Integrated Mental Health Care for Perinatal Anxiety and Depression in the United States: A Systematic Review.

Objective

The ongoing maternal mental health crisis highlights the urgent need to improve access to integrated behavioral health care within medical settings for perinatal individuals. This review aimed to synthesize the current evidence on integrated models of care in the United States targeting depression and anxiety among perinatal individuals, with attention to clinical outcomes, implementation feasibility, and sustainability.

Methods

A systematic search was conducted across MEDLINE, PsycInfo, Cochrane Library, CINAHL, and Embase, supplemented by manual searches of reference lists from key articles. Eligible studies were randomized controlled trials that were conducted in the United States and that evaluated integrated care programs for perinatal adults with depression or anxiety. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized controlled trials, which evaluated five domains: randomization, intervention deviation, missing data, appropriate measurement, and selective reporting.

Results

Fifteen articles met inclusion criteria, with six focused on collaborative care. Seven articles reported statistically significant improvements in clinical outcomes among patients receiving integrated care compared with usual care, whereas the remaining articles reported no significant differences. Limited data were available on patient and provider acceptability and financial sustainability.

Conclusions

Integrated care models show promise for reducing depression and anxiety symptoms among perinatal individuals, although the evidence varies across program types and populations. By synthesizing U.S.-based trials and identifying both meaningful clinical gains and gaps in implementation, acceptability, and financial sustainability, this review underscores that addressing these gaps is essential to realizing the potential of integrated care as a scalable solution to the maternal mental health crisis.