Evidence map›Paper›PMID 35123556›Full record

SynthesisSystematic reviews2022

Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis.

Abebaw Fekadu, Mekdes Demissie, Rahel Birhane, Girmay Medhin, Tesera Bitew, Maji Hailemariam, Abebaw Minaye, Kassahun Habtamu, Barkot Milkias, Inge Petersen and 7 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Systematic reviews, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 4 pooled it
19.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 4 syntheses or guidelines pooled it, 100 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 5 institutions in 4 countries.

Abebaw FekaduCentre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. abebaw.fekadu@aau.edu.et.ORCID 0000-0003-2219-0952
Mekdes DemissieDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Rahel BirhaneDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Girmay MedhinAklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
Tesera BitewDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Maji HailemariamDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Abebaw MinayeSchool of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia.
Kassahun HabtamuSchool of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia.
Barkot MilkiasDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Inge PetersenCentre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Vikram PatelDepartment of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA.
Anthony J CleareCenter for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.
Rosie MaystonKing's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK.
Graham ThornicroftCentre for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Atalay AlemDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Charlotte HanlonDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Martin PrinceKing's Global Health Institute, King's College London, NE Wing Bush House, 30 Aldwych, London, WC2B 4BJ, UK.
Addis Ababa University · ETKing's College London · GBBrighton and Sussex Medical School · GBHarvard University · USUniversity of KwaZulu-Natal · ZA

Funding

COBALT: Comorbid Affective Disorders, AIDS/HIV, and Long Term HealthR01MH100470 · NIMH · KING'S COLLEGE LONDON · PI FAIRALL, LARA ROSEMARY, PETERSEN, INGE · 2013 to 2018
$2.0M
Department of HealthMedical Research Council MR/M025470/1Medical Research Council MR/R023697/1Medical Research Council MR/S001255/1NIMH NIH HHS R01 MH100470
6 · The paper itself

Abstract

backgroundDepression is one of the commonest mental disorders in primary care but is poorly identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low- to middle-income countries (LMICs).

methodsA systematic review and meta-analysis was conducted using PubMed, PsycINFO, MEDLINE, EMBASE, LILAC, and AJOL with no restriction of year of publication. Risk of bias within studies was evaluated with the Effective Public Health Practice Project (EPHPP). "Gold standard" diagnosis for the purposes of this review was based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), other standard questionnaires and interview scales or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analyses of pooled data were stratified by diagnostic approaches.

resultsA total of 3159 non-duplicate publications were screened. Nine publications, 2 multi-country studies, and 7 single-country studies, making 12 country-level reports, were included. Overall methodological quality of the studies was good. Depression detection was 0.0% in four of the twelve reports and < 12% in another five. PHQ-9 was the main tool used: the pooled detection in two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in four reports that used PHQ-9 cutoff score of 10 (combined sample size = 5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). Severity of depression and suicidality were significantly associated with detection.

conclusionsWhile the use of screening tools is an important limitation, the extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039704 .

Indexed as

DepressionDeveloping CountriesHumansIncomePrimary Health CareSurveys and QuestionnairesDepressionDetectionLow and middle-income countriesPrimary health careReview

Identifiers

PMID35123556
PMCPMC8818168
OpenAlexW4221133563

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.