Effects of Mental Health Interventions on Depressive Symptoms, Anxiety, and Sleep Quality in University Students: A Systematic Review and Meta-Analysis

Abstract

Background: Mental health problems are common among university students. This systematic review and meta-analysis examined the effects of mental health interventions on depressive symptoms, anxiety, and sleep quality in this population. Methods: Randomized controlled trials published through 30 July 2026 were identified in MEDLINE/PubMed, Scopus, the Cochrane Library, Web of Science Core Collection, EBSCOhost, CINAHL, and ProQuest. Risk of bias and certainty of evidence were assessed using Cochrane Risk of Bias 2 and GRADE, respectively. Random-effects meta-analyses used mean differences (MDs) for outcomes reported on the same scale and Hedges’ g for sleep outcomes that used non-equivalent PSQI scores. Between-study variance was estimated using restricted maximum likelihood, with modified Hartung Knapp Sidik Jonkman inference. The protocol was registered in PROSPERO (CRD420261344616). Results: Nine studies met the eligibility criteria, and seven contributed to at least one meta-analysis. Interventions reduced PHQ-9 scores on average (MD = 2.21 points, 95% CI 0.89 to 3.54; p = 0.006; I2 = 81.0%), although the 95% prediction interval included no effect (−1.20 to 5.63). The pooled effects on GAD-7 scores (MD = 1.99, 95% CI −0.48 to 4.46; p = 0.089; I2 = 92.0%) and sleep quality (Hedges’ g = 1.30, 95% CI −3.08 to 5.68; p = 0.330; I2 = 99.1%) were not statistically conclusive. All prediction intervals included the null. Conclusions: Mental health interventions may reduce depressive symptoms among university students on average, but substantial heterogeneity limits the generalizability of this finding. Evidence for effects on anxiety and sleep quality remains inconclusive. More rigorous and clinically comparable trials are required.