Edinburgh Postnatal Depression Scale (EPDS)
The EPDS is a 10-item screening tool to help identify possible depressive and anxiety symptoms in antenatal and postnatal care. It is not diagnostic and must be interpreted with clinical judgment to guide follow-up.
What is the EPDS?
The EPDS is a standardized screening tool designed to identify possible symptoms of depression and anxiety during the antenatal and postnatal periods. It is not a diagnostic tool; it helps clinicians determine who may benefit from a more in-depth mental health assessment. Validated translations are available in several languages.
When to Use
Recommended for all women, ideally twice during the antenatal period and once or twice in the postnatal period (preferably 6 to 12 weeks after birth). The EPDS assesses feelings over the previous seven days. Clinicians should clarify that it is non-diagnostic and used solely to guide follow-up care.
Structure and Scoring
10 items, each scored 0 to 3 (some items are reverse-scored). Total range: 0 to 30. The final score indicates the likelihood of depressive symptoms but must be interpreted in clinical context.
| Score Range | Interpretation and Suggested Action |
|---|---|
| 0 to 12 | Below threshold for concern. Apply clinical judgment; pay attention to anxiety and self-harm responses. |
| 13 or higher | Flag for follow-up; assess for possible depressive symptoms. |
| Any score on Question 10 of 1 or higher | Immediate safety assessment is required regardless of the total score. |
Interpretation and Follow-Up
Clinical judgment is essential. A low score does not rule out depression; a high score does not confirm it.
- Antenatal: if 13 or higher, repeat in 2 to 4 weeks; if still 13 or higher, refer for formal clinical assessment.
- Postnatal: if 13 or higher, arrange referral or ongoing care according to clinical judgment.
- Anxiety indicators: elevated scores on Questions 3 to 5 may reflect anxiety; offer support or referral.
- Self-harm (Q10): any score 1 or higher requires immediate risk assessment and safety planning.
Cultural and Linguistic Considerations
Cutoffs and interpretation can vary across culturally and linguistically diverse populations. Language comprehension, mistrust of services, and perceived stigma may affect responses. Translations developed with specific communities improve accuracy. Always apply cultural sensitivity, ensure language support, and consider community-based interpretations.
Clinical Summary
- Use EPDS routinely in antenatal and postnatal care.
- Do not diagnose based on score alone.
- Repeat if 13 or higher in 2 to 4 weeks (antenatal).
- Act immediately on any self-harm thoughts (Question 10).
- Consider language and culture in interpretation.
- Combine with full clinical assessment and a follow-up plan.
Version and sources
Version: v1.0 — Edinburgh Postnatal Depression Scale (EPDS).
Primary sources and key references:
- Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10 item EPDS. Br J Psychiatry. 1987;150:782-786.
- Cox JL, Chapman G, Murray D, Jones P. Validation of the EPDS in non postnatal women. J Affect Disord. 1996;39(3):185-189.
- Rubertsson C, Borjesson K, Berglund A, Josefsson A, Sydsjo G. Swedish validation of EPDS during pregnancy. Nord J Psychiatry. 2011;65(6):414-418.
- Gibson J, McKenzie McHarg K, Shakespeare J, Price J, Gray R. Systematic review of EPDS validation in antepartum and postpartum women. Acta Psychiatr Scand. 2009;119(5):350-364.
- Boyce P, Stubbs J, Todd A. EPDS validation for an Australian sample. Aust N Z J Psychiatry. 1993;27(3):472-476.
- Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD, DEPRESSD EPDS Group. Accuracy of the EPDS for screening to detect major depression among pregnant and postpartum women: IPD meta analysis. BMJ. 2020;371:m4022.
Disclaimer: This page is an evidence-based summary for clinicians and does not replace local guidelines or clinical judgment. Follow your institution protocols and regulatory requirements.