{
  "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.",
  "authors": [
    {
      "affiliations": [
        "National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Centre, UMR 1219, Université de Bordeaux, Talence, Nouvelle-Aquitaine, France",
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo",
        "Faculty of Health Sciences, Department of Public Health, Center for Training and Research in Public Health (CFRSP), University of Lomé, Lomé, Togo"
      ],
      "name": "Arnold Junior Sadio"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo",
        "Faculty of Health Sciences, Department of Public Health, Center for Training and Research in Public Health (CFRSP), University of Lomé, Lomé, Togo"
      ],
      "name": "Fifonsi Adjidossi Gbeasor-Komlanvi"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Abdul-Halick Mama"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo",
        "Faculty of Health Sciences, Department of Public Health, Center for Training and Research in Public Health (CFRSP), University of Lomé, Lomé, Togo"
      ],
      "name": "Martin Kouame Tchankoni"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Komlan Gérard Koglo"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Innocent Gabkiangbe"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Gilbert Aku Agbetoglo"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Georgette Attisso"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Ahmat Ousmane"
    },
    {
      "affiliations": [
        "African Center for Research in Epidemiology and Public Health (CARESP), Lomé, Togo"
      ],
      "name": "Victoire Banka"
    },
    {
      "affiliations": [
        "Regional Health Directorate of Kara, Kara, Togo"
      ],
      "name": "Abdel Kadère Alfa"
    },
    {
      "affiliations": [
        "Regional Health Directorate of Kara, Kara, Togo"
      ],
      "name": "Sibabe Agoro"
    },
    {
      "affiliations": [
        "Psychiatry Department, Campus University Hospital Center of Lomé, Lomé, Togo"
      ],
      "name": "Sonia Kanekatoua"
    },
    {
      "affiliations": [
        "Bordeaux Population Health Research Center, ACTIVE Team, INSERM U1219, University of Bordeaux, Bordeaux, France"
      ],
      "name": "Mathilde Husky"
    },
    {
      "affiliations": [
        "National Institute for Health and Medical Research (INSERM), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Centre, UMR 1219, Université de Bordeaux, Talence, Nouvelle-Aquitaine, France",
        "Faculty of Health Sciences, Department of Public Health, Center for Training and Research in Public Health (CFRSP), University of Lomé, Lomé, Togo"
      ],
      "name": "Didier Koumavi Ekouevi"
    }
  ],
  "title": "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)",
  "uid": "bc03ac07-7307-56dd-9055-d9178fe54208"
}