Risk-Stratified Screening for Perinatal Depression and Anxiety: Integrating Sexual Function, Self-Esteem, and Psychosocial Context

Background: Perinatal depression and anxiety are common but often under-detected. Current screening relies on depression-centered instruments and may miss relational drivers including sexual dysfunction, low self-esteem, and psychosocial adversity. Objective: To synthesize evidence on sexual function, self-esteem/body image, and psychosocial context as correlates of perinatal depression and anxiety, and propose a risk-stratified screening framework. Methods: We conducted a narrative evidence synthesis of studies from January 2010 to May 2025 (PubMed/MEDLINE, Scopus, Web of Science) examining associations between perinatal mood/anxiety outcomes and sexual function (Female Sexual Function Index), self-esteem/body image (Rosenberg Self-Esteem Scale), and psychosocial factors (perceived support, intimate partner violence). Results: Sexual dysfunction was highly prevalent and consistently associated with depressive and anxiety symptoms. Longitudinal evidence demonstrated bidirectional pathways: mood symptoms reduced sexual satisfaction, while sexual difficulties intensified relational strain and symptom persistence. Low self-esteem and negative body image mediated links between physiological changes and postpartum depression. Psychosocial adversity, particularly low partner support and intimate partner violence, identified high-risk subgroups with greater severity and slower recovery. Single-instrument approaches (Edinburgh Postnatal Depression Scale alone) may miss pregnancy-specific anxiety and postpartum relational drivers. Conclusions: A staged, risk-stratified model is recommended: assess pregnancy-specific anxiety alongside depression screening in the second/third trimesters; postpartum, selectively add sexual function and self-esteem assessment for women with elevated symptoms or psychosocial risk. Integration within defined referral pathways may improve detection and enable targeted perinatal mental health care.