Edinburgh Postnatal Depression Scale (EPDS)
The ten-item Edinburgh Postnatal Depression Scale, reproduced in full with scoring, the published cut-offs, and clear guidance on responding to item 10. The standard screen for depression during pregnancy and the first postnatal year.
About this resource
The EPDS was developed by John Cox, Jeni Holden and Ruth Sagovsky at Edinburgh and Livingston health centres and published in 1987. It was designed to overcome a specific problem: general depression questionnaires ask about tiredness, poor sleep and changes in appetite, which are almost universal after a birth and so inflate scores in new mothers. The EPDS instead asks about mood, anhedonia, self-blame, anxiety, feeling overwhelmed, sadness, tearfulness and thoughts of self-harm over the past seven days. It is now used worldwide in pregnancy as well as postnatally, and with fathers and partners.
The scale is reproduced here because the authors permit reproduction without further permission provided the authors, title and source are cited on every copy. Each item has four responses scored 0 to 3, with seven of the ten items scored in reverse, giving a total of 0 to 30. The original paper proposed that a score above 12 (that is, 13 or more) indicated probable depressive illness, and a threshold of 10 or more has been widely used to capture possible depression. A large individual participant data meta-analysis by Levis and colleagues (2020) found that a cut-off of 11 or more maximised combined sensitivity and specificity for major depression, while 13 or more gave better specificity. Item 10, about thoughts of self-harm, must be reviewed separately every time regardless of the total.
This professional version adds guidance on the two thresholds, on distinguishing anxiety-driven from depression-driven scores (items 3, 4 and 5 are sometimes read as an anxiety subscale), on cultural and language considerations, and on the safety conversation that must follow any positive response to item 10.
How to use it
- Ask the parent to complete the scale on their own, underlining or ticking one answer for each of the ten questions about the past seven days. Explain that it is a routine check, not a judgement of parenting.
- Score each item 0 to 3 as shown in the Scoring section. Questions 1, 2 and 4 score 0 to 3 from top to bottom; the other seven questions score 3 to 0 from top to bottom. Add the ten scores.
- Look at question 10 before you look at the total. Any answer other than 'Never' requires a direct, calm conversation about thoughts of self-harm the same day, an assessment of risk, and a safety plan or referral as indicated. In Canada, the 9-8-8 Suicide Crisis Helpline is available by call or text at any time, and 911 for emergencies.
- Interpret the total using the cut-offs in the table. A score of 10 or above warrants clinical follow-up; 13 or above suggests probable depression and a fuller assessment. Repeat the scale in two weeks if the picture is unclear.
- Discuss the result with the parent in plain language and agree next steps together. Repeat the EPDS at review points to track change during treatment.
References
- Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.
- Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and individual participant data meta-analysis. BMJ, 371, m4022.
- Cox, J., Holden, J., & Henshaw, C. (2014). Perinatal mental health: The Edinburgh Postnatal Depression Scale (EPDS) manual (2nd ed.). RCPsych Publications.
