Screening tools for maternal mental health in Africa: a systematic review

Résumé

Background Maternal health during pregnancy and the postnatal period encompasses mental health, which is a key aspect in enhancing a positive outcome. Despite screening for other possible complications during pregnancy and the postnatal period, very little attention has been paid to screening for mental health. Screening is a key tool in early diagnosis and, eventually, timely diagnosis and management in cases where complications arise. Aim This study aimed to assess the available maternal mental health screening tools and compare the outcome on their utilization during pregnancy and postnatal periods in the African continent. Methodology This was a systematic review including articles published in Africa. It was registered on PROSPERO, ID CRD42024586869. The search databases were AJOL/PubMed/CINAHL, and studies published in English between 01/01/2014 and 31/12/2024 were included. Grey literature was included. The MESH terms were Maternal mental illness OR Perinatal Mental illness OR Depression OR Anxiety OR Pregnant OR postnatal AND screening tools OR Edinburgh Postnatal Depression Scale (EPDS) OR Patient Health Questionnaire (PHQ-9), OR Generalized Anxiety Disorder 7-item scale (GAD-7). To avoid risk of bias, the Cochrane risk of bias tool was utilized. Results Most studies were cross-sectional ( n = 15) or longitudinal cohort ( n = 6), with sample sizes ranging from 37 to 3,311 participants. The commonly used maternal mental health screening tool was the Edinburgh Postnatal Depression Scale (EPDS). Patient Health Questionnaire (PHQ-9) was common in Ethiopia, and the Self-Reporting Questionnaire (SRQ-20) was popular in West African countries. Studies were conducted predominantly in South Africa ( n = 12), Ethiopia ( n = 5), Nigeria ( n = 5), and other Sub-Saharan African countries, including Uganda, Rwanda, Kenya, Cameroon, The Gambia, and Mali. Conclusion Maternal mental health disorders remain highly prevalent across African settings yet are under-detected. The EPDS and SRQ-20 are the most validated and widely applied screening tools; however, gaps persist in service integration, provider training, and culturally sensitive screening. Embedding screening within routine maternal and child health care could bridge existing detection and treatment gaps. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024586869 , CRD42024586869.

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