Instruments used to measure well-being, ill-being, and health-related lifestyle behaviors in students attending Italian universities: a systematic review

Background: The well-being of university students is increasingly recognized as a critical public health issue, influenced by complex interactions among psychological, behavioral, and contextual factors. Despite growing research, measurement tools often lack standardization and contextual specificity, limiting the understanding of students’ health. This review aimed to map and critically analyze instruments assessing well-being, ill-being, and health-related lifestyle behaviors among Italian university students, as well as the associated variables, including risk and protective factors.Methods: The systematic review followed PRISMA guidelines and included peer-reviewed studies published from 2010 onward, identified across five databases: Scopus, APA PsycInfo, PubMed, ERIC, and Web of Science. A structured data extraction process was applied to collect information on sample characteristics, health-related outcomes, and associated variables (protective and risk factors). Descriptive statistics were used to synthesize frequencies, proportions, and distributions of measurement instruments and constructs across the included studies.Results: A total of 223 studies were included. Samples were largely non-probabilistic and female-biased. Ill-being measures appeared exclusively in 66.3% of the studies, while 7.9% focused on well-being, and 25.8% included both. A total of 159 instruments assessing well-being and ill-being were identified. Of these, the majority measured ill-being (118 instruments), followed by instruments assessing well-being (28), and a smaller number addressing both constructs (13). In addition, 154 instruments measuring lifestyle were identified. Lifestyle behaviors were measured in a fragmented, health-risk-oriented manner, often lacking contextual influences. Individual predictors (130) were prioritized over relational and environmental factors (53). Few instruments were tailored specifically to university students, and many studies used non-validated or ad hoc tools, especially those developed during the COVID-19 pandemic.Discussion: Findings highlight the need for standardized, validated, and context-sensitive instruments to assess student health holistically.