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

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.