Academic Stress and Mental Health Challenges Among International Students in China.

International students in China frequently encounter academic and acculturative challenges that adversely affect their psychological wellbeing. However, limited research has integrated quantitative and qualitative evidence to comprehensively examine the determinants of stress, anxiety, and depression among this population. This study investigated the effects of academic and acculturative stressors on the mental health of international students and explored their coping experiences and perceptions of institutional support. An explanatory sequential mixed-methods technique was employed. Quantitative data were collected from 500 international students enrolled at four universities in Changsha, China, followed by semi structured interviews with 10 participants. Confirmatory factor analysis demonstrated satisfactory construct validity (CFI = 0.93, TLI = 0.92, RMSEA = 0.052, SRMR = 0.047). Hierarchical regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Academic workload emerged as the strongest predictor of psychological distress, significantly predicting stress (β = 0.37, p < 0.001), anxiety (β = 0.34, p = 0.001), and depression (β = 0.31, p = 0.003). Language barriers and social isolation were also significantly associated with poorer mental health outcomes. Qualitative findings further revealed that research and publication pressures, cultural adjustment difficulties, and inadequate institutional support intensified students' psychological distress, whereas academic mentoring and peer support enhanced coping and resilience. Strengthening culturally responsive counseling, language support, academic mentoring, and social integration programs can substantially improve international students' mental wellbeing and academic success. These findings provide practical evidence for developing inclusive university support policies in China.