Depression and Anxiety Affect Up to One in Four Pregnancies in the United States. Pregnant People Are Less Likely to Be Screened for These Conditions Than at Any Other Point in Their Lives.

Perinatal mood and anxiety disorders are among the most common complications of pregnancy, yet the clinical systems designed to identify and treat them consistently fall short, particularly for patients who are already at the greatest risk. This integrative review from researchers at New York University's Rory Meyers College of Nursing synthesizes a decade of United States literature on why pregnant people are being under-screened and under-treated for depression and anxiety, and maps the individual, provider, and systems-level factors that drive those gaps. The findings are clinically actionable and the problem they describe is both preventable and urgent.

Eakley and Lyndon conducted an integrative review of United States studies published between January 2012 and January 2023 examining screening, identification, and treatment patterns for depression and anxiety during pregnancy. Studies were eligible if they examined disparities in these patterns, meaning the authors looked specifically for evidence of differential care rather than overall screening rates alone. The review covered individual-level factors such as race, ethnicity, age, and socioeconomic status; provider-level factors such as training, time, and role clarity; and systems-level factors such as clinic policies, reimbursement structures, and referral pathways.

Pregnant people are screened for depression and anxiety at lower rates than non-pregnant people during the same period of life, a finding consistent with prior literature that this review extends and clarifies. Results identified three interconnected layers of failure. At the individual level, patients who are younger, of lower socioeconomic status, of racial and ethnic minority backgrounds, and non-English speaking were screened at significantly lower rates, despite being at the greatest risk for perinatal mood and anxiety disorders (PMADs). At the provider level, role confusion about who is responsible for screening, lack of time during prenatal visits, and insufficient training in perinatal mental health all contributed to low screening rates. At the systems level, inadequate reimbursement for mental health services, absence of clear referral pathways, and lack of clinic-level screening protocols left many patients without appropriate resources even when symptoms were identified. Results further showed that many pregnant people who were identified as symptomatic still lacked appropriate referrals or resources to access treatment, meaning the gap between screening and actual care was itself a separate and significant failure point.

• —The review is limited to United States studies published in English between 2012 and 2023, which restricts generalizability to other health systems and may miss more recent policy changes.
• —The integrative review methodology allows inclusion of heterogeneous study designs, which introduces variability in how disparities were defined and measured across included studies.
• —Several studies that examined screening programs or interventions did not report whether outcomes were equitable across demographic groups, limiting the conclusions that can be drawn about what works for whom.
• —The review focuses on the pregnancy period specifically and does not extend to the postpartum period, where screening gaps are also well documented.

The United States screens pregnant people for depression and anxiety less reliably than it screens them for gestational diabetes. That is a policy failure, a training failure, and a systems failure, and it is not distributed evenly. Fixing it requires more than individual provider awareness. It requires clinic-level protocols, reimbursement reform, and a serious reckoning with why the patients most at risk are consistently the least likely to be reached.