Abstract Background In recent years, studies have highlighted that stress levels among medical students are alarmingly high. The study aim was to examine how academic stress and depressive symptoms in medical students are affected by individual moderators (self-efficacy/optimism) and structural influencing factors (health promotion offers). Methods Data collection occurred at three measurement points during the first 1.5 years at a medical school in Germany [baseline measurement (BM; Winter 2019, 226 participants), follow-up measurement 1 (FUM1; Summer 2020, 106 participants) and follow-up measurement 2 (FUM2; Winter 2020, 107 participants)]. Cross-sectional and longitudinal analyses were conducted with the data of FUM1 and FUM2, BM being only cross-sectionally analyzed as a baseline measurement. Interactions were calculated cross-sectionally with multiple linear regressions, and longitudinally with mixed effects models. Results Academic stress was positively correlated with depressive symptoms cross-sectionally. In the longitudinal sample, optimism was found to moderate the association between academic stress and depressive symptoms, while the moderating effect of self-efficacy was found cross-sectionally for FUM2. “University sports offers” was the most-used health promotion offer for both FUM1 and FUM2. The other services, especially “psychological counseling”, were rarely used by the students. The prevalence of depressive symptoms increased during the study course (BM: 4.9%; FUM1: 25.5%; FUM2: 23.4%). Conclusion The increase of depressive symptoms linked to rising academic stress within the study course is alarming. Individual attributes such as optimism and self-efficacy have a moderating role on the relationship between academic stress and depressive symptoms and prevention offers may affect those individual attributes. .
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