EPDS (Edinburgh Postnatal Depression Scale): Take It, Score It, Understand Your Results
The EPDS (Edinburgh Postnatal Depression Scale) is a 10-item self-report questionnaire used to screen for depression during pregnancy and the postpartum period. Developed by Cox, Holden, and Sagovsky in 1987 at the University of Edinburgh, it is the most widely used perinatal depression screening tool in the world and has been translated into more than 50 languages. The EPDS takes about 5 minutes to complete, is offered free of charge for clinical use, and produces a 0-30 score. A score of 10 or higher is the most commonly used threshold for possible depression warranting further evaluation; 13 or higher is often used as a more specific cutoff for likely major depression. The EPDS is a screening tool, not a diagnosis: any positive screen — especially any non-zero answer on item 10, which asks about thoughts of self-harm — should be reviewed promptly with a healthcare professional.
What is the EPDS?
The EPDS (Edinburgh Postnatal Depression Scale) is a 10-item perinatal depression screening questionnaire developed by Dr. John Cox, Jeni Holden, and Ruth Sagovsky and first published in 1987 in the British Journal of Psychiatry. It was specifically designed for use during pregnancy and the postpartum period and has become the global standard for perinatal depression screening. The EPDS is freely available for clinical use (with attribution) and has been translated and validated in dozens of languages. Major medical organizations including the American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the National Institute of Mental Health (NIMH) recommend perinatal depression screening, and the EPDS is one of the most commonly used instruments to do so.
What the EPDS measures
The EPDS measures depressive symptoms over the past seven days using items specifically designed for the perinatal period. The items deliberately avoid somatic symptoms (such as appetite or sleep changes) that overlap with normal pregnancy and postpartum experience, focusing instead on mood, anhedonia, anxiety, self-blame, difficulty coping, and self-harm thoughts. The recall window of one week is shorter than the two-week window used by the PHQ-9, reflecting the more rapid course of mood changes around childbirth. Item 10, the final item, asks directly about thoughts of self-harm — this question is a non-negotiable safety surface that warrants immediate clinical follow-up regardless of the total score.
How the EPDS is administered
The EPDS is a self-report questionnaire that takes about 5 minutes to complete. Each of the 10 items is rated on a 0-3 scale based on how the respondent has felt during the past seven days. Several items (specifically items 3 and 5-10) are reverse-scored — meaning the response order is inverted before summing — so the questionnaire should be scored carefully using the official scoring key rather than added casually. The total score is the sum of all 10 items after reverse-scoring, with a possible range of 0 to 30. The EPDS can be completed on paper, on a screen, or read aloud by a clinician. It can be administered at any point during pregnancy or in the first year postpartum, and many practices include it at every routine perinatal visit.
Who uses the EPDS
The EPDS is used routinely by obstetrician-gynecologists, midwives, primary care clinicians, pediatricians, mental health professionals, and home visitors who care for pregnant and postpartum parents. The American Academy of Pediatrics recommends that pediatricians screen for postpartum depression at well-child visits in the first year, recognizing that depressed parents may present at the pediatric office before they present at their own clinician. ACOG recommends screening at least once during the perinatal period using a validated tool. Although the EPDS was originally validated in women, it is increasingly used to screen non-birthing partners as well, with appropriate adjustments to interpretation. Public health programs, perinatal mental health initiatives, and research studies use the EPDS extensively.
EPDS is a screening tool, not a diagnosis
The EPDS is a screening instrument — it can indicate whether further evaluation for perinatal depression is warranted, but it cannot diagnose depression on its own. A high score suggests a clinician should follow up with a comprehensive assessment that takes the full clinical picture into account, including pregnancy-specific factors, previous mental health history, current life stressors, and social support. A low score does not rule out depression or other perinatal mental-health conditions such as postpartum anxiety, postpartum OCD, postpartum psychosis, or PTSD related to birth. Item 10 (thoughts of self-harm) is taken seriously regardless of the total score and warrants prompt clinical attention. If you are in crisis, call or text 988 (U.S. Suicide & Crisis Lifeline) or call the National Maternal Mental Health Hotline at 1-833-852-6262 for immediate, confidential support 24/7 in English and Spanish.
How to score and interpret your EPDS results
The Edinburgh Postnatal Depression Scale (EPDS) produces a single total score between 0 and 30. Each of the 10 items is rated on a 4-point scale and assigned 0 to 3 points, and the points are summed across all items. The score is meant to be used by a clinician (or by you, with a clinician’s follow-up) as a starting point for a conversation — not as a diagnosis.
Watch for reverse-scored items (the most common scoring mistake)
A frequent error when self-scoring the EPDS is missing that some items are reverse-scored. Items 1, 2, and 4 are scored in the natural direction (0 for the most positive response, 3 for the most negative). The remaining items — 3, and 5 through 10 — are scored in reverse, so the most negative-sounding response is worth 3 points and the most positive response is worth 0. If you score every item the same way, your total will be wrong by a wide margin. Use the official scoring key or a validated calculator rather than tallying responses casually.
The two thresholds clinicians use
| Cutoff | Source / framing | What it suggests | Typical action |
|---|---|---|---|
| ≥10 | PSI uniform cut-off for any positive screen | Possible perinatal depression — case-finding threshold; higher sensitivity | Discuss with a clinician for full evaluation |
| ≥13 (above 12) | AAFP; sensitivity 86%, specificity 78% for major postpartum depression in parents without prior history | Likely major depressive episode | Prompt comprehensive clinical assessment |
| Above 9 at 4 weeks postpartum, prior postpartum depression history | AAFP — captures 80% of those who relapse within 1 year | High-sensitivity surveillance | Closer monitoring and clinical contact |
A score of 0-9 is generally considered low risk, but it does not rule out perinatal depression or other perinatal mood and anxiety disorders (PMADs), and it does not override item 10.
Item 10 overrides the total score
Regardless of where your total falls, any non-”Never” answer on item 10 (the self-harm question) is treated as a clinical priority on its own. A person can score below the cutoff overall and still need same-day contact with their OB, midwife, primary care clinician, or a crisis line. If you are in crisis right now, call or text 988 (Suicide & Crisis Lifeline), call the National Maternal Mental Health Hotline at 1-833-852-6262 (24/7, English and Spanish), or contact Postpartum Support International at 1-800-944-4773.
The 10 EPDS items: what each one asks and why
The EPDS deliberately covers a different territory than general adult depression screeners. Each item asks how you have felt over the past seven days — a shorter recall window than the PHQ-9, which uses two weeks — because mood around childbirth can shift quickly. Items are answered on a 4-point scale, from “Yes, quite a lot” (or “Yes, quite often”) at one end to “No, not at all” (or “Never”) at the other.
What each item covers
- Item 1 — Ability to laugh and see the funny side. Loss of humor and lightness is an early, non-somatic marker of low mood.
- Item 2 — Looking forward with enjoyment. Captures anhedonia — the loss of pleasure or anticipation.
- Item 3 — Blaming yourself unnecessarily when things go wrong. Self-blame is heightened in perinatal depression; one of the reverse-scored items.
- Item 4 — Anxiety or worry for no good reason. Anxiety is a leading presenting symptom of perinatal mood and anxiety disorders, one reason the EPDS is preferred over the PHQ-9 in perinatal care.
- Item 5 — Feeling scared or panicky for no very good reason. Captures more acute fear and panic, separate from generalized worry.
- Item 6 — Things have been getting on top of me / difficulty coping. A practical marker of overwhelm.
- Item 7 — Sleep disturbance because of unhappiness. The wording is critical: it asks about sleep loss caused by low mood, not by the baby — avoiding the somatic overlap that confounds general screeners postpartum.
- Item 8 — Sadness or misery. Direct measurement of low mood.
- Item 9 — Crying. Frequency of tearfulness in the past week.
- Item 10 — Thoughts of harming yourself. A direct safety question, with its own dedicated section below.
Why the EPDS avoids somatic symptoms
Cox, Holden, and Sagovsky designed the EPDS in 1987 specifically for use during pregnancy and the year after birth. Symptoms that show up on general depression screeners — fatigue, appetite change, sleep disturbance — overlap with normal pregnancy and postpartum experience and would generate many false positives. By focusing on mood, anhedonia, anxiety, self-blame, coping, and self-harm thoughts, the EPDS gives a clearer signal in a population where physical symptoms are noisy.
Item 10: the self-harm question — what it is and what to do
Item 10 reads, verbatim: “The thought of harming myself has occurred to me”. The four response options are Yes, quite often / Sometimes / Hardly ever / Never.
This question is the safety floor of the entire instrument. The Perinatology calculator carries the standing instruction that applies whenever this item — or thoughts about harming the baby — is endorsed:
“If you have had any thoughts of harming yourself or your baby… tell your doctor or midwife immediately, or go to your nearest hospital emergency room.”
Why item 10 is treated differently
- Any non-”Never” answer is acted on, regardless of the total EPDS score. Even a low overall score does not cancel out a positive item 10.
- AAFP guidance emphasizes that clinicians should ask directly about suicidal thoughts, because many patients are reluctant to volunteer this information. If a clinician has not asked you directly and you have had these thoughts, raise it yourself — it is the most important data point on the form.
- Thoughts of harming the baby are taken with the same urgency and can be a sign of postpartum psychosis, which is rare but a medical emergency.
Crisis resources — keep these accessible
If item 10 is non-zero, or if you are having thoughts of harming yourself or your baby:
- Call 911 or go to your nearest emergency room for immediate danger.
- 988 Suicide & Crisis Lifeline — call or text 988 (24/7, free, confidential).
- National Maternal Mental Health Hotline — 1-833-852-6262 (24/7, English and Spanish, dedicated to pregnant and postpartum parents).
- Postpartum Support International HelpLine — 1-800-944-4773 (call or text); PSI also operates a free directory of perinatal-trained providers at postpartum.net.
These thoughts are a recognized symptom of perinatal depression, not a personal failing or a sign you are unfit to parent. They are treatable, and reaching out is the right next step.
What a positive EPDS means — and what it doesn’t
A positive EPDS — typically a total of 10 or higher, or any non-zero item 10 — is a trigger for a clinical conversation, not a diagnosis. The score tells a clinician that something on the questionnaire is worth a closer look. It does not, on its own, determine whether you have perinatal depression, how severe it is, or what treatment (if any) is appropriate.
What a clinician does after a positive screen
A comprehensive evaluation typically explores symptoms in depth, your personal and family mental health history, current life stressors and supports, prior pregnancy experiences, and any safety concerns. A clinician may also order blood tests to rule out medical contributors like thyroid problems, which can produce overlapping symptoms. Treatment options, if needed, span psychotherapy (cognitive behavioral therapy, interpersonal therapy), antidepressant medications, and — for severe postpartum depression — newer agents like brexanolone and zuranolone. Choosing among them is a decision made with a perinatal-aware clinician, not from a questionnaire result.
What a low score can still miss
A score under 10 does not rule out a perinatal mood or anxiety disorder. Several conditions can present with a normal or borderline EPDS:
- Postpartum anxiety, including generalized anxiety and panic — sometimes more prominent than low mood.
- Postpartum OCD, often presenting as intrusive, unwanted thoughts about the baby that the parent finds distressing rather than acts on.
- Postpartum PTSD, frequently tied to a traumatic birth experience.
- Postpartum psychosis — rare, but a medical emergency.
If your symptoms feel real to you and the score does not match, the symptoms are the more important signal.
Postpartum depression is common and treatable
Perinatal depression “can affect any pregnant or postpartum woman, regardless of age, race, ethnicity, income, culture, or education”. Non-birthing partners, including fathers and adoptive parents, can also experience postpartum depression; PSI notes the EPDS has been validated as a measure of mood in fathers, with a recommended cut-off of 5/6 rather than 10. A positive screen is not a verdict on your parenting — it is information that lets you and a clinician decide what comes next.
How accurate is the EPDS? (the validation evidence)
The EPDS was developed by Cox, Holden, and Sagovsky and published in the British Journal of Psychiatry in 1987, based on a validation study of 84 mothers in which an established psychiatric diagnostic interview served as the reference standard. The original paper reported “satisfactory sensitivity and specificity” and noted the scale was also sensitive to changes in depression severity over time.
Sensitivity and specificity at typical cutoffs
The American Academy of Family Physicians summarizes the most-cited replication numbers:
| Population | Cutoff | Sensitivity | Specificity |
|---|---|---|---|
| Parents without prior postpartum major depression | Above 12 (≥13) | 86% | 78% |
| Parents with prior postpartum major depression (relapse surveillance, 4 weeks postpartum) | Above 9 | Captures 80% of those who relapse within 1 year | — |
These numbers explain why the two main thresholds coexist:
- ≥10 is the case-finding threshold favored by Postpartum Support International — higher sensitivity, fewer missed cases, more false positives that are then sorted out by clinical follow-up.
- ≥13 (above 12) is the diagnostic-leaning threshold favored in some clinical guidance — higher specificity for major depression, fewer false positives, but more missed milder cases.
Performance shifts depending on the population studied, the cutoff applied, the reference diagnostic standard, the timing in the perinatal period, and the language of the translation used. The EPDS is available in several languages and has been widely replicated, which is part of why it has become the global standard for perinatal depression screening. The EPDS is best understood as a sensitive, well-validated trigger for clinical evaluation, not a stand-alone diagnostic test.
When and how the EPDS is used in clinical practice
Perinatal depression screening works best when it happens more than once, because risk and symptoms shift across pregnancy and the first year after birth. Postpartum Support International recommends screening at each of the following points:
- The first prenatal visit
- At least once during the second trimester
- At least once during the third trimester
- The six-week postpartum visit
- Follow-up at 6 and 12 months postpartum
The AAFP highlights two practical US primary-care windows: the 4-to-6-week postpartum visit and the 2-month well-child visit. The well-child visit matters because parents experiencing postpartum depression often appear at the pediatrician’s office for the baby before they make an appointment for themselves.
What happens after a positive screen
A positive EPDS triggers a referral pathway, not a prescription. Typical next steps include a comprehensive clinical evaluation with the screening clinician or a referral to a perinatal-trained mental health provider — Postpartum Support International maintains a free directory of perinatal-trained clinicians at postpartum.net and a HelpLine at 1-800-944-4773. AAFP notes the EPDS “can be quickly scored by office staff” and is “available in several languages,” making it practical to integrate at routine visits.
Prevention for parents at increased risk
The US Preventive Services Task Force gives a Grade B recommendation that clinicians “provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions”. Increased risk includes a personal history of depression, current subthreshold depressive symptoms, low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety, or significant negative life events.
Two evidence-based programs are cited: Mothers and Babies (6-12 weekly group sessions) and ROSE (4-5 prenatal sessions). Pooled across trials, cognitive behavioral and interpersonal counseling produced a 39% reduction in the likelihood of perinatal depression (RR 0.61), with a number needed to treat of about 13.5. USPSTF also notes there is no perfectly accurate tool for identifying who is at risk; clinical judgment, history, and validated instruments like the EPDS are used together.
When to talk to your doctor — and when to seek emergency help
The EPDS is a starting point. The decisions that follow are clinical. Reach out promptly in any of the situations below.
Call 911, go to your nearest emergency room, or call/text 988 right now if:
- You have any thoughts of harming yourself, harming your baby, or ending your life — regardless of your total EPDS score.
- You are seeing, hearing, or believing things that others around you do not — these can be signs of postpartum psychosis, which is rare but a medical emergency.
- You feel you cannot keep yourself or your baby safe in the next 24 hours.
Contact your OB, midwife, primary care clinician, or your baby’s pediatrician within the next day or two if:
- Your EPDS total is 10 or higher (PSI threshold for further evaluation).
- Your EPDS total is above 12 and you have not had a prior postpartum depression episode — this threshold has 86% sensitivity and 78% specificity for major postpartum depression.
- You scored above 9 at 4 weeks postpartum and have a history of postpartum depression — this captures most relapses within the first year.
- Any non-”Never” response on item 10 — even with a low total score.
- Symptoms have persisted beyond the first two weeks after delivery, past the typical “baby blues” window.
- You are experiencing persistent sadness, severe anxiety, difficulty bonding with the baby, intrusive unwanted thoughts about the baby, or sleep and appetite changes that worry you.
Use these crisis lines whenever you need them — 24/7, free, confidential:
- 988 Suicide & Crisis Lifeline — call or text.
- National Maternal Mental Health Hotline — 1-833-852-6262 (English and Spanish, dedicated to pregnant and postpartum parents).
- Postpartum Support International HelpLine — 1-800-944-4773; PSI also runs a free directory of perinatal-trained providers.
Non-birthing partners are not excluded from any of this. The EPDS has been validated in fathers (with a lower cut-off of 5/6), and partners of any gender can develop perinatal depression and benefit from the same evaluation and support.
Frequently asked questions
Can I take the EPDS during pregnancy, or is it only for after birth?
The EPDS was specifically designed for use during pregnancy as well as the postpartum period. Postpartum Support International recommends screening at the first prenatal visit, at least once during the second and third trimesters, at six weeks postpartum, and again at 6 and 12 months. Many clinicians use it across the full perinatal year.
Where can I find the official Edinburgh Postnatal Depression Scale PDF?
The Edinburgh Postnatal Depression Scale is available as a free PDF from clinical organizations including Postpartum Support International and Psychology Tools. AAFP notes it is “available in several languages” and easily scored by office staff. Symptomatik does not reproduce the full instrument, but it is freely usable for clinical and research purposes with attribution and no modification.
Is the EPDS available in Spanish or other languages?
Yes. The AAFP confirms the EPDS is available in several languages, and the National Maternal Mental Health Hotline (1-833-852-6262) offers 24/7 bilingual support in English and Spanish for pregnant and postpartum parents.
Can fathers and non-birthing partners take the EPDS?
Yes. Postpartum Support International states: “The EPDS is a reliable and valid measure of mood in fathers,” and recommends a lower cut-off of 5/6 rather than the standard 10 for fathers. Non-birthing partners of any gender can develop perinatal depression and benefit from screening and follow-up.
How is the EPDS different from the PHQ-9?
Both are validated for the perinatal population and both are free to use, but the EPDS has key perinatal-specific advantages. It uses a 1-week recall rather than the PHQ-9’s 2-week recall, avoids somatic items (fatigue, appetite, sleep) that overlap with normal pregnancy and postpartum experience, and explicitly covers anxiety and suicidal thoughts alongside depressive symptoms.
What if my score is borderline (10-12)?
A score of 10-12 is a positive screen by PSI’s case-finding cut-off of 10, but below the AAFP threshold of above 12 used for likely major postpartum depression. The clinical approach is the same: bring the result to your OB, midwife, primary care clinician, or a perinatal-trained mental health provider for a full evaluation. A borderline score is a reason for a conversation, not a reason to wait.
Is the EPDS free to use?
Yes. Postpartum Support International explicitly states: “Both the EPDS and the PHQ-9 are validated for use in the perinatal population, and there is no fee”. Use is permitted with proper attribution and without modification of the instrument.
Is there a CPT code for EPDS screening?
EPDS-specific billing falls under standard depression and behavioral health screening CPT codes rather than a single EPDS-only code. AAFP notes the EPDS can be quickly scored by office staff and is routinely integrated into perinatal care. The specifics depend on payer and practice; ask your billing office or clinician for the codes used in your visit.