Dual-edged swords: a qualitative study of protective and risk factors shaping mental health among Chinese health professions students

Abstract

Abstract Background Mental health challenges among health professions students are a global concern, yet how these challenges manifest within socio-cultural contexts like China remains underexplored. This study utilised Bronfenbrenner’s ecological systems theory to investigate the risk and protective factors influencing the mental health of health professions students in China. Methods This qualitative study employed reflexive thematic analysis to examine the experiences and perspectives of 30 undergraduates from clinical medicine, nursing, pharmacy, and allied health programmes. Participants were selected by purposive sampling and data were collected using semi-structured individual in-depth interviews. Results During the data analysis, five interconnected themes were identified. Within each theme, participants described factors operating as risks, as protective resources, or as dual-edged forces depending on context. The themes are: (1) Academic Pressure and Interpersonal Dynamics within Immediate Environments (Microsystem); (2) Fragmentation and Dysfunction within Support Networks (Mesosystem); (3) Institutional Logics and Structural Constraints (Exosystem); (4) The Internalisation of Macro-Cultural Values and Behavioural Guidance (Macrosystem); and (5) Chronological Interactions and the Reshaping of Developmental Trajectories (Chronosystem). Conclusions The findings reveal a complex transaction across all ecological levels, highlighting that student mental health is predominantly shaped by systemic and cultural forces beyond the individual. This study provides a foundational ecological model for understanding these challenges and suggests that future research quantitatively examine the interactions between these themes, compare experiences across different health disciplines, and evaluate the effectiveness of support interventions tailored to specific ecological levels.