Symptom Severity, Distribution and Clinical Change in Young Adults at a Northern Italy University Counselling Service

Objective University students access counselling services with heterogeneous levels of distress and symptom presentations. This exploratory longitudinal study characterised students accessing university counselling services and examined baseline correlates of short-term symptom change, with particular attention to whether symptom distribution contributed information beyond global symptom severity. Method N = 357 students (65% female; mean age = 22.28) completed the Symptom Checklist-90-Revised (SCL-90-R) before and after a four-session counselling cycle. Short-term change was defined as post-counselling minus baseline log-transformed Global Severity Index (GSI). Multiple linear regression models examined baseline correlates of change. Because symptom distribution was strongly related to global severity, the primary distribution index was a severity-adjusted residualised distribution. Sensitivity analyses tested alternative symptom-distribution thresholds. Results Students showed substantial pre-post reductions in global distress. Higher baseline GSI was associated with greater symptom reduction, whereas broader-than-expected symptom distribution was associated with less favourable change after accounting for baseline severity and contextual predictors. This residualised distribution effect was modest but statistically significant and was most evident when symptom distribution was defined using mild-to-moderate raw-score thresholds. Among students starting above the clinical GSI threshold of 1, broader-than-expected symptom distribution was also associated with a lower probability of crossing below this threshold at post-counselling. Conclusion Findings suggest that baseline symptom intensity and symptom distribution provide partly distinct information about short-term response profiles. Greater initial intensity was associated with larger reductions, whereas more diffuse symptom distribution was associated with less favourable change, supporting multidimensional screening. Trial Registration This naturalistic longitudinal study was not registered as a clinical trial