Adverse childhood experiences and mental health in a low-income setting characterised by silence and taboos: a cross-sectional analysis of hidden trauma in Togolese school-going adolescents (2025)

Abstract

BACKGROUND: Adverse childhood experiences (ACEs) are closely linked to mental health conditions. In Sub-Saharan Africa, cultural taboos and poor mental health service access amplify these conditions. This study aims to estimate the prevalence of depressive and anxiety symptoms among school-going adolescents in Togo, and to explore the role of ACEs. METHODS: A cross-sectional analysis was conducted as part of the national School Health Survey in Togo. A multistage stratified random sampling method recruited adolescents aged 10-19 years (n=2586) from secondary schools in Togo. Depressive symptoms, anxiety symptoms and ACEs were assessed using the Patient Health Questionnaire (PHQ-9A), the Generalised Anxiety Disorder-2, and the Adverse Childhood Experiences Questionnaire, respectively. Mixed-effects regression models identified associations between ACEs and mental health conditions. RESULTS: The median age of included adolescents was 16 years (56.6% female). Depressive symptoms prevalence was 19.1% (95% CI (18.7 to 20.0)); moderate to severe anxiety symptoms were 12.9% (95% CI (12.1 to 13.6)). Adolescents with 'low-to-moderate adversity' had higher depressive symptoms (aOR=2.30; 95% CI (1.66 to 3.20)), rising with 'high adversity' (aOR=6.92; 95% CI (4.76 to 10.10)). Girls reported a greater likelihood of depressive symptoms compared with boys (aOR=2.42; 95% CI (1.89 to 3.09)). Other associated factors included academic pressures (aOR=1.41; 95% CI (1.05 to 1.89)), eating disorders (aOR=2.29; 95% CI (1.82 to 2.88)), high-risk internet use (aOR=2.03; 95% CI (1.58 to 2.62)) and substance abuse (aOR=1.66; 95% CI (1.21 to 2.27)). CONCLUSION: This study highlights the substantial burden of mental health conditions among school-going adolescents in Togo, driven by ACEs and compounding sociobehavioural factors. The findings underscore the need for interventions promoting stable family environments, gender-sensitive mental health policies and school-based psychosocial support systems. Public health approaches must address cultural taboos and integrate trauma-informed care within educational and community settings to mitigate their long-term impacts on mental health.