Prevalence of mental disorders in Uganda Thesis by publication Masters of Clinical Science John Nelson Opio JBI, School of Public Health Faculty of Health and Medical Sciences The University of Adelaide Adelaide, South Australia Australia October 2020 List of publications This thesis includes the following articles about mental disorders in Uganda and appropriate systematic review methodology. I. Opio JN, Tufanaru C, Aromataris E. Prevalence of mental disorders in Uganda: a systematic review protocol. JBI Database System Rev Implement Rep. 2018;16(8):1613-20. II. Opio JN, Munn Z, Aromataris E. Prevalence of mental disorders in Uganda: a systematic review and meta-analysis (submitted to Annals of Epidemiology ) i Table of contents List of publications ..................................................................................................................................... i Table of contents ...................................................................................................................................... ii List of figures ............................................................................................................................................ v List of tables ............................................................................................................................................. v Abstract ................................................................................................................................................... vi Thesis declaration .................................................................................................................................. vii Acknowledgements ............................................................................................................................... viii List of abbreviations ................................................................................................................................ ix Chapter 1 Introduction and background ................................................................................................... 1 1.1 Introduction ..................................................................................................................................... 1 1.2 Health, mental health and mental disorders ................................................................................... 1 1.3 Burden of mental disorders ............................................................................................................ 3 1.4 Impact of mental disorders ............................................................................................................. 4 1.4.1 Health impact of mental disorders ........................................................................................... 4 1.4.2 Social impact of mental disorders ........................................................................................... 5 1.4.3 Economic impact of mental disorders ..................................................................................... 5 1.5 Classification of mental disorders ................................................................................................... 6 1.5.1 ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines ........................................................................................................................ 7 1.5.2 Diagnostic and Statistical Manual of Mental Disorders ........................................................... 8 1.5.3 Critique of the classification systems of mental disorders ....................................................... 9 1.5.4 Categories and dimensions ..................................................................................................... 9 1.5.5 Thresholds ............................................................................................................................ 10 1.6 Diagnosing mental disorders ........................................................................................................ 10 1.7 Diagnosis and prevalence of mental disorders ............................................................................. 12 1.7.1 Prevalence of any mental disorders ...................................................................................... 13 1.7.2 Anxiety disorders ................................................................................................................... 13 1.7.2.1 Prevalence of anxiety disorders ..................................................................................... 14 1.7.3 Depressive disorders ............................................................................................................ 16 1.7.3.1 Prevalence of depressive disorders ............................................................................... 16 1.7.4 Eating disorders .................................................................................................................... 18 1.7.4.1 Prevalence of eating disorders ...................................................................................... 18 1.7.5 Schizophrenia ....................................................................................................................... 18 1.7.5.1 Prevalence of schizophrenia .......................................................................................... 19 1.8 Comorbidity .................................................................................................................................. 19 ii 1.9 Factors associated with mental disorders ..................................................................................... 20 1.9.1 Non-modifiable factors .......................................................................................................... 20 1.9.2 Modifiable factors .................................................................................................................. 20 1.9.2.1 Individual factors ............................................................................................................ 21 1.9.2.2 Social and economic factors .......................................................................................... 21 1.9.2.3 Education ....................................................................................................................... 22 1.9.2.4 Societal and environmental factors ................................................................................ 22 1.10 Uganda ....................................................................................................................................... 23 1.11 Need for further evidence specific to Uganda ............................................................................. 24 1.12 Methodological approach ........................................................................................................... 25 1.12.1 Systematic review of prevalence studies ............................................................................ 25 1.12.2 Methodological quality assessment of prevalence studies .................................................. 26 1.12.3 Synthesis of prevalence data .............................................................................................. 27 1.12.4 Reporting of a systematic review of prevalence studies ...................................................... 27 1.13 Summary and significance of this study ..................................................................................... 27 1.14 Objective and review questions .................................................................................................. 28 1.15 Organisation of this thesis .......................................................................................................... 28 Chapter 2 Prevalence of mental disorders in Uganda: a systematic review protocol ............................. 29 2.1 Introduction ................................................................................................................................... 31 2.2 Review questions ......................................................................................................................... 32 2.3 Inclusion criteria ............................................................................................................................ 32 2.3.1 Participants ........................................................................................................................... 32 2.3.2 Condition ............................................................................................................................... 32 2.3.3 Context .................................................................................................................................. 33 2.3.4 Types of studies .................................................................................................................... 33 2.4 Methods ........................................................................................................................................ 33 2.4.1 Search strategy ..................................................................................................................... 33 2.4.2 Information sources ............................................................................................................... 34 2.4.3 Study selection .....................................................................................................................