Financial precarity and mental health among French health students: a nationwide cross-sectional study

Objectives This study aimed to describe the prevalence and determinants of financial precarity and examine its associations with mental health, healthcare avoidance and academic outcomes among French health students. Design Nationwide cross-sectional study based on an online self-administered questionnaire. Multivariate logistic regression models were used to identify factors associated with financial precarity. Setting All 34 French health universities. Participants A total of 12 565 health students participated, including medical (56%), paramedical (21%), midwifery, odontology, pharmacy or physiotherapy students (12%) and first-year health students (11%). Primary and secondary outcome measures Financial precarity was defined as an indicator combining financial insecurity, frequent overdrafts and foregoing essential purchases. Primary outcomes included depressive symptoms, anxiety and emotional exhaustion. Secondary outcomes included healthcare avoidance and academic outcomes. Results Among 12,565 respondents, 56% were medical students, 21% were paramedical, 12% midwifery, odontology, pharmacy or physiotherapy and 11% first-year health students. Financial precarity varies by academic fields of health, ranging from 4.6% in first-year health students to 12% in paramedical students. Adjusted analyses showed lower odds of precarity among medical (aOR=0.69; 95% CI 0.52 to 0.83), midwifery, odontology, pharmacy or physiotherapy (aOR=0.55; 95% CI 0.43 to 0.72) and first-year health students (aOR=0.54; 95% CI 0.38 to 0.77) than paramedical students. Risk factors included very low parental socio-economic status (aOR=2.96; 95% CI 2.33 to 3.89) and student loans (aOR=2.78; 95% CI 2.33 to 3.32). Financial precarity was strongly associated with depressive symptoms (aOR=4.90; 95% CI 4.13 to 5.80), anxiety (aOR=3.84; 95% CI 3.13 to 4.52), emotional exhaustion (aOR=8.49; 95% CI 5.98 to 12.06), renouncing healthcare (aOR=6.21; 95% CI 5.01 to 7.70) and repeating a year (aOR=1.80; 95% CI 1.54 to 2.10). Conclusions Financial precarity among health students is shaped by economic and academic factors, with family support protective of and low socio-economic background increasing vulnerability, and is associated with poorer mental health, reduced healthcare access and academic difficulties.