0
30
0
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0
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30
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The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used and internationally validated screening tool specifically designed for detecting perinatal depression — depression during pregnancy (antenatal) and in the first year after childbirth (postnatal). Developed by Cox, Holden, and Sagovsky in 1987, the EPDS consists of 10 items scored 0-3, asking about feelings over the past 7 days.
Perinatal depression affects approximately 10-20% of women worldwide, making it one of the most common complications of pregnancy and the postpartum period. Despite its prevalence, perinatal depression remains underdetected in over 50% of cases, as symptoms are often attributed to normal pregnancy/postpartum experiences. The consequences of untreated perinatal depression are severe for both mother and child.
For mothers: impaired maternal-infant bonding, reduced breastfeeding, poor self-care, substance abuse, and increased suicide risk (perinatal suicide is a leading cause of maternal death). For infants: developmental delays, insecure attachment, behavioral problems, and increased risk of childhood psychiatric disorders. Early detection through routine screening is a public health priority.
The EPDS was specifically designed to avoid somatic symptoms (sleep disturbance, appetite changes, fatigue) that are common in normal pregnancy and postpartum, which could inflate scores on general depression instruments. Instead, it focuses on psychological and emotional symptoms: anhedonia, self-blame, anxiety, panic, feeling overwhelmed, sleep difficulty due to unhappiness, sadness, crying, and self-harm thoughts.
The standard screening threshold is >=13 for probable major depression (sensitivity 86%, specificity 78%) and >=10 for possible depression requiring clinical follow-up. Item 10 (self-harm thoughts) is a critical safety item. The EPDS is recommended by ACOG, AAP, NICE, and WHO. It has been translated into over 60 languages and validated across diverse cultures.
Scoring:
Total Score = Sum of all 10 items (range 0-30)
Items scored 0-3 based on severity/frequency over the past 7 days.
Screening Thresholds:
Self-Harm Flag: Any score >0 on item 10 triggers immediate safety assessment.
Score <10: Depression unlikely. Provide reassurance and psychoeducation. Continue routine screening. Score 10-12 (Possible): Conduct brief clinical assessment, enquire about stressors, repeat in 2-4 weeks. Consider supportive interventions. Score >=13 (Screen Positive): Probable major depression. Refer for diagnostic evaluation. Treatment: psychotherapy (CBT, IPT — first-line for mild-moderate), SSRIs (sertraline preferred for breastfeeding), or combination. Self-Harm Flag: Any positive item 10 requires immediate follow-up: ask about intent, plan, means. Ensure safety of mother and baby.
Inputs
Results
EPDS score of 4 = below threshold. Normal postpartum adjustment. Continue routine care.
Inputs
Results
EPDS score of 17 = probable major depression. Self-harm item positive. Immediate clinical assessment, safety evaluation, and treatment initiation required.
The Edinburgh Postnatal Depression Scale is a 10-item self-report questionnaire specifically designed to screen for depression during pregnancy and the postpartum period. It avoids somatic symptoms normal in pregnancy, focusing on psychological and emotional symptoms.
ACOG recommends screening at least once during the perinatal period. Best practice: once during pregnancy and at 6-week, 3-month, and 6-month postpartum visits.
Score >=13 indicates probable major depression (86% sensitivity, 78% specificity). Score 10-12 suggests possible depression warranting follow-up. The EPDS is a screening tool — positive screens require clinical confirmation.
Yes, validated for both antenatal and postnatal use. Some studies suggest slightly lower cutoff (>=11 or >=12) during pregnancy.
Yes, paternal postnatal depression affects 8-10% of fathers in the first year. The EPDS has been validated for fathers, though lower cutoffs (>=9 or >=10) may be appropriate.
Baby blues affect 50-80% of women in the first 2 weeks and resolve spontaneously. Postnatal depression is more severe, persistent, impairs functioning, and requires treatment. EPDS at 6+ weeks distinguishes the two.
First-line: psychotherapy (no breastfeeding concerns). For medication: sertraline and paroxetine have lowest breastmilk transfer. Benefits of treating depression while breastfeeding typically outweigh risks.
Perinatal suicide is a leading cause of maternal death. Any positive response requires immediate clinical follow-up: inquiry about intent, plan, means. Safety of both mother and infant must be ensured.
Validated in over 60 languages. However, expression of emotional distress varies culturally. Cultural adaptation of translations is important.
Yes, free for clinical and research purposes. The authors made it publicly available. Can be reproduced and translated without permission.
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