Efficiency of student counseling among Japanese university students: Comparisons based on sex, therapy status, and the number of sessions attended

University students worldwide face increasing mental health challenges. Yet, research on the effectiveness of campus-based counseling in Japan is limited. This study evaluated changes in psychological symptoms among Japanese university students receiving counseling, using the Counseling Center Assessment of Psychological Symptoms—Japanese version (CCAPS-Japanese). Data were collected from 99 students at a national Japanese university who voluntarily sought counseling between November 2021 and July 2024. They completed the CCAPS-Japanese pre- and post-counseling. Outcomes were analyzed using paired t -tests and effect sizes across sex, therapy status (terminated or interrupted), and number of sessions attended (short-term [2 sessions], mid-term [3–10 sessions], or long-term [≥ 11 sessions]). Students showed significant improvements in depression, generalized anxiety, thought disturbances, and suicidal ideation. Effect sizes ranged from moderate to large. Improvements were noted regardless of sex or therapy status, although sex-specific patterns emerged: male students showed improvements in social anxiety and depression, whereas female students showed improvements in hostility. Both the terminated and interrupted groups exhibited significant symptom reductions; however, only the terminated group improved in academic distress. Furthermore, mid-term counseling yielded the most consistent improvements, whereas short-term counseling yielded no significant changes. Counseling effectively reduces key psychological symptoms among Japanese university students, particularly depression and anxiety. Mid-term interventions appear most beneficial for achieving therapeutic impact. These findings empirically support university counseling services in Japan and highlight the need for continued investment in and outcome monitoring of student mental health programs.