Abstract
<title>Abstract</title> <p> Background International students encounter intellectual, sociological, and psychological challenges when studying abroad. Although China plays a significant role in international education, limited qualitative research has examined how these students manage stress and perceive mental health support. Objective This study aimed to investigate the stress experiences, coping strategies, and mental health support needs of international students across various Chinese universities. Methods Sixteen international undergraduate, master's, and doctoral students were recruited through purposive sampling and participated in semi-structured interviews. Reflexive thematic analysis was employed to analyze the data. Results Three overarching themes were identified. <italic>Stressors and Adjustment Experiences</italic> encompassed sociocultural adaptation, daily living adjustment, academic challenges, and psychological and emotional adjustment. Students described both opportunities for personal growth and intercultural learning, as well as stressors such as language barriers, heavy workloads, homesickness, and loneliness. <italic>Coping Responses to Stress and Adjustment Challenges</italic> highlighted dynamic strategies, including practical action, emotional comfort, cognitive reframing, temporary avoidance, and physical self-care(sleep, exercise). <italic>Perceived Mental Health Needs</italic> revealed preferences for informal support, low counseling utilization due to self-reliance beliefs, and professional help barriers like campus confidentiality fears and cultural mismatches. Students recommended culturally responsive counseling and structured social integration programs. Conclusion Academic, social, and emotional pressures are interconnected for international students in China. Although these students demonstrate resilience, they primarily depend on informal support networks. Higher education institutions should provide accessible, culturally sensitive counseling and peer support to address these mental health needs effectively. </p>