Leveana Gyimah ^1,2 Irene Agyepong ^1,3 David Owiredu ⁴ Elizabeth Awini ³ Mary E. Ashinyo ⁵ Linda L. Yevoo ³ Sorre Grace E. Aye ³ Shazra Abbas ⁶ Anna Cronin de Chavez ⁷ Tolib Mirzoev ⁷ Anthony Danso-Appiah ^8*

• ¹ Ghana College of Physicians and Surgeons (GCPS), Accra, Ghana
• ² Pantang Hospital, Accra, Ghana
• ³ Dodowa Health Research Centre, Aburi, Ghana
• ⁴ School of Public Health, College of Health Sciences, University of Ghana, Legon, Greater Accra, Ghana
• ⁵ Institutional Care Division, Ghana Health Service, Accra, Ghana
• ⁶ Nossal Institute for Global Health, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
• ⁷ London School of Hygiene and Tropical Medicine, University of London, London, London, United Kingdom
• ⁸ UG Centre for Evidence Synthesis and Policy, University of Ghana, Accra, Greater Accra, Ghana

Introduction In sub-Saharan Africa, pregnant and postpartum women with mental health problems are often missed in healthcare systems. To address this, a practical and simple screening tool for maternal mental health should be available to primary healthcare workers. An important step towards having such a tool is to assess the existing tools and their effectiveness in primary care settings. Methods We systematically searched PubMed, LILAC, CINAHL, Google Scholar, African Index Medicus, HINARI and African Journals Online were searched from inception to 31st January 2023, without language restriction. Reference lists of retrieved articles were reviewed and experts in the field were contacted for studies not captured by our searches. All retrieved records were collated in Endnote, de-duplicated and exported to Rayyan for screening. Study selection and data extraction were done by at least two reviewers using a pre-tested flow chart and data extraction form. Disagreements between reviewers were resolved through discussion. We contacted primary authors for missing or insufficient information and conducted content analysis of the psychometric properties of the tools. Results One thousand one hundred and eighty-one (1,181) studies were retrieved by our searches, of which 119 studies were included in this review. Seventy-four out of the 119 studies (62%) screened for depression during pregnancy and or the postpartum period. The Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were the most commonly used tools. Twelve studies reported specificity and sensitivity for tools for measuring depression (EPDS, PHQ-9 and Whooley) and psychological distress (Self Report Questionnaire (SRQ) and Kessler Psychological Distress Scale (KPDS)). The average sensitivity and specificity of the EPDS reported were 75.5 % and 76.5% respectively at a cut-off of ≥13. The EPDS appears to be the most acceptable, adaptable, user-friendly and effective in screening for maternal mental health conditions during pregnancy and postpartum. However, the methodological approach varied for a particular tool and documentation on the attributes was scanty. Conclusions The EPDS was the most commonly used tool and considered as most acceptable, adaptable, user-friendly and effective. Information on the performance and psychometric properties of the vast majority of screening tools was limited.