Introduction:
The transition to university coincides with an adaptation to a different learning environment (LE), with new pedagogical, social and environmental settings that impact on the academic training, and also the emotional well-being of students. Studies have shown that health sciences students experience higher levels of psychological distress, however, investigation on the impact of LE has been limited. The aim of this study is to describe the perceived LE and its relationship with stress, depressive symptoms and well-being in first-year students of the Faculty of Health Sciences (FCS) of the Universitat Jaume I (UJI).

Methodology:
A cross-sectional study was conducted in first-year students of Medicine, Nursing and Psychology of the UJI (n=125, 80% female), between October-December 2023. LE perception was assessed using the Johns Hopkins Learning Environment Scale (JHLES), a 28-item instrument with 7 domains: peer community, faculty relationships, academic climate, meaningful engagement, mentoring, inclusion and safety, and physical space. Scales scores were dichotomised into unfavourable vs favourable perceptions, as suggested by the authors of the scale. Depressive and stress symptoms were assessed with the Depression, Anxiety, and Stress Scale (DASS-21). Each subscale has 7 items measured on a 4-point likert scale ranging from never to extremely severe. Emotional well-being was assessed with the World Health Organization-Five Well-Being Index (WHO-5) with 5 items rated on a 6-point scale. Low well-being was considered when any of the 5 responses was 0 or 1 point, as suggested by the authors of the scale. Descriptive and bivariate analysis was conducted. Logistic and ordinal regression models adjusted for gender, academic degree and sociodemographic variables were obtained.

Results:
Fifty-one percent of the participants showed unfavourable scores on overall LE, with a lower percentage in Medicine (29.0%), than in Psychology (68%) and Nursing (56%). A total of 36.8% showed low well-being. 30.9% and 28.3% showed moderate to very severe depression and stress scores, respectively. Students with unfavourable overall LE perception showed higher stress and depression and lower well-being scores compared to those with favourable perception, although statistical significance was only reached with well-being (stress, median(IR): 8[5] vs 7[7] points, p=0.085; depression, median(IR): 4[7] vs 3[5] points, p=0.114; well-being, median(IR): 52[33] vs 64[24] points, p=0.015). Regarding LE subscales, higher stress scores were observed in students with unfavourable perception of peer community and meaningful engagement. Lower well-being scores were observed in students with unfavourable perception of community of peers, faculty relationships and academic climate. Adjusted models showed no statistically significant association between global LE perception and outcomes. Less favourable perception of meaningful engagement (OR=3.99 IC95%1.45;10.98) and academic climate (OR=2.72 IC95%1.00;7.88) were associated with low wellbeing. Students with unfavourable perceptions of meaningful engagement showed higher risk of moderate to very severe stress symptoms (OR=2.3 IC95%: 1.06;5.19).

Conclusions:
Our study has shown that a less favourable perception of the learning environment, especially in components such as meaningful engagement and academic climate, could be related to symptoms of stress and lower well-being in first-year health science students.

Keywords: Learning environment, stress, depression, well-being.