SADIE: a longitudinal Survey on Anxiety, Depression, Internalising and Externalising symptoms in Italian university students – a study protocol

Introduction: University students experience escalating academic, social, and financial stress, resulting in high prevalence of anxiety (18–40%), depression (12–35%), and burnout (20–30%). The COVID‑19 pandemic intensified these issues, but most studies report symptom remission post‑lockdown, highlighting the need for long‑term, prospective data on symptom trajectories and risk factors.: The SADIE (Survey on Anxiety, Depression, Internalizing and Externalizing symptoms) study aims to: (1) estimate the prevalence and incidence of anxiety, depression, burnout, and suicidal ideation in Italian university students over 36 months, and (2) identify modifiable psychological and behavioral predictors-such as multidimensional perfectionism, academic stress, and substance use-associated with adverse symptom trajectories. Methods and analyses: We will recruit 5,000 undergraduates and postgraduates (≥18 years, fluent in Italian or English) from 14 Italian universities. Participants will complete online assessments via REDCap at baseline, 6-month, 18-month, and 36-month follow-ups. Measures include demographic survey; Maslach Burnout Inventory‑2; BDI‑II; GAD‑7; WHO‑5; AUDIT‑3; CDS‑5; C‑SSRS; HF Multidimensional Perfectionism Scale. Mixed-effects models (R/lme4) and growth-mixture models will be used to evaluate symptom trajectories, while logistic regression will identify predictors of adverse outcomes. Sensitivity analyses will address potential self-selection and attrition bias.Ethics and dissemination: The study has received approval from the Ethics Committee of the University of Padova (Protocol No. 235‑d). Participants will provide electronic informed consent and may withdraw at any time. Risk management includes automated alerts and links to local mental health services for high‑risk responses. Study findings will be disseminated through peer‑reviewed publications, conference presentations and summary reports to participating institutions; deidentified data may be made available on reasonable request in line with institutional and data protection regulations.