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Research article
Bradley N Gaynes
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8283-5030
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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-January 10, 2019). 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 included study. We assed quality using a modified version of Greenhalgh’s ten item checklist. 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 5343 unique citations identified, 57 articles including 75 screening tools were included. There were 44, 20 and 11 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (34). Regionally, South Asia (10) had the most validations, followed by West Asia (9) and South Africa (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 (27) had the lowest quality rating (unblinded) followed by good (21). Due to incomplete reporting, we combined only two sets of accuracy values in meta-analysis (GAD-7 cut-off ≥10; sensitivity: 76%, specificity: 64%).
Conclusion
Use of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations, yet many have been validated in inadequately designed studies. Locally validated screening tools for anxiety and PTSD need further evaluation and well-designed studies, including clinical trials, to determine whether their use can reduce the burden of disease.
PROSPERO registry number: CRD42019121794
Keywords
Anxiety, post-traumatic stress disorder, screening tool, validation, low-to-middle income countries
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CURRENT STATUS: Published
View the published article at BMC Psychiatry.
Version 1
Posted 03 Mar, 2020
No community comments so far
Editorial decision: Major revision
On 04 Mar, 2020
Review #1 received
Received 17 Feb, 2020
Reviewer #1 agreed
On 03 Feb, 2020
Reviewers invited
Invitations sent on 15 Jan, 2020
Editor assigned
On 13 Jan, 2020
Submission checks complete
On 12 Jan, 2020
Editor invited
On 12 Jan, 2020
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Subject Areas
Psychiatry
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A new preprint design is coming!
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See the published version of this preprint at BMC Psychiatry.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Bradley N Gaynes
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8283-5030
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Psychiatry.
Version 1
Posted 03 Mar, 2020
No community comments so far
Editorial decision: Major revision
On 04 Mar, 2020
Review #1 received
Received 17 Feb, 2020
Reviewer #1 agreed
On 03 Feb, 2020
Reviewers invited
Invitations sent on 15 Jan, 2020
Editor assigned
On 13 Jan, 2020
Submission checks complete
On 12 Jan, 2020
Editor invited
On 12 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Psychiatry
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Psychiatry.
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-January 10, 2019). 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 included study. We assed quality using a modified version of Greenhalgh’s ten item checklist. 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 5343 unique citations identified, 57 articles including 75 screening tools were included. There were 44, 20 and 11 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (34). Regionally, South Asia (10) had the most validations, followed by West Asia (9) and South Africa (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 (27) had the lowest quality rating (unblinded) followed by good (21). Due to incomplete reporting, we combined only two sets of accuracy values in meta-analysis (GAD-7 cut-off ≥10; sensitivity: 76%, specificity: 64%).
Conclusion
Use of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations, yet many have been validated in inadequately designed studies. Locally validated screening tools for anxiety and PTSD need further evaluation and well-designed studies, including clinical trials, to determine whether their use can reduce the burden of disease.
PROSPERO registry number: CRD42019121794
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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