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The aim of this review was to synthesize extant literature concerning the prevalence of mental health problems among Italian university students seeking psychological help in university counseling services (UCS) and the effectiveness of these interventions. A systematic search was conducted on main scientific databases following the PRISMA guidelines. Using the PICO method, the study included research on college students seeking psychological help through UCS (P), focusing on psychological interventions delivered by UCS (I), examining the prevalence of psychological problems and/or the effect of UCS intervention on symptoms of mental health issues as (primary or secondary) outcome (O). Class comparisons (C) did not apply to this study. Studies excluded consisted of non-peer-reviewed journal articles, qualitative studies, or publications that reported only descriptive or not fully relevant information. The systematic search was conducted on the PsycInfo, PsycArticles, PsycCRITIQUES, PubMed, Web of Science and Scopus databases up to December 17, 2023. The data was organized in a narrative synthesis. Finally, the review was registered on OSF (osf.io/t2y9q). Study quality was assessed using a modified Newcastle-Ottawa Scale. Thirty-six studies were found to meet the inclusion criteria for a total of 7,432 participants (5,390 female, 6,625 accessing UCS). Most studies (n = 21) had a pre-post intervention design, followed by cross-sectional (n = 12) and case-control (n = 3) designs. Data from the period between 1983 and 2022 were collected (n = 7 studies focused specifically on the COVID-19 pandemic period), primarily using self-report measures. Students attending UCS exhibited significant psychological distress (63.2-92.7 %), various psychopathological symptoms, and poor psychological functioning, including depressive symptoms (9-30 % up to 48.9 %) and anxiety symptoms (11.2-36 %). Studies (n = 21) testing the effectiveness of counseling intervention showed that treatment was helpful in improving students' mental health, regardless of the approach employed. Limitations in the examined studies' design (e.g., heterogeneity in studies outcomes and measures, small sample size, self-reported data, low methodological quality) should be addressed in future research to obtain a more comprehensive picture on the topic under investigation. The high levels of psychological problems and psychopathological symptoms found in students attending UCS support the need of mental-health promotion activities. Counseling interventions seems to be an effective first-line service for university students experiencing psychological problems.
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