Abstract
BACKGROUND: Depression and anxiety are leading mental health disorders (MHD) among adolescents. Adolescents living with HIV (ALHIV) face distinct challenges such as stigma, social isolation, and psychosocial adversity, which compound their vulnerability to MHD. Despite its significance, data on MHD among ALHIV in Togo remains limited. This study aimed to provide the first national estimate of MHD prevalence and associated factors among ALHIV in Togo. METHODS: A national cross-sectional study was conducted from February to March 2025 across the six health regions of Togo. A stratified multistage random sampling approach was used to recruit ALHIV aged 10–19 years from 25 health facilities. Data collection involved validated psychosocial tools, including the PHQ-9 A for depression, GAD-7 for anxiety, and ULS-8 for loneliness. For prevalence estimation, depression was dichotomized into “Yes” (PHQ-9 score ≥ 10) and “No” (PHQ score < 10). For inferential analysis, depression was categorized into three levels: absent, moderate, and severe. Ordinal and binary logistic regression models were used to identify factors associated with depression and MHD (“combined depression and anxiety”). RESULTS: A total of 542 ALHIV (48.5% females) were included (median age: 15 years). The prevalence of depression among ALHIV was 24.5* with moderate depression observed in 19.9% and severe depression in 4.6%. Anxiety was less prominent, with 0.4% (95%CI: 0.04–1.34%) reporting moderate to severe symptoms. ALHIV experiencing loneliness (aOR: 1.13; 95%CI: 1.06–1.20), stigma (aOR: 4.21; 95%CI: 1.79–9.88), and having coexisting chronic diseases (aOR: 4.09; 95%CI: 1.50-11.16) were more likely to be depressed. Conversely, ALHIV from households earning more than twice the minimum interprofessional wage were significantly less likely to suffer from depression (aOR: 0.25; 95%CI: 0.07–0.91). The same associations were observed for MHD. CONCLUSION: The study highlights a substantial mental health burden among ALHIV in Togo, with depression associated with loneliness, stigma, and comorbidities. Findings emphasize the integration of routine mental health screening into HIV care and tailoring stigma-reduction and economic-support strategies. These results form a critical foundation for national mental health programs addressing ALHIV in Togo. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-025-07488-7.