By Chiara Albanese 

The results of a year-long health check of Europe's banking sector has investors souring further on the broader outlook for Italy, whose banks failed the test in greater numbers than any other country's.

Nine Italian banks failed the so-called stress tests, and Banca Monte dei Paschi di Siena SpA--which would need to come up with EUR2.11 billion ($2.67 billion) in capital to satisfy regulators--was the biggest casualty of the yearlong exercise.

Although capital shortfalls are just one factor, analysts at Goldman Sachs Group Inc. said the long list of failing Italian banks cements concerns over the country's growth outlook.

"The main focus right now is on the growth outlook, and this is the context in which the 'failure' of some Italian banks needs to be seen," said Francesco Garzarelli, co-head of macro and markets research at Goldman Sachs.

Aside from Monte dei Paschi, Banca Carige SpA, Banca Popolare di Milano SCARL and Banca Popolare di Vicenza SpA also emerged from the test with a collective capital shortfall of EUR3.3 billion, according to the Bank of Italy.

"The long tail of weak listed and non-listed Italian banks, mostly serving regional economic districts, will continue to be seen as a headwind on GDP growth, and this may loop back into nonperforming loans, " Mr. Garzarelli said.

Goldman Sachs recently downgraded its stance on Italian sovereign credit from buy to neutral.

"Italian banks' troubles threaten to worsen the gloomy economic outlook there and could lead fears about the sustainability of the public finances to resurface," said Jennifer McKeown, European economist at Capital Economics.

The capital injection needed in Italy raises a worrying comparison with Spain's poor performance in the 2011 stress tests, which led to an EU-funded bank bailout. "The banks involved may struggle to raise much more capital privately," Ms. McKeown added.

Investec Wealth & Investment, which has about GBP24 billion ($39 billion) in assets under management, had been adding exposure to the European banking sector ahead of the release of the test results, but it has steered well clear of Italian banks.

"It has always been less easy to understand the level of transparency of domestic Italian banks compared to other European banks. We mostly hold U.K. and Swiss banks," said John Haynes, head of research at the firm.

While the banks that failed were already struggling, for Italy the results are a demonstration of vulnerability.

Mr. Haynes added that the results will lead to a period of introspection for Italy, with a likely short-term hit to markets.

"There are two banks in Italy which have to be dealt with: Monte Paschi and Carige. Together they represent 8% of market share in this industry and they have a problem," said Massimo Massimilla, a partner at Algebris Investments, a London-based asset manager founded by Italian investor Davide Serra.

Monte Paschi, Mr. Massimilla added, is a systemic bank for the country which requires immediate action. "Its loans account for 10% of GDP. International investors would put new capital in the bank but at a price which is 50% lower than what you see today," he said.

Looking ahead, the results should act as a wake-up call for the banking sector

"There are more banks than pharmacies per person, it's easier to open an account than to buy an aspirin. But high costs and overreliance on sovereign holdings mean vulnerability in a shock," said Alberto Gallo, head of macro credit research at Royal Bank of Scotland Group.

The government's plan to improve credit, which includes speeding up payments of public arrears, accelerating the bankruptcy process and a change in the voting system, leaves untouched the main issue, he added.

"There are too many banks and too few profitable ones. Without structural consolidation, Italy's credit reforms may be once again changing things so everything stays the same," he said.

Write to Chiara Albanese at chiara.albanese@wsj.com

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