Status of Mental Health in Sub-Saharan Africa: A Systematic Review of the Cultural Validity of Screening Tools Open Access

Abdulsalam, Amna (Spring 2019)

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Status of Mental Health in Sub-Saharan Africa: A Systematic Review of the Cultural Validity of Screening Tools

By Amna Hassana Abdulsalam

Background: Mental health burden is on the rise in all countries across the world, especially in sub-Saharan Africa, as the region faces a growing and aging population, recent and on-going conflicts, economic difficulties and tens of millions of people living with HIV/AIDS. Despite this, mental health care in the region remains sub-optimal. Mental health screenings are a fundamental way to help bridge this gap and allow for early identification and intervention. They can be particularly useful is in sub-Saharan Africa for non-specialists to task shift and provide community-based care. However, one of the greatest challenges medical professionals in Africa are faced with is how to incorporate cross-cultural understandings of mental disorders into psychiatric screening of their patients. Literature reveals a wealth of studies on mental disorder screening tools but only a few that attempt to systematically review their validity in this setting. There is an emergent need to systematize and strengthen screening tools in sub-Saharan Africa. There remains a gap in knowledge of the current attempts at ensuring cultural validity in screening instruments, of all mental disorders, in sub-Saharan Africa. This review was conducted to identify the construct and cultural validity of mental disorder screening tools and how this impacts their reliability for use in these settings. 

Methods: Four electronic databases (Pubmed, Web of Science, Popline and PsychINFO) were

searched for published papers on cultural validity of mental health screening tools in sub-Saharan Africa. Original papers, published in English, on all ICD-10 mental disorders in sub-Saharan were included. 

Results: Fifty-five studies satisfied the inclusion criteria. Overall, language translation (56%), adaptation of terms (47%) and method of administration (72%) were found to be the main methods of culturally validating screening tools. Back translation of tools into the local language was the most frequent translation method. Adaptation of terms was done through group consensus meetings by research experts and translators (46%), focus groups with community members (12%), pre-study pilot testing in a sample of the study population (8%) whilst the remainder of studies (37%) utilized a combination of the methods. 40 studies (72%) administered tools through interviews as opposed to using self-administered tools.Additionally, data analysis was the primary basis for concluding the validity of the instruments being measured in all the studies. 33 out of 55 studies (60%) developed a Receiver Operating Curve to calculate sensitivity and specificity.

Conclusion: Themes identified in this review highlight the strong methodological techniques utilized to cultural validity screening tools in sub-Saharan Africa, and the recommendations proposed should be used to stimulate meaningful discussions to improve these methods. This is essential to promote the best screening tools for use in sub-Saharan Africa and to relieve the rising burden of mental disorders in the region.

Table of Contents

Abstract iv

Table of Contents v

I. Introduction 1

1.1 Importance of Mental Health 1

1.2 Importance of Screening Tools 4

1.3 Importance of Cultural Validity 6

Research Gap 9

II. Background and Literature Review 10

III. Methods 13

3.1 Study Aim 13

3.2 Literature Search Strategy 13

3.3 Scope of Review 14

3.4 Study Selection 15

3.5 Inclusion Criteria 15

3.6 Exclusion Criteria 16

IV. Results 17

4.1 Study Selection 17

4.2 Study Features 18

4.3 Screening Tools 22

4.4 Cultural Validity 27

4.5 Statistical Analysis 36

V. Discussion 40

VI. Limitations 47

VII. Conclusion 48

Appendixes i

Appendix A i

Appendix B xxxviii

VIII. References xxxix

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