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

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

Background Anxiety is widespread among university students. The COVID-19 pandemic af-fected students’ mental health negatively. Given the long duration of the pandemic monitoring mental health remains important. This study aims to determine to which extent anxiety is preva-lent among students (1), what factors are associated with it (2) and which student groups are mostly affected (3). Methods The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) sur-veyed mental health and well-being of students at five universities in Germany from 27.10.-14.11.21. Anxiety was assessed using the GAD-2. Associations between anxiety and sociodem-ographic, socioeconomic/social support factors as well as health- and COVID-19-related factors were determined using multiple binary logistic regression models. Results The mean age of students was 24.1 years (SD = 4.9), 67% were women and 31% men. The prevalence of anxiety was 32% and diverse gender (OR = 3.98, 95% CI: 1.71-9.23), a com-plicated relationship status (OR = 1.66, 95% CI: 1.06-2.60), the lack of a confidant (OR = 2.50, 95% CI: 1.80-3.46), and financial difficulties (e.g., being able to cover monthly expenses; OR = 1.76, 95% CI: 1.36-2.29) were associated with anxiety. Participants who were worried about (re)infection with COVID-19 had a 1.28-times higher chance (OR, 95% CI: 1.03-1.59) for anxie-ty. Students who were (rather) not worried that a relative would become severely ill with COVID-19 had a lower chance to experience anxiety (OR = 0.72, 95% CI: 0.53-0.98) as well as those who were confident receiving medical care in case of an infection with COVID-19 (OR = 0.80, 95% CI: 0.65-0.98). Conclusions Concepts for prevention and counselling in terms of mental health problems in students should be developed considering specific stressors due to the pandemic. Key messages • This study shows that anxiety is widespread among university students and associated with a variety of stressors. • The findings can help to develop specific concepts for prevention and counselling.

Background Students faced unique challenges during the COVID-19 pandemic that may have affected their financial situation as well as their mental health. This study sought to examine whether changes in financial situation before and during the COVID-19 pandemic were associated with depressive symptoms among German university students. Methods The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS; N = 7,267) was implemented at five German universities between 27.10. and 14.11.2021. Students were asked if they had had sufficient financial resources to cover monthly expenses before the pandemic, as well as during the first and third waves of the pandemic. Depressive symptoms were assessed using the CES-D 8 (score ranges 0-24) and the PHQ-2 (0-6); higher scores indicating more severe depressive symptoms. Linear regression models were used to examine associations between variables. Results A worsened financial situation between the first and the third wave of the pandemic was associated with a one point (0.95) increase on the CES-D 8 scale (95% CI: 0.61, 1.29) and an improved financial situation with a decrease by 0.81 points (95% CI: -1.20, -0.42). A worsened financial situation was associated with a 0.26-point increase in PHQ-2 (95% CI: 0.14, 0.37) and an improved financial situation with a -0.12-point decrease (95% CI: -0.25, 0.01). Similarly, worsened financial situation in the third wave compared to prior to the pandemic, was also associated with an increase in CES-D 8 score and PHQ-2 and an improved financial situation with a decrease in CES-D 8 and PHQ-2. Conclusions Our findings suggest associations between students’ financial situation during the COVID-19 pandemic and their mental health. Due to their instable financial situation, students are a vulnerable group in need of mental and financial support during pandemic crises. Key messages

Introduction Vaccination behaviour is influenced by various determinants. Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of complications compared to the general population in Germany. However, little is known about other COVID-19-related determinants for the population of German university students. This study aimed to investigate determinants of vaccination behaviour among German university students. Methods The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities at the end of 2021 via an online survey (n = 7.267). Multiple logistic regressions were calculated to examine associations of vaccination behaviour (not vaccinated vs. fully vaccinated) and attitudes towards vaccination (5Cs: confidence in the safety of the vaccine, complacency - not perceiving diseases as high risk, constraints - structural and psychological barriers, calculation - engagement in information seeking, collective responsibility - willingness to protect others), health literacy in a pandemic (CHL-P), and additional determinants. Results All 5Cs were associated with the vaccination status ‘fully vaccinated’, except for complacency. Regarding CHL-P, we found that students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had a higher odds for being vaccinated (OR = 3.02; 95% CI: 2.26-4.04). Regarding additional determinants, the analysis revealed that students who had been previously infected had in all regressions a lower odds for being vaccinated compared to students with no previous infection. Conclusions Due to the strong association of the attitudes towards vaccination and vaccination behaviour among university students, we recommend that the different components of the 5Cs should be considered in future COVID-19 vaccination campaigns in the university context. Key messages