Mental health in university students: an umbrella review grading the evidence for psychosocial interventions

QUESTION: Psychological distress is increasingly prevalent among university students, raising concerns about their mental health. This review aimed to assess the strength and credibility of evidence on the efficacy of psychosocial interventions for improving mental health in this population. STUDY SELECTION AND ANALYSIS: We conducted an umbrella review of systematic reviews (SRs) with meta-analyses of randomised controlled trials assessing psychosocial interventions among university students. Searches were performed in Medline, PubMed, Cochrane Central, PsycINFO, CINAHL, Epistemonikos and Campbell Collaboration from 1 January 2014 to 1 February 2026. Data on intervention type, comparator, outcome and study-level effect sizes were analysed using inverse-variance random-effects models with restricted maximum likelihood estimation of between-study heterogeneity (τ²). Strength of associations was evaluated according to umbrella review criteria, reporting quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). FINDINGS: A total of 34 SRs were identified. After excluding overlapping syntheses, 28 unique meta-analyses from 12 SRs were included. Mindfulness-based interventions versus inactive controls for distress (standardised mean difference (SMD) -0.40; 95% CI -0.53 to -0.28) showed highly suggestive evidence (class II; GRADE: low; AMSTAR: high). Seven associations provided suggestive evidence (Class III): mindfulness-based interventions versus inactive controls for anxiety (SMD -0.54; 95% CI -0.81 to -0.27) and depression (SMD -0.52; 95% CI -0.65 to -0.39); cognitive-based interventions versus inactive controls for anxiety (SMD -0.48; 95% CI -0.62 to -0.34) and depression (SMD -0.60; 95% CI -0.75 to -0.45); cognitive-based interventions versus active controls for well-being (SMD -0.30; 95% CI -0.42 to -0.18); positive psychology interventions versus inactive controls for distress (SMD -0.22; 95% CI -0.35 to -0.10); and multimodal interventions versus inactive controls for distress (SMD -0.85; 95% CI -1.32 to -0.87). The remaining associations were weak or non-significant, generally supported by low or very low certainty and mostly low or very low reporting quality. CONCLUSIONS: The most robust evidence emerged for mindfulness and cognitive-based interventions, with some support also for positive psychology approaches. These interventions appear to improve depression, anxiety, distress and well-being among university students, though further rigorous research is needed. PROSPERO REGISTRATION NUMBER: CRD42023493618.