Climate change can affect mental health through chronic environmental exposure and disruption of everyday life. Women may encounter these pressures through caregiving, household resource management, and concerns for family well-being. This study explored reproductive-aged women’s perceptions and experiences of climate-related psychological distress in Qom, Iran.

Conventional qualitative content analysis was used. Twenty-five women aged 18–45 years were recruited from health centers, universities, parks, and other community settings using maximum-variation purposive sampling. Variations were sought in age, marital status, education, occupational status, and recruitment setting. Semi-structured interviews were conducted and analysed inductively in Persian. Saturation was reached after interview 17 and confirmed through eight additional interviews.

Four themes, nine categories, and 17 subcategories were developed: Living with a disrupted and increasingly insecure environment; consequences of climate change in everyday life; climate-related psychological distress; and social consequences of climate change for mental health. Participants linked heat, drought, water insecurity, salinity, dust, and air pollution with bodily discomfort; household and livelihood pressures; emotional responses such as fear, irritability, and place-based grief; cognitive preoccupation with caregiving, resources, and future liveability; moral self-monitoring during household water use; and family tension.

Climate-related psychological distress emerged as a cumulative, situated response with interrelated emotional, cognitive, and moral manifestations embedded in environmental, bodily, material, caregiving, relational, and place-based contexts. These responses should not automatically be pathologized. The findings support the co-design and evaluation of locally tailored responses that integrate psychosocial support with practical adaptation across primary care, university, and community settings.