Anxiety among secondary school students in the war-torn Tigray, Ethiopia, 2024: A call for action

TL;DR

This study found that over a third of secondary school students in war-affected Tigray, Ethiopia, experience significant anxiety, linked to trauma and other factors.

Contribution

The study provides the first data on post-war anxiety prevalence among secondary school students in Tigray, Ethiopia.

Findings

32.7% of students showed clinically significant anxiety symptoms.

Female students and those aged 18 or older were more likely to experience anxiety.

Trauma exposure, such as combat and sexual abuse, was strongly associated with anxiety.

Abstract

Adolescents are especially vulnerable to stress and trauma. Exposure to armed conflict significantly raises the risk of anxiety, which often lasts into the post-conflict phase. The war in northern Ethiopia has caused widespread trauma, displacement, and destruction of services. Understanding mental health after conflict is crucial for guiding recovery efforts, informing school-based programs, and shaping local public health priorities. However, data on the prevalence of post-war anxiety among secondary school students in the region is lacking. This study assessed the prevalence and factors associated with clinically significant anxiety among secondary school students in Tigray, Ethiopia. A school-based cross-sectional study was conducted among 608 randomly selected secondary school students in Adigrat Town, Tigray, Ethiopia. Data was collected using a structured self-administered questionnaire, including the Generalized Anxiety Disorder (GAD)-7 scale for anxiety assessment. Multivariable binary logistic regression was used to identify factors associated with clinically significant anxiety symptoms. The prevalence of clinically significant anxiety symptoms among students was 32.7% (95% CI: 28.9%, 36.5%). Among sociodemographic factors, being female (AOR = 6.52, 95% CI: 3.70, 11.46) and age ≥ 18 years (AOR = 3.19, 95% CI: 1.60, 6.39) were significantly associated with anxiety symptoms. Trauma-related experiences, including combat or exposure to a battlefield (AOR = 5.05, 95% CI: 1.95, 13.12), physical violence (AOR = 2.25, 95% CI: 1.32, 3.82), bullying (AOR = 2.26, 95% CI: 1.24, 4.11), and contact sexual abuse (AOR = 3.97, 95% CI: 1.58, 9.96), were significantly associated with anxiety symptoms. Suicidal ideation (AOR = 4.01, 95% CI: 1.96, 8.24) and depression (AOR = 3.99, 95% CI: 2.32, 6.87) were also significantly associated with anxiety symptoms. This study reveals a high prevalence of clinically significant anxiety symptoms among secondary school students, associated with gender, age, trauma exposure, and comorbid conditions. These findings highlight the need for school-based mental health screening and trauma-informed support to reduce long-term psychological effects in this vulnerable generation.

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