seen a significant increase in recent years. According to BARMER data, 7% of 18- to 25-year-olds had some form of depression in 2016, compared to approximately 3% in 2006, marking a substantial rise over a decade ( 14 ). The prevalence of depressive symptoms varies depending on the educational institution and the methodology of data collection. However, it is estimated to affect between one fifth to one third of students, a proportion notably higher than that observed in age-matched non-student populations or in the general German population. Gender differences have also been reported, with some studies reporting that women are more likely to experience depression than men ( 15 , 16 ). However, findings on the relationship between gender and mental health in university students are still inconsistent ( 17 ). The rising prevalence of mental health issues among students, as evidenced by the increasing rates of depression and other psychological disorders ( 14 ), underscores the broader consequences of psychological distress. These consequences do not only impact academic performance and retention rates ( 18 , 19 ), but also extend into long-term challenges in personal well-being, workplace productivity and societal economic costs ( 20 , 21 ). Students with poor mental health also report more difficulties in coping with study demands and report lower study satisfaction ( 22 ). Potential consequences of psychological distress are lower academic performance ( 18 , 19 ) and a higher likelihood of dropping out ( 23 , 24 ). Poor mental health in adulthood can also have a negative impact on general performance, social interactions, emotional and physical health, quality of life and career prospects after graduation ( 25 , 26 ). In terms of work performance, people with psychological distress are more likely to be absent from work. In cases of psychological distress manifested in anxiety disorders or depression, this can lead to long term work disability ( 20 ). In addition to high economic costs, mental disorders also lead to high financial expenditures for treatment and therapy ( 21 , 27 ). These social and economic consequences underscore the negative societal impact of students' mental health challenges. At the same time, psychosocial and sociodemographic factors also play a significant role in influencing students' mental and subjective well-being ( 17 , 28 , 29 ). Psychosocial and sociodemographic factors such as social support, relationship status, household composition and gender influence mental and subjective health ( 17 , 28 , 29 ). Studies have shown that loneliness and social isolation were related to poorer mental health ( 17 ). With regard to the relationship between gender and mental health, associations between poorer mental health and female gender in students have been reported ( 30 , 31 ), however, the existing body of research to this date is still inconclusive ( 17 ). Students with lower social support, particularly those who are single or non-parents, exhibited higher levels of depressive symptoms, a trend that was particularly pronounced during the COVID-19 pandemic ( 29 ). Relationship status also plays a key role in mental well-being, with married individuals generally reporting better mental health compared to those who are single, divorced, or widowed ( 32 , 33 ). Cohabitation and intimate partnerships offer similar protective benefits, likely due to enhanced social and financial support ( 34 , 35 ). Gender differences have also been observed: for men, being single or divorced/widowed is more strongly associated with depressive symptoms, while for women, this association is primarily linked to being single, but not divorced/widowed ( 28 ). Further studies have shown that having a partner is not associated with overall health, whereas living with parents during academic terms is linked to better health outcomes ( 36 ). Additionally, urban-rural household registration has a small but significant effect on anxiety (β = 0.03, p < .001) and depression (β=-0.03, p < .001) among Chinese university students. Rural students, in particular, experience higher levels of anxiety (β = 0.01, p < .001) and depression (β = 0.01, p < .001), primarily due to lower perceived social status and increased feelings of isolation. These findings underscore the complex role that social and environmental factors play in student mental health ( 37 ). While these psychosocial and sociodemographic factors clearly influence students' mental health, contextual factors related to their academic environment, such as study demands and social support, are also crucial contributors to their psychological well-being. Perceived psychological distress in students has been linked to study conditions and contextual factors such as study demands, qualification potential, and social support ( 38 ). Regarding social support, feelings of loneliness and social support among peers emerged as the strongest predictor of poor mental health ( 38 ). Regarding mental health difficulties among students of different faculties, Grützmacher et al. ( 21 ) reported that students of linguistics and cultural studies were particularly burdened by increased levels of depressive and anxiety symptoms. A survey of students at the Freie Universität Berlin reported that students of veterinary medicine, law and physics were particularly affected by stress ( 39 ). In summary, the transition to university life presents significant challenges for students, including heightened risks to mental health. Increasing prevalence of stress, anxiety, and depression underscores the need for targeted interventions. The present study aims to report on the mental health of students at two universities and to investigate potential associations between social support, self-rated health, and depressive symptoms in these two samples. Methods We combined the data of two separate data collections at two universities in the Berlin-Potsdam metropolitan area (Germany) to further investigate similarities and differences in the two samples and gather information about potential influencing factors on these associations such as gender and relationship status. Data for the present analyses were collected as part of two separate studies at the Universität Potsdam (UP) and at Charité - Universitätsmedizin Berlin, respectively. For the UP sample, the study was approved by the local ethics committees of the Universität Potsdam in accordance with the Declaration of Helsinki (No. 06/2016 with the amendments 62/2019, 59/2023, and 100/2023). For the Charité sample, data collection was part of a multicentre project approved by the local ethics committee of the Friedrich Alexander Universität Erlangen-Nürnberg working in accordance with the Declaration of Helsinki that rated that no detailed examination would be necessary for the study (vote 21-393-ANF from 21 November 2021). All participants provided their written informed consent prior to participating in the study. 2.1 Participants and data collection Data collection for the UP sample took place over a two-month period during the winter term 2023/2024, from 11 December 2023 to 5 February 2024, and was advertised by the local Student Health Management via internal mailing lists of the Zentrum für Hochschulsport (Centre for University Sports), e-mail, flyers, posters and personal contacts within the university. 185 participants from 6 faculties completed the online survey within the university survey system Umfragen.UP (based on SoSci Survey), which was accessed through a link or QR code on the study invitation. The six faculties at the UP were: Faculty of Law, Faculty of Humanities, Faculty of Human Sciences, Faculty of Business, Economics and Social Sciences, Faculty of Mathematics and Natural Sciences and Faculty of Digital Engineering. Data collection for the Charité - Universitätsmedizin Berlin sample took place over a three-month period during the winter term 2023/24 from 29 November 2023 to 1 March 2024 and was advertised by internal mailing lists of the local student union. 296 participants enrolled in the programs medicine, dentistry, midwifery and nursing at the Medical Faculty completed the online survey. A-priori power analyses or sample size calculations were not carried out as the present analyses are based on data of two independent exploratory cross-sectional survey studies. 2.2 Measures This section describes the assessments used to collect the data analysed for comparison of the two samples in the present study. The data analysed for the present article were selected based on the overlap of assessments at Charité- Universitätsmedizin Berlin and Universität Potsdam. 2.2.1 Sociodemographic variables Sociodemographic information including gender (female, male, diverse, not specified), age, partnership status, family and living situation were assessed in both samples. To allow for comparison of the two samples, socio-demographic information on family status and living situation were combined into the following modified dichotomous variables: partnership status (yes/no), having children (yes/no), and living alone (yes/no). 2.2.2 Social Support Social support was assessed differently in the two analysed samples. For assessing social support in the UP sample, item 2 of the Oslo-3 ( 40 , 41 ) scale was used: ‘How much interest and concern do people show in what you are doing?’ (possible answers were: ‘a lot of concern and interest’, ‘some concern and interest’, ‘uncertain’, ‘little concern and interest’ and ‘no concern and interest’). In the Charité sample, the 15-item Personal Resource Questionnaire (PRQ 2000) was used to assess the perceived level of social support ( 42 ). The 15 items, e.g., “I know that others appreciate me as a person” were answered on a 7-point Likert scale ranging between strongly disagree ( 1 ) and strongly agree ( 7 ), and a common mean for the entire scale was calculated with higher scores indicating higher levels of perceived social support. 2.2.2. Health Outcomes Depressive symptoms were assessed using the two-item version of the Patient Health Questionnaire (PHQ-2; ( 43 )), an brief self-report screening instrument for depression that is comprised of the first two items from the longer version PHQ-9. The two items assess depressed mood and anhedonia over the last two weeks on a 4-point scale. Self-rated health (SRH) was assessed using two slightly different versions of the internationally established indicator of general health. In accordance with the wording in the socio-economic panel ( 44 ), participants in the UP sample were asked “How would you describe your current health?”. The response options were ‘very good’ (= 1), ‘good’, ‘satisfactory’, ‘poor’, and ‘bad’ (= 5) and were then dichotomized into the categories ‘rather good’ (very good and good) and ‘rather poor’ (other three categories). In accordance with a recommendation of the World Health Organization (WHO) ( 45 ) participants in the Charité sample were asked: ‘How is your health in general?’. The participants responded using a five-point scale (very good = 1, good, average, poor, very poor = 5), which was combined into the categories of ‘very good/good’ and ‘average/bad/very bad’ for the present analyses. Since the wording in the two versions only differed slightly, we were able to analyse ‘positively perceived subjective health’ as defined by the nationwide health monitoring (‘very good’ or ‘good’ SRH) for both versions of SRH assessments. In addition, the SRH item used in the Charité sample was recoded ( 46 ) to harmonize it with the SRH item used for the UP sample, allowing us to compare the mean values of the two samples. 2.3 Data analysis All statistical analyses were performed using IBM SPSS Statistics version 29 ( 47 ). To analyse differences between the two samples, we conducted chi square tests for categorical variables, t-tests for continuous variables, and Mann-Whitney U tests for non-normally distributed continuous variables. Results are reported as statistically significant at a level of p⋜ 0.05. Confidence intervals (CIs) are reported at the 95% confidence level. 2.3.1 Multivariate Analyses Since different measures were used to assess social support in the two samples, multivariate linear regression models were analysed separately for the two samples to investigate the association of the two health indicators (SRH and depressive symptoms) with social support while also accounting for relationship status (yes/no), living situation (living alone yes/no) and gender (f, m). Due to the small cell sizes of the students who indicated 'diverse' or 'no response' for the gender variable, the regression analyses had to be carried out excluding these cases. However, all regression analyses were repeated without the gender predictor and with the full sample to analyse potential effects of excluding these subjects, which did not change the results. 2.3.2 SRH - Assumptions for the regression models We found no evidence of significant multicollinearity with variance inflation factors (VIF) below 1.066 (UP) or 1.132 (Charité) for all predictors (gender, social support, relationship status, living alone). In addition, the average VIF for all predictors was 1.040 (UP) and 1.078 (Charité) and the tolerance statistics were above .938 (UP) and above .883 (Charité) ( 48 – 50 ). 2.3.3 Depressive symptoms- Assumptions for the regression models We found no evidence of significant multicollinearity with variance inflation factors (VIF) below 1.066 (UP) or below 1.135 (Charité) for all predictors (gender, social support, relationship status, living alone). In addition, the average VIF for all predictors was 1.040 (UP) and 1.080 (Charité) and the tolerance statistics were above .938 (UP) and above .881 (Charité) ( 48 – 50 ). Since there was evidence for heteroskedasticity (Breusch-Pegan-Test p < .05) within the model analysing PHQ-2 with the predictors gender, social support, relationship status and living situation for the Charité sample, we report p-values for heteroscedasticity-consistent parameters for this specific model (see Table 2 ) ( 51 ). Results Sociodemographic and clinical characteristics of the study sample are depicted in Table 1 both for the entire sample of 428 participants and for the two samples (UP and Charité) separately. The mean age of the participants was 24 years (range 17.4–57 years), and 80% were female. The two university samples differed regarding their relationship status with a higher (52% vs. 41%) rate of participants in a relationship in the Charité sample (χ 2 ( 1 ) = 6.416, p = .011). Furthermore, students at Charité reported better subjective health: On average, students at Charité reported better subjective health (M = 2.54, ± 0.88.3) than students at UP (2.37, ± 0.81; t(424) = 2.096, p = .037, d = .205) and students at Charité reported positively perceived subjective health more often (78%) than students at UP (62%; χ 2 ( 1 ) = 6.668, p = .010). Also, the rate of students, who either reported elevated depression scores or who did not report positively perceived subjective health was lower in the Charité sample (χ 2 ( 1 ) = 8.812, p = .003). Table 1: sample characteristics Variables Overall Sample Universität Potsdam Charité - Universitätsmedizin Berlin p N 428 185 243 Gender Female (n, %) Male (n, %) Diverse (n, %) Missing (n, %) 312, 72.9% 106, 24.8% 5, 1.2% 5, 1.2% 136, 73.5% 45, 24.3% 1, 0.5% 3, 1.6% 176, 72.4% 61, 25.1% 4, 1.6% 2, 0.8% .167 Age (mean in years, ±SD) 24.17, ±1.64 1 24.56, ±5.98 23.86, ±4.63 1 .180 Children (yes, %) 28, 6.5% 11, 5.9% 17, 7.0% .663 In a relationship (yes, %) 185, 47.2% 2 75, 40.5% 127, 52.3% 2 .011 Living alone (yes, %) 126, 29.4% 62, 33.5% 64, 26.3% .107 Social support, PRQ (mean, ±SD) - - 5.83, ±1.01 2 - Social support, Oslo (item 2) (mean, ±SD) - 3.37, ±0.81 - - PHQ2 (mean, ±SD) 2.10, ±1.64 3 2.26, ±1.76 1.98, ±1.53 3 .082 PHQ2 above cut-point (n, %) 131, 31.0% 3 66, 35.7% 65, 26.7% 3 .065 SRH: harmonized scales) (mean, ±SD) 5 2.47, ±0.86 4 2.37, ±0.81 2.54, ±0.88.3 4 .037 SRH: positively perceived subjective health (n, %) 293, 68.5% 4 115, 62.2% 178, 78.3% 4 .010 Depression or SRH above cut-point 194, 45.3% 4 99, 53.5% 95, 39.1% 4 .003 Note . SD = standard deviation, PRQ = Personal Resource Questionnaire, PHQ = patient health questionnaire, SRH = self-rated health, 1 missing n=11, 2 missing n=3, 3 missing n=5, 4 missing n=2, 5 higher scores indicate worse SRH 3.1 Depressive Symptoms In the UP sample, higher depressive symptom scores were associated with lower social support (β=-.317, CI=-.459 – − .175, p .12). Similarly, in the Charité sample, higher depression scores were linked to lower social support (β=-.326, CI=-.451 – − .201, p .12). In this sample however, gender was linked to depressive symptoms with higher depression scores in female students (β = .207, CI = .085 – .239, p < .001). 3.2 Subjective Health Status In the UP sample, higher (i.e. better) SRH was associated with higher social support (β = .222, CI = .077 – .367, p = .003) and was not associated with gender, relationship status or living situation (all p > .09). Similarly, in the Charité sample, higher SRH scores were linked to higher social support (β = .176, CI = .045 – .306, p = .50). In this sample, gender was linked to SRH with higher (i.e. better) SRH in male students (β=-.231, CI=-.357 – − .105, p = < .001). Table 2 Prediction of depressive symptoms (PHQ-2) and self-rated health in two university samples Universität Potsdam N = 181 1 Charité - Universitätsmedizin Berlin N = 229 1 Variables Standardized beta (95% CI) p Standardized beta (95% CI) p Depressive symptoms Gender (male/female) − .043 (-.183 – .097) .545 .207 (.085 – .329) < .001 Social support 1 − .317 (-.459 – − .175) < .001 − .326 (-.451 – − .201) < .001 Relationship (yes/no) − .060 (-.203 – .083) .409 .108 (-.020 – .236) .121 2 Living alone (yes/no) − .111 (-.253 – .031) .124 .021 (-.105 – .147) .762 2 Self-rated health Gender (male/female) .005 (-.133 – .143) .941 − .231 (-.357 – − .105) < .001 Social support 1 .222 (.077 – .367) .003 .176 (.045 – .306) .008 Relationship (yes/no) .126 (-.022 – .275) .095 − .045 (-.174 – .090) .532 Living alone (yes/no) − .012 (-.155 – .132) .871 − .044 (-.175 – .087) .508 Note . CI = Confidence Interval, Universität Potsdam: depressive symptoms R 2 = .118, self-rated health R 2 = .074; Charité - Universitätsmedizin Berlin: depressive symptoms R 2 = .157, self-rated health R 2 = .091, 1 Reduced N due to exclusion of “diverse” and “missing” cases regarding gender for the multivariate models, 2 p values corresponding to heteroscedasticity-consistent parameters Excluding gender as a predictor and analysing the full sample including students who indicated 'diverse' or 'no response' for the gender variable did not alter the present results. Discussion The present study aims to report on the mental health of students at two universities and to investigate potential associations between social support, self-rated health and depressive symptoms in these two samples. We present survey results for students from Universität Potsdam and Charité - Universitätsmedizin Berlin regarding their depressive symptoms and self-reported health. Our study found that 31% of all participating students (36% at UP and 27% at Charité) reported depressive symptoms above the clinically relevant threshold. When exploring factors contributing to depressive symptoms, our results revealed significant associations with social support and gender. Specifically, increased depressive symptoms and lower overall health were significantly associated with reduced social support in both samples and with female gender in the Charité sample. Neither romantic relationships nor living alone were predictive of the outcomes in our sample. These findings underscore results from previous studies showing alarming levels of mental health difficulties in student populations ( 15 , 52 ). Compared to previous research ( 14 ), which found estimates of depressive symptoms in students ranging from 4–7%, our sample reported a considerably higher prevalence at 31%. This finding is particularly notable when compared to BARMER data ( 14 ), which reflected the percentage of patients diagnosed by professionals. As BARMER, a German health insurance company, had access to billing data, their statistics are based on diagnoses, whereas our findings rely on self-report screening tools. This methodological difference might show how prevalence rates can vary depending on the type of data collection used, such as self-reports versus clinical assessments. The PHQ-2 as a two-item screener used in our study can be seen as an indicator for mental health difficulties, but is not directly comparable to clinically relevant, diagnosed conditions. On the other hand, our results align with studies examining the use of the PHQ-2 for depression screening among university students in other countries. For example, a study investigating depressive symptoms in university students in France using the PHQ-2 reported a prevalence of 23% of students with elevated depression scores ( 53 ). Especially the UP sample of the present study reported depressive symptoms more frequently. This difference suggests that variations in cultural contexts and mental health support systems between regions or universities may influence the prevalence of depressive symptoms reported by students. Furthermore, it is estimated that only about 40% of individuals suffering from a depressive disorder seek professional help, which could explain why many students may not seek or receive formal diagnoses, despite experiencing significant mental health difficulties. Universities should focus on improving access to mental health services through low-threshold offerings and raising awareness about available resources. Despite the high prevalence of depressive symptoms, socioeconomic status (SES) has generally been shown to be a protective factor against mental health difficulties ( 54 ) and student populations could be considered advantaged regarding their SES. However, as Ibrahim et al. ( 52 ) demonstrated, there are many factors that increase students’ vulnerability to depression, including changes in sleeping and eating habits, financial stressors, changes in family relationships, worries about academic performance and post-graduation life. Our findings on the associations between lower social support, increased depressive symptoms and lower self-rated health in both samples are consistent with previous studies showing the importance of social support on student health ( 55 ). These results emphasize the need for universities to strengthen peer networks and institutional support systems. Further research is necessary to better understand the mechanisms through which social support positively impacts mental health, such as by providing emotional or practical assistance, to create a design for effective interventions. Similarly, Mikolajczyk et al. ( 36 ) identified a correlation between SRH and health-related behaviours. However, in contrast to our findings, they found that living with parents during the semester was associated with better mental health, but their findings might reflect cultural differences or other mediating factors not addressed in our sample. Their results, however, align with ours in showing no association of being in a relationship and mental health outcomes. The results of our study highlight the high prevalence of depressive symptoms among students at UP and Charité, with particularly high rates among female students in the Charité sample. This aligns with findings from Freire et al. ( 30 ) and Schmidt et al. ( 31 ), who also reported poorer SRH among female students. Furthermore, consistent with our findings, Freire et al. ( 30 ) observed no significant association between living situation, SES and SRH. This suggests that factors, such as social isolation, may play a more significant role in female students' mental health than SES or living arrangements. In contrast, Ansari et al. ( 56 ) found reciprocal relationships between health, health behaviour and academic performance but no gender differences in these associations, suggesting that gender-related factors may vary depending on the context or population studied. Wainwright and Marandet ( 57 ) examined students with dependent children in higher education, focusing on social mobility and family impacts. About 48.5% of these students identified as lone parents, a recognized risk factor for negative health outcomes ( 57 ). The responsibilities of raising children while studying likely contribute to mental health challenges, such as increased stress. Lone parents, in particular, may face unique stressors, including financial instability, lower social support and limited time for self-care, which can exacerbate the risk of depression and other health issues ( 57 ). Additionally, the high proportion of lone parents among students with dependent children highlights the need for targeted support services within universities to address these specific challenges. Providing more comprehensive support systems, such as childcare services, financial aid and mental health resources could help mitigate the negative impact of these stressors on the mental health of student parents. The findings of our study underscore the urgent need to address mental health challenges in student populations. Consistent with previous research, such as Eisenberg et al. ( 13 ), which reported a higher prevalence of mental health issues among women compared to men (34% vs. 30%; p < 0.01), our results confirm that female students are particularly vulnerable. These findings underline the importance of gender-sensitive mental health strategies at universities. Eisenberg et al. ( 13 ) also reported that financial difficulties, both current (OR: 2.15, p < 0.01) and during childhood (OR: 1.71, p < 0.01), were associated with an increased risk of depression. Protective factors such as living on campus were associated with reduced anxiety levels (OR: 0.81, p = 0.02). Our study further aligns with Eisenberg’s finding of a higher prevalence of depression among women compared to men (10% vs. 7.5%; p < 0.01). However, in multivariable analyses controlling for other covariates, the gender difference in depression was not statistically significant (OR, 1.10; p = 0.11). This apparent discrepancy may be explained by the influence of other factors, such as financial stress, social support or health-seeking behaviour, which are unequally distributed across genders and may attenuate the direct relationship between gender and depression when included in adjusted models. Consistent with our findings, Farrer et al. ( 58 ) identified financial stress, low social support and academic pressures as key contributors to depressive symptoms and poor SRH. These factors highlight unique student stressors, particularly during transitional phases such as first-year university experiences. In line with our results, Farrer et al. ( 58 ) also found that romantic relationships did not significantly influence depression risk. This suggests that romantic relationships may not be a major protective or risk factor for mental health in university students and that other factors, such as academic and financial stress, may play a more substantial role. Additionally, Farrer et al. ( 58 ) reported that relocating to university increased the risk of depression, highlighting the importance of stability during transitions. This finding emphasizes the need to support students not only academically but also emotionally and socially. The process of relocation can induce feelings of isolation or uncertainty, which may contribute significantly to mental health challenges during the adjustment to university life. In line with our results, the meta-analysis by Yan et al. ( 59 ) also identified gender (female) as a significant predictor of depressive symptoms among college students. However, protective factors such as perceived social support (pooled effect = 0.93, CI: 0.85–1.02) and family function (pooled effect = 0.96, CI: 0.91–1.01) were not significantly associated with depressive symptoms. This discrepancy may reflect limited data on these protective factors in the meta-analysis, reducing its statistical power. This finding indicates that, although perceived social support is often viewed as a protective factor, a significant direct impact on depression risk may not always be observed, especially in studies with limited data or under specific conditions. In addition, our findings align with previous research by Hilger-Kolb et al. ( 60 ), investigating the impact of academic stress on university students' mental and self-rated health across 46 German universities. In their study, 13.5% of students rated their health as poor, with depression and anxiety significantly linked to high effort, low reward and over-commitment, as measured by the student version of the Effort-Reward Imbalance Questionnaire (ERI). This tool captures the imbalance between academic demands (effort) and perceived rewards, as well as the strain of excessive self-imposed obligations (over-commitment). Building on these findings, our study highlights the critical role of social support as a mitigating factor. Lower social support may exacerbate the negative effects of an effort-reward imbalance, as students experience fewer rewards intensifying the stress associated with high effort or over-commitment. Conversely, students with strong social support may experience this imbalance less acutely, as the emotional and practical benefits of social support can supplement perceived rewards and help maintain better mental and self-rated health. These results underscore the importance of addressing both academic stress and social support within mental health strategies to enhance students’ well-being. Interestingly, we did not find the protective effect of partnerships for depressive symptoms reported elsewhere for either sample ( 28 , 61 ). One explanation could be that students are unsettled in the sense that their lifestyle necessitates flexibility. This might also reflect the unique, exploratory nature of student life, where academic and personal transitions reduce the importance of stable romantic partnerships. Academic studies are generally a time of trying out new things, traveling abroad and exploring one’s own interests. Thus, the continuity and dependability offered by romantic partnerships might not be as important in this fast-paced period than it is just five to ten years later. Previous research ( 55 ) has also pointed to the importance of peer-/university groups in this particular life phase, which might have a stronger impact at this time than romantic relationships. With regard to children, the number of student parents in our sample was low (n = 28; 7%). Thus, generalization from this small sub-sample is limited. Studies particularly focusing on the experience of being a parent whilst studying would provide more insights. Our findings suggest that children are neither a burden nor a gift in the sense of influencing the mental health of parent students. Comparing the two university samples, our data show differences in relationship status, reported subjective health, depression scores and positively perceived subjective health. As for differences between the samples of the two institutions, we can only speculate why UP students form fewer romantic relationships and report lower self-reported health. Further research is needed to understand regional differences and peculiarities. Inconsistent with previous findings ( 15 , 16 ), we only found an association of gender and depressive symptoms in one of our samples (Charité sample). A previous study also did not find an effect of gender on depression in Italian humanities students ( 62 ). Interestingly, the Charité sample included only students enrolled at the medical faculty, which is in line with previous research showing that female medical students were more likely to be affected by depression and mental health difficulties than men ( 63 ). Differences for students of different departments still need further investigation. 4.1 Limitations Our study is limited by the sole use of self-report assessments and convenience sampling as design choices. Recruiting for a survey on study demands and mental health might have appealed more to those burdened by study demands and mental health difficulties. Such a selection bias in our convenience samples might explain the relatively high number of students reporting depressive symptoms. However, it does not explain the strong gender effect at Charité. Self-reports are naturally limited by selection bias and subjectivity. The study uses a cross-sectional design that cannot determine causal relationships between the variables studied. In addition, differences in data collection periods and measures between the two universities may have led to systematic differences in reported symptoms and perceived social support. These differences may affect the comparability of the results. The sample includes students from only two universities (UP and Charité - Universitätsmedizin Berlin). This limits the generalizability of the results to other universities and regions. The study may not have taken into account all relevant factors that could influence depressive symptoms and perceived social support, such as personal circumstances, financial burdens or cultural differences, migration background or field of study. This study aimed to capture social support on a general level. Social support should be captured and analysed in more detail in future studies, e.g., whether it is provided by family, friends, peers, or in the form of institutionalized social support at the university. A more nuanced measure of social support would allow for a better understanding of the role and effectiveness of social support and recommendations for how universities can improve student health. Further research should also include additional protective factors such as resilience, physical activity and the availability of health promotion services. 4.2 Conclusion Our study assessed health outcomes in students of two German universities with particular focus on depressive symptoms, social support and self-reported health. With roughly a third of students in both sites reporting depressive symptoms, our results provide further evidence that mental health difficulties are a critically important issue in the university context. In their Prevention Law ( 64 ) the German federal government has obligated universities as “living environments” to develop and implement health promotion and prevention services. Many universities already offer some counselling services for students ( 65 ), however, these initiatives are often the result of years of effort by individuals. We suggest that universities consider providing the necessary infrastructure and incorporating it into the core budget to support students' academic success, social well-being, and mental health. Considering that our results provided additional evidence for gender specific effects, we suggest acknowledging gender sensitive aspects in mental health promotion. Abbreviations BMBF Federal Ministry of Education and Research CI Confidence Interval COVID-19 Coronavirus Disease 2019 DZPG German Center for Mental Health (Deutsches Zentrum für Psychische Gesundheit) ERI Effort-Reward Imbalance Questionnaire PHQ Patient Health Questionnaire PRQ Personal Resource Questionnaire SD Standard Deviation SES Socioeconomic Status SRH Self-Rated Health UP Universität Potsdam VIF Variance Inflation Factor WHO World Health Organization Declarations Ethics approval and consent to participate For the UP sample, the study was approved by the local ethics committees of the Universität Potsdam in accordance with the Declaration of Helsinki (No. 06/2016 with the amendments 62/2019, 59/2023, and 100/2023). For the Charité sample, data collection was part of a multicentre project approved by the local ethics committee of the Friedrich Alexander Universität Erlangen-Nürnberg working in accordance with the Declaration of Helsinki that rated that no detailed examination would be necessary for the study (vote 21-393-ANF from 21 November 2021). All participants provided their written informed consent prior to participating in the study. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due data security restrictions but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The study was funded by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung [BMBF]) and the ministry of Brandenburg within the initial phase of the German Center for Mental Health (DZPG) (grant: 01EE2301D) Authors' contributions MT: study conception and design, data acquisition and analysis, data interpretation, first draft of the manuscript, approved the submitted manuscript KKS: drafted and revised the manuscript, approved the submitted manuscript DHS: drafted and revised the manuscript, approved the submitted manuscript SJB: study conception and design, data acquisition and analysis, revised the manuscript, approved the submitted manuscript JS: data acquisition, revised the manuscript, approved the submitted manuscript VE: data acquisition and analysis, revised the manuscript, approved the submitted manuscript TS: data acquisition and analysis, revised the manuscript, approved the submitted manuscript AV: study conception and design, data acquisition and analysis, drafted and revised the manuscript, approved the submitted manuscript BF: study conception and design, data acquisition and analysis, revised the manuscript MR: study conception and design, revised the manuscript, approved the submitted manuscript JCZ: study conception and design, data acquisition and analysis, drafted and revised the manuscript, approved the submitted manuscript Acknowledgements Not applicable. 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During that time, they are facing personal and developmental challenges including self-identity formation, intellectual and social development in the work context, high degrees of self-organization and autonomy as well as settling into the institutional context of academia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). For many students, this transition phase is characterized by separation from home due to change of residence, relationship stressors, increased demands on time management skills and overall high levels of psychological stress (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Moreover, the mean age for students starting university is known to be a peak risk period for the onset of mental disorders such as affective disorders (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Students can thus be considered a particularly vulnerable population regarding mental illnesses.\u003c/p\u003e \u003cp\u003eAccording to the Techniker Krankenkasse (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and the Federal Ministry of Education and Research (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), mental health problems are particularly prevalent among university students, with stress, depression and anxiety symptoms having notably negative effects. These findings also reveal that in 2023, nearly two-thirds of students in Germany rated their overall health as good or very good, while approximately one-tenth rated it as fair or poor. Moreover, the proportion of students reporting negative health has more than tripled since 2015 (3% in 2015, 10% in 2023). One possible reason for this trend could be the COVID-19 pandemic. University closures and the shift to online learning led to increased isolation and lifestyle changes, while lockdowns and other restrictions negatively affecting students' health (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This period of prolonged stress and reduced social interactions likely contributed to a decline in students' overall health perceptions, as they struggled with disrupted routines, financial uncertainties and fewer support networks (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A study by Gewalt et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) examined these effects on the physical and mental health of 1,246 German university students. The study found that 53% reported a decline in mental health, with 9% indicating a significant worsening. Similarly, Werner et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) found an intraindividual increase in depression during the pandemic compared to pre-pandemic levels among 424 German students. Holm-Hadulla et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) investigated the effects of 18 months of social restrictions and reported that 72% of students experienced significant impairments in well-being and 76% exhibited signs of at least one psychological syndrome, with 42% showing depressive symptoms.\u003c/p\u003e \u003cp\u003eUniversity and college centres had already been noting a shift from addressing benign developmental and informational needs to dealing with more severe psychological problems and mental illnesses (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study conducted by the German health insurance BARMER (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) reported that 17% of student clients were affected by a professionally diagnosed mental illness. Among these, 5% of students were diagnosed with an affective disorder, with depressive episodes being the second most common diagnosis affecting 4% of students. This prevalence has seen a significant increase in recent years. According to BARMER data, 7% of 18- to 25-year-olds had some form of depression in 2016, compared to approximately 3% in 2006, marking a substantial rise over a decade (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The prevalence of depressive symptoms varies depending on the educational institution and the methodology of data collection. However, it is estimated to affect between one fifth to one third of students, a proportion notably higher than that observed in age-matched non-student populations or in the general German population. Gender differences have also been reported, with some studies reporting that women are more likely to experience depression than men (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, findings on the relationship between gender and mental health in university students are still inconsistent (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rising prevalence of mental health issues among students, as evidenced by the increasing rates of depression and other psychological disorders (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), underscores the broader consequences of psychological distress. These consequences do not only impact academic performance and retention rates (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), but also extend into long-term challenges in personal well-being, workplace productivity and societal economic costs (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Students with poor mental health also report more difficulties in coping with study demands and report lower study satisfaction (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePotential consequences of psychological distress are lower academic performance (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and a higher likelihood of dropping out (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Poor mental health in adulthood can also have a negative impact on general performance, social interactions, emotional and physical health, quality of life and career prospects after graduation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In terms of work performance, people with psychological distress are more likely to be absent from work. In cases of psychological distress manifested in anxiety disorders or depression, this can lead to long term work disability (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In addition to high economic costs, mental disorders also lead to high financial expenditures for treatment and therapy (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). These social and economic consequences underscore the negative societal impact of students' mental health challenges. At the same time, psychosocial and sociodemographic factors also play a significant role in influencing students' mental and subjective well-being (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychosocial and sociodemographic factors such as social support, relationship status, household composition and gender influence mental and subjective health (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Studies have shown that loneliness and social isolation were related to poorer mental health (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). With regard to the relationship between gender and mental health, associations between poorer mental health and female gender in students have been reported (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), however, the existing body of research to this date is still inconclusive (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Students with lower social support, particularly those who are single or non-parents, exhibited higher levels of depressive symptoms, a trend that was particularly pronounced during the COVID-19 pandemic (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Relationship status also plays a key role in mental well-being, with married individuals generally reporting better mental health compared to those who are single, divorced, or widowed (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Cohabitation and intimate partnerships offer similar protective benefits, likely due to enhanced social and financial support (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Gender differences have also been observed: for men, being single or divorced/widowed is more strongly associated with depressive symptoms, while for women, this association is primarily linked to being single, but not divorced/widowed (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Further studies have shown that having a partner is not associated with overall health, whereas living with parents during academic terms is linked to better health outcomes (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Additionally, urban-rural household registration has a small but significant effect on anxiety (β\u0026thinsp;=\u0026thinsp;0.03, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and depression (β=-0.03, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) among Chinese university students. Rural students, in particular, experience higher levels of anxiety (β\u0026thinsp;=\u0026thinsp;0.01, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and depression (β\u0026thinsp;=\u0026thinsp;0.01, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), primarily due to lower perceived social status and increased feelings of isolation. These findings underscore the complex role that social and environmental factors play in student mental health (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile these psychosocial and sociodemographic factors clearly influence students' mental health, contextual factors related to their academic environment, such as study demands and social support, are also crucial contributors to their psychological well-being.\u003c/p\u003e \u003cp\u003ePerceived psychological distress in students has been linked to study conditions and contextual factors such as study demands, qualification potential, and social support (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Regarding social support, feelings of loneliness and social support among peers emerged as the strongest predictor of poor mental health (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding mental health difficulties among students of different faculties, Gr\u0026uuml;tzmacher et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) reported that students of linguistics and cultural studies were particularly burdened by increased levels of depressive and anxiety symptoms. A survey of students at the Freie Universit\u0026auml;t Berlin reported that students of veterinary medicine, law and physics were particularly affected by stress (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, the transition to university life presents significant challenges for students, including heightened risks to mental health. Increasing prevalence of stress, anxiety, and depression underscores the need for targeted interventions. The present study aims to report on the mental health of students at two universities and to investigate potential associations between social support, self-rated health, and depressive symptoms in these two samples.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe combined the data of two separate data collections at two universities in the Berlin-Potsdam metropolitan area (Germany) to further investigate similarities and differences in the two samples and gather information about potential influencing factors on these associations such as gender and relationship status.\u003c/p\u003e \u003cp\u003eData for the present analyses were collected as part of two separate studies at the Universit\u0026auml;t Potsdam (UP) and at Charit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin, respectively.\u003c/p\u003e \u003cp\u003e For the UP sample, the study was approved by the local ethics committees of the Universit\u0026auml;t Potsdam in accordance with the Declaration of Helsinki (No. 06/2016 with the amendments 62/2019, 59/2023, and 100/2023). For the Charit\u0026eacute; sample, data collection was part of a multicentre project approved by the local ethics committee of the Friedrich Alexander Universit\u0026auml;t Erlangen-N\u0026uuml;rnberg working in accordance with the Declaration of Helsinki that rated that no detailed examination would be necessary for the study (vote 21-393-ANF from 21 November 2021). All participants provided their written informed consent prior to participating in the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants and data collection\u003c/h2\u003e \u003cp\u003eData collection for the UP sample took place over a two-month period during the winter term 2023/2024, from 11 December 2023 to 5 February 2024, and was advertised by the local Student Health Management via internal mailing lists of the Zentrum f\u0026uuml;r Hochschulsport (Centre for University Sports), e-mail, flyers, posters and personal contacts within the university. 185 participants from 6 faculties completed the online survey within the university survey system Umfragen.UP (based on SoSci Survey), which was accessed through a link or QR code on the study invitation. The six faculties at the UP were: Faculty of Law, Faculty of Humanities, Faculty of Human Sciences, Faculty of Business, Economics and Social Sciences, Faculty of Mathematics and Natural Sciences and Faculty of Digital Engineering.\u003c/p\u003e \u003cp\u003eData collection for the Charit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin sample took place over a three-month period during the winter term 2023/24 from 29 November 2023 to 1 March 2024 and was advertised by internal mailing lists of the local student union. 296 participants enrolled in the programs medicine, dentistry, midwifery and nursing at the Medical Faculty completed the online survey.\u003c/p\u003e \u003cp\u003eA-priori power analyses or sample size calculations were not carried out as the present analyses are based on data of two independent exploratory cross-sectional survey studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Measures\u003c/h2\u003e \u003cp\u003eThis section describes the assessments used to collect the data analysed for comparison of the two samples in the present study. The data analysed for the present article were selected based on the overlap of assessments at Charit\u0026eacute;- Universit\u0026auml;tsmedizin Berlin and Universit\u0026auml;t Potsdam.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Sociodemographic variables\u003c/h2\u003e \u003cp\u003eSociodemographic information including gender (female, male, diverse, not specified), age, partnership status, family and living situation were assessed in both samples. To allow for comparison of the two samples, socio-demographic information on family status and living situation were combined into the following modified dichotomous variables: partnership status (yes/no), having children (yes/no), and living alone (yes/no).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Social Support\u003c/h2\u003e \u003cp\u003eSocial support was assessed differently in the two analysed samples. For assessing social support in the UP sample, item 2 of the Oslo-3 (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) scale was used: \u0026lsquo;How much interest and concern do people show in what you are doing?\u0026rsquo; (possible answers were: \u0026lsquo;a lot of concern and interest\u0026rsquo;, \u0026lsquo;some concern and interest\u0026rsquo;, \u0026lsquo;uncertain\u0026rsquo;, \u0026lsquo;little concern and interest\u0026rsquo; and \u0026lsquo;no concern and interest\u0026rsquo;). In the Charit\u0026eacute; sample, the 15-item Personal Resource Questionnaire (PRQ 2000) was used to assess the perceived level of social support (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The 15 items, e.g., \u0026ldquo;I know that others appreciate me as a person\u0026rdquo; were answered on a 7-point Likert scale ranging between strongly disagree (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and strongly agree (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and a common mean for the entire scale was calculated with higher scores indicating higher levels of perceived social support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Health Outcomes\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDepressive symptoms\u003c/b\u003e were assessed using the two-item version of the Patient Health Questionnaire (PHQ-2; (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)), an brief self-report screening instrument for depression that is comprised of the first two items from the longer version PHQ-9. The two items assess depressed mood and anhedonia over the last two weeks on a 4-point scale.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-rated health\u003c/b\u003e (SRH) was assessed using two slightly different versions of the internationally established indicator of general health. In accordance with the wording in the socio-economic panel (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), participants in the UP sample were asked \u0026ldquo;How would you describe your current health?\u0026rdquo;. The response options were \u0026lsquo;very good\u0026rsquo; (=\u0026thinsp;1), \u0026lsquo;good\u0026rsquo;, \u0026lsquo;satisfactory\u0026rsquo;, \u0026lsquo;poor\u0026rsquo;, and \u0026lsquo;bad\u0026rsquo; (=\u0026thinsp;5) and were then dichotomized into the categories \u0026lsquo;rather good\u0026rsquo; (very good and good) and \u0026lsquo;rather poor\u0026rsquo; (other three categories).\u003c/p\u003e \u003cp\u003eIn accordance with a recommendation of the World Health Organization (WHO) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) participants in the Charit\u0026eacute; sample were asked: \u0026lsquo;How is your health in general?\u0026rsquo;. The participants responded using a five-point scale (very good\u0026thinsp;=\u0026thinsp;1, good, average, poor, very poor\u0026thinsp;=\u0026thinsp;5), which was combined into the categories of \u0026lsquo;very good/good\u0026rsquo; and \u0026lsquo;average/bad/very bad\u0026rsquo; for the present analyses.\u003c/p\u003e \u003cp\u003eSince the wording in the two versions only differed slightly, we were able to analyse \u0026lsquo;positively perceived subjective health\u0026rsquo; as defined by the nationwide health monitoring (\u0026lsquo;very good\u0026rsquo; or \u0026lsquo;good\u0026rsquo; SRH) for both versions of SRH assessments. In addition, the SRH item used in the Charit\u0026eacute; sample was recoded (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) to harmonize it with the SRH item used for the UP sample, allowing us to compare the mean values of the two samples.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics version 29 (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo analyse differences between the two samples, we conducted chi square tests for categorical variables, t-tests for continuous variables, and Mann-Whitney U tests for non-normally distributed continuous variables. Results are reported as statistically significant at a level of p⋜ 0.05. Confidence intervals (CIs) are reported at the 95% confidence level.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Multivariate Analyses\u003c/h2\u003e \u003cp\u003eSince different measures were used to assess social support in the two samples, multivariate linear regression models were analysed separately for the two samples to investigate the association of the two health indicators (SRH and depressive symptoms) with social support while also accounting for relationship status (yes/no), living situation (living alone yes/no) and gender (f, m). Due to the small cell sizes of the students who indicated 'diverse' or 'no response' for the gender variable, the regression analyses had to be carried out excluding these cases. However, all regression analyses were repeated without the gender predictor and with the full sample to analyse potential effects of excluding these subjects, which did not change the results.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 SRH - Assumptions for the regression models\u003c/h2\u003e \u003cp\u003eWe found no evidence of significant multicollinearity with variance inflation factors (VIF) below 1.066 (UP) or 1.132 (Charit\u0026eacute;) for all predictors (gender, social support, relationship status, living alone). In addition, the average VIF for all predictors was 1.040 (UP) and 1.078 (Charit\u0026eacute;) and the tolerance statistics were above .938 (UP) and above .883 (Charit\u0026eacute;) (\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Depressive symptoms- Assumptions for the regression models\u003c/h2\u003e \u003cp\u003eWe found no evidence of significant multicollinearity with variance inflation factors (VIF) below 1.066 (UP) or below 1.135 (Charit\u0026eacute;) for all predictors (gender, social support, relationship status, living alone). In addition, the average VIF for all predictors was 1.040 (UP) and 1.080 (Charit\u0026eacute;) and the tolerance statistics were above .938 (UP) and above .881 (Charit\u0026eacute;) (\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince there was evidence for heteroskedasticity (Breusch-Pegan-Test p\u0026thinsp;\u0026lt;\u0026thinsp;.05) within the model analysing PHQ-2 with the predictors gender, social support, relationship status and living situation for the Charit\u0026eacute; sample, we report p-values for heteroscedasticity-consistent parameters for this specific model (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSociodemographic and clinical characteristics of the study sample are depicted in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e both for the entire sample of 428 participants and for the two samples (UP and Charit\u0026eacute;) separately. The mean age of the participants was 24 years (range 17.4\u0026ndash;57 years), and 80% were female. The two university samples differed regarding their relationship status with a higher (52% vs. 41%) rate of participants in a relationship in the Charit\u0026eacute; sample (\u0026chi;\u003csup\u003e2\u003c/sup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;6.416, p\u0026thinsp;=\u0026thinsp;.011). Furthermore, students at Charit\u0026eacute; reported better subjective health: On average, students at Charit\u0026eacute; reported better subjective health (M\u0026thinsp;=\u0026thinsp;2.54, \u0026plusmn;\u0026thinsp;0.88.3) than students at UP (2.37, \u0026plusmn;\u0026thinsp;0.81; t(424)\u0026thinsp;=\u0026thinsp;2.096, p\u0026thinsp;=\u0026thinsp;.037, d\u0026thinsp;=\u0026thinsp;.205) and students at Charit\u0026eacute; reported positively perceived subjective health more often (78%) than students at UP (62%; \u0026chi;\u003csup\u003e2\u003c/sup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;6.668, p\u0026thinsp;=\u0026thinsp;.010). Also, the rate of students, who either reported elevated depression scores or who did not report positively perceived subjective health was lower in the Charit\u0026eacute; sample (\u0026chi;\u003csup\u003e2\u003c/sup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;8.812, p\u0026thinsp;=\u0026thinsp;.003).\u003c/p\u003e\n\u003cp\u003eTable 1: sample characteristics\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eOverall Sample\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUniversit\u0026auml;t Potsdam\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCharit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale (n, %)\u003c/p\u003e\n \u003cp\u003eMale (n, %)\u003c/p\u003e\n \u003cp\u003eDiverse (n, %)\u003c/p\u003e\n \u003cp\u003eMissing (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e312, 72.9%\u003c/p\u003e\n \u003cp\u003e106, 24.8%\u003c/p\u003e\n \u003cp\u003e5, 1.2%\u003c/p\u003e\n \u003cp\u003e5, 1.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e136, 73.5%\u003c/p\u003e\n \u003cp\u003e45, 24.3%\u003c/p\u003e\n \u003cp\u003e1, 0.5%\u003c/p\u003e\n \u003cp\u003e3, 1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e176, 72.4%\u003c/p\u003e\n \u003cp\u003e61, 25.1%\u003c/p\u003e\n \u003cp\u003e4, 1.6%\u003c/p\u003e\n \u003cp\u003e2, 0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eAge (mean in years, \u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e24.17, \u0026plusmn;1.64\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e24.56, \u0026plusmn;5.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e23.86, \u0026plusmn;4.63\u003csup\u003e1\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eChildren (yes, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e28, 6.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e11, 5.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e17, 7.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eIn a relationship (yes, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e185, 47.2%\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e75, 40.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e127, 52.3%\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eLiving alone (yes, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e126, 29.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e62, 33.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e64, 26.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSocial support, PRQ\u0026nbsp;\u003cbr\u003e\u0026nbsp;(mean, \u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e5.83, \u0026plusmn;1.01\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSocial support, Oslo (item 2) (mean, \u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.37, \u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003ePHQ2 (mean, \u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2.10, \u0026plusmn;1.64\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e2.26, \u0026plusmn;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.98, \u0026plusmn;1.53\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003ePHQ2 above cut-point (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e131, 31.0%\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e66, 35.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e65, 26.7%\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSRH: harmonized scales) (mean, \u0026plusmn;SD)\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2.47, \u0026plusmn;0.86\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e2.37, \u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e2.54, \u0026plusmn;0.88.3\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSRH: positively perceived subjective health (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e293, 68.5%\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e115, 62.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e178, 78.3%\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eDepression or SRH above cut-point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e194, 45.3%\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e99, 53.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e95, 39.1%\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. SD = standard deviation, PRQ = Personal Resource Questionnaire, PHQ = patient health questionnaire, SRH = self-rated health, \u003csup\u003e1\u003c/sup\u003e missing n=11, \u003csup\u003e2\u0026nbsp;\u003c/sup\u003emissing n=3, \u003csup\u003e3\u003c/sup\u003e missing n=5, \u003csup\u003e4\u0026nbsp;\u003c/sup\u003emissing n=2, \u003csup\u003e5\u0026nbsp;\u003c/sup\u003ehigher scores indicate worse SRH\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Depressive Symptoms\u003c/h2\u003e\n \u003cp\u003eIn the UP sample, higher depressive symptom scores were associated with lower social support (\u0026beta;=-.317, CI=-.459 \u0026ndash; \u0026minus;\u0026thinsp;.175, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and were not associated with gender, relationship status or living alone (all p\u0026thinsp;\u0026gt;\u0026thinsp;.12). Similarly, in the Charit\u0026eacute; sample, higher depression scores were linked to lower social support (\u0026beta;=-.326, CI=-.451 \u0026ndash; \u0026minus;\u0026thinsp;.201, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and no association was found with relationship status or living alone (all p\u0026thinsp;\u0026gt;\u0026thinsp;.12). In this sample however, gender was linked to depressive symptoms with higher depression scores in female students (\u0026beta;\u0026thinsp;=\u0026thinsp;.207, CI\u0026thinsp;=\u0026thinsp;.085 \u0026ndash; .239, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Subjective Health Status\u003c/h2\u003e\n \u003cp\u003eIn the UP sample, higher (i.e. better) SRH was associated with higher social support (\u0026beta;\u0026thinsp;=\u0026thinsp;.222, CI\u0026thinsp;=\u0026thinsp;.077 \u0026ndash; .367, p\u0026thinsp;=\u0026thinsp;.003) and was not associated with gender, relationship status or living situation (all p\u0026thinsp;\u0026gt;\u0026thinsp;.09). Similarly, in the Charit\u0026eacute; sample, higher SRH scores were linked to higher social support (\u0026beta;\u0026thinsp;=\u0026thinsp;.176, CI\u0026thinsp;=\u0026thinsp;.045 \u0026ndash; .306, p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.008) and no association was found with relationship status or living situation (all p\u0026thinsp;\u0026gt;\u0026thinsp;.50). In this sample, gender was linked to SRH with higher (i.e. better) SRH in male students (\u0026beta;=-.231, CI=-.357 \u0026ndash; \u0026minus;\u0026thinsp;.105, p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePrediction of depressive symptoms (PHQ-2) and self-rated health in two university samples\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eUniversit\u0026auml;t Potsdam\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;181\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCharit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;229\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eStandardized beta\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eStandardized beta\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepressive symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.183 \u0026ndash; .097)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.085 \u0026ndash; .329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.459 \u0026ndash; \u0026minus;\u0026thinsp;.175)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.451 \u0026ndash; \u0026minus;\u0026thinsp;.201)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.203 \u0026ndash; .083)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.020 \u0026ndash; .236)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.121\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving alone (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.253 \u0026ndash; .031)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.105 \u0026ndash; .147)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.762\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-rated health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender (male/female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.133 \u0026ndash; .143)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.357 \u0026ndash; \u0026minus;\u0026thinsp;.105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.077 \u0026ndash; .367)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(.045 \u0026ndash; .306)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.022 \u0026ndash; .275)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.174 \u0026ndash; .090)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving alone (yes/no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.155 \u0026ndash; .132)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(-.175 \u0026ndash; .087)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e. CI\u0026thinsp;=\u0026thinsp;Confidence Interval, Universit\u0026auml;t Potsdam: depressive symptoms \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.118, self-rated health \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.074; Charit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin: depressive symptoms \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.157, self-rated health \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.091, \u003csup\u003e1\u003c/sup\u003e Reduced \u003cem\u003eN\u003c/em\u003e due to exclusion of \u0026ldquo;diverse\u0026rdquo; and \u0026ldquo;missing\u0026rdquo; cases regarding gender for the multivariate models, \u003csup\u003e2\u003c/sup\u003e p values corresponding to heteroscedasticity-consistent parameters\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eExcluding gender as a predictor and analysing the full sample including students who indicated \u0026apos;diverse\u0026apos; or \u0026apos;no response\u0026apos; for the gender variable did not alter the present results.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":" \u003cp\u003eThe present study aims to report on the mental health of students at two universities and to investigate potential associations between social support, self-rated health and depressive symptoms in these two samples. We present survey results for students from Universit\u0026auml;t Potsdam and Charit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin regarding their depressive symptoms and self-reported health. Our study found that 31% of all participating students (36% at UP and 27% at Charit\u0026eacute;) reported depressive symptoms above the clinically relevant threshold. When exploring factors contributing to depressive symptoms, our results revealed significant associations with social support and gender. Specifically, increased depressive symptoms and lower overall health were significantly associated with reduced social support in both samples and with female gender in the Charit\u0026eacute; sample. Neither romantic relationships nor living alone were predictive of the outcomes in our sample. These findings underscore results from previous studies showing alarming levels of mental health difficulties in student populations (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Compared to previous research (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), which found estimates of depressive symptoms in students ranging from 4\u0026ndash;7%, our sample reported a considerably higher prevalence at 31%. This finding is particularly notable when compared to BARMER data (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), which reflected the percentage of patients diagnosed by professionals. As BARMER, a German health insurance company, had access to billing data, their statistics are based on diagnoses, whereas our findings rely on self-report screening tools. This methodological difference might show how prevalence rates can vary depending on the type of data collection used, such as self-reports versus clinical assessments. The PHQ-2 as a two-item screener used in our study can be seen as an indicator for mental health difficulties, but is not directly comparable to clinically relevant, diagnosed conditions. On the other hand, our results align with studies examining the use of the PHQ-2 for depression screening among university students in other countries. For example, a study investigating depressive symptoms in university students in France using the PHQ-2 reported a prevalence of 23% of students with elevated depression scores (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Especially the UP sample of the present study reported depressive symptoms more frequently. This difference suggests that variations in cultural contexts and mental health support systems between regions or universities may influence the prevalence of depressive symptoms reported by students. Furthermore, it is estimated that only about 40% of individuals suffering from a depressive disorder seek professional help, which could explain why many students may not seek or receive formal diagnoses, despite experiencing significant mental health difficulties. Universities should focus on improving access to mental health services through low-threshold offerings and raising awareness about available resources. Despite the high prevalence of depressive symptoms, socioeconomic status (SES) has generally been shown to be a protective factor against mental health difficulties (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e) and student populations could be considered advantaged regarding their SES. However, as Ibrahim et al. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) demonstrated, there are many factors that increase students\u0026rsquo; vulnerability to depression, including changes in sleeping and eating habits, financial stressors, changes in family relationships, worries about academic performance and post-graduation life.\u003c/p\u003e \u003cp\u003eOur findings on the associations between lower social support, increased depressive symptoms and lower self-rated health in both samples are consistent with previous studies showing the importance of social support on student health (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). These results emphasize the need for universities to strengthen peer networks and institutional support systems. Further research is necessary to better understand the mechanisms through which social support positively impacts mental health, such as by providing emotional or practical assistance, to create a design for effective interventions.\u003c/p\u003e \u003cp\u003eSimilarly, Mikolajczyk et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) identified a correlation between SRH and health-related behaviours. However, in contrast to our findings, they found that living with parents during the semester was associated with better mental health, but their findings might reflect cultural differences or other mediating factors not addressed in our sample. Their results, however, align with ours in showing no association of being in a relationship and mental health outcomes.\u003c/p\u003e \u003cp\u003eThe results of our study highlight the high prevalence of depressive symptoms among students at UP and Charit\u0026eacute;, with particularly high rates among female students in the Charit\u0026eacute; sample. This aligns with findings from Freire et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and Schmidt et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), who also reported poorer SRH among female students. Furthermore, consistent with our findings, Freire et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) observed no significant association between living situation, SES and SRH. This suggests that factors, such as social isolation, may play a more significant role in female students' mental health than SES or living arrangements. In contrast, Ansari et al. (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) found reciprocal relationships between health, health behaviour and academic performance but no gender differences in these associations, suggesting that gender-related factors may vary depending on the context or population studied.\u003c/p\u003e \u003cp\u003eWainwright and Marandet (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e) examined students with dependent children in higher education, focusing on social mobility and family impacts. About 48.5% of these students identified as lone parents, a recognized risk factor for negative health outcomes (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). The responsibilities of raising children while studying likely contribute to mental health challenges, such as increased stress. Lone parents, in particular, may face unique stressors, including financial instability, lower social support and limited time for self-care, which can exacerbate the risk of depression and other health issues (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Additionally, the high proportion of lone parents among students with dependent children highlights the need for targeted support services within universities to address these specific challenges. Providing more comprehensive support systems, such as childcare services, financial aid and mental health resources could help mitigate the negative impact of these stressors on the mental health of student parents.\u003c/p\u003e \u003cp\u003eThe findings of our study underscore the urgent need to address mental health challenges in student populations. Consistent with previous research, such as Eisenberg et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), which reported a higher prevalence of mental health issues among women compared to men (34% vs. 30%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), our results confirm that female students are particularly vulnerable. These findings underline the importance of gender-sensitive mental health strategies at universities. Eisenberg et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) also reported that financial difficulties, both current (OR: 2.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and during childhood (OR: 1.71, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), were associated with an increased risk of depression. Protective factors such as living on campus were associated with reduced anxiety levels (OR: 0.81, p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003eOur study further aligns with Eisenberg\u0026rsquo;s finding of a higher prevalence of depression among women compared to men (10% vs. 7.5%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, in multivariable analyses controlling for other covariates, the gender difference in depression was not statistically significant (OR, 1.10; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11). This apparent discrepancy may be explained by the influence of other factors, such as financial stress, social support or health-seeking behaviour, which are unequally distributed across genders and may attenuate the direct relationship between gender and depression when included in adjusted models.\u003c/p\u003e \u003cp\u003eConsistent with our findings, Farrer et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) identified financial stress, low social support and academic pressures as key contributors to depressive symptoms and poor SRH. These factors highlight unique student stressors, particularly during transitional phases such as first-year university experiences. In line with our results, Farrer et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) also found that romantic relationships did not significantly influence depression risk. This suggests that romantic relationships may not be a major protective or risk factor for mental health in university students and that other factors, such as academic and financial stress, may play a more substantial role. Additionally, Farrer et al. (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) reported that relocating to university increased the risk of depression, highlighting the importance of stability during transitions. This finding emphasizes the need to support students not only academically but also emotionally and socially. The process of relocation can induce feelings of isolation or uncertainty, which may contribute significantly to mental health challenges during the adjustment to university life.\u003c/p\u003e \u003cp\u003eIn line with our results, the meta-analysis by Yan et al. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e) also identified gender (female) as a significant predictor of depressive symptoms among college students. However, protective factors such as perceived social support (pooled effect\u0026thinsp;=\u0026thinsp;0.93, CI: 0.85\u0026ndash;1.02) and family function (pooled effect\u0026thinsp;=\u0026thinsp;0.96, CI: 0.91\u0026ndash;1.01) were not significantly associated with depressive symptoms. This discrepancy may reflect limited data on these protective factors in the meta-analysis, reducing its statistical power. This finding indicates that, although perceived social support is often viewed as a protective factor, a significant direct impact on depression risk may not always be observed, especially in studies with limited data or under specific conditions.\u003c/p\u003e \u003cp\u003eIn addition, our findings align with previous research by Hilger-Kolb et al. (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), investigating the impact of academic stress on university students' mental and self-rated health across 46 German universities. In their study, 13.5% of students rated their health as poor, with depression and anxiety significantly linked to high effort, low reward and over-commitment, as measured by the student version of the Effort-Reward Imbalance Questionnaire (ERI). This tool captures the imbalance between academic demands (effort) and perceived rewards, as well as the strain of excessive self-imposed obligations (over-commitment). Building on these findings, our study highlights the critical role of social support as a mitigating factor. Lower social support may exacerbate the negative effects of an effort-reward imbalance, as students experience fewer rewards intensifying the stress associated with high effort or over-commitment. Conversely, students with strong social support may experience this imbalance less acutely, as the emotional and practical benefits of social support can supplement perceived rewards and help maintain better mental and self-rated health. These results underscore the importance of addressing both academic stress and social support within mental health strategies to enhance students\u0026rsquo; well-being.\u003c/p\u003e \u003cp\u003eInterestingly, we did not find the protective effect of partnerships for depressive symptoms reported elsewhere for either sample (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). One explanation could be that students are unsettled in the sense that their lifestyle necessitates flexibility. This might also reflect the unique, exploratory nature of student life, where academic and personal transitions reduce the importance of stable romantic partnerships. Academic studies are generally a time of trying out new things, traveling abroad and exploring one\u0026rsquo;s own interests. Thus, the continuity and dependability offered by romantic partnerships might not be as important in this fast-paced period than it is just five to ten years later. Previous research (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) has also pointed to the importance of peer-/university groups in this particular life phase, which might have a stronger impact at this time than romantic relationships. With regard to children, the number of student parents in our sample was low (n\u0026thinsp;=\u0026thinsp;28; 7%). Thus, generalization from this small sub-sample is limited. Studies particularly focusing on the experience of being a parent whilst studying would provide more insights. Our findings suggest that children are neither a burden nor a gift in the sense of influencing the mental health of parent students. Comparing the two university samples, our data show differences in relationship status, reported subjective health, depression scores and positively perceived subjective health. As for differences between the samples of the two institutions, we can only speculate why UP students form fewer romantic relationships and report lower self-reported health. Further research is needed to understand regional differences and peculiarities.\u003c/p\u003e \u003cp\u003eInconsistent with previous findings (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), we only found an association of gender and depressive symptoms in one of our samples (Charit\u0026eacute; sample). A previous study also did not find an effect of gender on depression in Italian humanities students (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e). Interestingly, the Charit\u0026eacute; sample included only students enrolled at the medical faculty, which is in line with previous research showing that female medical students were more likely to be affected by depression and mental health difficulties than men (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). Differences for students of different departments still need further investigation.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Limitations\u003c/h2\u003e \u003cp\u003eOur study is limited by the sole use of self-report assessments and convenience sampling as design choices. Recruiting for a survey on study demands and mental health might have appealed more to those burdened by study demands and mental health difficulties. Such a selection bias in our convenience samples might explain the relatively high number of students reporting depressive symptoms. However, it does not explain the strong gender effect at Charit\u0026eacute;. Self-reports are naturally limited by selection bias and subjectivity.\u003c/p\u003e \u003cp\u003eThe study uses a cross-sectional design that cannot determine causal relationships between the variables studied. In addition, differences in data collection periods and measures between the two universities may have led to systematic differences in reported symptoms and perceived social support. These differences may affect the comparability of the results. The sample includes students from only two universities (UP and Charit\u0026eacute; - Universit\u0026auml;tsmedizin Berlin). This limits the generalizability of the results to other universities and regions.\u003c/p\u003e \u003cp\u003eThe study may not have taken into account all relevant factors that could influence depressive symptoms and perceived social support, such as personal circumstances, financial burdens or cultural differences, migration background or field of study.\u003c/p\u003e \u003cp\u003eThis study aimed to capture social support on a general level. Social support should be captured and analysed in more detail in future studies, e.g., whether it is provided by family, friends, peers, or in the form of institutionalized social support at the university. A more nuanced measure of social support would allow for a better understanding of the role and effectiveness of social support and recommendations for how universities can improve student health.\u003c/p\u003e \u003cp\u003eFurther research should also include additional protective factors such as resilience, physical activity and the availability of health promotion services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Conclusion\u003c/h2\u003e \u003cp\u003eOur study assessed health outcomes in students of two German universities with particular focus on depressive symptoms, social support and self-reported health. With roughly a third of students in both sites reporting depressive symptoms, our results provide further evidence that mental health difficulties are a critically important issue in the university context. In their Prevention Law (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e) the German federal government has obligated universities as \u0026ldquo;living environments\u0026rdquo; to develop and implement health promotion and prevention services. Many universities already offer some counselling services for students (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e), however, these initiatives are often the result of years of effort by individuals. We suggest that universities consider providing the necessary infrastructure and incorporating it into the core budget to support students' academic success, social well-being, and mental health. Considering that our results provided additional evidence for gender specific effects, we suggest acknowledging gender sensitive aspects in mental health promotion.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMBF Federal Ministry of Education and Research\u003c/p\u003e\n\u003cp\u003eCI Confidence Interval\u003c/p\u003e\n\u003cp\u003eCOVID-19 \u003cstrong\u003eCoronavirus Disease 2019\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDZPG German Center for Mental Health (Deutsches Zentrum f\u0026uuml;r Psychische Gesundheit)\u003c/p\u003e\n\u003cp\u003eERI Effort-Reward Imbalance Questionnaire\u003c/p\u003e\n\u003cp\u003ePHQ Patient Health Questionnaire \u003c/p\u003e\n\u003cp\u003ePRQ Personal Resource Questionnaire\u003c/p\u003e\n\u003cp\u003eSD Standard Deviation\u003c/p\u003e\n\u003cp\u003eSES Socioeconomic Status\u003c/p\u003e\n\u003cp\u003eSRH Self-Rated Health\u003c/p\u003e\n\u003cp\u003eUP Universit\u0026auml;t Potsdam\u003c/p\u003e\n\u003cp\u003eVIF Variance Inflation Factor\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the UP sample, the study was approved by the local ethics committees of the Universit\u0026auml;t Potsdam in accordance with the Declaration of Helsinki (No. 06/2016 with the amendments 62/2019, 59/2023, and 100/2023). For the Charit\u0026eacute; sample, data collection was part of a multicentre project approved by the local ethics committee of the Friedrich Alexander Universit\u0026auml;t Erlangen-N\u0026uuml;rnberg working in accordance with the Declaration of Helsinki that rated that no detailed examination would be necessary for the study (vote 21-393-ANF from 21 November 2021). All participants provided their written informed consent prior to participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due data security restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by the Federal Ministry of Education and Research (Bundesministerium f\u0026uuml;r Bildung und Forschung [BMBF]) and the ministry of Brandenburg within the initial phase of the German Center for Mental Health (DZPG) (grant: 01EE2301D)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMT: study conception and design, data acquisition and analysis, data interpretation, first draft of the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eKKS: drafted and revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eDHS: drafted and revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eSJB: study conception and design, data acquisition and analysis, revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eJS: data acquisition, revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eVE: data acquisition and analysis, revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eTS: data acquisition and analysis, revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eAV: study conception and design, data acquisition and analysis, drafted and revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eBF: study conception and design, data acquisition and analysis, revised the manuscript \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMR: study conception and design, revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003eJCZ: study conception and design, data acquisition and analysis, drafted and revised the manuscript, approved the submitted manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHofmann FH, Sperth M, Holm-Hadulla RM. 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A methodological and technical Primer on the QuestionLink Engine. Mannheim, Germany: Leipniz-Institu f\u0026uuml;r Sozialwissenschaften; 2022. \u003c/li\u003e\n\u003cli\u003eIBM SPSS Statistics for Windows, Version 29.0.2.0. Armonk, NY: IBM Corp.; 2023. \u003c/li\u003e\n\u003cli\u003eBowerman, B. L., \u0026amp; O\u0026rsquo;Connell, R. T. BL, O\u0026rsquo;Connell RT. Linear statistical models: An applied approach. 2. ed. PWS-Kent Publ. Co.; 1990. \u003c/li\u003e\n\u003cli\u003eMyers RH. Classical and Modern Regression with Applications. 2. ed. PWS-KENT; 1990. 504 p. \u003c/li\u003e\n\u003cli\u003eMenard S. Applied Logistic Regression Analysis. SAGE Publications; 1995. 130 p. \u003c/li\u003e\n\u003cli\u003eHayes AF, Cai L. Using heteroskedasticity-consistent standard error estimators in OLS regression: An introduction and software implementation. Behav Res Methods. 2007 Nov 1;39(4):709\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eIbrahim AK, Kelly SJ, Adams CE, Glazebrook C. 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J Ment Health Abingdon Engl. 2018 Jun;27(3):230\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAnsari WE, Stock C. Is the Health and Wellbeing of University Students Associated with their Academic Performance? Cross Sectional Findings from the United Kingdom. Int J Environ Res Public Health. 2010 Feb;7(2):509\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eWainwright E, Marandet E. Parents in higher education: Impacts of university learning on the self and the family. Educ Rev - EDUC REV. 2010 Nov 1;62:449\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eFarrer LM, Gulliver A, Bennett K, Fassnacht DB, Griffiths KM. Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students. BMC Psychiatry. 2016 Jul 15;16(1):241. \u003c/li\u003e\n\u003cli\u003eLiu Y, Zhang N, Bao G, Huang Y, Ji B, Wu Y, et al. Predictors of depressive symptoms in college students: A systematic review and meta-analysis of cohort studies. J Affect Disord. 2019 Feb 1;244:196\u0026ndash;208. \u003c/li\u003e\n\u003cli\u003eHilger-Kolb J, Diehl K, Herr R, Loerbroks A. Effort-reward imbalance among students at German universities: associations with self-rated health and mental health. Int Arch Occup Environ Health. 2018 Nov;91(8):1011\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003ePalosaari UK, Aro HM. Parental divorce, self-esteem and depression: an intimate relationship as a protective factor in young adulthood. J Affect Disord. 1995 Dec 13;35(3):91\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eBert F, Ferrara M, Boietti E, Langiano E, Savatteri A, Scattaglia M, et al. Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study. Psychol Rep. 2022 Feb;125(1):256\u0026ndash;79. \u003c/li\u003e\n\u003cli\u003eBurger PHM, Scholz M. Gender as an underestimated factor in mental health of medical students. Ann Anat - Anat Anz. 2018 Jul 1;218:1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eEntwurf eines Gesetzes zur St\u0026auml;rkung der Gesundheitsf\u0026ouml;rderung und der Pr\u0026auml;vention (Pr\u0026auml;ventionsgesetz \u0026ndash; Pr\u0026auml;vG) [Internet]. Nov 3, 2015. Available from: https://dserver.bundestag.de/btd/18/042/1804282.pdf\u003c/li\u003e\n\u003cli\u003eTsouros AD, Dowding G, Thompson J, Dooris M. Health promoting universities: concept, experience and framework for action [Internet]. World Health Organization. Regional Office for Europe; 1998 [cited 2025 Jan 2]. Available from: https://iris.who.int/handle/10665/108095\u003c/li\u003e\n\u003c/ol\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-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"self-rated health, mental health, depressive symptoms, social support, university students","lastPublishedDoi":"10.21203/rs.3.rs-5863692/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5863692/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Mental health problems have been shown to be prevalent among university students, with stress, depression and anxiety symptoms having a strikingly negative impact. Factors such as gender and social support have been considered important factors for mental and self-rated health. The present study aims to report on the mental and self-rated health of students at two universities within the Berlin-Potsdam metropolitan area (Germany) and to investigate potential associations between social support, self-rated health and depressive symptoms in these two samples.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Students from two universities and different faculties participated in an online-survey reporting on their self-rated health, depressive symptoms and social support. To analyse differences between the two samples we conducted chi square tests for categorical variables, t-tests for continuous variables, and Mann-Whitney U tests for non-normally distributed continuous variables. We also used multivariate linear regression models for the two samples separately to investigate the association of the two health indicators with social support while accounting for relationship status, living situation (living alone yes/no) and gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 31% of students (27% to 36% in our two samples) reported depressive symptoms above the clinically relevant threshold. Increased depressive symptoms (β=-.317, p\u0026lt;.001; β=-.326, p\u0026lt;.001) and lower overall health (β=.222, p=.003; β=.176, p=.008) were associated with fewer social support in both samples. Female gender was associated with higher depressive symptoms (β=.207, p\u0026lt;.001) and lower overall health (β=-.231, p\u0026lt;.001) in one sample; gender did not have a significant effect in the other sample. Relationship status and living situation did not show a significant effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: With roughly a third of students reporting depressive symptoms at both study sites, our data supports the notion that mental health difficulties are a critically relevant topic for universities. We recommend that universities actively provide the infrastructure needed and anchor them in the core budget in order to promote studyability, social support and mental health amongst their students. We also recommend acknowledging gender sensitive aspects in mental health promotion.\u003c/p\u003e","manuscriptTitle":"What is the impact of social support on self-rated health and depressive symptoms in university students: a survey study in two German universities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-07 12:01:39","doi":"10.21203/rs.3.rs-5863692/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-19T02:22:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-13T15:02:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2880635630680539853634108173500129865","date":"2025-03-02T09:54:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-27T14:28:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211669637529759673983644734920402302792","date":"2025-02-19T07:34:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-03T01:50:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-03T01:42:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-30T02:50:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-29T09:19:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-01-29T09:18:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"912f570b-ef4b-4f7e-9723-1adf3b00a7b1","owner":[],"postedDate":"March 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:04:50+00:00","versionOfRecord":{"articleIdentity":"rs-5863692","link":"https://doi.org/10.1186/s12889-025-23362-3","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-07-03 15:56:58","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2025-03-07 12:01:39","video":"","vorDoi":"10.1186/s12889-025-23362-3","vorDoiUrl":"https://doi.org/10.1186/s12889-025-23362-3","workflowStages":[]},"version":"v1","identity":"rs-5863692","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5863692","identity":"rs-5863692","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}