Access to Mental Health Care Treatment for Women with Cancer: A Systematic Review of Global Literature Including Sub-Saharan Africa

Background and Purpose: Mental illness is one of the leading causes of the disease burden worldwide. The United Nations Sustainable Development Goal 3 (SDG3) aims to ensure universal access to healthcare for all, including universal access to quality mental health services for all. Studies show that women diagnosed with serious illnesses such as breast and cervical cancer are more likely to develop mental illness. It is unclear how prevalent the treatment interventions for mental illness are for women with cancer in Sub-Saharan Africa. Increasingly, global health researchers and practitioners are interested in evaluating the implementation of health interventions to improve access to such care. This paper fills the current gap by conducting a systematic review of studies examining access to mental health care for women with cancer globally. Also, we examined theories and analytic frameworks that strengthen the research quality and fidelity of global health intervention implementation evaluations.

Methods: We used PRISMA guidelines to develop an evidence-based minimum set of items for reporting in systematic reviews. A search of 4 databases initially yielded 1,112 articles from peer-reviewed journals. Subsequently, titles and abstracts were screened, resulting in 201 potentially relevant articles for inclusion. Eligible for inclusion were articles focused on women diagnosed with cancer in low-resourced global contexts, with a focus on mental health, published in English. The search yielded 37 articles representing 25 countries focused on mental health among women with serious illnesses. We generated a data table that included country/location, publication year, theoretical framework, intervention type, design, sample, measurements, findings, fidelity, and ethical considerations. Using the principles of thematic content analysis, we assessed the studies’ findings, quality, and rigor.

Results: A noticeable gap was that none of the 37 studies were from Africa. Studies that included theoretical or conceptual frameworks combined several frameworks into one discussion but rarely explained why they used this process. Fifteen studies elaborated on mental health interventions among women with a breast or cervical cancer diagnosis. Some of these studies reported scaling evidence-based interventions using implementation science, which involves adjusting effective interventions in new sociocultural settings through a complex and rigorous process of fidelity assessment and process evaluation. This is also a cost-effective strategy to provide mental health care in low-income countries.

Conclusions and Implications: Mental health conditions, if left untreated, worsen over time. Social work researchers have documented the importance of addressing mental health for people with serious illnesses. This review could not find research from countries in Sub-Saharan Africa presenting concerns about health inequity. Evidence-based interventions should be scaled using implementation science, a cost-effective and sustainable approach to reduce global mental healthcare delivery inequities and attain SDG3.