Psychological counselling services at a Southern Italian university: utilization rates and characteristics of university students asking help

Gaia Caldarelli1, Barbara Pizzini2, Marina Cosenza1, Gaetana Affuso1, Alda Troncone1

1Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy; 2Department of Psychology, Telematic University “Giustino Fortunato”, Benevento, Italy.

Summary. Aim. To assess the utilization rate of a university psychological counselling center in Southern Italy, a retrospective analysis of data collected from September 2018 to December 2023 was conducted. Method. Data were gathered through an online questionnaire, which was distributed to students seeking psychological help (SH) from University Counselling Service (UCS) at their first contact with the service. Results. The frequency of contacts with UCS (n=639) and the number of SH students who received psychological counselling (n=503) significantly differed over a 6-year period, with the highest number of interviews delivered after the Covid-19 pandemic (contacts: χ2=84.814, p<.0001; interventions: χ2=25.161, p<.0001). More than 40% of the SH students were medical students, followed by approximately 32% of students attending psychological courses. Differences were found across years in the type of course attended by SH students (χ2=54.323, p<.0001) and in dropout rates (χ2=24.427, p<.0001). Discussion and conclusions. The significantly higher demand for psychological help confirms the increased psychological distress in university students. The shift to online modalities and the broader dissemination of mental health literacy, particularly in the aftermath of the Covid-19 outbreak, may explain the significant increase in service utilization rates. These findings highlight the need for timely interventions to address the needs of SH students.

Key words. Covid-19, psychological counselling, students, students’ mental health, university.

Il servizio di counselling psicologico presso un’università del Sud Italia: tassi di utilizzo e caratteristiche degli studenti che richiedono aiuto.

Riassunto. Scopo. Allo scopo di analizzare i tassi di utilizzo di un servizio universitario di counselling psicologico presso un ateneo del Sud Italia è stata condotta un’analisi retrospettiva di dati relativi al periodo settembre 2018-dicembre 2023. Metodo. I dati sono stati raccolti attraverso un questionario online, somministrato agli studenti al momento del primo contatto con il servizio di counselling. Risultati. Nel corso dei 6 anni considerati la frequenza dei contatti (n=639) e il numero degli studenti che hanno ricevuto supporto (n=503) sono risultati aumentati, con un numero maggiore di colloqui svolti dopo la pandemia di Covid-19 (contatti: χ2=84.814, p<.0001; interventi: χ2=25.161, p<.0001). Più del 40% degli studenti è risultato afferire ai corsi di medicina, seguiti dal 32% di studenti di psicologia. Sono state, inoltre, rilevate differenze nei corsi di provenienza degli studenti richiedenti aiuto (χ2=54.323, p<.0001) e nei tassi di dropout (χ2=24.427, p<.0001). Discussione e conclusioni. L’aumento delle richieste di supporto psicologico conferma l’incremento dello stress riportato dagli studenti universitari negli anni recenti. Ciò potrebbe essere dovuto al passaggio alla modalità online e all’ampia diffusione di conoscenze sulla salute mentale, specialmente dopo la pandemia di Covid-19. Questi risultati sottolineano la necessità di interventi tempestivi per rispondere ai bisogni degli studenti.

Parole chiave. Counselling psicologico, Covid-19, salute mentale degli studenti, studenti, università.

Introduction

In recent years, both national and international studies have increasingly recognized university students as a population at heightened risk of psychological distress1-5. There is a general consensus that the transition to university life and the challenges of emerging adulthood6 may make students more vulnerable to mental health problems7,8.

The post-Covid-19 pandemic era has seen a surge in psychological problems among university students, as well as a rise in psychopathological symptoms9-11. Unsurprisingly, recent investigations into the mental health status of university students who sought help at University College Services (UCS) have revealed high rates of psychological problems12-14. According to a recent review15, Italian students seeking psychological help (SH) in UCS have shown high rates of distress (ranging from 63.2% to 97.2%), along with poor general functioning and symptoms of depression and anxiety (respectively 9% to 30% and 11% to 36%).

Given the significant impact of mental health issues on students’ learning and academic performance16,17, it is crucial not only to continuously monitor the prevalence and incidence of psychological counselling requests, but also to recognize potential shifts in students’ needs over time. This is essential for providing timely and effective support while addressing evolving mental health challenges among students facing the many and diverse tasks of university life.

In the last years, Italy has witnessed a noticeable increase in the number of UCS, as highlighted by recent studies4,18. Most Italian researchers have analyzed the effectiveness of counselling interventions, focusing on the analysis of improvements in students’ psychological problems following psychological consultations19,20. UCSs have demonstrated efficacy in improving students’ mental health, regardless of the approach or methodology used, highlighting their pivotal role as a first-line service for the Italian university students15.

However, to the best of our knowledge, little attention has been given in these studies to examining trends in UCS demand over time or the characteristic of SH students.

The present study aims to describe the experience of UCS at the University of Campania “Luigi Vanvitelli”. Specifically, the study’s objectives are to:

• analyze service utilization rates over a six-year period, providing a comprehensive overview of yearly trends;

• describe the characteristics of SH students, focusing on socio-demographic and academic features.

Method

Study design, sample, and procedure

This cohort study quantified the trend in the utilization of psychological counselling services (SAPS) at a large university in Southern Italy. The University of Campania “Luigi Vanvitelli” consists of 16 departments, covering fields such as Architecture, Engineering, Mathematics, Psychology, Political Science, Biological and Pharmaceutic sciences, Economics, Medicine, Law, and Humanities. The number of students enrolled each academic year exceeds 22,00021. The SAPS is available free of charge to all students enrolled in the university and offers four weekly sessions. A retrospective analysis of data collected among University of Campania students who contacted SAPS from September 2018 to December 2023 was conducted, with no exclusion criteria applied. Data were collected using an online questionnaire (Google Form) administered to the SH students during the first contact with the service. The questionnaire comprised three sections. In the first section, participants were informed about the study, privacy protection measures, and were asked to provide digital informed consent. The second section included questions about demographic and academic data (i.e., type of course attended, delayed student). The third section included measures assessing psychological distress (using the Clinical Outcomes in Routine Evaluation, CORE-OM22), psychological problems (measured through the UCLA Loneliness Scale-3, UCLA LS-323, and the Difficulties in Emotion Regulation Scale, DERS24) as well as service satisfaction. The results presented in this study are based on the analysis of data from section 2. The study adheres to the principles of the Helsinki Declaration and received approval from the ethical committee of the authors’ institution (no. 08, 09/03/2021).

Data analysis

Descriptive analysis of socio-demographic and academic data was conducted. Intergroup mean comparisons were performed using one-way ANOVA test, while categorical variables were compared using Chi-square (χ2) test (Adjusted Standardized Residuals, ASRs, used to identify groups responsible for significant difference). All analyses were conducted using Excel and SPSS v. 27 for Windows. A two-tailed p-value <.05 was considered statistically significant.

Results

Service use rates across 2018-2023

SAPS utilization rates from 2018 to 2023 are shown in Figure 1.




The frequency of contacts with UCS significantly differed over time (χ2=84.814, p<.0001), with a total of n=639 students accessing the service across a span of almost six years. The observed rates indicate a notable upward trend in the annual percentage of students contacting the SAPS, particularly evident in 2023 (ASR=2.9), reflecting an approximately 288% increase from 2018 to 2023. Likewise, there were significant changes over time in the number of SH students who received psychological counselling (n=503, χ2=25.161, p<.0001) and, consequently, in the total number of interviews conducted (n=1832, χ2=87.751, p<.0001). Dropout students’ frequency differed over time (χ2=24.427, p<.0001), with a notable increase observed across years, particularly evident in 2023 (ASR=3.7). Moreover, regarding frequency of interviews, n=426 students completed the four-sessions psychological counselling, n= 31 underwent three interviews, n=12 had two interviews and n=11 underwent only one interview. Additionally, n=23 did not have any interview because they were assigned to a psychologist but chose not to start the psychological intervention.

Characteristics of students seeking psychological help

The distribution of SH students’ demographic and academic data, along with comparisons across studied years, are shown in Table 1.




 Out of n=503 SH students who underwent psychological counselling, n=353 (about 70.2%) were female. No significant differences in male:female ratio and mean age (m/f: χ2=3.691, p=.595; age: F=.844, p=.498) were observed across years. However, frequencies of delayed SH students significantly differed over time (χ2=71.536, p<.0001), decreasing in 2021 (ASR=-2.2) and increasing in 2022 (ASR=5.9). More than 40% of the SH students were enrolled in medical courses, followed by students attending psychological courses (approximately 32%). Significant differences were observed over the study period in the distribution of SH students across different types of courses attended (χ2=54.323, p<.0001). Specifically, there was a notable increase in the number of students from Psychology from 2018 to 2019 (ASR=3.8). Conversely, there was a significant decrease in the number of students from Law, Economics, Engineering, and Architecture courses during the same period (ASR=-2.6), although the numbers of students from these courses increased in 2023 (ASR=2.4).

Discussion

The primary aim of this cohort study was to report the experience of a UCS at a large-sized Italian university. The study analyzed service utilization rates from 2018 to 2023 in the context of a multidimensional online survey focused on students’ psychological problems. In line with previous evidence indicating a higher demand for support services in recent years13, the present findings suggest a significant upward trend in both SAPS use rates and the prevalence of psychological counselling interventions over the six-year study period. These results are consistent with existing literature describing university students as experiencing increased psychological issues and a greater prevalence of mental health problems compared to other groups16,25. It is noteworthy that the highest number of contacts and psychological counselling interventions occurred after the Covid-19 outbreak, with notable increases observed in subsequent years (2020: n=77; 2021: n=112; 2022: n=109, 2023: n=119). This trend aligns with previous evidence demonstrating heightened psychological distress among students in the aftermath of the Covid-19 pandemic9-11, prompting them to seek psychological support from UCS more frequently. As noted in Italian research, the lockdown imposed significant burdens on Italian students, profoundly impacting their mental health and contributing to an increase in symptoms of depression and anxiety26. In this context, it is reasonable to assume that UCS served as a primary and easily accessible resource for psychological support.

However, when interpreting these trends, it is crucial to consider that starting from April 2020, the SAPS introduced the use of online psychological counselling. This shift in service delivery may have significantly contributed to the significant growth in the number of students who sought help. It should be noted that, according to recent findings27, students’ interest in online counselling interventions has been increasing, partly due to the perceived flexibility of this delivery method, which allows students to manage appointments and maintain contact with UCS more easily.

Therefore, it can be hypothesized that SH students find online counselling more accessible due to reduced travel time, more immediate access to psychologists, and a potential reduction in stress, especially for students experiencing difficulties with social interactions12,28. Similarly, it could also be hypothesized that the extensive communication about mental health problems during the outbreak29,30 may have contributed to the significant increase in the service utilization rates. The widespread promotion of mental health literacy during the Covid-19 pandemic may have in fact fostered people’s knowledge about how to manage mental issues, thereby reducing stigma and encouraging requests for professional help31,32. However, it should also be noted that alongside the increase in service utilization rates, there was a notable rise in dropout frequency across the years. These dropout rates, ranging from 4 % to 24%, are comparable to findings from previous Italian and international studies (20.9%33; 24.6%34; 15.9%35), indicating that the highest attrition frequency occurred in 2023, when psychological counselling was delivered in both in-person or online formats. In the same year, the highest difference between the number of contacts (n=190) and the number of psychological counselling interventions (n=119) was observed. Such results indicate that these issues need to be further explored.

Regarding the characteristics of SH students, it is noteworthy that the highest number of requests, consistent over 6-years period, came from female students. This result may be explained by previous findings indicating that women tend to experience lower emotion regulation, higher symptoms of anxiety and depression36, as well as less stigma toward mental health issues (compared to their male colleagues). These factors making them more inclined to engage in counselling interventions37. In contrast with some existing evidence suggesting higher psychological problems among undergraduate students16,38, the present results did not reveal any significant differences in the mean age of SH students across years. Instead, the frequency of delayed SH students significantly varied, displaying a fluctuating trend over time. Additionally, it is notable that most SH students were enrolled in Medicine courses, which aligns with findings from previous studies indicating that medical students have high rates of mental distress and are at increased risk of showing symptoms of depression and anxiety39,40. The differences observed across years in the types of courses attended by SH students highlight interesting shifting enrollment trends among SH students across various academic disciplines. These findings may be attributed, as discussed in relation to the increasing number of psychological interventions, to a combined effects of the spread of mental health literacy and problems, as well as of more flexible access to UCS, especially following the pandemic.

Limitations

There were several limitations to note in the present study. Firstly, despite the SAPS was established in 2005, research activities began later, limiting the measurement of UCS utilization trends to the period from 2018 onward. Additionally, the evaluation of the service lacked the analysis of specific socio-demographic and psychological data (e.g., reasons for consulting the UCS, concurrent psychopathological diagnoses). These data need to be examined in future studies to provide deeper insights into the service utilization rates, the characteristics of SH students and their needs. Furthermore, it is important to note that in 2018, only data from September to December were available. Additionally, future studies should explore the reasons behind counselling intervention contacts and dropout rates to provide a more comprehensive and representative investigation into the possible barriers to accessing UCS. Identifying concrete strategies tailored to address these barriers is crucial for enhancing the effectiveness of UCS services.

Conclusions

The present study underscores a progressive rise in student engagement with psychological help services. Despite providing a brief overview of the SAPS experience between 2018 and 2023, amidst the traumatic impact of the Covid-19 pandemic, this report has significant implications for the delivery of mental health services in universities. Specifically, the findings serve as a valuable reminder to academic, political, and scientific communities of the necessity to expand psychological support offerings in university contexts. Considering the influence of psychological distress on academic performance38, implementing the offer of psychological interventions to meet students’ needs during their university course can improve and optimize young adults’ academic achievement and, simultaneously, their degree of future professional satisfaction. To this end, dedicated assistance and appropriate mental treatment, including psychological consultation, psychotherapy, and digitally delivered options, should be made available according to the students’ psychological needs. In addition to counselling services, preventive interventions should be promoted, including mental health literacy initiatives to destigmatize mental health issues, thereby facilitating access to services and supporting students in facing and overcoming academic challenges.

Data availability statement: data is available upon reasonable request.

Conflict of interest statement: the authors declare they have no relevant financial or non-financial interest to disclose.

Acknowledgments: the authors gratefully thank all university students who agreed to take part in the investigation.

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