Ecological Factors Associated With Psychological Distress Among Adolescents: The Role of Educational Stress, Peer Victimization, and Physical Activity.

BACKGROUND: Adolescent psychological distress is shaped by influences across educational, familial, peer, and behavioral domains, yet few studies in low- and middle-income countries (LMICs) have examined these determinants within a unified theoretical framework. Guided by Bronfenbrenner's bioecological model, this study investigated ecological factors associated with psychological distress among Bangladeshi adolescents, with particular attention to educational stress, peer victimization, and physical activity. METHODS: A school-based cross-sectional survey was conducted among 501 higher secondary students in Bangladesh. Psychological distress was assessed using the Depression Anxiety and Stress Scale-21, whereas educational stress, family relationship quality, peer relationships, and physical activity were measured using validated instruments. Hierarchical multiple linear regression models evaluated the incremental contribution of theoretically ordered factor blocks. Relative importance analysis (Lindeman-Merenda-Gold method) quantified each factor's proportional contribution to explained variance. Domain-specific regression models were conducted for depression, anxiety, and stress. Heteroskedasticity-consistent (HC3) robust standard errors were applied. RESULTS: The fully adjusted model explained 23.8% of the variance in overall psychological distress. Educational stress (B = 0.56, p < 0.001), female gender (B = 12.32, p < 0.001), and peer victimization (B = 2.07, p < 0.001) were positively associated with distress, whereas physical activity was inversely associated (B = -0.91, p = 0.004). Relative importance analysis indicated that educational stress (20.4%), gender (17.7%), peer victimization (16.8%), and physical activity (15.9%) accounted for the largest proportions of explained variance. Similar patterns were observed across depression, anxiety, and stress subscales. CONCLUSIONS: Psychological distress among Bangladeshi adolescents is associated with the combined influence of academic pressure, peer victimization, gender-related vulnerability, and behavioral health factors. Interventions that address educational stress and peer safety while promoting physical activity may help inform a coordinated and contextually grounded strategy for adolescent mental health prevention in Bangladesh and similar LMIC settings.