AUTHOR=Gyimah Leveana , Agyepong Irene Akua , Owiredu David , Awini Elizabeth , Yevoo Linda Lucy , Ashinyo Mary Eyram , Aye Sorre Grace Emmanuelle Victoire , Abbas Shazra , Cronin de Chavez Anna , Mirzoev Tolib , Danso-Appiah Anthony 

TITLE=Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review

JOURNAL=Frontiers in Public Health

VOLUME=Volume 12 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1321689

DOI=10.3389/fpubh.2024.1321689

ISSN=2296-2565

ABSTRACT=Introduction
In sub-Saharan Africa, pregnant and postpartum women with mental health problems are often missed in healthcare systems. To address this, a practical and simple screening tool for maternal mental health should be available to primary healthcare workers. An important step towards having such a tool is to assess the existing tools and their effectiveness in primary care settings.

Methods
We systematically searched   PubMed, LILAC, CINAHL, Google Scholar, African Index Medicus, HINARI and African Journals Online were searched from inception to 31st January 2023, without language restriction.  Reference lists of retrieved articles were reviewed and experts in the field were contacted for studies not captured by our searches. All retrieved records were collated in Endnote, de-duplicated and exported to Rayyan for screening. Study selection and data extraction were done by at least two reviewers using a pre-tested flow chart and data extraction form. Disagreements between reviewers were resolved through discussion.   We contacted primary authors for missing or insufficient information and conducted content analysis of the psychometric properties of the tools.

Results
One thousand one hundred and eighty-one (1,181) studies were retrieved by our searches, of which 119 studies were included in this review. Seventy-four out of the 119 studies (62%) screened for depression during pregnancy and or the postpartum period. The Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were the most commonly used tools. Twelve studies reported specificity and sensitivity for tools for measuring depression (EPDS, PHQ-9 and Whooley) and psychological distress (Self Report Questionnaire (SRQ) and Kessler Psychological Distress Scale (KPDS)). The average sensitivity and specificity of the EPDS reported were 75.5 % and 76.5% respectively at a cut-off of ≥13.  The EPDS appears to be the most acceptable, adaptable, user-friendly and effective in screening for maternal mental health conditions during pregnancy and postpartum. However, the methodological approach varied for a particular tool and documentation on the attributes was scanty.

Conclusions 
The EPDS was the most commonly used tool and considered as most acceptable, adaptable, user-friendly and effective. Information on the performance and psychometric properties of the vast majority of screening tools was limited.