Screening tools for common mental disorders in older adults in South Asia: a systematic scoping review.

Lachlan Fotheringham,Richard Walker,Ammu Lukose,Mathew Varghese,Stella-Maria Paddick,Evelyn Barron Millar,Claire Norman

doi:10.1017/s1041610220003804

Abstract

Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population. A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies - version 2 (QUADAS-2) tool. Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%). This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.

Highlights

The world population is aging rapidly, in low- and middle-income countries (LMICs) compared with high-income countries (HICs) (UN 2015), and while South Asia has in the past lagged behind other parts of the world in this, its fertility rate is declining and life expectancy is climbing, bringing on a rapid demographic transition (Chand, 2018)
Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings
The work of the 10/66 Collaboration is primarily focused on dementia, and Study on Global Ageing and Adult Health (SAGE) aims to provide a broad representation from different geographic regions across LMICs (Lotfaliany et al, 2019), rather than a sharply focused impression of any one region in particular

Summary

Introduction

The world population is aging rapidly, in low- and middle-income countries (LMICs) compared with high-income countries (HICs) (UN 2015), and while South Asia has in the past lagged behind other parts of the world in this, its fertility rate is declining and life expectancy is climbing, bringing on a rapid demographic transition (Chand, 2018). There is a need to focus on older people across LMICs, and on South Asia in particular. The majority of existing data in this area focus on HICs, with a relative lack in older people and LMICs. The majority of existing data in this area focus on HICs, with a relative lack in older people and LMICs Initiatives such as the 10/66 International Dementia Research Collaboration (Prince et al, 2007) and the Study on Global Ageing and Adult Health (SAGE) (Kowal et al, 2012) have greatly added to the understanding of mental disorders in older people in LMICs, they still leave much to learn. There may be common psychosocial constructs across the region (Rama et al, 2014), suggesting that it is useful to consider South Asia as a whole in a review such as this

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