Background
Methods
Search strategy and study selection
Inclusion criteria
Exclusion criteria
Literature review
Quality appraisal
Data abstraction and analysis
Results
Study selection
Quality appraisal
Quality Rating | Number of Studies |
---|---|
Very good | 2 |
Good | 20 |
Fair | 2 |
Acceptable | 5 |
Unblinded | 29 |
Total | 58 |
Description of included studies
Disorder Category | Specific disorders | Total |
---|---|---|
Anxiety Disorders | Generalized Anxiety Disorder | 46 |
Panic Disorder | ||
Social Anxiety Disorder | ||
Anxiety Disorder NOS | ||
PTSD | PTSD | 19 |
Anxiety and Depression | Generalized Anxiety Disorder | 12 |
Major Depressive Disorder | ||
Total | 77 |
Population Descriptors | Number of Studies | |
---|---|---|
Adults (36) | Outpatients | 5 |
General Population | 7 | |
HIV | 4 | |
Psychiatric patients | 7 | |
Conflict area/refugee | 4 | |
Other or unspecified | 9 | |
Perinatal (6) | HIV | 1 |
Other | 5 | |
Adolescents and Adults (6) | Survivors of natural disaster | 2 |
Other | 4 | |
Children and/or Adolescents (10) | Psychiatric Patient | 2 |
Survivor of natural disaster | 2 | |
Other | 6 |
Continent | Region | Country (Number of Studies) | LMICs with no studies |
---|---|---|---|
Africa (20) | North | None | 6 (Sudan, Algeria, Egypt, Libya, Morocco, Tunisia) |
Middle | None | 9 (Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Sao Tome and Principe) | |
East (8) | Zimbabwe (2), Somalia (1), Uganda (1), Burundi (1), Tanzania (1), Zambia (1), Ethiopia (1) | 10 (Comoros, Djibouti, Eritrea, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Rwanda, South Sudan) | |
West (2) | Nigeria (2) | 14 (Benin, Burkina Faso, Cabo Verde, Cote dIvoire, Gambia, Ghana, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Senegal, Sierra Leone, Togo) | |
South (10) | South Africa (10) | 4 (Botswana, Lesotho, Namibia, Swaziland) | |
Asia (35) | East (7) | China (7) | 2 (North Korea, Mongolia) |
South (11) | Pakistan (2), India (3), Nepal (3), Afghanistan (1), Iran (2) | 4 (Bangladesh, Bhutan, Maldives, Sri Lanka) | |
South East (7) | Vietnam (3), Malaysia (2), Indonesia (1), Thailand (1) | 4 (Cambodia, Laos, Philippines, Timor-Leste) | |
West (9) | Kuwait (1), Lebanon (3), Turkey (4), Iraq (1) | 7 (Armenia, Azerbaijan, Georgia, Jordan, Palestine, Syria, Yemen) | |
Central (1) | Tajikistan (1) | 4 (Kazakhstan, Kyrgyzstan, Turkmenistan, Uzbekistan) | |
America (5) | South (4) | Brazil (2), Peru (2) | 6 (Bolivia, Colombia, Ecuador, Guyana, Paraguay, Suriname) |
Central (1) | Mexico (1) | 7 (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama) | |
Caribbean | None | 6 (Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica) | |
Europe (1) | Southern (1) | Bosnia and Herzegovina (1) | 4 (Albania, Macedonia, Montenegro, Serbia) |
Eastern | None | 5 (Belarus, Bulgaria, Moldova, Romania, Ukraine) | |
Oceania | None | 2 (Melanesia, Micronesia) | |
Total (61a) |
Disorder | Screening Tool | Number of Validations |
---|---|---|
Anxiety disorders | HADS-A | 3 |
HADS | 3 | |
DASS-A | 1 | |
Zung SAS | 2 | |
STAI | 1 | |
EPDS | 2 | |
HAM-A | 1 | |
K10 | 7 | |
K6 | 3 | |
PHQ-4 | 1 | |
GAD-7 | 6 | |
HDRS | 1 | |
HSCL-25 | 4 | |
MINI-SPIN | 1 | |
PHC | 1 | |
GHQ-12 | 2 | |
SCARED/SCARED-C/−P | 1/1/1 | |
PASS | 1 | |
RCADS-GAD scale | 1 | |
BAI | 2 | |
Total | 46 | |
PTSD | HTQ/−R | 1 |
HTQ | 3 | |
K10 | 2 | |
PDS | 3 | |
PCL-C/−5 | 2/2 | |
CPSS | 2 | |
TSSC | 1 | |
UCLA PTSD Index | 1 | |
PTSD Screening Tool | 2 | |
Total | 19 | |
Anxiety and Depression | HSCL-25 | 2 |
Independently developed (Zambia) | 1 | |
YSR | 1 | |
HADS | 1 | |
AKUADS | 1 | |
SRQ-20 | 1 | |
AYMH | 1 | |
HEI | 1 | |
K10/K6 | 1/1 | |
PHQ-4 | 1 | |
Total | 12 |
Author (year) | Screening tool/disorder | Gold Standard | Subregion | Country | Population | Study Quality | No. Participants | Prevalence (%) | DSM Version | AUC | Cut-Off Score (≥) | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Africa | |||||||||||||
Ventevogel et al. (2014) [37] | CPSS/PTSD | K-SADS-PL | Africa East | Burundi | Children aged 10–15 | good | 65 | 23 | DSM 4 | 0.78 | 26 | 71 | 83 |
Chibanda et al. (2016) [38] | GAD-7/GAD | SCID | Africa East | Zimbabwe | Adults except pregnant women | good | 264 | 3 | DSM 4 | 0.9 | 10 | 89 | 73 |
Kaaya et al. (2002) [39] | HSCL-25/Anxiety and depression | SCID | Africa East | Tanzania | Pregnant women with HIV | good | 903 (100 for SCID) | 3.3 | DSM 4 | 0.86 | 1.06 | 89 | 80 |
Verhey et al. (2018) [40] | PCL-5/PTSD | CAPS-5 | Africa East | Zimbabwe | Adults except perinatal women | very good | 204 | 19.6 | DSM 5 | 0.78 | 33 | 74.5 | 70.6 |
Odenwald et al. (2007) [41] | PDS/PTSD | CIDI | Africa East | Somalia | Patients with trauma exposure | good | 135 (62 for CIDI) | 16.1 | DSM 4 | 0.874 | 14 | 90 | 79 |
Ertl et al. (2011) [42] | PDS/PTSD | CAPS | Africa East | Uganda | Adults and adolescents aged 12–25 | good | 68 | 32.4 | DSM 4 | 0.79 | 16 | 82 | 70 |
Mbewe et al. (2013) [43] | self-made/Anxiety and depression | Interview | Africa East | Zambia | Adults with epilepsy | good | 575 | 53.7 | DSM 4 | x | 17 | 56.5 | 68.1 |
Geibel et al. (2016) [44] | YSR/anxiety and depression | Interview | Africa East | Ethiopia | Vulnerable teens assisted by two aid organizations | good | 134 | 64.6 | DSM 4 | 0.729 | 6.5 | 75 | 63.1 |
Saal (2019) [45] | Beck Anxiety Inventory/GAD | SCID | Africa South | South Africa | Adults undergoing HIV testing | unblinded* | 500 | 3.4 | DSM 5 | 0.86 | 21.5 | 82 | 80 |
van Heyningen et al. (2018) [46] | EPDS/anxiety | MINI | Africa South | South Africa | Adult women in the antenatal period | unblinded* | 376 | 23 | DSM 4 | 0.69 | 5 | 67 | 59 |
Marsay et al. (2017) [47] | EPDS/anxiety | NetSCID | Africa South | South Africa | Adult women pregnant for 22–28 weeks | unblinded* | 145 | 14.5 | DSM 5 | x | 7 | 54.8 | 81.6 |
van Heyningen et al. (2018) [46] | GAD-2/anxiety | MINI | Africa South | South Africa | Adult women in the antenatal period | unblinded* | 376 | 23 | DSM 4 | 0.73 | 2 | 64 | 74 |
Seedat et al. (2007) [48] | HADS-A/anxiety | MINI | Africa South | South Africa | Adult schizophrenic patients | unblinded | 70 | 22.9 | DSM 4 | x | 11 | 37.5 | 72.2 |
Seedat et al. (2007) [48] | HAM-A/anxiety | MINI | Africa South | South Africa | Adult schizophrenic patients | unblinded | 70 | 22.9 | DSM 4 | x | 22 | 31.3 | 90.7 |
Myer et al. (2008) [49] | HTQ/PTSD | MINI | Africa South | South Africa | HIV-positive adults | good | 465 | 5 | DSM 4 | 0.74 | 62 | 74 | 70 |
Spies et al. (2009) [50] | K-10/Agoraphobia | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 18.4 | DSM 7 | 0.69 | 26 | 65 | 67 |
van Heyningen et al. (2018) [46] | K10/anxiety | MINI | Africa South | South Africa | Adult women in the antenatal period | unblinded* | 376 | 23 | DSM 4 | 0.77 | 11 | 76 | 70 |
Andersen et al. (2011) [51] | K-10/Anxiety and Depression | CIDI | Africa South | South Africa | Adults | unblinded | 4077 | x | DSM 4 | 0.73 | 16 | 70 | 67 |
Spies et al. (2009) [52] | K10/GAD | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 18.4 | DSM 4 | 0.78 | 30 | 72 | 80 |
Spies et al. (2009) [50] | K-10/GAD | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 18.4 | x | 0.78 | 30 | 72 | 80 |
Spies et al. (2009) [50] | K-10/Panic disorder | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 15.3 | DSM 6 | 0.77 | 28 | 76 | 73 |
Spies et al. (2009) [52] | K-10/PTSD | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 21.5 | DSM 8 | 0.77 | 29 | 75 | 78 |
Spies et al. (2009) [50] | K-10/PTSD | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 21.5 | x | 0.77 | 29 | 75 | 78 |
Spies et al. (2009) [50] | K-10/Social anxiety | MINI | Africa South | South Africa | HIV-positive adults | unblinded* | 429 | 12.3 | DSM 5 | 0.9 | 30 | 92 | 80 |
van Heyningen et al. (2018) [46] | K6/anxiety | MINI | Africa South | South Africa | Adult women in the antenatal period | unblinded* | 376 | 23 | DSM 4 | 0.77 | 8 | 69 | 76 |
Andersen et al. (2011) [51] | K-6/Anxiety and Depression | CIDI | Africa South | South Africa | Adults | unblinded | 4077 | x | DSM 4 | 0.72 | 10 | 70 | 62 |
Martin et al. (2009) [53] | PDS/PTSD | CIDI | Africa South | South Africa | HIV-positive adults | unblinded | 85 | x | DSM 4 | 0.74 | 15 | 68.6 | 65 |
van der Westhuizen (2016) [54] | SRQ-20/Anxiety/Depression | MINI | Africa South | South Africa | Adults with assault-related injury or accidents | unblinded* | 200 | x | ICD 10 | 0.87 | 5 | 83.3 | 76 |
Seedat et al. (2007) [48] | STAI/anxiety | MINI | Africa South | South Africa | Adult schizophrenic patients | unblinded | 70 | 22.9 | DSM 4 | x | 40 | 75 | 48.1 |
Makanjuola et al. (2014) [55] | GHQ-12/anxiety | CIDI | Africa West | Nigeria | Adult patients of general practices | unblinded | 1590 | x | DSM 4 | 0.61 | 3 | 59 | 63.3 |
Abiodun et al. (1994) [56] | HADS/Anxiety and Depression | Interview | Africa West | Nigeria | Adult patients in non-psychiatric wards and community | unblinded* | 1078 | Various† | ICD 9 | x | 8 | 87.5 | 90.6 |
Makanjuola et al. (2014) [55] | K6/anxiety | CIDI | Africa West | Nigeria | Adult patients of general practices | unblinded | 1590 | x | DSM 4 | 0.58 | 4 | 65 | 55 |
Asia | |||||||||||||
Hollander et al. (2007) [21] | HSCL-25/anxiety | Interview | Asia Central | Tajikistan | Adult patients at outpatient clinics | acceptable | 75 | x | DSM 4 | x | 1.6 | 84 | 60 |
Hollander et al. (2007) [21] | HTQ-R/PTSD | Interview | Asia Central | Tajikistan | Adult patients at outpatient clinics | acceptable | 75 | x | DSM 4 | x | 1.73 | 97 | 65 |
Tong et al. (2016) [57] | GAD-7/Generalized anxiety | MINI | Asia East | China | Adults with epilepsy who were Chinese citizens | unblinded | 213 | 23.5 | DSM 4 | 0.974 | 6 | 94 | 91.4 |
Sheng et al. (2010) [58] | HADS-A/anxiety | MINI | Asia East | China | Adult psychiatric outpatients | unblinded | 70 | 25.5 | DSM 4 | 0.805 | 6 | 86 | 79 |
Yang et al. (2014) [59] | HADS-A/anxiety | MINI | Asia East | China | Adult cardiac outpatients | unblinded* | 100 | 15 | DSM 4 | 0.81 | 6 | 81.6 | 75.8 |
Wang et al. (2017) [60] | HEI/Anxiety and depression | MINI | Asia East | China | Hospitalized patients aged 15+ | unblinded* | 763 | 7.11 | DSM 4 | 0.88 | 11 | 88 | 76.6 |
Liu et al. (2008) [61] | PTSD screening tool/PTSD | DSM-IV PTSD criteria | Asia East | China | Survivors of a flood aged 16+ | unblinded | 27,267 | 9.5 | DSM 4 | 0.858 | 3 | 87.9 | 97.9 |
Liu et al. (2007) [62] | PTSD screening tool/PTSD | DSM-IV PTSD criteria | Asia East | China | Child survivors of a flood aged 7–15 | unblinded | 6073 | 4.6 | DSM 4 | x | 3 | 96.9 | 99 |
Ali et al. (1998) [63] | AKUADS/GAD and MDD | Interview | Asia South | Pakistan | Residents aged 16–60 in Karachi squatter settlement | unblinded | 487 | x | DSM 3 | x | 19 | 74 | 81 |
Kohrt et al. (2003) [64] | BAI/anxiety | DSM-IV criteria | Asia South | Nepal | Adults with psychiatric illness and controls | acceptable | 363 | Various† | DSM 4 | x | 14 | 91 | 89 |
Thapa et al. (2005) [65] | PCL-C/PTSD | CIDI | Asia South | Nepal | Adults residing in conflict areas | unblinded | 290 | 53.4 | DSM 4 | 0.81 | 50 | 80 | 80 |
Kohrt et al. (2011) [66] | CPSS/PTSD | K-SADS | Asia South | Nepal | Adolescents aged 11–14 | good | 162 | 6.4 | DSM 4 | 0.77 | 20 | 68 | 73 |
Chaturvedi et al. (1994) [67] | HADS/anxiety | Interview | Asia South | India | Cancer patients of all ages | unblinded* | 70 | not specified | DSM 3 | x | 7 | 87 | 79 |
Ventevogel et al. (2007) [68] | HSCL/anxiety | PAS | Asia South | Afghanistan | Clinic patients aged 15+ | good | 116 | 24.1 | x | 0.61 | 2 | 75 | 43 |
Ventevogel et al. (2007) [68] | HSCL/depression and anxiety | PAS | Asia South | Afghanistan | Clinic patients aged 15+ | good | 116 | 24.1 | x | 0.61 | 2 | 69 | 67 |
Housen et al. (2018) [69] | HSCL-25/anxiety | MINI | Asia South | India | Adult general medical outpatients | good | 290 | 3.5 | DSM 4 | 0.81 | 1.75 | 73 | 81 |
Thapa et al. (2005) [65] | HSCL-25/anxiety | CIDI | Asia South | Nepal | Adults residing in conflict areas | unblinded | 290 | 80.7 | DSM 4 | 0.76 | 1.75 | 77 | 58 |
Ahmadi (2020) [70] | PHQ-4/anxiety | SCID | Asia South | Iran | Adults with coronary heart disease | unblinded* | 279 | not specified | DSM 5 | 0.94 | 7 | 80 | 94 |
Ahmadi (2020) [70] | PHQ-4/Anxiety and depression | SCID | Asia South | Iran | Adults with coronary heart disease | unblinded* | 279 | not specified | DSM 5 | 0.94 | 7 | 86 | 90 |
Russell et al. (2013) [71] | SCARED/anxiety | K-SADS-PL | Asia South | India | Adolescents aged 11–19 | unblinded* | 500 | x | DSM 4 | 0.9 | 21 | 84.6 | 87.36 |
Namazi et al. (2013) [72] | UCLA PTSD (PTSD) | Interview | Asia South | Iran | Children aged 7–12 after earthquake | unblinded* | 50 | 56 | 4-R | x | 38 | 96 | 50 |
Tran et al. (2013) [73] | DASS-A/anxiety | SCID | Asia South East | Vietnam | Adult perinatal women | good | 221 | 10.9 | DSM 4 | 0.806 | 10 | 79.2 | 67 |
Sidik et al. (2012) [74] | GAD-7/anxiety | CIDI | Asia South East | Malaysia | Adult females | good | 895 | 7.8 | DSM 4 | x | 8 | 76 | 94 |
Yahya et al. (2015) [75] | HDRS/anxiety | DSM-IV | Asia South East | Malaysia | Patients with existing psychiatric disorder and controls | unblinded* | 120 | x | DSM 4 | 0.917 | 8 | 90 | 86.2 |
Silove et al. (2007) [76] | HTQ/PTSD | SCID | Asia South East | Thailand | Cambodian population in Thailand | good | 118 | 20.3 | DSM 4 | 0.71 | 2 | 63 | 61 |
Tran et al. (2019) [77] | K-10/anxiety | MINI-KID | Asia South East | Indonesia | Adolescents age 16–18 | unblinded* | 196 | x | DSM 4 | 0.82 | 18 | 87.1 | 70.9 |
Tran et al. (2019) [77] | K-6/anxiety | MINI-KID | Asia South East | Indonesia | Adolescents age 16–19 | unblinded* | 196 | x | DSM 4 | 0.8 | 12 | 83.9 | 73.3 |
Tran et al. (2011) [78] | Zung SAS/anxiety | Interview | Asia South East | Vietnam | Adult perinatal women | good | 364 | 11.8 | DSM 4 | 0.79 | 38 | 67.9 | 75.3 |
Tran et al. (2012) [79] | Zung SAS/anxiety | Interview | Asia South East | Vietnam | Men who are partners of pregnant or perinatal women | good | 231 | 5.2 | DSM 4 | 0.775 | 36 | 70.7 | 79 |
Mahfoud et al. (2011) [80] | AYMH/Anxiety and depression | Interview | Asia West | Lebanon | Socioeconomically disadvantaged children aged 10–14 | good | 153 | 17.6 | DSM 4 | 0.71 | 39 | 63 | 79 |
Sawaya et al. (2016) [81] | GAD-7/anxiety | Interview | Asia West | Lebanon | Adult psychiatric outpatients | acceptable | 176 | x | DSM 4 | 0.57 | 10 | 57 | 53 |
Senturk et al. (2007) [82] | GHQ-12/anxiety | CIDI-PHCV | Asia West | Turkey | Adult leprosy patients | unblinded* | 65 | 12.3 | ICD 10 | 0.69 | 5 | 71 | 57 |
Malasi et al. (1991) [83] | HADS/anxiety | Interview | Asia West | Kuwait | Adult psychiatric outpatients and controls | acceptable | 135 | x | DSM 3 | 13 | 45 | 47 | |
Senturk et al. (2007) [82] | HADS/anxiety | CIDI-PHCV | Asia West | Turkey | Adult leprosy patients | unblinded* | 65 | x | ICD 11 | 0.75 | 11 | 66 | 58 |
Yazici et al. (2018) [84] | PASS/anxiety | SCID-1 | Asia West | Turkey | Adult women in perinatal period | unblinded* | 312 | 19.2 | DSM 4 | 0.94 | 16 | 95 | 84 |
Ibrahim et al. (2018) [85] | PCL-5/PTSD | DSM 5 interview | Asia West | Iraq | Adults living in a camp for displaced people in Iraq | good | 206 | 37.75 | DSM 5 | 0.82 | 23 | 82 | 70 |
Gormez et al. (2017) [86] | RCADS-GAD scale/GAD | K-SADS | Asia West | Turkey | Child psychiatry outpatients aged 8–17 | unblinded* | 483 | not specified | DSM 4 | x | 7.5 | 70 | 71 |
Hariz et al. (2013) [87] | SCARED-C/anxiety | Interview | Asia West | Lebanon | Child and adolescent psychiatric patients | good | 82 | 40.2 | DSM 4 | 0.63 | 26 | 66 | 56 |
Hariz et al. (2013) [87] | SCARED-P/anxiety | Interview | Asia West | Lebanon | Child and adolescent psychiatric patients | good | 82 | x | DSM 4 | 0.7 | 24 | 67 | 55 |
Başoglu et al. (2001) [88] | TSSC/PTSD | CAPS | Asia West | Turkey | Survivors of 1999 August earthquake aged 16–70 | acceptable | 130 | 49 | DSM 4 | x | 2 | 76 | 73 |
Europe | |||||||||||||
Oruc et al. (2008) [89] | HTQ/(PTSD) | SCID | Europe Southern | Bosnia and Herzegovina | Adults enrolled in primary care clinic | very good | 180 | 26 | DSM 4 | 0.98 | 2.06 | 99.9 | 93.9 |
South America | |||||||||||||
Zhong et al. (2015) [90] | GAD-7/GAD | CIDI | South America | Peru | Pregnant women aged 18–49 who speak Spanish | unblinded* | 946 | 33.3 | DSM 4 | 0.75 | 7 | 73.3 | 67.3 |
de Lima Osório et al. (2007) [91] | MINI-SPIN/Social anxiety disorder | SCID | South America | Brazil | University students | fair | 2320 | 10.4 | DSM 4 | 0.81 | 6 | 94 | 46 |
Gelaye et al. (2017) [92] | PCL-C/PTSD | CAPS | South America | Peru | Perinatal women | very good | 3289 | 3 | DSM 4 | 0.75 | 26 | 86 | 63 |
Multiple Countries | |||||||||||||
Goldberg et al. (2017) [36] | PHC/current anxiety | CIS-R | South America, Asia South, Asia East, Central America | Brazil, Pakistan, China, Mexico | Primary care patients | fair | 1488 (all countries) | Brazil: 26.5; Pakistan: 13; China: 18.9; Mexico: 23 | ICD 11 | 0.77 | 3 | 75 | 68 |
Meta-analyzed GAD-7 Values | |||||||||||||
GAD-7/anxiety | NA | NA | NA | NA | NA | NA | NA | NA | NA | ≥10 | 76 | 64 |