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Abstract Introduction/problem Anxiety disorders are increasingly prevalent in sub-Saharan Africa (SSA). Limited data exist on factors contributing to anxiety, particularly among final year junior high school (JHS) students in Ghana preparing for the Basic Education Certificate Exam (BECE). Purpose This study aimed to investigate the factors influencing anxiety levels among final year JHS students in Ghana, focusing on hunger, parental support, sleep duration, co-occurring mental health concerns, gender, and other variables. Methods A sample of 394 final year JHS students in the Greater Accra Region of Ghana was surveyed using established measures for anxiety, sleep duration, parental support, hunger, substance use, and mental health concerns. Logistic regression analyses were conducted to explore the relationships between these variables and anxiety levels among students. Key findings The study revealed a high prevalence of anxiety among final year JHS students, with 71.4% exhibiting symptoms above the chronic anxiety cut-off point. Significant factors associated with anxiety included hunger, living with a single parent, and co-occurring mental health concerns. Age, gender, access to school counseling, school type, and substance use showed no significant associations with anxiety. Conclusions/implications The findings underscore the need for a comprehensive approach to addressing anxiety among final year JHS students, considering socio-economic factors, family dynamics, and mental health support. Stakeholders can use these insights to develop targeted interventions that promote mental well-being and academic success. Recommendations Enhancing access to mental health services, addressing socio-economic disparities, providing support for students from single-parent households, and integrating mental health education into school curricula are recommended.