EPDS: Edinburgh Postnatal Depression Scale
10-item perinatal depression screener. Score 0–30; standard cutoff ≥13. Item 10 (self-harm) always requires clinical follow-up. Translated and validated across multiple languages and cultures.
The EPDS is a 10-item self-report screener for postnatal and prenatal depression. Validated in over 50 languages, it is the most widely used perinatal depression screening tool internationally. Item 10 always requires clinical follow-up regardless of total score.
Item 10 Safety Rule: Any score above 0 on EPDS item 10 (thoughts of self-harm) requires immediate clinical follow-up, regardless of total score. If you are in crisis, call 988 (US) or your local emergency services.
What is the Edinburgh Postnatal Depression Scale?
The EPDS (Edinburgh Postnatal Depression Scale) is a 10-item self-report screening tool for postnatal and prenatal depression developed by Cox, Holden, and Sagovsky (1987) at the University of Edinburgh. It was specifically designed to detect depression in perinatal populations, where standard depression measures may over-attribute somatic symptoms (fatigue, sleep changes, appetite changes) to normal pregnancy or postpartum physiology.
Each item is scored 0–3, yielding a total of 0–30. The EPDS covers depressed mood, inability to enjoy things, anxiety, self-blame, panic or worry, inability to cope, sleep difficulties due to unhappiness, sadness or misery, tearfulness, and thoughts of self-harm. The standard clinical cutoff is ≥13 for probable depression, though a lower threshold of ≥10 is sometimes used when sensitivity is prioritized.
The EPDS is validated for use in both the postnatal period and during pregnancy (prenatal), and has been translated and validated in over 50 languages. It is recommended by the American College of Obstetricians and Gynecologists (ACOG), the UK National Institute for Health and Care Excellence (NICE), and the Canadian Pediatric Society for perinatal depression screening.
Item 10, Always Follow Up
Item 10 asks about thoughts of self-harm or suicide ("The thought of harming myself has occurred to me"). Any response above 0 on this item requires immediate clinical assessment, regardless of the total EPDS score. This is a mandatory clinical safety rule, not a discretionary guideline.
Answer all 10 questions about how you have felt in the past 7 days. Your score is calculated automatically. This tool is for educational and screening purposes only, it is not a diagnostic tool.
Item 10 Safety Rule: Any response above "Never" on item 10 requires immediate clinical follow-up regardless of total score. If you are in crisis right now, call or text 988 (free, confidential, 24/7).
This tool is for educational and screening purposes only. It is not a substitute for professional clinical assessment.
EPDS Scoring & Cutoffs
Sum of all 10 items (0–3 each). Score range: 0–30. Note: item 10 is always a clinical priority regardless of total score.
Cutoff Flexibility
Some settings use ≥10 when higher sensitivity is needed (e.g., universal screening programs). Local clinical guidelines and population context should inform threshold selection.
When to Administer the EPDS
Clinical guidelines recommend screening at multiple time points across the perinatal period.
ACOG recommends screening at least once during pregnancy (ideally first trimester) and again in the third trimester. Prenatal depression is a significant predictor of postpartum depression.
Postnatal (4–6 weeks)
The 4–6 week postnatal visit is the most common EPDS administration point. Postpartum depression typically emerges within the first 4 weeks and can persist for months without treatment.
3–6 Months Postpartum
Some guidelines recommend repeat screening at 3–6 months. Late-onset postpartum depression can emerge after the initial postnatal window and is frequently missed without protocol-driven rescreening.
Documenting EPDS scores in clinical notes?
EPDS scores belong in the Objective section of your note. See our SOAP notes guide and Progress Notes guide for templates and examples.
References
- 1.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.View source
Frequently Asked Questions
What does EPDS stand for?
EPDS stands for Edinburgh Postnatal Depression Scale. It was developed by Cox, Holden, and Sagovsky at the University of Edinburgh and published in 1987. It is also sometimes called the Edinburgh Depression Scale (EDS) or postnatal depression test.
What score indicates postpartum depression on the EPDS?
A score of ≥13 is the most widely used threshold for probable postnatal depression (Cox et al., 1987, PMID 3651732). Some settings use ≥10 for increased sensitivity, particularly in universal screening programs. Any score on item 10 (self-harm thoughts) requires immediate clinical follow-up regardless of total score.
Is the EPDS used during pregnancy as well as postpartum?
Yes. The EPDS was originally developed for postnatal use but has been validated for prenatal (antenatal) depression screening. ACOG recommends screening at least once during pregnancy. Prenatal depression is a significant predictor of postpartum depression, making prenatal screening clinically important.
Why is item 10 on the EPDS treated specially?
EPDS item 10 asks whether the respondent has had thoughts of harming herself. Any response above 0 (Never) indicates some presence of self-harm ideation and requires immediate clinical assessment — this applies regardless of the total EPDS score, even if the overall score is below the depression cutoff. This is a mandatory safety protocol, not a guideline.
Does the EPDS work differently for fathers or partners?
The EPDS has been used to screen paternal postnatal depression in fathers and non-birthing partners, though it was not originally designed or validated for this population. Some studies support its use in fathers; others suggest lower sensitivity and specificity compared to the birthing parent validation data. Clinicians should interpret results in fathers with this limitation in mind.
How is the EPDS different from the PHQ-9?
The EPDS was specifically designed for perinatal populations and avoids over-attributing somatic symptoms (sleep changes, fatigue, appetite changes) to depression — symptoms that are also common in normal pregnancy and postpartum. The PHQ-9 includes somatic items that may inflate scores in perinatal patients. For perinatal depression screening, EPDS is the preferred tool; PHQ-9 is preferred in general adult primary care settings.
Is the EPDS free to use?
Yes. The Edinburgh Postnatal Depression Scale is in the public domain and free for clinical and research use without permission. It is widely available from health authorities, ACOG, and NICE in validated translations for over 50 languages.
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