A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries

Mughal, Anisa Y.; Devadas, Jackson; Ardman, Eric; Levis, Brooke; Go, Vivian F.; Gaynes, Bradley N.

doi:10.1186/s12888-020-02753-3

BMC Psychiatry

Table 6 Included studies listed by continent, sub-region, screening tool/disorder and quality

From: A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries

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
Chibanda et al. (2016) [38] and Sawaya et al. (2016) [81]	GAD-7/anxiety	NA	NA	NA	NA	NA	NA	NA	NA	NA	≥10	76	64

Quality: ranges from highest to lowest (very good, good, fair, acceptable, unblinded, unblinded* (unblinded [unconfirmed so considered unblinded]); x: value not specified; various†: multiple values specified, see Appendix file; Abbreviations: HADS Hospital Anxiety and Depression Scale, HADS-A Hospital Anxiety and Depression Scale Anxiety subscale, DASS Depression Anxiety Stress Scales, Zung SAS Zung Self-Rating Anxiety Scale, STAI State Trait Anxiety Inventory, EPDS Edinburgh Postnatal Depression Scale, HAM-A Hamilton Anxiety Rating Scale, K10/K6 Kessler 10/6, GAD Generalized Anxiety Test, HDRS Hamilton Depression Rating Scale, HSCL Hopkins Symptom Checklist, MINI-SPIN Mini-Social Phobia Inventory, PHC Primary Health Care Screening Tool, GHC General Health Questionnaire, SCARED Screen for Child Anxiety Related Disorders, PASS Perinatal Anxiety Screening Scale, RCADS Revised Children’s Anxiety and Depression Scales, BAI Beck Anxiety Inventory; HTQ Harvard Trauma Questionnaire, PDS Posttraumatic Diagnostic Scale, PCL-C PTSD Checklist-Clinician Version, PHQ-4 Patient Health Questionnaire, CPSS Child PTSD Symptom Scale, TSSC Traumatic Stress Symptom Scale, YSR Youth Self-Report, AKUADS Aga Khan University Anxiety and Depression, SRQ Self-Reporting Questionnaire, AYMH Arab Youth Mental Health Scale, HEI Huaxi Emotional-Distress Index

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