Institution-Level and Individual Factors Associated with Student Mental Health in Germany: A Multilevel Analysis of StudiBiFra Data.

While individual determinants of students' well-being are well established, less is known about the association with the institutional context. This study evaluates institutional-level factors associated with students' mental health while controlling for individual characteristics. The cross-sectional analysis used data from 12 German institutions (n = 13,715) collected in the StudiBiFra survey on study conditions and student mental health. Individual-level variables included gender, age, study subject group, and four mental health variables (general well-being, depressiveness, cognitive stress, and exhaustion). Institution-level variables comprised institution type, excellence status, multi-campus structure, size, and satisfaction with the quality of health promotion services. Multilevel binary logistic regression models were applied to examine associations between institutional characteristics and mental health outcomes, adjusting for individual factors. Students enrolled at universities of applied sciences showed a lower likelihood of reporting depressiveness and exhaustion. Higher levels of depressiveness and cognitive stress were observed among students at medium-sized institutions compared to small ones. Students not enrolled at institutions with excellence status had lower risks of depressiveness, stress, and exhaustion. Additionally, higher satisfaction with institutional health promotion services was associated with reduced odds of depressiveness. Institutional factors are related to students' mental health beyond individual characteristics, highlighting the need for a holistic, setting-based approach.