Edinburgh Postnatal Depression Scale (EPDS)
The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item self-report questionnaire designed to screen for postpartum depression in women during the postnatal period. It is widely used in obstetric, midwifery, and primary care settings globally.
About
The Edinburgh Postnatal Depression Scale (EPDS) was developed by Cox, Holden, and Sagovsky in 1987 at the University of Edinburgh. It is a 10-item self-report scale that assesses depressive symptoms over the past 7 days. Each item is scored 0-3, yielding a total score of 0-30. The EPDS has been validated in over 60 languages and across diverse populations worldwide. It is the most widely used screening instrument for postpartum depression and is recommended by the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the US Preventive Services Task Force (USPSTF). A cutoff of ≥10 indicates possible depression, while ≥13 indicates probable depression of varying severity. Item 10 screens for self-harm thoughts and requires immediate attention regardless of total score.
Formula
EPDS = Sum of all 10 item scores (0-3 each)
The EPDS total score is the sum of responses to all 10 questions. Each question is scored 0, 1, 2, or 3 based on the frequency or intensity of symptoms over the past 7 days. The minimum total score is 0 and the maximum is 30. A score of 10 or higher is considered the standard cutoff for a positive screen for possible postpartum depression. A score of 13 or higher suggests probable depression warranting clinical evaluation. Item 10 (self-harm thoughts) must always be reviewed immediately regardless of total score — any score >0 on item 10 requires urgent safety assessment.
Score Interpretation
The Edinburgh Postnatal Depression Scale (EPDS) is the most widely validated and clinically used screening instrument for postpartum depression worldwide. Its clinical significance is supported by extensive research across multiple domains. First, postpartum depression affects 10-15% of new mothers and the EPDS enables early detection, which is critical as untreated postpartum depression has significant consequences for maternal health, child development, and mother-infant bonding. Second, the EPDS has been validated in over 60 languages and across diverse cultural and socioeconomic settings, making it accessible globally. Third, the EPDS includes item 10 which specifically screens for self-harm thoughts, providing a critical safety assessment that is often missed in general depression screening tools. Fourth, the EPDS is recommended by all major clinical guidelines including ACOG, NICE, the USPSTF, and the World Health Organization (WHO). The standard screening protocol recommends administration at the 6-8 week postnatal visit, with repeat screening as clinically indicated. The EPDS takes approximately 5 minutes to complete and is available in both self-report and interviewer-administered formats.
Low probability of depression — 0–9
Scores below 10 indicate a low probability of postpartum depression. Routine postnatal care is appropriate.
Management: No immediate action required. Continue routine postnatal care. Re-screen at next visit if concerns persist.
Possible depression — 10–12
Scores of 10-12 suggest possible depression. Further assessment is needed to determine clinical significance.
Management: Refer for further assessment (CBT, counseling, or psychiatric evaluation). Monitor mood symptoms closely. Schedule follow-up in 1-2 weeks. Rule out hypothyroidism and anemia.
Probable depression — 13–30
Scores of 13 or higher suggest probable depression requiring clinical evaluation and intervention.
Management: Urgent mental health referral indicated. Comprehensive psychiatric assessment recommended. Assess suicide risk and ensure safety plan. Consider pharmacotherapy (SSRIs generally safe in breastfeeding).
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Postpartum women (any time after delivery) | 0 – 9 (Negative screen) | Low probability of postpartum depression. Continue routine care. |
Dr. Mahmoud El-Sayed
Dr. Mahmoud El-Sayed is a consultant obstetrician and gynecologist with over 20 years of experience in clinical practice, specializing in maternal-fetal medicine and perinatal mental health.
View medical review board & editorial policy →Example Calculation
A 29-year-old primiparous woman presents for her 6-week postpartum check-up. She reports difficulty sleeping even when the baby is sleeping, feels tearful most days, and has lost interest in activities she previously enjoyed. She denies thoughts of self-harm. Her EPDS responses are as follows: Q1 (laughter): 1, Q2 (enjoyment): 2, Q3 (self-blame): 1, Q4 (anxiety): 2, Q5 (fear/panic): 0, Q6 (overwhelmed): 2, Q7 (sleep difficulty): 3, Q8 (sadness): 2, Q9 (tearfulness): 2, Q10 (self-harm): 0. Total score = 1 + 2 + 1 + 2 + 0 + 2 + 3 + 2 + 2 + 0 = 15/30. This score falls in the "Probable depression" range (≥13). The clinical recommendation includes urgent mental health referral, comprehensive psychiatric assessment, and consideration of pharmacotherapy (SSRIs which are generally safe in breastfeeding). Close follow-up should be scheduled within 1 week.
Related Conditions
Related Medications
Common Mistakes
Using EPDS as a standalone diagnostic tool for postpartum depression
EPDS is a screening tool, not a diagnostic instrument. Positive screens (≥10) require comprehensive clinical diagnostic evaluation. A formal diagnosis of postpartum depression requires clinical interview per DSM-5 or ICD-11 criteria.
Ignoring item 10 (self-harm) if the total score is low
Any score >0 on item 10 requires immediate safety assessment regardless of total EPDS score. Self-harm ideation in the postpartum period is a psychiatric emergency requiring urgent evaluation and safety planning.
Frequently Asked Questions
When should the EPDS be administered?
What does a cutoff score of ≥10 mean?
What should I do if item 10 (self-harm) is positive?
References
- Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786. PubMed
- National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192). NICE; 2014 (updated 2020).
- American College of Obstetricians and Gynecologists. Screening for Perinatal Depression. ACOG Committee Opinion No. 757. Obstet Gynecol. 2018;132(5):e208-e212.
- US Preventive Services Task Force. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(24):2168-2179. PubMed