Depression and anxiety: A 3-year follow-up study of associated risk and protective factors among university students.

Background: Longitudinal research on anxiety and depression and associated factors in university students can guide public health policies.

Methods: Prevalence and incidence of probable Major Depressive Episode-MDE and Generalized Anxiety Disorder-GAD were estimated in a multicenter cohort study of first-year students from five Spanish universities. Web-based surveys were conducted at baseline, 12, 24, and 36 months using an adapted Composite International Diagnostic Interview-CIDI. Bivariate and multivariate associations with risk/protective factors were estimated using generalized estimation equation models. Sample weights addressed population distribution and loss to follow-up.

Results: A total of 2118 first-year students (55.4 % women; mean age = 18.8 years, SD = 1.4) completed the baseline survey. Nearly 40 % of the sample reported a lifetime mental health problem. Four-year period prevalence was 36.7 % for 12-month probable MDE and 31.3 % for GAD, with three-year cumulative incidence of 19.7 % and 15.9 %, respectively. Higher proportions were observed in women. Prior episodes showed strongest association with prevalent cases: MDE (adjusted Prevalence Ratio-aPR 1.35) and GAD (aPR 1.46); bipolar spectrum disorder (aPR 1.14) was significant for GAD, and GAD (aPR 1.07) for MDE. Recent breakups/arguments (aPRs 1.04-1.06) were risk factors for both. Parental support significantly protected against MDE, and peer support against GAD.

Limitations: Self-reported data, with limited survey participation and further losses during follow-up.

Conclusions: Probable MDE and GAD are common among students. Lifetime disorders, emotional abuse, and interpersonal stressors increased risk, while perceived family and peer support offered modest protection. Findings emphasize the importance of early screening and targeted prevention tailored to specific risk and resilience pathways.