Psychiatry
EPDS (Postnatal Depression)
Edinburgh Postnatal Depression Scale.
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Background
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire developed to screen for depression in the perinatal period. Each item asks how the woman has felt over the past seven days and is scored 0–3, giving a total of 0–30. It deliberately avoids somatic symptoms such as fatigue and sleep change that are normal after childbirth, focusing instead on mood, anhedonia, anxiety, guilt and thoughts of self-harm. It is used both antenatally and postnatally.
Interpreting the result
Higher totals indicate a greater likelihood of depression: broadly, 0–9 suggests a lower likelihood, 10–12 possible depression warranting review and a repeat, and 13 or more a likely depressive illness needing fuller assessment. The exact cut-off varies between guidelines and settings, so a positive screen should lead to a clinical interview rather than a diagnosis. Crucially, item 10 asks directly about self-harm and must always be reviewed regardless of the total.
Worked example
A woman six weeks postnatal scores 2s and 3s across the low-mood, anxiety and anhedonia items and a 1 on the self-harm item, totalling 16. This is a positive screen suggesting likely depression, and because item 10 is non-zero she needs an immediate risk assessment alongside a full mental-health evaluation.
Critical actions
Any non-zero answer to item 10 (self-harm) requires immediate risk assessment, regardless of total score.
Pearls / pitfalls
- It is a screening aid, not a diagnosis — a positive score requires a clinical assessment to confirm depression and exclude other causes.
- Always check item 10: any non-zero answer to the self-harm question needs immediate risk assessment irrespective of the total.
- Cut-offs differ by guideline and language version; know the threshold your service uses and consider re-screening borderline results.
- It can also flag anxiety, which is common perinatally; a high anxiety subscale still warrants follow-up even if total depression criteria are not met.
Evidence & validation
The scale was developed and validated by Cox, Holden and Sagovsky in 1987 and has since been validated in many languages and populations. It is the most widely used perinatal depression screen and is recommended within antenatal and postnatal mental-health pathways, used as a screen rather than a diagnostic test.
Frequently asked questions
What EPDS score indicates depression?
Broadly, 10–12 suggests possible depression and 13 or more a likely depressive illness, but the exact cut-off varies by setting and language. A positive screen prompts a clinical assessment, not an automatic diagnosis.
Why does the EPDS avoid questions about sleep and tiredness?
Disrupted sleep and fatigue are normal after childbirth and would otherwise inflate scores. The EPDS focuses on mood, anhedonia, anxiety and guilt to stay specific in the perinatal period.
What should I do about item 10?
Item 10 asks about thoughts of self-harm, and any non-zero answer requires an immediate risk assessment regardless of the total score. It is never overridden by a low overall number.
Can the EPDS be used during pregnancy?
Yes. It is validated both antenatally and postnatally and is used across the perinatal period, though the chosen cut-off may differ between services.
Does a low EPDS score rule out depression?
No screening tool is perfect. A low score makes depression less likely but does not exclude it, so clinical concern or new symptoms should still prompt assessment.
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.
- NICE CG192: Antenatal and postnatal mental health: clinical management and service guidance. 2014 (updated).
About the creator
Cox JL et al.
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