This study protocol is structured in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The PRISMA contains a 27-item checklist which is aimed at facilitating the development and reporting of robust systematic review protocols [20]. The systematic review was registered on the PROSPERO database (CRD42017064148).
Information sources
PubMed, PsychINFO, EMBASE and African Index Medicus, BIREME, LILACS, and MEDLINE databases will be searched for studies reporting primary data on common mental disorders (depression and/or anxiety) among students in universities and colleges within LMICs. For this study, LMICs will be defined using the World Bank Country Lending Group list for the year 2017 [21].
Search strategy
In light of the paucity of studies in LMICs, no time restrictions will be imposed on the search. Controlled vocabulary terms will be appropriately incorporated for each database. We will use the terms to search for three main concepts namely (1) undergraduate university/college students, (2) prevalence of depression or anxiety, and (3) low- and middle-income countries. A full search strategy for one database is displayed in Appendix 1. Reference lists of retrieved articles will also be examined and additional articles added if they meet the inclusion criteria.
Eligibility criteria
Studies will be included if they report the prevalence of depression or anxiety among university/college students undertaking undergraduate degree programs. Study types will include descriptive and analytical studies such as cross-sectional and longitudinal studies, case-series analysis, and randomized control trials that include data on prevalence of depression or anxiety. We will include studies in all languages, which will be translated into English. Due to paucity of research on depression or anxiety in most LMICs, the studies will not be excluded based on how they measured depression or anxiety since it is important to understand how these conditions are being measured in different settings.
Data extraction
Two reviewers will independently screen titles and then abstracts of included articles using a piloted data extraction sheet (Appendix 2). Examples of the type of data that will be extracted include study design, setting, study sample sizes, assessments used for diagnosing depression or anxiety, and prevalence of depression or anxiety. Where there will be doubts on whether a title is relevant, it will be included for retrieval. Reconciliation of disagreements on which article(s) to include will be resolved by discussion and consensus between the two reviewers, or mediation by a third person.
Assessment of methodological quality
All retrieved papers eligible for selection will undergo an assessment process conducted by two independent reviewers. Standardized critical appraisal tools will be utilized in the quality assessment. In this study, four critical appraisal tools [22] will be used to assess for quality depending on the study design. These are as follows:
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1.
The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal tool [23]
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2.
The JBI critical appraisal checklist for randomized control/pseudo-randomized trials
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3.
The JBI critical appraisal checklist for descriptive/case series
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4.
The JBI critical appraisal checklist for comparable cohort/case control.
These tools were developed primarily for use in systematic reviews. Where there are disagreements between the two reviewers, a third reviewer will be engaged and discussions among the three reviewers will be used to resolve the differences.
Data analysis and synthesis
Meta-analysis of the prevalence of depression and anxiety among university students will be conducted using a random effects model which will generate pooled prevalence with their respective 95% CIs. Analyses will be conducted in Stata 14. The results from the review will be summarized and presented in text, Appendix 3, and tables.