Prevalence and factors related with depression in Iranian university students: a large sample cross-sectional study

Abstract Background Entrance into university brings about significant vicissitudes to living circumstances and often augments psychological pressure. Mental health challenges such as depression are probable if students are unable to cope with these pressures. Therefore, this study seeks to investigate the prevalence of depression and its associated factors among Iranian university students. Methods This online, cross-sectional survey was implemented in Iran between October 9 and November 22, 2024. A total of 2783 students contributed by completing the questionnaires. The instruments included the Patient Health Questionnaire (PHQ-9), the Perceived Stress Scale (PSS-4), the Generalized Anxiety Disorder Scale (GAD-7), the Oslo Social Support Scale (OSSS-3), and the Meaning in Life Questionnaire (MLQ). To determine the associated factors of depression, we performed both univariate and multivariate regression analyses. Results The occurrence of depression among students was 46.74%. Based on the findings, being older than 25 years ( OR : 0.59; 95% CI : 0.40–0.88; P : 0.010), having a moderate to good economic status ( OR : 0.62; 95% CI : 0.43–0.90; P : 0.013), moderate social support ( OR : 0.66; 95% CI : 0.52–0.84; P : 0.001), strong social support ( OR : 0.30; 95% CI : 0.15–0.59; P : 0.001), a regular sleep schedule ( OR : 0.42; 95% CI : 0.34–0.53; P < 0.001), sleeping 6 – 7 h per night ( OR : 0.61; 95% CI : 0.27–2.08; P : 0.014), sleeping 8 – 9 h per night ( OR : 0.66; 95% CI : 0.45–0.99; P : 0.049), and having a meaning in life ( OR : 0.45; 95% CI : 0.36–0.57; P < 0.001) were associated with a reduced risk of depression. Also, smoking ( OR : 1.39; 95% CI : 1.08–1.78; P : 0.011), substance use ( OR : 2.22; 95% CI : 1.12–4.42; P : 0.022), sexual abuse before puberty ( OR : 1.53; 95% CI : 1.10–2.13; P : 0.010), sexual abuse both before and after puberty ( OR : 2.40; 95% CI : 1.43–4.02; P : 0.001), moderate anxiety ( OR : 4.31; 95% CI : 3.15–5.89; P < 0.001), moderately severe anxiety ( OR : 25.33; 95% CI : 17.71–36.23; P < 0.001), severe anxiety ( OR : 94.02; 95% CI : 55.26–159.98; P < 0.001), moderate perceived stress ( OR : 2.06; 95% CI : 1.13–3.75; P : 0.017), and high-perceived stress ( OR : 3.91; 95% CI : 2.09–7.31; P : 0.001) were associated with a higher risk of depression. Conclusions There was a high prevalence of depression among students. The identified associated factors highlight the urgent need for comprehensive mental health strategies addressing the multifaceted nature of depression. A holistic approach—considering psychological, social, and environmental dimensions—is essential for preventing and managing depression in university settings.