EPDS: Edinburgh Postnatal Depression Scale

The EPDS is a 10-item self-report screener for postnatal and prenatal depression. Validated in many languages, it is one of the most widely used perinatal depression screening tools 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 does the EPDS measure?

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 at the University of Edinburgh ^[1]. 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 many 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.

How do you give the EPDS?

The respondent answers all 10 questions about how they have felt in the past 7 days. The EPDS is a screening tool, 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.

The scale can be completed in about 5 minutes and has a simple method of scoring ^[1].

When to screen

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.

How do you score and interpret the EPDS?

Sum of all 10 items (0–3 each). Score range: 0–30. Note: item 10 is always a clinical priority regardless of total score.

A total of ≥13 is the most widely used threshold for probable depression. In an individual participant data meta-analysis, a cutoff of ≥11 maximized combined sensitivity and specificity; ≥13 was less sensitive but more specific ^[2].

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.

Psychometric properties

• Original validation. In 84 mothers assessed against Research Diagnostic Criteria from a standardized psychiatric interview, the EPDS showed satisfactory sensitivity and specificity and was sensitive to change in depression severity over time ^[1].
• Meta-analysis. An individual participant data meta-analysis of 58 studies (15,557 participants) compared the EPDS with semi-structured interviews ^[2]:
  • At ≥10: sensitivity 0.85, specificity 0.84 ^[2].
  • At ≥11: sensitivity 0.81, specificity 0.88 ^[2].
  • At ≥13: sensitivity 0.66, specificity 0.95 ^[2].
• Pregnancy and postpartum. Accuracy was similar for pregnant and postpartum women ^[2].

Limitations

• Screening, not diagnosis. A high score indicates probable depression that needs clinical assessment; the EPDS does not diagnose.
• Cutoff trade-off. At ≥13 sensitivity was 0.66, so about a third of women with major depression score below the cutoff ^[2]; lower cutoffs reduce false negatives at the cost of more false positives.
• Partners and fathers. The EPDS was not originally designed or validated for fathers or non-birthing partners; some studies suggest lower accuracy in these groups.
• Self-report. Scores rely on the respondent's willingness to disclose symptoms, including on item 10.

EPDS vs PHQ-9

The EPDS avoids somatic items (sleep, fatigue, appetite) that are common in normal pregnancy and after birth. The PHQ-9 includes them, so it is more often used in general adult primary care.

Documenting EPDS scores

EPDS scores belong in the Objective section of a SOAP note.