Background and Objective: University students are generally vulnerable to mental health problems. This vulnerability was further exacerbated by the COVID-19 pandemic as students experienced restrictions in public and academic life. The aim of this study was (1) to describe students’ perception of study conditions, (2) to identify study conditions that may be associated with symptoms of anxiety and depression, and (3) to analyse the use of counselling services at universities during the pandemic. Methods: The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) was conducted at five universities in Germany in autumn 2021 (N=7,267). Descriptive analyses were performed to describe students’ perceived study conditions, self-rated mental health and counselling utilisation patterns. Additionally, linear regression models were applied to analyse the associations between study conditions and mental health outcomes. Results: More than one third of the students felt burdened by their study conditions: 44.1% indicated that they were less aware of what was expected of them in their study modules during the pandemic and 39.6% reported that their workload had significantly increased since the first COVID-19 outbreak. A total of 42.4% of university students reported feeling down, depressed, or hopeless and 44.5% that they felt nervous, anxious or ‘on edge’ several days per week. Higher academic stress and dissatisfaction were associated with depressive symptoms and anxiety. Only 7.1% indicated that they had utilised counselling services. Those who had were more likely to be female, enrolled in a Bachelor’s programme, and had more than one reason for utilisation. Conclusions: Our research underlines the need for universities to review their study conditions and to provide targeted counselling services and intervention strategies to promote students’ mental well-being.