A qualitative study was conducted in Butterworth, in the rural Eastern Cape Province of South Africa, to explore sources of distress for young people. Semi-structured, individual in-depth interviews were conducted with 16 men and 24 women aged 16–22 years. The findings revealed interconnections between structural factors such as death, poverty, unemployment and gender injustices to cause distress. Negative home dynamics such as disinheritance, financial hardships, undisclosed paternal identity, substance abuse, child abuse and unpredictable informal adoption circumstances were worries of the participants. Worries over their inability to complete school dominated the narratives of orphaned participants. Lack of communication and consultation within families on important matters contributed to distress. Distress related to sexual relationships, such as infidelity, an unacknowledged pregnancy, intimate partner violence, transactional sex and sexual orientation were evident only in women’s narratives. Strengthening of families, improving financial security, extension of social grants and no-fee school policies are needed to alleviate distress in young people in this area. These findings are a call for the monitoring of policy delivery imperatives for child protection.