Adverse Childhood Experiences Are Driving Teen Depression in Togo, Researchers Report

A new article published in BMJ Public Health finds that Adverse Childhood Experiences (ACEs) are linked to depressive symptoms in adolescents in Togo, West Africa.

Academic pressure, eating disorders, high-risk internet use, and substance abuse were also linked with higher rates of depressive symptoms.

The study was led by Arnold Junior Sadio at the University of Lomé and conducted as part of the national School Health Survey in Togo (SHeST). The research team analyzed data from 2,586 students ages 10 to 19 enrolled in secondary schools across the northern and southern regions of the country.

“Our findings reveal a significant mental health challenge, with depressive symptoms prevalence of 19.1 percent and moderate to severe anxiety symptoms affecting 12.6 percent of adolescents,” the authors write. They note that exposure to adverse childhood experiences (ACEs), being female, preparing for national exams, disordered eating, problematic internet use, and substance use played meaningful roles in shaping emotional distress.

The findings add to a global body of research linking childhood adversity to depression, anxiety, and other long-term health outcomes. Yet the authors emphasize that Togo’s social and cultural context—including widespread taboo around discussing family violence—shapes what adolescents feel able to disclose and, in turn, what kinds of support they receive.

The goal of the current work was to examine the prevalence of depressive and anxiety symptoms in school-going adolescents in Togo. The authors also wanted to investigate possible links between common mental health issues and factors such as ACEs.

The current research was part of a larger project, the national School Health Survey in Togo (SHeST). This study aimed to investigate the prevalence of asthma in Togolese adolescents while also collecting data on other variables such as ACEs and mental health issues. The SHeST collected data from the Northern and Southern regions of Togo between February and March 2025.

Schools were randomly selected for participation in the SHeST. After a school was chosen, classrooms within that school and students within each classroom were randomly selected for inclusion. To be included in the current work, participants had to be between 10 and 19 years old and regularly enrolled at the chosen school. Additionally, the participants’ parents and the participants themselves had to provide consent to participate in the study. In total, the authors used data from 2,586 school-going adolescents.

Measures

Depressive Symptoms and suicidal behaviors were measured using the Patient Health Questionnaire (PHQ). This self-report survey rates depressive symptoms on a scale from 0 to 27. The authors classified scores of 0 – 4 as minimal depressive symptoms, 5 – 9 as mild, 10 – 14 as moderate, 15 – 19 as moderately severe, and 20 – 27 as severe. Scores of 0 – 9 were grouped together as ‘absence of depressive symptoms’ and scores of 15 – 27 were grouped together as ‘severe depressive symptoms.’ Two extra questions added to the PHQ were used to assess suicidal thoughts in the past month, and whether or not the participant had ever attempted suicide before.

ACEs were evaluated using the Adverse Childhood Experiences Questionnaire (ACE-Q). This self-report survey asks participants to report experiences of abuse, neglect, and household dysfunction. Experiences of extrafamilial violence, such as bullying and political violence, are notably absent from this survey. The schools also required the removal of questions about domestic violence. Scores on this version of the ACE-Q ranged from 0 to 9. A score of 0 indicated no adverse experiences, a score of 1-3 was categorized as low to moderate adversity, and a score of 4+ was categorized as high adversity.

The Generalized Anxiety Disorder (GAD-2) scale was used to assess anxiety. This self-report survey rates anxiety symptoms on a scale from 0 – 6, with scores of 3+ indicating significant anxiety and possible anxiety disorder. The presence of eating disorders was measured using the SCOFF self-report survey. This survey asks participants five questions about disordered eating behaviors. An answer of yes to two or more questions indicates a likely eating disorder.

The Problematic Internet Use Questionnaire was used to measure problematic internet use. Substance use was calculated using the WHO Smoking and Substance Involvement Screening Test. Physical activity was assessed using questions taken from the Youth Risk Behavior Surveillance System.

Mental Health Issues, ACEs, and Other Factors

Disordered eating behaviors were common among Togolese adolescents, with 43.4% scoring high enough on the SCOFF to indicate a possible eating disorder. It’s likely that a number this high could reflect a poor fit for the SCOFF as an inventory of eating disorders in places like Togo. 21.2% of participants reported problematic internet use, and 9% reported substance abuse.

Females were more likely to report abuse and neglect (58.2%) compared to males (50.1%). This was particularly true for emotional neglect (45.2% vs 35.1%) and sexual abuse (4.9% vs 0.8%). Females also reported higher rates of household dysfunction (47.8%) compared to males (42.2%).

Depressive symptoms were reported by 19.1% of participants. Females (24.7%) were significantly more likely to report depressive symptoms compared to males (11.9%). 12.9% reported moderate to severe anxiety, with females (16.8%) significantly more likely to struggle with anxiety compared to males (7.4%). This trend was also observed with suicidal thoughts and behaviors. Females were more likely to report both suicidal thoughts (13.7% vs 5.4%) and suicide attempts (10.8% vs 3.7%).

Depressive symptoms were significantly linked to ACEs. Participants reporting between 1 and 3 ACEs were 2.3 times more likely to report depressive symptoms compared to those reporting no ACEs. Those with 4+ ACEs were 6.92 times more likely to report depressive symptoms. Female sex (2.42 times more likely), prepping for national exams (1.41), living in the south (1.58), substance abuse (1.66), disordered eating behaviors (2.29), and problematic internet use (2.03) were also associated with depressive symptoms to varying degrees.

ACEs were most strongly linked to depressive symptoms in females, with those reporting 4+ ACEs being nearly 10 times more likely (9.19) to report depressive symptoms compared to those reporting no adversity. Suicidal thoughts were also more common in adolescents who reported abuse, neglect, and/or household dysfunction.

Limitations

The authors acknowledge several limitations to the current work. The self-report nature of the surveys likely means some experiences, such as ACEs and substance use, were under-reported. According to the authors, this is especially true in the context of Togo, as this region has strong taboos against these experiences. The censorship of questions around domestic violence also led to under-reporting of adverse experiences. Again, this is especially significant in the context of Togo, where over one-third of women report intimate partner violence. As this data was collected exclusively within Togo, generalizability to other populations is limited.

Research from countries across the world, including Togo, Turkey, Kenya, Vietnam, Indonesia, the U.S, the U.K., Brazil, Australia, Ireland, Canada, Ethiopia, Germany, Norway, Austria, France, Honduras, Mexico, Japan, China, and Spain, has linked childhood abuse, maltreatment, and household dysfunction to mental health issues.

Past research has found that ACEs and childhood maltreatment are linked to anxiety and depression, regardless of background, as well as psychosis, poorer recovery from first episode psychosis, treatment-resistant schizophrenia, higher levels of distress in voice hearers, ADHD, lower mental well-being, distress later in life, poor sleep, lower academic achievement, and lifelong physical health consequences such as cancer, heart attack, stroke, diabetes, and chronic obstructive pulmonary disease.

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Sadio, A. J., Gbeasor-Komlanvi, F. A., Mama, A. H., et al. 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). BMJ Public Health 2025;3:e003730. (Link)