Objective To identify treatment preferences, help-seeking steps, and responses from social support persons among women at risk for perinatal depression or anxiety. Design Prospective descriptive survey of women at risk for depression or anxiety. Setting Private hospital in central Ohio. Participants From an original sample of 220 women recruited between the third trimester of pregnancy and 2 months postpartum, we selected 36 women reporting clinically significant levels of depressive or anxious symptoms to complete a telephone survey. An additional 17 family members were surveyed as identified social support persons. Methods Two telephone interviews including survey and open-ended responses were administered to participants approximately 6 weeks apart. Social support persons also received survey interviews assessing their opinions about the participants' mood changes. Results More participants reported consulting friends and family about symptoms (83%) than consulting health care professionals (50%). However, most participants and their social support persons disagreed about the primary illness cause (66%). Approximately two thirds of participants recalled receipt of depression screening and feedback, but far fewer received referral or treatment via pharmacotherapy (36.1%) or psychotherapy (16.7%). Conclusion Findings suggest screening and referral can be enhanced through expanding perinatal mental health education to target social support persons as they are often consulted by women when determining whether depression exists or should be treated. Further, a more active, personalized referral processes should be used routinely in addition to screening and education to facilitate appropriate treatment.