Adolescence is a critical human developmental stage where rapid biological, psychological, and social transitions occur. These changes may increase susceptibility to mental health conditions, including anxiety, depression, and suicidal ideation. Moreover, such conditions are leading contributors to disability and mortality among youth worldwide. Despite this, limited research has addressed these issues in Nepal. This study examined the prevalence and associated factors of anxiety, depression, and suicidal ideation among high school adolescents in Parbat District, Nepal. A cross-sectional study was conducted in August 2024 among 304 students in grades 11 and 12. Validated Nepali-language instruments, including the GAD-7, PHQ-9, and SBQ-R, were used to assess anxiety, depression, and suicidal ideation, respectively. Multivariable logistic regression analyses identified factors associated with each condition, with results reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). The prevalence of anxiety, depression, and suicidal ideation was 36.5%, 17.4%, and 7.6%, respectively. Female adolescents exhibited higher odds of anxiety (aOR: 2.59; 95% CI: 1.30–5.19) and depression (aOR: 5.65; 95% CI: 1.82–17.53). Similarly, non-Hindu participants had higher odds of anxiety (aOR: 6.63; 95% CI: 1.96–22.42) and depression (aOR: 7.86; 95% CI: 1.94–31.85). Lower scholastic achievement was significantly associated with anxiety (aOR: 0.27, 0.09 – 0.81, p < 0.05) and depression (aOR: 0.13, 0.02 – 0.70, p < 0.01). Likewise, childhood trauma was associated with depression (aOR: 15.61, 3.18 – 76.67, p < 0.001) and suicidal ideation (aOR: 16.14, 1.89 – 138.15, p < 0.01). A prior history of mental health problems was strongly linked to suicidal ideation (aOR: 38.83; 95% CI: 4.71–320.26). These findings suggest a substantial mental health burden among adolescents. Early identification and targeted, school-based interventions are important, especially for vulnerable groups such as female adolescents and those with poor academic performance or adverse childhood experiences.
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