Background: The mental well-being of university students has become a significant concern for public health. On the one hand, the transition to university often leads to increased social and academic pressures, along with significant lifestyle changes, potentially exacerbating psychological distress and mental health disorders. On the other hand, several clinical conditions,  including anxiety and depressive symptoms, as well as attention-deficit/hyperactivity disorder (ADHD) could affect students’achievements. The COVID-19 pandemic has further worsened students' mental health vulnerabilities due to restrictions enforcing online learning and self-isolation. Taking into account the organizational and individual barriers to help-seeking, digital technologies might represent useful options to address students’ mental health needs in terms of accessibility, and cost-effectiveness. Even though many patterns are consistent across countries, variations in students' mental health may arise when cultural and social differences are considered. Thus, the overall aim of this study was to assess mental health among students from the University of Milano-Bicocca (Italy) and the University of Surrey (United Kingdom) and to explore associated factors. Furthermore, the study examined students’ perceptions about the impact of the pandemic and the use of digital interventions for mental health support.

More in detail, the project encompassed five studies. The first qualitative study (1) aimed at providing Unimib and UoS students’ perspectives on mental health during the pandemic, as well as at informing the content of the online survey. The subsequent quantitative study (2) aimed at assessing mental health among students from Unimib and UoS and at exploring associated socio-demographic and psychological factors using a survey design informed by individual in-depth interviews. The third quantitative study (3) focused on assessing the relationship between ADHD, poor academic performance, anxiety and depressive symptoms. The fourth qualitative, along with the fifth study (4,5) aimed at gaining knowledge on factors and domains that could represent the key characteristics of potential digital preventive interventions to improve students’ mental health and psychological well-being.

Methods: For the purpose of the qualitative component (1,4), in-depth interviews were conducted and thematically analyzed to provide a range of perspectives on and experiences of mental health and university students. Qualitative data helped to develop a students’ survey, including clinical assessment, and conducted using a longitudinal design across different waves (quantitative component; 2,3). A baseline online survey collected data between March and April 2022. Two waves were carried out in October-November 2022 and March-April 2024.

Finally, we performed a systematic review of randomized controlled trials (RCTs) testing digital mental health interventions for anxiety and depression in university students during the COVID-19 global emergency, both synthesising the available evidence on their efficacy and assessing its quality (5).

Results: According to in-depth interviews (N = 33; 18 Italy; 15 UK), COVID-19 restrictions increased anxiety, through several putative mechanisms, such as loneliness, excessive online time, poor time management, and students-institutions difficult communication, particularly affecting freshers, international students, and those on the extremes of the introversion/extroversion spectrum. Effective coping strategies included a healthy use of free time, interactions with family, as well as mental health support. Italian students were more affected by academic issues, while UK students experienced a greater loss of social connectedness (1). The baseline data from the survey identified anxiety and depressive symptoms, followed by eating disorders and mood swings, as the most common conditions among students from Italy (N = 1,975) and the UK (N = 612), with mental health outcomes being related to poor academic performance and infrequent social interactions. After a longer period of time since the pandemic (T1), nearly all the assessment scores began to decline, suggesting a decrease in symptoms, as well as lower feelings of loneliness among students. Cultural and lifestyle differences influenced the complex relationship between mental health, loneliness, social interactions, and academic pressure (2). ADHD symptoms also affected academic achievements, partially mediated by depression (3). Digital technologies, namely social media, apps, and podcasts were seen as beneficial for mental health support due to their accessibility and anonymity, despite some limitations, which lean towards a multi-modal approach (4). Finally, digital cognitive behavioural therapy, dialectical behaviour therapy, and mind-body practices showed effectiveness for anxiety, while digital positive psychology and mindfulness had mixed results. For depression, dialectical behaviour therapy and positive psychology showed some efficacy (5). Overall, digital interventions appeared to be able to support student mental health, though more high-quality research is needed (4,5).

Conclusions: This study emphasizes the psychological burden among university students, characterized by high levels of anxiety and depressive symptoms. Academic pressure and changes in lifestyle and social interactions could lead to loneliness and poor mental health. Interventions targeting communication, degree programme organization, and university social experience are crucial to support students’ well-being. Further research is needed to provide additional insight into this field taking into account national cultural specificities.