This study assessed the level of psychological distress, associated factors, coping strategies, and gender differences among conflict induced school dropout adolescents in North Mecha Woreda, Amhara Region, Ethiopia. The study employed a concurrent mixed methods design. A total of 410 participants were involved in the study, including 395 adolescents’ survey respondents (177 males and 218 females) and 15 interview participants selected purposively from adolescents, caregivers, community elders, religious leaders, health professionals, education experts, and Women, Youth and Social Affairs Office representatives. Quantitative participants were selected using stratified and proportional sampling techniques, while qualitative participants were selected purposively. Data were collected through the Kessler Psychological Distress Scale (K10), Social Support Scale, Brief COPE Scale, semi structured interviews, and document review. Frequency, percentage, mean, standard deviation, bar graph, independent samples t-test, and multiple linear regression were employed to analyze quantitative data, whereas qualitative data were analyzed thematically through narration, paraphrasing, and direct quotations. The findings revealed a critically high level of psychological distress among conflict induced school dropout adolescents. About 98.6% female and 90.4% male of respondents experienced severe psychological distress, while the remaining 7.9% of male and 1.4% of female respondents experienced moderate distress. Depressive symptoms, hopelessness, sadness, worthlessness, and nervousness were the most frequently reported psychological problems. The study also found a statistically significant gender difference in psychological distress, with female adolescents reporting significantly higher distress levels than males. Economic hardship and safety and security concerns were identified as significant predictors of psychological distress. Qualitative findings further revealed that conflict related trauma, exposure to violence, gender based violence, family separation, social distrust, community fragmentation, and loss of livelihoods were major contributors to adolescents' psychological suffering. Regarding coping strategies, adolescents predominantly relied on emotion focused and avoidant coping strategies, while problem focused coping strategies were less frequently utilized. The study concluded that psychological distress is a serious mental health concern among conflict induced school dropout adolescents in North Mecha Woreda. Therefore, government institutions, humanitarian organizations, and mental health professionals should strengthen community based mental health and psychosocial support services, improve protection and educational reintegration programs, and address the socio economic and security challenges affecting conflict affected adolescents.