Abstract
BACKGROUND: The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed. AIM: We aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country. METHODS: A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022. RESULTS: The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms. CONCLUSION: The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population.