What is the Edinburgh Postnatal Depression Scale?
The Edinburgh Postnatal Depression Scale (EPDS) is a widely-used screening tool developed in 1987 by Cox, Holden, and Sagovsky to help identify symptoms of depression during pregnancy and in the first year after childbirth. It consists of 10 simple questions about feelings experienced in the past 7 days.
The EPDS is not a diagnostic tool—it's a screening questionnaire designed to identify individuals who may benefit from further evaluation by a healthcare professional.
Who should take the EPDS?
The EPDS is recommended for:
- Pregnant women at any stage
- New mothers (up to 1 year postpartum)
- Can also be used by fathers/partners
- Anyone concerned about perinatal mood changes
Many healthcare providers routinely administer the EPDS during prenatal and postnatal visits.
How the EPDS is scored
Question scoring
Each of the 10 questions has 4 possible answers, scored 0-3:
- Questions 1, 2, 4: Scored 0, 1, 2, 3 (top to bottom)
- Questions 3, 5-10: Reverse scored 3, 2, 1, 0 (top to bottom)
Total score interpretation
| Score Range | Interpretation |
|---|
| 0-9 | Low risk for depression |
| 10-12 | Possible depression symptoms |
| 13-30 | Likely depression - professional follow-up recommended |
Important cutoff points
- Score of 10 or higher: Indicates possible depression; repeat screening in 2-4 weeks
- Score of 13 or higher: High likelihood of depression; immediate follow-up recommended
- Any positive response to Question 10: Requires immediate assessment regardless of total score
The 10 EPDS questions
The questionnaire covers the following topics:
- Ability to laugh - Can you still find things funny?
- Looking forward to things - Do you still anticipate enjoyment?
- Self-blame - Are you blaming yourself excessively?
- Anxiety without reason - Are you feeling anxious for no clear reason?
- Fear/panic - Are you experiencing unexplained fear or panic?
- Things getting on top of you - Are you feeling overwhelmed?
- Difficulty sleeping due to unhappiness - Is sadness affecting your sleep?
- Feeling sad or miserable - How often do you feel sad?
- Crying - Have you been crying more than usual?
- Thoughts of self-harm - Have you thought about harming yourself?
Anxiety subscale
Questions 3, 4, and 5 form an anxiety subscale:
| Anxiety Score | Interpretation |
|---|
| 0-3 | Low anxiety |
| 4-5 | Moderate anxiety |
| 6-9 | High anxiety - may need attention |
Elevated anxiety scores (especially 6+) warrant further discussion with a healthcare provider, even if the total EPDS score is below threshold.
Question 10: Self-harm
Question 10 asks about thoughts of self-harm. This question is critically important:
- Any score above 0 requires immediate follow-up
- Healthcare providers should assess safety
- Does not necessarily indicate imminent danger
- But must be taken seriously every time
If you or someone you know is having thoughts of self-harm:
- National Suicide Prevention Lifeline: 988
- Crisis Text Line: Text HOME to 741741
- Postpartum Support International: 1-800-944-4773
Limitations of the EPDS
What the EPDS cannot do
- Diagnose depression: Only a healthcare professional can diagnose
- Assess severity: Score doesn't indicate how severe symptoms are
- Replace clinical judgment: Should be used alongside, not instead of, professional evaluation
- Detect all cases: Some people with depression may score low
False positives and negatives
The EPDS may:
- Miss some cases of depression (false negative)
- Flag some without depression (false positive)
- Be affected by cultural or language factors
Sensitivity and specificity
At different cutoff scores:
| Cutoff | Sensitivity | Specificity |
|---|
| 9/10 | 86% | 78% |
| 10/11 | 81% | 88% |
| 12/13 | 68% | 95% |
Higher cutoffs reduce false positives but may miss some cases.
When to seek help
You should contact a healthcare provider if:
- Your EPDS score is 10 or higher
- You answered positively to question 10
- Your symptoms are interfering with daily life
- You're concerned about your mood or wellbeing
- Family or friends have expressed concern
Postpartum depression facts
How common is it?
- Affects 1 in 7 new mothers
- Can occur anytime in the first year postpartum
- Also affects fathers (about 10%)
- More common after traumatic birth or with history of depression
Risk factors
| Factor | Impact |
|---|
| Previous depression | Significantly increased risk |
| Lack of support | Increased risk |
| Stressful life events | Increased risk |
| Complications during pregnancy/birth | Increased risk |
| History of anxiety | Increased risk |
Symptoms beyond the EPDS
Postpartum depression may also include:
- Changes in appetite
- Physical symptoms (headaches, body aches)
- Difficulty bonding with baby
- Withdrawal from family and friends
- Intrusive thoughts about the baby
Treatment options
Postpartum depression is highly treatable:
Therapy
- Cognitive behavioral therapy (CBT)
- Interpersonal therapy
- Support groups
Medication
- Antidepressants (many are safe during breastfeeding)
- Discuss options with your doctor
Self-care strategies
- Sleep when possible
- Accept help from others
- Stay connected with support network
- Gentle exercise
- Limit alcohol and caffeine
Taking the EPDS again
Recommended frequency
| Situation | Timing |
|---|
| Routine screening | Once each trimester, 6 weeks postpartum |
| Elevated score | Repeat in 2-4 weeks |
| After starting treatment | Every 2-4 weeks to monitor progress |
Tracking changes
If taking the EPDS multiple times:
- Note the date and score each time
- Share all results with your healthcare provider
- Look for trends over time
Summary
The Edinburgh Postnatal Depression Scale:
- Is a screening tool - not a diagnostic test
- Takes about 5 minutes to complete
- Scores range from 0-30 with higher scores indicating more symptoms
- Scores of 10+ suggest possible depression
- Question 10 about self-harm requires immediate attention if positive
- Should be followed up with a healthcare provider for elevated scores
If you're concerned about your mental health during or after pregnancy, please reach out to a healthcare provider. Postpartum depression is common, treatable, and nothing to be ashamed of.