ArticleBMJ public health2025
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).
Article in BMJ public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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