Mental health on campus: mapping risk behaviours to safeguard student well-being

Abstract Background Mental health issues among university students represent a rising public health concern across Europe. While psychological distress is increasingly reported, the role of behavioural risk factors, such as physical inactivity, poor sleep, and digital overexposure, remains insufficiently addressed in surveillance systems. There is a pressing need for multidimensional tools capable of capturing both mental health symptoms and modifiable lifestyle determinants. Methods As part of the Italian initiative “Health Mode On”, funded by the Ministry of University and Research (Decree No. 1159, 23 July 2023 - PROBEN call), the WMH-ICS survey (World Mental Health International College Student) was translated, culturally adapted, and expanded through an eDelphi process involving experts in public health, psychiatry, psychology, and education. The enhanced instrument includes domains on sleep, diet, physical activity, substance use, academic stress, and digital behaviours. A pilot cross-sectional study was conducted among 814 students from 12 university colleges in Pavia. Results Clinically relevant psychological distress was reported by 43.2% of participants, with a high prevalence of loneliness (36.8%) and hopelessness (17.7%). Multivariable analyses revealed significant associations between poor mental health and behavioural factors such as low physical activity and poor sleep quality (adjusted OR range: 0.44-0.66). Conclusions The expanded WMH-ICS tool offers a robust framework for integrated surveillance of student mental health and lifestyle patterns. By capturing behavioural determinants, it enables universities to design targeted, evidence-based interventions. Promoting mental well-being through behavioural health strategies is essential to reducing inequities and fostering resilience in higher education settings. Key messages • Integrated mental health and lifestyle surveillance can help universities identify at-risk students and design targeted prevention strategies based on modifiable behavioural factors. • Addressing sleep, physical activity, and digital habits is key to promoting resilience and mental well-being among university students and reducing health inequities across academic settings.