Body image and mental health in university students: a scoping review of global evidence and research gaps.

Background: University students represent a high-risk population for psychological distress. While body dissatisfaction has emerged as a critical determinant of well-being, a comprehensive synthesis of contemporary evidence, mediating mechanisms, and systemic gaps is required to inform clinical practice. Objectives: To synthesize the scientific literature on body self-perception and mental health in university students, identifying core findings, mediating pathways, and existing research gaps. Methods: Following the PCC (Population, Concept, and Context) eligibility framework, a scoping review was conducted (March-April 2025), following the PRISMA-ScR guidelines. A systematic search was performed across Scopus, PubMed/MEDLINE, PsycINFO, SciELO, and Redalyc databases, including studies from 2014 to 2025 in English and Spanish. Eligibility criteria encompassed peer-reviewed quantitative, qualitative, and mixed-methods studies, as well as previous reviews; grey literature and unpublished theses were excluded. Two researchers performed independent data selection and extraction, followed by a narrative synthesis of the evidence. Full search strings are available as Supplementary material. In accordance with PRISMA-ScR guidelines for scoping reviews, formal quality appraisal of the included studies was not performed. Results: A total of 18 studies were included, which were categorized into four thematic clusters. Body dissatisfaction was consistently associated with elevated levels of depression and anxiety across diverse cultural contexts. Self-esteem and fear of negative evaluation were identified as primary mediators. Furthermore, dissatisfaction was significantly linked to suicidal ideation, impaired sleep quality, and social dysfunction. Methodologically, most studies utilized cross-sectional, quantitative designs and remained anchored in the gender binary, largely excluding gender-diverse populations. Conclusion: Body dissatisfaction is a potent risk factor for severe psychological distress in university students, driven by complex cognitive and digital mediators. There is an urgent need for longitudinal research and the inclusion of underrepresented populations. Findings highlight that Higher Education Institutions must transition toward proactive mental health frameworks, including integrated screening and inclusive, gender-affirming counseling policies. Systematic review registration: https://osf.io/6zefc.