*1.1. Mental Health among University Students*

The COVID-19 outbreak has impacted almost all sectors of society, including higher education. Indeed, all classes were suspended because of social distancing, and students had to follow lessons using online platforms during the lockdown [11]. These changes had a significant impact on students' lifestyle, academic performance, and mental health. Most students have negative perceptions about e-learning and believe that it does not greatly im-

pact their learning [12]. Approximately 50% of students reported a decrease in study hours and their academic performance, over 10% of students delayed graduation or dropped out from classes, about 40% of working students lost their job [13], and approximately 55% of students reported increasing concern about the exam outcomes [14]. Regarding mental health issues, students reported an increased level of stress, anxiety, and depression during the COVID-19 pandemic [15–17] and an increase in suicidal thoughts [18]. Moreover, students reported difficulty concentrating on academic work and negative changes in their sleep and dietary patterns [17]. Some studies found significant sex differences: female students showed more anxiety than male students [19], and they were at more risk of developing depression in comparison to males. Moreover, females reported more sleep and sexual problems [18]. Some factors contributed to increased stress, anxiety, and depression among university students, such as worry about health, disruption of the daily routine, decreased social interaction [17], and a history of self-injury and suicidal attempts [18]. These results are particularly relevant if we consider that, even before the pandemic, mental health problems were widespread among university students. Anxiety disorders (i.e., panic disorder, generalized anxiety disorders, and social phobia), mood disorders, and substance disorders are the most prevalent disorders among university students [20]. Even if it is not a specific diagnosis, suicide is a significant problem among university students: 6.7% of students have suicidal ideation [21]. Moreover, mental health problems were associated with role impairment in different domains [22] and university career problems [23]. Often, students do not ask for psychological help despite feeling the need for it. Young people prefer to ask for help from friends or family rather than doctors or psychologists [24]. The general misinformation about mental health and the fear of being stigmatized frequently prevent help-seeking behaviour [25,26].
