Investigating the mental health burden amongst breast and cervical cancer patients in Rwanda using a modified self-reported questionnaire for mental health screening (SRQ- 20): A validation study

Background Despite continued advancement in cancer care, mental health support has been inadequately integrated, particularly for female breast and cervical cancer in low- and middle-income countries. This study aims to address this gap by validating a mental health screening tool and apply it to investigate the mental health burden and associated factors among this patient population in Rwanda. Methods A cross-sectional study was conducted with 437 breast and cervical cancer patients who sought care at six major cancer care hospitals in Rwanda between October 2022 and February 2023. The survey questionnaire included questions about participant’s socio-demographic characteristics, cancer diagnosis and care, mental health, sexual and gender-based violence (SGBV) experience, and sexual health. Descriptive statistics were used to summarize patients’ characteristics. Psychometric analysis was conducted to validate the modified self-reported questionnaire (SRQ-20) for mental health screening, generating unweighted mental health scores for each woman on a X-20 scale. Prevalence estimates of mental health follow-up needs were calculated, and multivariable regression analysis were conducted to identify factors associated with mental health follow-up needs. Results The items used for mental health screening loaded on two distinct factors named “Anhedonic symptoms” and “Psychomotor changes” (Chronbach’s alpha = 0.92). The overall average mental health score was 9.6. The overall prevalence of mental health follow-up need was 38.9%. In adjusted regression models, mental health follow-up was associated with lifetime experience of physical or sexual violence (aOR = 2.59, 95% CI 1.25, 5.39), having experienced sexual dysfunction after cancer treatment initiation (aOR = 2.11, 95% CI 1.15, 3.88), being in the age category of 50–65 (aOR = 0.36, 95% CI 0.14, 0.91), and having a partner who is perceived as not satisfied with sexual life before and after cancer diagnosis (aOR = 2.49, 95% CI 1.20, 5.17). Conclusions The modified SRQ-20 questionnaire is a valid tool for mental health screening among breast and cervical patients in Rwanda. The need for mental health follow-up in this population is high and cancer care needs to integrate psychotherapy for the couples, alongside interventions targeting sexual and gender-based violence and sexual health care.