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BMC Psychiatry

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Open Access 01-12-2020 | Post-Traumatic Stress Disorder | Research article

A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries

Authors: Anisa Y. Mughal, Jackson Devadas, Eric Ardman, Brooke Levis, Vivian F. Go, Bradley N. Gaynes

Published in: BMC Psychiatry | Issue 1/2020

Abstract

Background

Anxiety 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.

Methods

MEDLINE, 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.

Results

Of 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%).

Conclusion

Use 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 registration

PROSPERO registry number CRD42019121794.

Available only for authorised users

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Title: A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries
Authors: Anisa Y. Mughal
Jackson Devadas
Eric Ardman
Brooke Levis
Vivian F. Go
Bradley N. Gaynes
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Post-Traumatic Stress Disorder
Mood Disorders
Anxiety or Fear-Related Disorders
Affective Disorder
Anxiety
Published in: BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-020-02753-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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