Introduction: University students are at high risk for loneliness with a potential negative impact on health. The COVID-19 measures disrupted students’ academic routine and social life, which might have affected their perception of loneliness. This study investigated the prevalence of perceived loneliness among university students in Germany during the COVID-19 pandemic and its associations with mental health, behavioral outcomes, and sociodemographic characteristics.Methods: COVID-19 German student well-being study (C19 GSWS) collected data from five German universities from October 27th to November 14th, 2021, resulting in a sample of 7,203 respondents. Associations of loneliness with depressive symptoms, anxiety, social and physical activity, as well as sociodemographic characteristics, were analyzed using multivariable logistic regressions.Results: A total of 20.6% of students reported loneliness. Students with depressive or anxiety symptoms had more than eight- or sixfold odds, respectively, for reporting loneliness (depressive symptoms: OR = 8.29; 95% CI: 7.21–9.52; anxiety: OR = 6.48; 95% CI: 5.65–7.43) compared with students who did not report any symptoms. Students who were less physically active were more likely to experience loneliness compared with students who were more physically active (no moderate physical activity: OR = 1.39; 95% CI: 1.21–1.59; no vigorous physical activity: OR = 1.19; 95% CI: 1.04–1.36). We found no association between loneliness and social activity. However, loneliness was associated with being single (OR = 2.93; 95% CI: 2.55–3.36), living alone (OR = 1.31; 95% CI: 1.13–1.52), or having a temporary residency status in Germany (OR = 2.24; 95% CI: 1.65–3.04).Conclusion: Our findings highlight the importance of loneliness as a relevant factor associated with health. Further research is needed to determine potential protective factors to tackle loneliness and to investigate how study conditions at higher education institutions may affect students’ perceived loneliness.

Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.

In addition to the professional treatment of eating disorders, the use of self-help groups has become increasingly important. Social media offers new possibilities for self-help, not only as online groups but also in increased access to recovery stories of people with similar diseases. People with eating disorders use the internet and social media depending on their motivation in different ways. Eating disorder recovery stories on social media have not yet been systematically used in treatment as appropriate guidelines are still lacking. This study provides an initial insight into the possibilities of using social media for self-help for eating disorders. Due to the exploratory nature, a qualitative design was used, combining interviews with people who have a recovery account on Instagram (n = 6) and self-help experts (n = 2). The results show that recovery stories on Instagram could serve as door openers for further treatment, motivation for therapy, a first step towards behaviour change, and support for existing therapies. If affected people can cope with the self-protection strategies, they can use Instagram positively for themselves and their disease. Nevertheless, there is a risk of negative influence as well as a risk of content and time overload. Therapeutic personnel can use these results to improve existing support services.

Aims: Using a social-ecological perspective, this study aims to understand loneliness in university students by (1) assessing its prevalence, and (2) identifying inter-personal and organizational factors associated with loneliness during studies.Methods: Data from the StudiBiFra study, a cross-sectional survey among university students in Germany, were used. The sample consisted of 12,874 students from 7 universities, surveyed between May 2022 and March 2023 using the Bielefeld Questionnaire on Study Conditions and Mental Health. Hierarchical logistic regression was employed to examine the associations of individual, inter-personal, and organizational variables with loneliness.Results: A total of 28.2% of students experienced loneliness during their studies. Gender-diverse students (OR = 1.69; 95% CI: 1.04 – 2.73) and males (OR = 1.43; 95% CI: 1.26 – 1.63), as well as those with poor subjective overall health (OR = 2.62; 95% CI: 2.26 – 3.05), were at high risk of feeling lonely. At the inter-personal level, positive social relationships among students acted as a protective factor against loneliness (OR = 0.31; 95% CI: 0.29 – 0.34). At the organizational level, weak connectedness to the university was positively associated with loneliness (OR = 1.43; 95% CI: 1.23 – 1.67), while high university engagement was negatively associated with loneliness (OR = 0.90; 95% CI: 0.83 – 0.97). Students enrolled in universities of applied sciences were less likely to experience loneliness compared to those at universities (OR = 0.76; 95% CI: 0.63 – 0.91).Conclusions: The findings underscore the importance of both individual and institutional efforts to address loneliness at German universities, a demand that was accelerated during and after the pandemic. Promoting social connections and strengthening students’ ties to their university are important strategies for combating loneliness, highlighting the importance of community-building health promotion.

Aim: Discrimination is associated with poorer well-being and academic performance among university students. Loneliness during the study period may further undermine psychosocial well-being and academic development. This research examines how discrimination within the study environment, by fellow students or lecturers, is associated with loneliness, identification with university, and worsened academic achievement among university students in Germany. It also explores the role of loneliness as a moderator. Subject and methods: We analysed cross-sectional data from the Survey on Study Conditions and Mental Health of University Students (StudiBiFra) survey ( n = 24,533), conducted across 13 German universities between 2021 and 2023. Perceived discrimination by lecturers and fellow students was assessed separately. Self-reported outcomes included loneliness, identification with university, and academic achievement. Multivariable logistic regression models were applied, adjusting for sociodemographic factors to account for the diversity of the sample. Moderation analyses assessed whether associations differed by loneliness. Results: Perceived discrimination within the study programme, by lecturers and fellow students, was significantly associated with higher odds of loneliness, no identification with university, and worsened academic achievement. Associations were generally stronger for discrimination by fellow students. Gender-diverse students showed higher odds, whereas students aged over 40 years had lower odds across outcomes. Loneliness did not moderate the relationship with academic achievement but moderated the association with identification with university, with weaker associations among lonely students. Conclusion: Perceived discrimination within higher education is closely linked to students’ psychosocial well-being and academic outcomes. Our findings highlight the role of university environments in shaping inequalities and underscore the need for structural and institutional strategies that address discrimination and promote inclusive and supportive study conditions.