Abstract
BackgroundAnxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). Screening has been proposed to improve identification and management of these disorders, but little is known about the validity of screening tools for these disorders. We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs.MethodsMEDLINE, EMBASE, Global Health and PsychINFO were searched (inception-April 22, 2020). Eligible studies (1) screened for anxiety disorders and/or PTSD; (2) reported sensitivity and specificity for a given cut-off value; (3) were conducted in LMICs; and (4) compared screening results to diagnostic classifications based on a reference standard. Screening tool, cut-off, disorder, region, country, and clinical population were extracted for each study, and we assessed study quality. Accuracy results were organized based on screening tool, cut-off, and specific disorder. Accuracy estimates for the same cut-off for the same screening tool and disorder were combined via meta-analysis.ResultsOf 6322 unique citations identified, 58 articles including 77 screening tools were included. There were 46, 19 and 12 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (35). Regionally, South Asia (11) had the most validations, followed by South Africa (10) and West Asia (9). The Kessler-10 (7) and the Generalized Anxiety Disorder-7 item scale (GAD-7) (6) were the most commonly validated tools for anxiety disorders, while the Harvard Trauma Questionnaire (3) and Posttraumatic Diagnostic Scale (3) were the most commonly validated tools for PTSD. Most studies (29) had the lowest quality rating (unblinded). Due to incomplete reporting, we could meta-analyze results from only two studies, which involved the GAD-7 (cut-off ≥10, pooled sensitivity = 76%, pooled specificity = 64%).ConclusionUse of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations. However, many have been validated in inadequately designed studies, precluding any general recommendation for specific tools in LMICs. Locally validated screening tools for anxiety and PTSD need further evaluation in well-designed studies to assess whether they can improve the detection and management of these common disorders.Trial registrationPROSPERO registry number CRD42019121794.
Highlights
Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs)
Inclusion criteria Our eligibility criteria required that studies: (1) screen for anxiety and/or PTSD; (2) provide estimates of sensitivity and specificity for a given cut-off value for one of the included disorders; (3) were conducted in a LMIC [24]; and (4) compare screening results to a validated reference standard
Study selection Of 6322 unique citations identified from the database search, 6188 were excluded after title and abstract review and five additional papers from the reference lists of relevant systematic reviews were added
Summary
Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs. Mental health disorders, including anxiety and posttraumatic stress disorder (PTSD) are among the leading contributors to global disability adjusted life years, comprising five of the top twenty contributing disorders [1]. In 2017, it was estimated that over 264 million people experienced an anxiety disorder, with the global prevalence for both anxiety disorders and PTSD ranging from 2.5 to 7% by country [2,3,4]. Both anxiety and PTSD are widespread common mental disorders (CMDs) that have been shown to cause significant negative health outcomes within various populations and contribute to a large portion of the global disease burden [5, 6]. There is evidence suggesting that the presence of an anxiety disorder or PTSD increases the likelihood of comorbidity with other severe health conditions, such as major depressive disorder and substance use disorder [10, 11]
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