INTRODUCTION: The transition from adolescence to adulthood is characterized by changes and challenges for students, that can affect their mental well-being. Furthermore, mental disorders often emerge before the age of 24, underscoring the significance of addressing mental health during the college years. The study's objective is to conduct a systematic review of the mental health of Italian university students, exploring the prevalence of psychopathological dimensions, identifying risk and protective factors, and investigating the impact on academic performance. METHODS: The initial search yielded 842 papers. After the screening process, a total of 27 studies were included (22,928 participants). RESULTS: The prevalence of mental distress is notable: stress affects 72.6%, anxiety 61.8%, depression 41.6%, sleep disorders 63.9%, and suicide risk 6.1%. DISCUSSION: Biological factors like chronic illness and family history increase the risk of psychological disorders. Psychological factors, including sexual orientation, play a role. Dysfunctional personality traits, adverse events, financial concerns, and the pandemic amplify distress. Resilience, coping strategies, peer support, inclusive environments, physical activity, and balanced lifestyles act as protective factors. Mental distress impacts academic performance and often is exacerbated by the pressure to excel. Interventions encompass targeted support, cognitive-behavioral therapy, and the promotion of inclusive and supportive environments.