A systematic review and meta-analysis of diagnostic test accuracy of mental health screening tools applicable to adolescents in sub-Saharan Africa

Résumé

Introduction Mental health disorders (MHDs) is a global public health concern. Existing evidence highlighted the need for context-specific measurements of MHDs among adolescents in sub-Saharan Africa (SSA). This review aimed to provide an evidence-based inventory of effective mental health (MH) screening tools applicable to adolescents in SSA aged 12–18 years. Methods We systematically searched Medline, Web of Science Core Collection, PsycINFO, and CINAHL for validation studies of MH screening tools published between January 1, 2000 and December 31, 2024. Pooled sensitivity and specificity were estimated using hierarchical summary receiver operating characteristic (HSROC) models. Study quality was assessed using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Heterogeneity was evaluated using I ² statistic and forest plots, while funnel plots and Deeks’ funnel plot asymmetry test were used to assess publication bias. The analyses were conducted in R 4.5.3 version. Results Out of the 18,918 screened articles, 128 studies (covering 26 MHDs) were included in the systematic review. Of these, 60% (77/128) were rated high risk of bias on at least one domain of the QUADAS-2 tool. Only 21 of 48 SSA countries validated at least one screening tool. The meta-analysis included 36 articles evaluating four tools—Edinburg Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9)/two-step PHQ-9 (PHQ-2/9), two-item PHQ (PHQ-2), or Kessler Psychological Distress Scale (K-10)—which focused on depression only. Heterogeneity was present across validation studies for all tools in the meta-analyses. Both Deeks’ test and visual assessment of funnel plots did not suggest publication bias for EPDS and PHQ-9/PHQ-2/9. Discussion Prioritizing the validation of mental health screening tools tailored to adolescents aged 12–18 years is crucial to effectively address the MHDs in SSA. Future research in SSA should focus on adapting and validating existing tools, updating outdated versions, and developing new tools for emerging mental health challenges. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42023454180.

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