Drought exposure and severe mental distress among adolescent girls and young women in Lesotho: the moderating role of food insecurity.

BACKGROUND: Climate-related shocks such as drought are increasingly recognised as threats to mental health, yet evidence remains limited on how these stressors affect adolescent girls and young women (AGYW) in Lesotho. This study examines the association between drought exposure and severe mental distress among AGYW in Lesotho and assesses whether household food insecurity moderates this relationship. METHODS: We analysed nationally representative cross-sectional data from 7,101 AGYW aged 13–24 years drawn from the 2018 Lesotho Violence Against Children and Youth Survey. Severe mental distress was measured using the Kessler-6 scale. Drought exposure was defined using district-level Integrated Food Security Phase Classification data. Multivariable logistic regression models assessed independent associations, and interaction terms were used to examine moderation by food insecurity. Predicted probabilities were estimated to illustrate combined effects. RESULTS: Drought exposure was associated with increased odds of severe mental distress (adjusted odds ratio [aOR] = 1.47; 95% CI: 1.01–2.15; p = 0.045). Food insecurity independently increased the odds of distress (aOR = 1.47; 95% CI: 1.06–2.05; p = 0.022). In the interaction model, the association between drought vulnerability and severe mental distress differed by food insecurity status (interaction aOR = 2.21; 95% CI: 1.15–4.27; p = 0.018). AGYW experiencing both drought and food insecurity had the highest predicted probability of severe mental distress. CONCLUSIONS: The association between drought vulnerability and severe mental distress among AGYW in Lesotho was stronger in food-insecure households. Integrated climate adaptation, food security, and mental health interventions may help protect vulnerable AGYW in drought prone settings such as Lesotho.