Abstract
BackgroundA major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings.Methods and FindingsOf 1,027 records identified through searching 7 electronic databases, we reviewed 126 full-text reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. ConclusionsThe EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts.
Highlights
Major depressive disorder is a major public health issue and accounts for a large proportion of the global burden of disease [1,2], especially among women of reproductive age [3]
The high burden of perinatal depression in many African countries [8,9] has not been matched by adequate mental health systems or human resources for mental health [10,11]
The 25 studies enrolled 12,544 women living in nine different North African and sub-Saharan African countries, with Nigeria and South Africa accounting for more than one-half of the studies
Summary
Major depressive disorder is a major public health issue and accounts for a large proportion of the global burden of disease [1,2], especially among women of reproductive age [3]. When episodes occur during the antenatal or postnatal periods, maternal depression can compromise children’s physical health [4] and socio-emotional development [5] These collateral impacts provide added impetus for alleviating the burden of perinatal depression in low- and middle-income countries [6,7]. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. We included unique studies, which were disseminated in journal articles and 1 doctoral dissertation These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Conclusions: The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. More qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts
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