The psychological wellbeing of university students has been a concern for many years worldwide (Campbell et al., 2022; Chaudhry et al., 2024; Duffy et al., 2019). The dual continua model of mental health assumes that psychological wellbeing and psychological distress are two related, yet distinct dimensions of a unique mental health continuum (Keyes, 2005). Both dimensions can coexist independently, allowing individuals to experience low distress alongside low wellbeing or, conversely, high distress alongside robust wellbeing (Iasiello and Van Agteren, 2020).

Since 1986, the World Health Organization (WHO) views “wellbeing” as more than the absence of illness (Keyes, 1998; Ryff, 1989), and the socio-ecological theory emphasizes the individual, social and environmental determinants of wellbeing (Reupert, 2017). Psychological wellbeing is often assessed through Ryff's Psychological Wellbeing Scale (PWBS; Ryff, 1989). Psychological wellbeing is a multidimensional concept stemming from positive psychology and encircling a positive state of health that enables individuals to excel across mental, physical, emotional, and social dimensions (Ryff and Singer, 2008; Niemiec, 2024). The six dimensions of Ryff's PWBS include Self-Acceptance, Positive Relationships, Autonomy, Environmental Mastery, Purpose in Life, and Personal Growth, reflecting a eudaimonic perspective focused on life perception rather than the hedonic focus on positive feelings (happiness, positive emotions, and life satisfaction). Clinical studies reported that higher PWBS scores are associated with lower levels of depression and stress, enhancing emotional regulation, and improving overall health outcomes, highlighting its restorative role in mental health (Klainin-Yobas et al., 2021; Lopes and Nihei, 2021).

On the other hand, psychological distress reflects negative states, such as anxiety, depression, or stress (Viertiö et al., 2021). It negatively impacts mental health and undermines psychological wellbeing, limiting an individual's ability to function, cope with challenges, and maintain a balanced, fulfilling life (Sharp and Theiler, 2018). Enrollment in university is a pivotal transition in a young person's life, marked by significant changes and high expectations. Challenges include adapting to various aspects of academic life, such as independent living, establishing new social networks, navigating diverse learning styles, and managing growing financial responsibilities, all of which can significantly affect overall mental wellbeing (Worsley et al., 2021; Teixeira et al., 2022). Recent epidemiological research indicates that university students frequently report symptoms of depression and anxiety, along with high levels of perceived psychological stress (Asif et al., 2020; Ochnik et al., 2021; Auerbach et al., 2018). For instance, a longitudinal cohort study conducted between 2013 and 2021, involving over 350,000 students, reported that more than 60% met the diagnostic criteria for at least one mental health disorder (Lipson et al., 2022). Similarly, a meta-analysis of 64 studies, which included 100,187 university students, estimated the prevalence of depressive symptoms at 33.6% and anxious symptoms at 39.0% (Li et al., 2022).

In recent years, there has been a steady increase in the number of students seeking help at University Psychological Counseling Services, and the concerns they bring have become increasingly severe (Salimi et al., 2023; Adachi et al., 2020). This growing need reflects both a reduction in the stigma surrounding mental health and an evolving recognition of the importance of wellbeing in academic environments (Priestley et al., 2022). Beyond addressing mental health concerns (Craig et al., 2023), University Psychological Counseling Services might play a key role in fostering positive dimensions, such as personal growth, resilience, and academic engagement. Regardless of the critical function of these services, there remains a notable lack of longitudinal research examining the interplay between risk factors (e.g., academic burnout, social isolation) or protective factors (e.g., resilience, self-efficacy, and social support) in this population (Broglia et al., 2021).

It has been suggested that academic engagement may serve as a risk or protective factor for psychological distress of university students (Vizoso et al., 2018). Academic engagement is recognized as a multidimensional construct including social, affective, and behavioral components (Fredricks, 2022). This concept plays a crucial role in shaping students' capacity to form meaningful relationships, remain committed to their academic journey, and integrate their university experience into the broader context of their lives. Strong connections with institutions, faculty, and peers are key drivers of academic success and persistence (Martinot et al., 2022). Fostering engagement not only reduces dissatisfaction and boredom, but also enhances motivation and academic performance, offering benefits for students facing psycho-social vulnerabilities (Freda et al., 2021). Thus, academic engagement is a crucial element in students' lives, affecting individual vulnerability and how one responds to environmental stressors. Moreover, sociodemographic variables such as socioeconomic status, gender, cultural background, and living arrangements further contribute to students' wellbeing by influencing their access to resources, support systems, and their ability to navigate academic and personal challenges potentially shaping their levels of psychological wellbeing (Fuentes et al., 2022).

Despite the growing recognition of the importance of wellbeing among university students, the literature review shows that research about students' mental health focuses mainly on negative aspects. Furthermore, to our knowledge, no studies investigated the effectiveness of psychological counseling interventions within the framework of the dual continua model of mental health, specifically examining academic factors among university students. Therefore, the hypotheses proposed in this study are grounded in the epistemological assumptions of the dual continua model of mental health (Keyes, 2005), which highlights the importance of assessing mental health not only by reducing distress or clinical symptoms, but also by promoting positive functioning and wellbeing outcomes. This model builds upon the eudaimonic approach to wellbeing proposed by Ryff (1989), which conceptualizes psychological wellbeing as a multidimensional construct. These dimensions offer a comprehensive understanding of mental health beyond symptom reduction and serve as the foundation for exploring the interplay between wellbeing and psychological distress.

Based on this theoretical framework, the first aim of this study is to explore the relationship between psychological wellbeing, academic engagement, and psychological distress in a broad sample of university students seeking help to the University Psychological Counseling Service. This framework is relevant for university settings, where the promotion of flourishing can impact students' ability to succeed academically and personally. Specifically, our pre-analyses conjectures are presented in Figure 1. We hypothesized that (a) psychological wellbeing would be positively related to academic engagement and negatively related psychological distress; (b) psychological wellbeing and academic engagement would influence psychological distress, while adjusting for the other confounders; and (c) academic engagement might mediate the relationship between psychological distress and psychological wellbeing.

Additionally, this study aims to assess the efficacy of counseling interventions in enhancing psychological wellbeing and alleviating distress among university students. Specifically, it will evaluate changes in these variables from baseline (T0) to post-intervention (T1), while examining the proportion of participants who meet clinical cut-off thresholds for psychological distress before and after the intervention.

In Table 1, the sociodemographic data and the mean scores for the predictor and outcome variables are presented.

A multiple regression analysis (Table 2) was conducted to examine the predictors of psychological distress. The Model indicated that 36% (R² = 0.363, p < 0.001) of the variance in the CORE-OM-total score was accounted for by Environmental Mastery (p = 0.037) and Self-Acceptance (p < 0.001). Both variables were negatively associated with psychological distress, with lower levels of Environmental Mastery and Self-Acceptance leading to higher levels of psychological distress.

Furthermore, a mediation analysis (Figure 2, Table 3) was conducted through the PROCESS macro (Model 4) to examine the direct and indirect effects of Self-Acceptance and Environmental Mastery on total psychological distress, with six dimensions of academic engagement included as potential mediators. The analyses revealed a significant direct effect of Self-Acceptance on psychological distress (CORE-OM-total), with higher levels associated with lower psychological distress (β = −0.0237, p < 0.001). The model explained 14.92% of the variance in CORE-OM-total score (R² = 0.1492, p < 0.001). Regarding the mediating variables, none of the engagement dimensions significantly mediated the relationship between Self-Acceptance and CORE-OM-total score. The total indirect effect was not significant. Similarly, none of the specific indirect effects through the engagement dimensions reached statistical significance. Self-Acceptance showed significant direct associations with the engagement dimensions such as Perception of the capability to persist in the university choice (p = 0.037), University value and sense of belonging (p < 0.0001), Value of university course (p < 0.0001), Relationships between university and relational network (p < 0.0001), Engagement with university peers (p < 0.0001), and with university professors (p = 0.0004); indicating that higher Self-Acceptance was positively linked to these aspects of engagement.

Female students reported significantly higher scores than males (Supplementary Table S2) in the Wellbeing Deficits subscale of the CORE-OM (p = 0.003). Regarding academic engagement (SAES), females scored significantly higher in the Perception of the capability to persist in the university choice (p = 0.002), University value and sense of belonging (p = 0.008), and Relationships between university and relational network (p = 0.022).

The CORE-OM-total score was significantly influenced by Environmental Mastery (p < 0.0001) score, showing a negative direct effect. The Environmental Mastery showed significant direct associations with all engagement dimensions: Perception of the capability to persist in the university choice (p = 0.02), University value and sense of belonging (p < 0.0001), Value of university course (p < 0.0001), Relationships between university and relational network (p < 0.0001), Engagement with university peers (p < 0.0001), and with university professors (p = 0.0004). However, indirect effects through the six engagement measures were not significant.

Regarding longitudinal data, at T0, most participants (84.4%) were classified as students who exceeded the clinical cutoff of CORE-OM-total, while at T1, 56.7% exceeded the cutoff (Table 4). A chi-square test revealed significant differences between students exceeding the cutoff at T0 vs. T1 (p < 0.001). Overall, the percentage of students who did not exceeded the cutoff increased from 15.6% at T0 to 41.9% at T1, while the percentage of students who exceeded the cutoff decreased from 83.9% at T0 to 43.3% at T1. This change indicates a shift in the classification of participants over time, suggesting a significant improvement in their clinical status following the psychological counseling sessions.

The paired samples t-test revealed significant differences across multiple measures assessed at the two distinct time points (Table 5). The Wellbeing Deficits scale showed a significant decrease from the first to the second assessment (p = 0.001). Similarly, the Problems/Symptoms scale demonstrated a significant reduction (p = 0.005). Life Functioning Difficulties also significantly declined (p < 0.001). Moreover, overall psychological distress (CORE-OM total) exhibited a significant decrease over time (p < 0.001).

Regarding the PWBS, the Autonomy dimension showed a significant increase between the two time points (p = 0.003). Likewise, the Self-Acceptance dimension increased significantly (p = 0.002).

The main aim of this study was to examine the association between psychological wellbeing and distress in university students approaching the University Psychological Counseling Service. By doing so, our goal was to further validate the relevance of the dual continua model of mental health (Kraiss et al., 2023), assuming the discriminant validity of psychological distress and mental wellbeing (Hides et al., 2020). Then, cross-sectional and longitudinal data were collected, and analyses were conducted to examine the interplay between academic factors, as well as to assess the efficacy of counseling interventions in enhancing psychological wellbeing and reducing psychological distress among university students.

The results of our study highlight the importance of considering both wellbeing and distress when evaluating students' mental health, particularly in the context of University Psychological Counseling Services. We found that psychological wellbeing significantly predicted psychological distress, with Self-Acceptance and Environmental Mastery emerging as key protective factors. Specifically, these dimensions were negatively associated with psychopathological symptoms, suggesting that students with a lower sense of self-acceptance and perceived control over their surroundings are more vulnerable to psychological distress. This finding is in line with previous research indicating that low levels of Self-Acceptance, or the ability to recognize and embrace one's own strengths and limitations, can reduce emotional resilience and increase vulnerability to anxiety and depression disorders (Faustino et al., 2020; Trompetter et al., 2017; Zimmermann et al., 2021). Environmental Mastery, or the perception of being able to effectively manage one's surroundings, contributes to develop a sense of competence and stability, further mitigating psychological distress (Buratta et al., 2023). These two dimensions appear to protect from mental health difficulties, reinforcing the need for university-based interventions focusing on students' capacity for self-reflection, adaptive coping, and proactive problem-solving (Haliwa et al., 2022; Moeller et al., 2022). However, it is important to acknowledge that our sample consisted exclusively of students from a single university, which limits the generalizability of the findings. Future studies should involve larger, multisite samples to enhance external validity.

In the theoretical framework of the scientific discourse on mental health, these findings support the dual continua model which posits that mental health is not merely the absence of psychological distress, but also the presence of psychological wellbeing. Clinical studies provided substantial evidence in favor of this model, highlighting impairments in wellbeing among individuals with mood and anxiety disorders (Blasco-Belled et al., 2021; Franken et al., 2018). Khumalo et al. (2022) provided evidence for the model through factor and latent class analyses, reinforcing the idea that psychological wellbeing and distress are distinct yet interrelated dimensions of mental health. Other studies have suggested that wellbeing and distress should not be viewed as opposite poles of a single continuum, but rather as coexisting constructs that can independently fluctuate (Westerhof et al., 2023; Yeo and Suárez, 2022). Opposing perspectives argued that psychological wellbeing and distress represent entirely separate constructs, questioning the applicability of the dual continua model and suggesting that wellbeing should be conceptualized as the mere absence of distress (Kent et al., 2025; Lamers et al., 2011). In this vein, Kraiss et al. (2023) reported that psychological distress and wellbeing are only moderately associated when examined within individuals, suggesting that the dual continua model might not be applicable for everyone. Thus, although the debate remains open regarding the relationship between psychological distress and wellbeing, the current study underscores the importance of considering positive psychological functioning as an interrelated indicator of mental health in relation to psychological distress. This perspective carries significant theoretical implications. Specifically, higher levels of Self-Acceptance and Environmental Mastery were associated with lower psychological distress, pointing to a meaningful connection between the two constructs without suggesting they are interchangeable. Moreover, the absence of a mediating effect and the persistence of distress in some participants, despite gains in wellbeing, indicate that these dimensions can coexist and evolve independently. This pattern supports the view that mental health involves more than the mere absence of symptoms and includes the promotion of positive psychological resources.

Contrary to our expectations, we did not find a significant direct relationship between the sub-dimensions of academic engagement and psychological distress. Furthermore, academic engagement did not mediate the relationship between psychological wellbeing and distress. One possible explanation for this outcome is that psychological wellbeing contributes to a student's overall functioning, while academic engagement may be influenced by additional factors beyond wellbeing (Ma and Bennett, 2021; Sadoughi and Hejazi, 2023). Engagement in academic activities may not be sufficient to buffer against psychological distress, particularly if students are experiencing external stressors, academic burnout, or underlying mental health conditions (Ugwu et al., 2013). This finding highlights the complexity of the relationship between wellbeing, engagement, and distress (Keyes, 2005; Suldo and Shaffer, 2008). While previous research has emphasized the positive role of engagement in promoting academic success (Upadyaya and Salmela-Aro, 2013), its direct impact on mental health may be more nuanced, potentially requiring additional mediating or moderating variables, such as resilience, social support, or intrinsic motivation (Yu and Chae, 2020). Each of these variables has demonstrated a strong relationship with student wellbeing and engagement in empirical research. Resilience helps students thrive despite stress (Pidgeon et al., 2014), supportive social networks protect mental health under pressure (Breitenstein et al., 2025), and intrinsic motivation fosters both engagement and emotional wellbeing (Passeggia et al., 2023; Qureshi et al., 2024). Future studies should explore these factors as potential mediators or moderators in the complex dynamics between academic engagement, wellbeing and distress.

Although sex was included as a covariate in the regression analyses and did not emerge as a significant predictor, we conducted additional exploratory comparisons to assess potential sex-based differences. Results indicated that female students reported higher levels of wellbeing deficits and greater academic engagement, particularly in persistence, sense of belonging, and relational connectedness. These findings are consistent with previous research suggesting that female students tend to report greater emotional distress (Graves et al., 2021; Vuelvas-Olmos et al., 2023), while also displaying stronger academic motivation and social integration (Wang and Zhang, 2024). This dual pattern may reflect sex-based differences in emotional coping, with women more likely to internalize distress while simultaneously engaging with support networks and academic goals. No statistically significant differences were observed in the PWBS scores. However, some dimensions such as Personal Growth, Positive Relations, and Purpose in Life showed trends toward borderline significance in favor of female participants. These findings partially align with prior studies reporting sex-based differences in wellbeing profiles, with men typically scoring higher in Self-Acceptance and Autonomy, and women in Personal Growth and Positive Relations (Matud et al., 2019). Research should further investigate sex-related variations in psychological wellbeing using adequately powered designs, as these distinctions may have important implications for targeted intervention strategies in university settings.

Longitudinal analyses were conducted to assess pre-post changes following the counseling intervention. The findings showed a significant reduction in psychological distress among students following the counseling intervention, as evidenced by the decrease in those exceeding the CORE-OM clinical cut-off. This is an encouraging outcome, indicating that for many students, the psychological support provided by the University Psychological Counseling Service effectively alleviates distress and mitigates risk behaviors (Cerutti et al., 2022; Stewart et al., 2020; Murray et al., 2016). However, a considerable percentage of students remained within the at-risk category even after completing the brief counseling intervention (56.7%). This indicates that, while the brief counseling sessions were beneficial for many, they may not be sufficient for students experiencing more severe psychological challenges. These students likely require more intensive, individualized, or longer-term therapeutic support beyond the scope of the current University Psychological Counseling Service framework (Erekson et al., 2023; Strepparava et al., 2017). While short-term counseling services play a crucial role in providing immediate support, they may not be sufficient for individuals with more complex or enduring psychological difficulties (Bani et al., 2022).

Interestingly, we showed a significant improvement in psychological wellbeing, particularly in the dimensions of Self-Acceptance and Autonomy after counseling sessions. The significant increase in Self-Acceptance might suggest that, over the course of the counseling sessions, students developed a more positive perception of themselves. This aspect is crucial, as self-acceptance is a determining factor for overall psychological wellbeing and the ability to face daily challenges resiliently. Similarly, the significant increase in Autonomy highlights a greater ability of participants to self-determine and make independent decisions. This is a key element for optimal psychological functioning, as it allows individuals to pursue personal goals aligned with their values and desires, reducing dependence on external influences. These findings are consistent with previous studies showing that psychological counseling interventions significantly enhance wellbeing and decrease distress symptoms (Vescovelli et al., 2017). A recent meta-analysis (Van Dierendonck and Lam, 2023) examined the effectiveness of different types of interventions aimed at enhancing eudaimonic wellbeing across more than 70 studies. The meta-analytic results indicated that the most substantial effects were observed in the dimensions Environmental Mastery, Self-Acceptance and Personal Growth. Conversely, the weakest effects were found in the domains of Positive Relations with Others and Autonomy. While further research is needed to fully comprehend and apply the principles of positive psychology, our results indicate that it can serve a significant role in counseling interventions (Smith et al., 2021), particularly in university students (Prince, 2015). Indeed, goals of counseling can be comprised as both the restoration of wellbeing (remediating problems) and the promotion of wellbeing (growth and promotion). However, it will be crucial for University Psychological Counseling Services to integrate traditional interventions with various positive psychological approaches, including practicing forgiveness, participating in happiness training, keeping a gratitude journal, reflecting on positive experiences, engaging in meditation and mindfulness, writing a gratitude letter, performing acts of kindness, counting one's blessings, participating in productive activities, undergoing resilience training, nurturing relationships, and engaging in physical activities that promote wellbeing (Herbert, 2022). This integrative approach is further supported by recent evidence demonstrating that brief, structured interventions rooted in cognitive-behavioral therapy, positive psychology, or solution-focused models can meaningfully reduce psychological distress and enhance psychological resources in university student populations (Atik et al., 2023; Reschke et al., 2024; Wang et al., 2024; Barnett et al., 2021).

In this context, future research should advance along two key directions. First, it is important to explore individual trajectories of psychological change over time, using longitudinal modeling approaches such as growth curve or latent class analysis. Second, future studies should assess the effectiveness of evidence-based therapeutic approaches adapted to the university context. These could include Acceptance and Commitment Therapy (ACT), which enhances psychological flexibility (Levin et al., 2017); Mindfulness-Based Stress Reduction (MBSR), which improves emotional regulation (Sanilevici et al., 2021); and positive psychology interventions such as gratitude journaling and strengths identification (Datu et al., 2018). Psychoeducational programs focused on resilience have also shown encouraging results in reducing distress and fostering adaptive coping (Houston et al., 2017). Evaluating these interventions across diverse student populations and formats will be crucial to strengthen the impact and scalability of university counseling services.

Several limitations should be considered when interpreting these findings. Firstly, the sample size was limited and derived from a single university, which may affect the generalizability of the results and limit their representativeness of the broader student population. Furthermore, as the findings cannot be generalized to clinical samples, this may limit their applicability to samples in which the dual-continua model might manifest less distinctly (Peter et al., 2011).

Another limitation is the lack of sample clustering, which could have provided more nuanced insights into specific subgroups. A recent study in a large non-clinical adult population found that the PWBS network model identified four dimensions, with Self-Acceptance, Life Purpose, And Environmental Mastery clustering together, and Self-Acceptance emerging as the most central dimension (Blasco-Belled and Alsinet, 2022). Future studies should further explore the stability of the PWBS network model and its implications for mental health interventions

Furthermore, interventions utilized in the counseling sessions were non-specific, which may limit the ability to attribute improvements in psychological wellbeing to therapeutic techniques or approaches. Therefore, it is essential to develop and test effective intervention strategies that sustainably enhance psychological wellbeing, ensure a lasting impact, and can be widely implemented while also benefiting both physical and mental health.

To the best of our knowledge, this is the first study to use both cross-sectional and longitudinal data, emphasizing the importance of applying a widely used framework to measure the dual-continua model of mental health in students seeking help from university counseling services. By applying this model, the study enhances our understanding of how mental health is not simply the absence of mental illness but rather a dynamic, multidimensional construct that include also psychological wellbeing dimensions. Specifically, the results emphasize the importance of measuring both psychological wellbeing and distress to gain a comprehensive understanding of university students' experiences with the current University Psychological Counseling Services. Secondly, our findings suggest that psychological counseling interventions are effective in enhancing wellbeing and reducing distress. Although a portion of students remained in the at-risk category after completing the sessions, the overall results are promising, demonstrating that psychological interventions have the potential to improve wellbeing dimension such as Self-Acceptance and Autonomy. The study indicates that various types of therapeutic interventions can contribute to wellbeing, with benefits arising from different formats, delivery methods, across non-clinical populations. However, further research focusing on clinical populations is needed to better understand the full scope of these interventions' impact. In conclusion, University Psychological Counseling Services play a pivotal role in fostering the psychological wellbeing of students, which in turn contributes to their academic success. To effectively support student wellbeing, universities should consider integrating positive psychology into their curricula, offering training programs that promote resilience, gratitude, and stress management.