Eligibility criteria
The following criteria were needed for an article to be included in our
review
- Time frame: study realized during the coronavirus Disease 19
(COVID-19) outbreak,
- Reports’ characteristics: peer-reviewed articles without language
restriction,
- Design: Observational studies with more than 30 participants and
thereby including cross-sectional, case-control and cohort studies
(baseline data),
- Participants and outcomes: articles reporting frequencies with or
without associated/risk factors of mental health issues such as
depression, anxiety and stress, among African universities’ students.
We excluded unrelated or duplicated articles, as well as abstract-only
papers in case of unavailability of information required for our review.
Information sources and search strategies: We applied a
search strategy on PubMed/MEDLINE, Excerpta Medica Database (EMBASE) and
African Journals Online (AJOL) by the July 24, 2021, respectively at
00:00, 00:15 and 00:30 (Greenwich Mean Time). To build the search
strategies respectively dedicated to each of the three databases, we
associated key-terms groups, with as first group the one related to
mental health issues, as second the one related to “students”, and as
third the one pertaining to African regions and countries. For each
group, synonyms and subtypes were joined using the Boolean operator
“OR”, and the three groups were linked by the Boolean operator
“AND”. For instance, regarding the group related to mental issues and
the PubMed/MEDLINE database, we associated terms such as “Mental
Health”, “Psychological”, “Depression”, “Anxiety” and “Stress”.
Our search strategies are available in table 1. After applying our
strategies in each database, the respective resulting lists were
exported and further uploaded in Rayyan, a web and mobile app conceived
for screening purpose in systematic reviews
(https://rayyan.qcri.org/)
[21]. In Rayyan, all the records (from the three databases) were
joined as a same review project.
Selection process: We performed a two-steps selection
process. First, based on the appraisal of titles and abstracts, and
considering our eligibility criteria, two authors (FTE and WADL)
independently selected articles. Discrepancies were resolved by a
consensus or if necessary, by a third assessor (DLTM). After this first
selection step, all relevant papers were exported from Rayyan in an
appropriate file which later served to create a reference list of our
selected articles, by using a reference software, notably Zotero
(https://www.zotero.org/)
[22]. The second step of the selection process involved to search
for the full texts, and explore these full-texts considering our
eligibility criteria and especially our outcomes of interest. This step
was independently performed by two authors (FTE and DLTM), with
disagreements solved by a consensus or a third appraiser if necessary
(WADL).
Data collection process: The selection process was
followed by data extraction. Indeed, we reviewed and collected data of
interest from each article retained after titles, abstracts and
full-texts screening. For this purpose, we used a predefined and
pretested extraction tool, available in table 2. The data extraction
process was independently ensured by two authors (FTE and WADL), and a
third one intervened if dissimilarities were not solvable through a
consensus.
Data items: Throughout the data collection step, we
looked at the following items
- Bibliometric information: family name of the first author, year and
journal of publication,
- Study characteristics: study’s country, study design, study period
(and related COVID-19 stage if mentioned), study setting (one or more
Faculties, one or more universities), sampling method, minimal sample
size calculation, type of data collection process (paper and/or
electronic version),
- Participants’ characteristics: subtype of university students
(medical/ pharmacy/ health science students, etc.), mean or median
age, age range, total sample size, sample size for males and females
respectively,
- Outcomes: mental health issues (depression, anxiety, stress, etc.)
with the tool used to screen for each one, the cut-off scores
potentially used, the reported frequency, as well as associated/risk
factors if assessed.
Study risk of bias assessment: We based our risk of bias
assessment on the tool developed by Hoy and colleagues [23]. This
tool is made of 10 items addressing four domains of bias plus a summary
risk of bias assessment. Included studies were classified according to
their total score as low risk of bias (8 – 10), moderate risk of bias
(6 – 7) and high risk of bias (0 – 5).
Synthesis methods: We planned to present our results as
narrative, graphical and tabular summaries, with respect to the
following items
- Information on the study selection process through the PRISMA model of
study flow chart presentation,
- Selected articles’ individual characteristics with mental health
issues assessed, displayed as
narrative and tabular summary, and specifically including articles’
bibliometric profiles, study and participants characteristics, tools/
cut-off scores/ frequencies/ factors regarding each studied mental
health condition,
- Methodological quality and risk of bias of each study, presented as
narrative and tabular synopsis.