Associations between mental health and substance use in higher education students in Germany – a cross-sectional study

Background: Research has identified students as a high-risk group for both legal and illegal substance use. Various factors are associated with substance use among students, e. g. poor mental health. Therefore, this study aims to explore the associations between mental health and substance use among students in Germany.

Methods: The cross-sectional survey on “Study Conditions and Mental Health of Students (StudiBiFra)” assessed the frequencies of alcohol and tobacco consumption alongside the usage of (illicit) drugs among 14,592 participants (66.9% female, 69.4% aged 18-25) from 13 higher education institutions in Germany. Moreover, the study included items measuring mental health outcomes such as study-related anxiety and depressive symptoms. Multiple logistic regression models for each substance (adjusted for age, gender, field of study and university) were employed to determine associations between mental health and consumption.

Results: Findings indicated that 40.4% reported binge drinking at least once a month. Smoking (occasional or daily) was reported by 22.4% of students. Cannabis use within the past twelve months was reported by 20.1% of students, while 3.8% reported using MDMA, 3.7% cocaine, and 1.4% neuro-enhancers. 

Male students displayed higher odds of consumption across all substances compared with female students. Those in the 18-25 age group exhibited reduced odds for cannabis, cocaine, and tobacco use but had higher odds for binge drinking compared with their counterparts aged 26-30. Experiencing financial difficulties was associated with a higher likelihood of substance use (e. g. cocaine: OR = 2.78, 95% CI = 2.16-3.58), except for binge drinking. Students reporting cognitive stress symptoms were more likely to engage in all types of substance use (e. g. neuro-enhancer: OR = 1.40, 95% CI = 1.22-1.62). Similarly, students with study-related anxiety symptoms were more likely to engage in substance use, excluding neuro-enhancers (e. g. cannabis: OR = 1.23, 95% CI = 1.17-1.31). Lastly, depressive symptoms were associated with a higher likelihood of using tobacco (OR = 1.12, 95% CI = 1.04-1.21). However, students reporting feelings of exhaustion were less likely to use tobacco, MDMA and cocaine (e. g. MDMA: OR = 0.86, 95% CI = 0.79-0.94).

Conclusions: The study highlights the necessity for implementing substance use prevention programmes among higher education students in Germany due to the prevalent consumption of alcohol, binge drinking, and (illicit) drug use. Targeted interventions should address students’ specific challenges and promote a supportive environment for their mental health.