Understanding the Edinburgh Postnatal Depression Scale (EPDS)
What the 10-item perinatal screen measures, how it is scored, and what the cutoffs actually mean
DepressionInfo SheetFree ResourceLast reviewed April 2026
Understanding the Edinburgh Postnatal Depression Scale (EPDS)
What the 10-item perinatal screen measures, how it is scored, and what the cutoffs actually mean
Understanding the Edinburgh Postnatal Depression Scale (EPDS)
What the 10-item perinatal screen measures, how it is scored, and what the cutoffs actually mean
The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening questionnaire for depression during pregnancy and after birth. It was developed in Scotland by Cox, Holden, and Sagovsky (1987) specifically because general depression scales kept mistaking the ordinary features of new parenthood (tiredness, appetite change, broken sleep) for illness. The EPDS leaves those items out and asks about mood, anhedonia, self-blame, anxiety, panic, coping, sleep unrelated to the baby, sadness, crying, and thoughts of self-harm over the past seven days. It takes about five minutes. This sheet explains how it is scored, what the research says about cutoffs, and how clinicians should act on a result. It is an explainer for clinicians, trainees, and parents who have been handed the form. It does not reproduce the scale itself; the authors permit reproduction with full citation, and the original paper is listed below. If you are in crisis, call or text 988. The Postpartum Support International HelpLine is 1-800-944-4773.
What the EPDS Covers
- Ten items, past seven days Each item asks how the parent has felt over the past week, with four response options scored 0 to 3. The total ranges from 0 to 30. Several items are reverse-scored so that the highest-severity answer always earns 3 points.Example: An item about being able to laugh and see the funny side of things is scored so that 'not at all' earns 3 and 'as much as I always could' earns 0.
- Mood and anhedonia Two items ask about the capacity for humor and for looking forward to things with enjoyment. Loss of anticipatory pleasure is a core depression feature that new-parent exhaustion alone does not usually produce.Example: A mother who is exhausted but still lights up planning the baby's first outing scores low here. A mother who feels nothing about the outing scores high.
- Self-blame One item asks whether the parent has blamed herself unnecessarily when things went wrong. Excessive guilt is one of the most sensitive markers of perinatal depression.Example: 'The baby has reflux and I keep thinking it is because of something I ate or did.'
- Anxiety and panic Items 3, 4, and 5 form an anxiety cluster (sometimes called the EPDS-3A), covering self-blame, anxiety without good reason, and feeling scared or panicky. Because anxiety is at least as common as depression after birth, these items matter. See Understanding Postpartum Anxiety.Example: A parent whose total is below the depression cutoff but who scores 3 on each anxiety item still needs an anxiety evaluation.
- Coping, sleep, sadness, and crying Items ask whether things have been getting on top of her, whether she has had difficulty sleeping because of unhappiness (specifically unhappiness, so the baby's schedule does not inflate the score), and about sadness and crying.Example: Lying awake for two hours after the 3 a.m. feed because of racing negative thoughts scores; being woken by the baby does not.
- Item 10: thoughts of self-harm The final item asks whether the thought of harming herself has occurred to her. Any score above 0 on item 10 requires a same-day safety assessment regardless of the total. In a screening study of 10,000 postpartum women, 19.3% of those who screened positive reported self-harm ideation (Wisner et al., 2013).Example: A total score of 8 (below any cutoff) with a 1 on item 10 is still a positive screen for the purpose of safety follow-up.
Scoring and Cutoffs
- Total score 0 to 30 Add the ten item scores. Higher is more severe. The EPDS is a screen, not a diagnosis; a positive screen means a clinical interview is needed.Example: A score of 16 does not mean 'has postpartum depression.' It means 'talk to this parent today and assess formally.'
- The traditional cutoff of 13 or more The original validation proposed 12/13 as the threshold for probable depressive illness. At 13 or more, a large individual-participant meta-analysis found sensitivity of 0.66 and specificity of 0.95 for major depression (Levis et al., 2020). It misses about a third of true cases but produces few false positives.Example: Using 13 in a busy clinic keeps referral numbers manageable at the cost of missing some depressed parents.
- The lower cutoff of 11 or more The same meta-analysis found that a cutoff of 11 best balanced sensitivity (0.81) and specificity (0.88) (Levis et al., 2020). Many guidelines now favor 10 or 11 for initial screening, accepting more false positives to catch more cases. Wisner and colleagues used 10 or more and identified every mother with the highest intensity of self-harm ideation (Wisner et al., 2013).Example: A perinatal program screens at 10 or more and follows every positive with a clinical interview, so false positives cost one conversation rather than a missed diagnosis.
- Antenatal use The EPDS is validated during pregnancy as well, with similar accuracy (Levis et al., 2020). Depression during pregnancy is the strongest predictor of postpartum depression, and about one-third of postpartum episodes actually begin during pregnancy (Wisner et al., 2013).Example: Screening at the first prenatal visit, the third trimester, and 6 weeks postpartum catches episodes at each onset window.
- Fathers and partners The EPDS has been used with fathers and non-birthing partners, and paternal depression is common enough (about 8 to 10% in the first year) to justify screening (Paulson and Bazemore, 2010; Cameron et al., 2016). Optimal cutoffs for fathers may be lower than for mothers; interpret with that in mind. See Understanding Paternal and Partner Postpartum Depression.Example: A pediatric practice hands the EPDS to both parents at the two-month visit and finds the father's score is the one above threshold.
Interpreting a Result
- Below cutoff, item 10 = 0 Negative screen. Offer psychoeducation on warning signs and re-screen at the next contact. A negative screen does not rule out anxiety, OCD, or a parent who minimized.Example: 'Your score is low today. If the sad or anxious feelings pick up in the next few weeks, tell us, because this is very treatable.'
- Above cutoff Positive screen. Conduct or arrange a diagnostic interview covering depression, anxiety, OCD symptoms, and, critically, any history of mania or hypomania. Nearly a quarter of screen-positive mothers in one large study had a bipolar spectrum disorder (Wisner et al., 2013), which changes treatment.Example: Before starting an antidepressant, the clinician asks about past episodes of days without sleep while feeling energized and productive.
- Any endorsement of item 10 Same-day safety assessment, regardless of the total. Suicidality in the perinatal period is less common than in other periods but far from absent (Lindahl et al., 2005), and it is the leading preventable cause of maternal death in several high-income countries.Example: The nurse sees a 1 on item 10, steps back into the room, and asks directly about the thought, its frequency, intent, and plan before the parent leaves.
- High anxiety items with a lower total Evaluate for postpartum anxiety or OCD. Ask explicitly about intrusive thoughts of harm and about checking or avoidance. Many parents will not volunteer these. See Understanding Postpartum OCD and Intrusive Thoughts.Example: 'Lots of new parents get scary unwanted thoughts about the baby. Has anything like that been happening to you?'
- Repeat the measure The EPDS is useful for tracking response to treatment. A drop below cutoff with a return of enjoyment and no self-harm ideation is a reasonable marker of recovery. Re-screen at intervals through the first postpartum year, since onset can occur at any point (Gavin et al., 2005).Example: A mother scores 18 at 6 weeks, 12 at 10 weeks after starting CBT, and 5 at 16 weeks.
- A positive screen is not a diagnosis The EPDS identifies who needs a closer look. The diagnosis, when there is one, will be the standard condition: major depressive disorder or bipolar disorder with the peripartum onset specifier, an anxiety disorder, or OCD. 'Postpartum depression' is the everyday name for those diagnoses when pregnancy and birth were the trigger.
Strengths and Limits
- Strengths Brief, free to reproduce with citation, translated into dozens of languages, validated across pregnancy and postpartum, and designed to avoid confusing normal postpartum changes with illness. Universal perinatal screening with a validated instrument is recommended by the U.S. Preventive Services Task Force (O'Connor et al., 2016).Example: A community health worker in a rural clinic can administer and score it in under ten minutes with no special training.
- Limits It is a self-report screen and can be minimized or exaggerated. It does not diagnose, does not assess bipolar disorder or psychosis, and captures only one week. Stigma and fear of child protective involvement lead some parents to under-report. Trust and the way the form is introduced change the answers.Example: Handed silently on a clipboard, the form returns a 4. Introduced with 'we ask every parent this because these feelings are common and treatable,' the same parent scores 14.
- Where our tools fit Therapy Resource does not host an automated EPDS. For a broader perinatal checklist that adds anxiety and intrusive-thought items, see the Postpartum Mood and Anxiety Screening worksheet. For general depression and anxiety severity, the PHQ-9 and GAD-7 are free and score in the browser on our assessments page.Example: A therapist uses the EPDS at intake because it is the perinatal standard, then tracks weekly progress with the PHQ-9 alongside it.
When to Get Help Now
- Call or text 988 (Suicide and Crisis Lifeline) For any thoughts of self-harm or suicide.
- Postpartum Support International HelpLine: 1-800-944-4773 Call or text for support and referrals to perinatal mental health specialists.
- Emergency care Call 911 or go to an emergency department for confusion, days without sleep, or beliefs and perceptions that are not real. These point to postpartum psychosis, covered in Understanding Postpartum Psychosis.
References
- Cameron, E. E., Sedov, I. D., and Tomfohr-Madsen, L. M. (2016). Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. Journal of Affective Disorders, 206, 189-203.
- Cox, J. L., Holden, J. M., and Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.
- Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., and Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5), 1071-1083.
- Levis, B., Negeri, Z., Sun, Y., Benedetti, A., Thombs, B. D., and the DEPRESSD EPDS Group. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data. BMJ, 371, m4022.
- Lindahl, V., Pearson, J. L., and Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women's Mental Health, 8(2), 77-87.
- O'Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., and Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315(4), 388-406.
- Paulson, J. F., and Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, 303(19), 1961-1969.
- Wisner, K. L., Sit, D. K., McShea, M. C., et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498.
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See also
Clinical guides that use this worksheet
Common Questions
What is the Understanding the Edinburgh Postnatal Depression Scale (EPDS) worksheet?
The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening questionnaire for depression during pregnancy and after birth.
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