Understanding Chinese adolescents’ psychological distress through modifiable biopsychosocial domains: a qualitative study

Adolescents’ emotional experiences and coping strategies, as well as adults’ attitudes towards mental health, are associated with psychological distress. However, qualitative research exploring adolescents’ lived experiences and mental health needs is limited. This leaves critical gaps in the information needed to develop early intervention programmes. This study explored Chinese adolescents’ experiences of psychological distress, focusing on emotional experiences, coping strategies, help-seeking processes, and adult responses. It also identified support needs for early recognition and support. A qualitative design involving semi-structured interviews was employed. Purposive sampling was used to recruit 27 participants, including 11 adolescents aged 12–18 years with affective disorders, their 11 parents, and 5 healthy school-attending adolescents. Data were analysed primarily using inductive thematic analysis. The modifiable biopsychosocial model of health and well-being was subsequently used as a sensitising framework to organise and interpret the themes identified from the data. Participants reported that emotional and behavioural changes were not always recognised as possible signs of psychological distress. Recognition depended on the meaning adults assigned to these changes, adolescents’ ability and willingness to communicate their experiences, and the responses they received from others. Coping strategies changed as distress persisted and support-seeking experiences accumulated. Fewer adaptive healthy responses emerged when early coping and support were insufficient. The findings were organised into four modifiable domains: healthy environments, developmental competencies, a sense of belonging, and coping. Early recognition and support should strengthen adults’ ability to recognise psychological distress, respect adolescents’ developing autonomy, facilitate safe communication, and respond promptly when early coping and support become insufficient. Appropriate support should be available before distress progresses to substantial functional impairment or crisis.