Depression and Anxiety Among Women in Lesotho: A Multilevel Analysis of the 2023–2024 LSDHS

Background: Women's mental health significantly influences families, communities, and national development. In low-resource settings like Lesotho, factors such as chronic illness, financial barriers, and limited access to care contribute to the burden of mental health conditions. However, population-level evidence on depression and anxiety among reproductive age women remains limited. Methods: A cross-sectional multilevel analysis was conducted using data from the 2023-2024 Lesotho Demographic and Health Survey (LSDHS). A weighted sample of 3265 women aged 15-49 years was included. Outcomes were defined as physician-diagnosed depression, Patient Health Questionnaire (PHQ)-based depressive symptoms, and self-reported anxiety. Multilevel multivariable logistic regression models were fitted separately for each outcome to identify associated factors while accounting for the hierarchical structure of the data. Results: The prevalence of self-reported physician-diagnosed depression was 10.62%, PHQ-based depressive symptoms 5.37%, and self-reported physician-diagnosed anxiety was 9.07%. Chronic illness was significantly associated with all three outcomes. Financial barriers to healthcare were associated with self-reported physician-diagnosed depression and PHQ-based depressive symptoms, while higher parity and younger age were associated with PHQ-based depressive symptoms. Smoking and lack of media exposure were associated with higher odds of self-reported physician-diagnosed anxiety. Regional disparities were observed for self-reported physician-diagnosed depression and anxiety. Conclusions: Mental health problems remain a significant concern among women in Lesotho. Both shared and outcome-specific factors were identified, with chronic illness emerging as a consistent determinant. These findings highlight the need for integrated and targeted mental health interventions, particularly within primary healthcare and chronic disease management, alongside efforts to improve access to information and reduce regional inequalities.