Background <p>Adolescents’ mental health is shaped by their coping strategies and the broader family context in which they live. However, few studies have examined psychological distress and help-seeking patterns jointly, especially from a person-oriented perspective. Understanding distinct adolescent risk profiles and how family and parental factors influence them may inform more effective prevention strategies. This study aimed to: (1) identify latent profiles of adolescents based on their psychological distress and help-seeking intentions; and (2) explore how family and parental factors predict profile membership and self-harm risk.</p> Methods <p>A cross-sectional study was conducted in 2021 with 7,934 Chinese secondary school students and one parent per adolescent. Adolescents completed validated measures of depression, anxiety, and help-seeking intentions; parents reported on family income, family function, mental health symptoms, and mental health stigma. Latent profile analysis and the BCH three-step method were used to identify subgroups and examine predictors and outcomes.</p> Results <p>Five profiles were identified: normative, safe, distress, high-risk, and aware. The high-risk profile (5.98%) showed high distress, low help-seeking, and the highest self-harm rate (48.7%). Lower family functioning and higher parental distress predicted higher-risk profiles. Professional help-seeking intentions were associated with reduced self-harm risk among distressed adolescents.</p> Conclusions <p>Family and parental factors significantly shape adolescent coping profiles and mental health risks. Findings underscore the value of early screening and family-focused interventions to reduce self-harm.</p>