Integrated Perinatal Mental Healthcare: Screening for Depression and Anxiety, Obstetric Risk Factors, and Continuity of Family-Centered Care
DOI:
https://doi.org/10.64784/345Palabras clave:
perinatal mental health, perinatal depression, postpartum depression, perinatal anxiety, pregnancy, postpartum period, EPDS, obstetric risk factors, collaborative care, family medicine, psychiatry, continuity of careResumen
Perinatal mental health disorders, particularly depression and anxiety, represent a relevant component of maternal morbidity and may emerge during pregnancy, persist after childbirth, or recur in women with previous psychiatric vulnerability. This study analyzed perinatal mental health from an interdisciplinary perspective, integrating early detection, obstetric and psychosocial risk factors, and continuity of care across gynecology, psychiatry, and family medicine. An integrative literature review based on the Scientific Method was conducted using evidence from clinical guidelines, systematic reviews, meta-analyses, observational studies, and clinical trials. The analysis identified a substantial prevalence of perinatal depression and anxiety, with depressive symptoms affecting approximately one quarter of women in several pooled analyses and anxiety reaching its highest pooled prevalence during the third trimester. The Edinburgh Postnatal Depression Scale demonstrated variable diagnostic performance according to the selected cutoff, highlighting the need to interpret screening within a broader clinical assessment. Obstetric factors also showed relevant associations with maternal mental health, particularly emergency cesarean delivery, which was linked to higher odds of postpartum depression than elective procedures. In addition, collaborative-care interventions showed higher remission rates and greater mental health service utilization than enhanced maternity support alone. These findings indicate that perinatal mental healthcare should not be limited to isolated screening or the immediate postpartum period. A continuous model incorporating validated screening, obstetric and psychosocial risk assessment, timely psychiatric evaluation, treatment, referral, and longitudinal family-centered follow-up may provide a more comprehensive framework for maternal mental healthcare throughout pregnancy and the first postpartum year.
Referencias
• American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology, 141(6), 1232–1261. doi:10.1097/AOG.0000000000005200.
• American College of Obstetricians and Gynecologists. (2023). Treatment and management of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 5. Obstetrics & Gynecology, 141(6), 1262–1288. doi:10.1097/AOG.0000000000005202.
• Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782–786. doi:10.1192/bjp.150.6.782.
• Cuijpers, P., Franco, P., Ciharova, M., Miguel, C., Segre, L., Quero, S., & Karyotaki, E. (2023). Psychological treatment of perinatal depression: A meta-analysis. Psychological Medicine, 53(6), 2596–2608. doi:10.1017/S0033291721004529.
• Dennis, C.-L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315–323. doi:10.1192/bjp.bp.116.187179.
• de Paula Eduardo, J. A. F., de Rezende, M. G., Menezes, P. R., & Del-Ben, C. M. (2019). Preterm birth as a risk factor for postpartum depression: A systematic review and meta-analysis. Journal of Affective Disorders, 259, 392–403. doi:10.1016/j.jad.2019.08.069.
• Fairbrother, N., Challacombe, F. L., Green, S. M., & O’Mahen, H. A. (2025). Anxiety and related disorders during the perinatal period. Annual Review of Clinical Psychology, 21, 465–496. doi:10.1146/annurev-clinpsy-081423-020126.
• Grote, N. K., Katon, W. J., Russo, J. E., Lohr, M. J., Curran, M., Galvin, E., & Carson, K. (2015). Collaborative care for perinatal depression in socioeconomically disadvantaged women: A randomized trial. Depression and Anxiety, 32(11), 821–834. doi:10.1002/da.22405.
• Levis, B., Negeri, Z., Sun, Y., Benedetti, A., Thombs, B. D., & DEPRESsion Screening Data (DEPRESSD) EPDS Group. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data. BMJ, 371, m4022. doi:10.1136/bmj.m4022.
• Mitchell, A. R., Gordon, H., Lindquist, A., Walker, S. P., Homer, C. S. E., Middleton, A., Cluver, C. A., Tong, S., & Hastie, R. (2023). Prevalence of perinatal depression in low- and middle-income countries: A systematic review and meta-analysis. JAMA Psychiatry, 80(5), 425–431. doi:10.1001/jamapsychiatry.2023.0069.
• Moore Simas, T. A., Flynn, M. P., Kroll-Desrosiers, A. R., Carvalho, S. M., Levin, L. L., Biebel, K., & Byatt, N. (2018). A systematic review of integrated care interventions addressing perinatal depression care in ambulatory obstetric care settings. Clinical Obstetrics and Gynecology, 61(3), 573–590. doi:10.1097/GRF.0000000000000360.
• Shorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., & Chong, Y. S. (2018). Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235–248. doi:10.1016/j.jpsychires.2018.08.001.
• Simpson, W., Glazer, M., Michalski, N., Steiner, M., & Frey, B. N. (2014). Comparative efficacy of the Generalized Anxiety Disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. The Canadian Journal of Psychiatry, 59(8), 434–440. doi:10.1177/070674371405900806.
• U.S. Preventive Services Task Force. (2019). Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement. JAMA, 321(6), 580–587. doi:10.1001/jama.2019.0007.
• Wang, L., Kroenke, K., Stump, T. E., & Monahan, P. O. (2021). Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. General Hospital Psychiatry, 68, 74–82. doi:10.1016/j.genhosppsych.2020.12.007.
• World Health Organization. (2022). WHO guide for integration of perinatal mental health in maternal and child health services. World Health Organization.
• Xu, H., Ding, Y., Ma, Y., Xin, X., & Zhang, D. (2017). Cesarean section and risk of postpartum depression: A meta-analysis. Journal of Psychosomatic Research, 97, 118–126. doi:10.1016/j.jpsychores.2017.04.016.
• Yin, X., Sun, N., Jiang, N., Xu, X., Gan, Y., Zhang, J., Qiu, L., Yang, C., Shi, X., Chang, J., & Gong, Y. (2021). Prevalence and associated factors of antenatal depression: Systematic reviews and meta-analyses. Clinical Psychology Review, 83, 101932. doi:10.1016/j.cpr.2020.101932.
• Zhao, X.-H., & Zhang, Z.-H. (2020). Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian Journal of Psychiatry, 53, 102353. doi:10.1016/j.ajp.2020.102353.
