Anxiety is a common mental disorder, with a prevalence of 301.4 million cases worldwide and 18.6 million cases in Brazil. Lifestyle factors are associated with mental disorders and are considered both risk factors and potential interventions. Understanding the lifestyle of those with anxiety symptoms, particularly young people, can guide the development of proper screening and approaches in this area.

Describe lifestyle characteristics of university students with anxiety symptoms and compare whether these characteristics differ between those with and without symptoms.

This cross-sectional study is part of the UNIversity students’ LIFEstyle behaviors and Mental health (UNILIFE-M) cohort investigating the associations between university students’ lifestyle behaviors and mental health symptoms. We used baseline data from participants from 13 federal universities in Brazil (2023 to 2024). Screening for anxiety symptoms was conducted with the Generalized Anxiety Disorder Questionnaire (GAD-7) (7-item, 0-21), where scores = 10 indicate the presence of symptoms. Lifestyle was measured using the Short Multidimensional Inventory Lifestyle Evaluation for University Students (U-SMILE) (24-item, 7-96), where higher scores indicate a healthier lifestyle across the seven domains (diet, substance use, physical activity, stress management, sleep, social support, and environmental exposures). Means and standard deviations were reported. We used different tests to compare the overall lifestyle and its domains between individuals with and without anxiety symptoms according to Levene’s test. The Mann-Whitney U test was used for substance use, social support, and environmental exposure domains and the Student’s t-test was used for the remaining domains.

We included 6371 undergraduate students (60.5% were female, mean age of 19.9 (±3.19) years). From total valid responses, 2834 individuals (49.9%) were screened positive for anxiety symptoms, with a total lifestyle score of 62.3 (±7.39). The highest-scoring domains were substance use, with a mean score of 15.2 (±1.38) out of 16 (95%), social support with 16.1 (±3.02) out of 20 (80.5%), and diet with 7.7 (±1.61) out of 12 (64.7%). In contrast, the lowest-scoring domains were stress management with 4.0 (±1.57) out of 8 (50%), environmental exposures with 8.7 (±2.17) out of 16 (54.3%), physical activity with 7.6 (±2.51) out of 12 (63.8%) and sleep with 7.6 (±1.99) out of 12 (63.8%). Students with anxiety symptoms presented a less healthy lifestyle compared to those without it (67.0; ±7.47). The mean difference in total lifestyle score was statistically significant (4.74; p < .001; 95%CI 4.34 to 5.13) with a moderate effect size (Cohen’s d = 0.638; 95%CI 0.58 to 0.69). Separately, significant differences were found in all domains except for stress management.

Students with anxiety symptoms had low lifestyle scores in the stress management, environmental exposures, physical activity, and sleep domains. Overall, their lifestyle was less healthy compared to individuals without anxiety symptoms.

Understanding the lifestyle characteristics of university students with anxiety symptoms in this sample may support the implementation of more targeted intervention strategies in the future.