Abstract
IMPORTANCE: Perinatal depression and anxiety are common yet underdiagnosed and undertreated. There are limited data on screening rates, severity, and treatment, and thus an urgent need to estimate accurately perinatal depression and anxiety over time, to inform timely and efficacious interventions. OBJECTIVE: To evaluate screening and treatment rates, prevalence, and symptom trajectories over time of perinatal depression and anxiety in a large urban medical center. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included electronic health records of all patients who gave birth at NewYork-Presbyterian (NYP)/Weill Cornell Medical Center or NYP Lower Manhattan Hospital between December 1, 2020, and February 1, 2024. In March 2023, a mandatory Edinburgh Postnatal Depression Scale (EPDS) screening policy was implemented in 3 clinics covering 35% of deliveries in the hospital. EXPOSURE: Completion of mental health screening during the perinatal period. MAIN OUTCOMES AND MEASURES: The study included 3 primary mental health measures: depression severity (Patient Health Questionnaire-9 [PHQ-9]), anxiety severity (Generalized Anxiety Disorder-7 [GAD-7]), and perinatal depression severity (EPDS). Percentage of women screened, prevalence of clinically meaningful symptoms, as well as rates and frequency of mental health services were examined. Furthermore, symptom changes 1 year before and after delivery were tested using mixed effects models, and whether patient characteristics and mental health services were associated with symptom change was determined. RESULTS: The study included data from medical records of 27 393 women who gave birth during the study period. The final sample included 3051 women (mean [SD] age, 34.3 [5.2] years; age range, 14-54 years) who completed perinatal depression or anxiety screening within 1 year before and after birth. A total of 723 women (3.0%) were administered depression screening (PHQ-9), and 472 (2.0%) completed anxiety (GAD-7) screening. Following a mandatory screening policy, EPDS screening rates increased from 1.0% (274 women) before March 2023 to 14.2% (2304 women) after March 2023. Of those screened, 23.2% (95% CI, 21.7%-24.8%) reported clinically meaningful depression symptoms and 8.8% (95% CI, 7.2%-10.8%) endorsed suicidality; 17.1% of women (523 women) screened received mental health services. Treated women were mostly seen 4 months before and after birth for psychosocial interventions, had faster depression reductions over time (PHQ-9, F1,1504 = 9.6; P = .002), and a sustained decline in depression severity postpartum, compared with untreated women (F1,5166 = 33.8; P < .001). CONCLUSIONS AND RELEVANCE: These findings underscore the need for routine and consistent screening, monitoring, and treatment of perinatal depression and anxiety. Women who received mental health services had faster reductions in depression over time, highlighting the potential impact for scalable and efficacious interventions during this critical period.