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. 2025 Dec 8;26(1):23.
doi: 10.1186/s12905-025-04207-y.

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

Jean Christophe Rusatira  1 , Jean Berchmans Uwimana  2 , Dieudonne Rutagumba  1 , Samuel Byiringiro  1 , Saswathi Natta  1 , Johannes Espmark  3 , Eric Rurangwa  1 , Anna E Kågesten  3 , Innocent Nzeyimana  1 , Andrea Diane Ndoli  1
Affiliations

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

Jean Christophe Rusatira et al. BMC Womens Health. .

Abstract

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, where psychosocial needs remain largely unmet. This study aimed to address this gap by validating a mental health screening tool and applying 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 participants’ 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 an X-20 scale. Prevalence estimates of mental health follow-up needs were calculated, and a multivariable logistic regression analysis was 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” (Cronbach’s alpha = 0.92). The overall average mental health score was 9.6. The overall prevalence of mental health follow-up needs was 38.9%. In adjusted logistic 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.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12905-025-04207-y.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The current study was approved by the Rwanda Ministry of Health Institutional Review Board on July 20, 2022, with the approval letter #20/4060/DPMEHF/2022. All the methods and processes of this study were carried out under the guidelines of the National Ethics Committee and the Rwanda Health Research Committee. All participants provided informed consent before participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Scree plots from principal component analysis and parallel analysis
See this image and copyright information in PMC

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