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How to use the Edinburgh Postnatal Depression Scale (EPDS)

Score the Edinburgh Postnatal Depression Scale correctly, including the reverse-scored items, and learn which cutoff to use.

November 6, 2026

By Ryan DeCook, LCSW • Clinically reviewed by Maddie Tong, LCSW

13 min read

By Ryan DeCook, LCSW • Clinically reviewed by Maddie Tong, LCSW

What to know

1

The Edinburgh Postnatal Depression Scale, or EPDS, is a tool used to screen for postpartum depression.

2

Each item is scored 0–3, with seven reverse-scored items. Common cutoffs range from 9–13. Any item 10 response that indicates risk requires immediate assessment regardless of the total.

3

Screening tools like the EPDS are most useful when the results lead to assessment, clear documentation, treatment or referral, and tracked follow-up.

Understanding the EPDS

The British Medical Journal describes the Edinburgh Postnatal Depression Scale (EPDS) as “the most commonly used depression screening tool in perinatal care.” For clinicians working out how to screen for postpartum depression, the EPDS is usually the starting point.

Clinicians sometimes get stuck on the reverse-scored items, competing cutoff thresholds, noticing a higher-risk response on item 10, and parsing what happens after a positive screen. Using it well means getting the scoring, interpretation, and documentation right, then letting the result drive referral, treatment, and follow-up.

What is the Edinburgh Postnatal Depression Scale (EPDS)?

The EPDS is a 10-item self-report questionnaire that screens for depression — and informally for anxiety — during pregnancy and the first year after birth. Most people finish it in about five minutes. Here’s a sample EPDS questionnaire featuring the 10 questions.

  • Origin and validation: The questionnaire was developed by Cox, Holden, and Sagovsky in 1987 to screen for depression in postnatal women. In the original validation study, researchers gave the questionnaire to 84 new mothers and compared their scores with in-depth mental health interviews. It identified most mothers with depression without over-flagging those without.
  • Seven-day recall window: Each item asks how the client has felt during the past seven days. This captures a recent pattern of symptoms rather than overinterpreting mood during a single day.
  • What it deliberately excludes: It omits many somatic depression symptoms, such as fatigue, appetite change, and non-mood-related sleep disturbance, because similar peripartum physical changes can occur independent of depression.
  • Antenatal use: It is validated during pregnancy as well as postpartum, with research showing comparable accuracy in both groups.
  • Screening only: A positive score identifies people who need further conversation and assessment. It does not diagnose depression, determine treatment, or override clinical judgment.

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How to administer the EPDS

  • Administration instruction: Ask the client to select the answer that best reflects how they have felt during the previous seven days. Each item has four response options that reflect symptom frequency or severity.
  • Completion requirements: The client must complete all 10 items independently. An interviewer-administered or validated translated version can be used for limited English or reading difficulty.
  • Privacy during completion: The client should not discuss answers with a partner, family member, or staff member while filling out the scale. Privacy helps preserve the accuracy of the client’s own report.
  • Translations: Multilingual practices can benefit from over 60 EPDS translations, including Urdu, Punjabi, Arabic, Cantonese, Persian/Farsi, Bangla, and Romanian.

How to score the EPDS (including the reverse-scored items)

1. Score each response: Each of the 10 items has 4 potential responses, with 0–3 points to each answer.

2. Apply standard scoring: For items 1, 2, and 4, score the response options from top to bottom as 0, 1, 2, 3 on the standard form.

3. Apply reverse scoring: For items 3, 5, 6, 7, 8, 9, and 10, score top to bottom as 3, 2, 1, 0. Scoring every item 0–3 is the most common error as it creates an incorrect total.

4. Sum the total: EPDS scoring is simply adding all 10 scores. There are no subscale calculations.

ItemsScore each response, top to bottom
1, 2, 40 – 1 – 2 – 3
3, 5, 6, 7, 8, 9, 103 – 2 – 1 – 0
Total range0–30
Item 10Any score above 0 → same-visit safety assessment

5. Check the informal anxiety items: Items 3, 4, and 5 function as an informal anxiety screen. Perinatal anxiety often presents alongside or instead of depression, so higher scores on these 3 items deserve attention even when the total is subthreshold.

6. Score before the client leaves: Same-visit scoring is the only reliable way to take action on an item 10 score that is above 0 (self-harm ideation).=

EPDS cutoff scores and what each range means

  • The validated range: Cutoff thresholds differ, but commonly range from 9–13. Guidance differs on these because populations, translations, and screening goals vary. A major meta-analysis found that ≥11 best balanced sensitivity and specificity, but this should not be considered a universal diagnostic boundary.
  • A practical interpretation framework: The Parent Infant Research Institute (PIRI) describes scores of 9 or below as indicating a lower probability of depression, 10–12 as a moderate probability, and 13 or above as relatively high probability, requiring further assessment. These categories can guide follow-up, but they do not establish a diagnosis.
  • The sensitivity trade-off: Threshold choice is fundamentally a decision about which error the practice is better equipped to absorb. A lower cutoff of 10 catches more true cases but generates more false positives and referral workload. A higher cutoff of 13 reduces false positives but misses milder or subthreshold cases.
  • Below-threshold scores: A number under the cutoff never overrides clinical judgment. Persistent symptoms, functional impairment, or safety concerns can justify assessment or referral regardless of the total score.
  • Pick one and document it: A written threshold, applied the same way every time, makes your documentation easier to defend with auditors and payers.
  • Known limitation: A negative EPDS does not exclude bipolar disorder, postpartum psychosis, or specific anxiety disorders. Assess these separately when indicated.

Item 10: How to respond to a positive screen for self-harm

  • Trigger the follow-up: Any item 10 score above zero requires immediate assessment, regardless of the total EPDS score. A positive response does not automatically mean suicidal intent or require hospitalization, but it always requires a same-visit conversation.
  • Establish the nature of the thoughts: Assess the frequency, intensity, and recency of self-harm thoughts. Determine if the intent is to self-harm (e.g., cut or burn) or if it is to cause death. Assess if the client has a specific plan, access to means, past attempts, protective factors, and available support. Ask whether any of the thoughts involve the infant. Distinguish distressing, unwanted intrusive thoughts from delusions, hallucinations, or an intent to act.
  • Open the conversation: Reference their answer directly, normalize it, and ask about their current thoughts. For example, “I go over everyone's answers before they leave. On the last question, you marked that thoughts of harming yourself have come up this past week. A lot of new parents have thoughts like that, and I'm glad you told me. Can you tell me what they've been like?”
  • Match the response to the risk level: For non-imminent risk, develop a collaborative safety plan, address access to lethal means, and arrange shortened follow-up. For moderate risk, obtain same-day assessment and potentially involve the family or a friend in staying with the client and child or reducing access to means at home. For imminent danger or suspected postpartum psychosis, arrange an emergency evaluation, don't leave the client alone, and arrange care for the infant. Follow your organization's crisis protocol and your state's requirements.
  • Document the assessment: Record the risk assessment findings, clinical reasoning, and disposition (screen used, result, discussion, plan, referral/follow-up). This drives treatment follow-through and helps protect both the provider and client, though it cannot guarantee legal protection.
  • Have the plan before you screen: Policies, emergency resource lists, and referral pathways should exist before the first screen is given. Those include the 988 Suicide & Crisis Lifeline (call or text 988), the Crisis Text Line (text HOME to 741741), and the National Maternal Mental Health Hotline at 1‑833‑TLC‑MAMA (1‑833‑852‑6262). The latter is a free, confidential, 24/7 for pregnant and postpartum people and their families.

When and how often to screen with the EPDS

  • A practical schedule: The American College of Obstetricians and Gynecologists (ACOG) recommends screening at the initial prenatal visit, later in pregnancy, and postpartum visits. The American Academy of Pediatrics (AAP) recommends depression screens at the baby’s 1, 2, 4, and 6 month doctor’s appointments. It is reasonable to consider screenings through 9–12 months postpartum.
  • Guideline differences: ACOG specifies three screening stages but leaves exact appointment timing open. The AAP recommends more specific intervals. Use clinical judgment to determine the frequency that makes the most sense.
  • Late-onset presentations: Around 40% of perinatal depression onsets during postpartum, so a negative pregnancy or early-postpartum screen does not justify stopping screenings. Symptoms can emerge even months after a reassuring result.
  • Reading the trend: Each EPDS captures only the previous week, so multiple scores over time are preferred. Interpret changes alongside pregnancy complications, sleep, stress, support, treatment, and functioning.
  • Build it into scheduling: Attach screening and same-visit review to recurring appointments and automated EHR reminders rather than relying on memory.

What to do after a positive EPDS: Assessment, referral, and documentation

  • Add the clinical interview: Assess symptom onset, duration, daily functioning, sleep quality, appetite, stressors, and bonding with the child. Use a biopsychosocial assessment to develop a full clinical picture and organize findings. The EPDS alone cannot establish a diagnosis.
  • Gather history: Review previous depressive episodes, treatment, hospitalizations, suicidality, medications, substance use, medical conditions, and family psychiatric history. Assess support, housing, financial strain, and interpersonal safety. Coordinate medical evaluation for possible contributors.
  • Work the differentials: Distinguish depression, which runs at least two weeks and causes functional impairment, from postpartum blues, which typically resolve within two weeks and do not cause much functional impairment. Differentiate it from bipolar disorder, anxiety, and OCD involving unwanted intrusive thoughts. Clarify insight and intent rather than equating intrusive infant-harm thoughts with dangerousness. Suspected psychosis requires emergency evaluation.
  • Screen for bipolarity when indicated: Bipolar disorder is one of the highest risk factors for postpartum psychosis. Ask about past elevated or irritable mood, increased energy, decreased need for sleep, impulsivity, and being activated by antidepressant medication.
  • Document the encounter: Record the scale used, total score, threshold applied, item 10 response, interview findings, safety assessment, clinical impression, and disposition. Connect the client’s symptoms and functional impairment to the proposed care to support medical necessity.
  • Track serial scores: Re-administer the same screen at follow-up as an outcome measure of progress and treatment response. This is helpful for payer justification and for clinical adjustments as needed.
  • Confirm the referral pathway first: Screening improves outcomes only when treatment actually follows. Evidence‑based treatment includes psychotherapy (CBT and IPT have the strongest perinatal evidence). When referrals are needed, such as for medication from a prescribing provider, make sure to have already identified accepting providers, urgency criteria, as well as warm handoff and follow-up processes.

EPDS vs. PHQ-9 and other postpartum depression screening tools

  • PHQ-9 and PHQ-2: Both fit primary-care workflows well. The PHQ-2 serves as a very brief prescreen that requires follow-up. The PHQ-9 has strong perinatal validation, though it is not designed as an antenatal or postpartum depression screening tool. Head-to-head results with the EPDS are mixed, with at least one comparison favoring the EPDS.
  • Where the EPDS wins: It has perinatal design and removes somatic symptoms that can overlap with pregnancy and infant care. The anxiety-related items also flag concerns that a depression-only tool may overlook.
  • Where the PHQ-9 wins: It is one item shorter, maps directly onto DSM major-depression criteria, and is often already built into EHR systems.
  • A reasonable default: Use the EPDS as the primary perinatal screen, add a bipolar screen such as the Mood Disorder Questionnaire (MDQ) when bipolarity is suspected, and administer the same scales repeatedly to track treatment response over time.

Can partners and fathers use the EPDS?

  • Validation status: Though the EPDS was developed for mothers, it also shows screening utility in fathers. Evidence for other non-birthing partners is more limited.
  • Interpreting partner scores: Maternal cutoffs may not transfer to fathers. Paternal studies support varying cutoff thresholds, often 7–10. Conduct a full clinical assessment to interpret scores alongside symptoms, functioning, history, and safety.
  • Why it matters clinically: Paternal depression affects bonding, the couple, and the child’s well-being.
  • The access gap: Fathers generally lack their own scheduled postpartum checkups. Primary care and pediatric contacts are useful opportunities for screening.
  • Referral pathway for partners: Connect partners with individual mental health care. Add couples or family providers when appropriate. A couples intake assessment and treatment can complement, but not replace, individual treatment.

Why most perinatal patients still aren't screened

  • Prevalence versus screening rates: National data show that 11.9% of women with a recent live birth reported postpartum depressive symptoms. However, one health-system study found that, on average, only 64.4% of patients returning within three months postpartum received documented depression screening. These screening rates varied between 25-96% of patients screened depending on the clinic.
  • The three recurring provider barriers: Across surveys, clinicians cite limited time, a lack of mental health resources and referral pathways, and a fear of "opening Pandora's box" — uncovering a positive result they are not equipped to manage.
  • Low self-referral: One study found that many peripartum women don't seek help on their own, often because of fear of disclosure, distrust of medical systems, or minimizing their own experience.
  • Equity gap: Screening and treatment disparities fall along lines of race, language, and insurance. One study shows that Black, Asian, and other non-white (Native American, mixed-race) patients were less likely to be screened than white women. Non-native English speakers and publicly insured patients were also less likely to be screened.
  • What is at stake: Untreated perinatal depression has been linked to higher maternal mortality, higher suicide risk, preterm birth, low birth weight, early breastfeeding cessation, impaired bonding and attachment, and lasting cognitive, emotional, and behavioral effects in the child.

FAQs about the Edinburgh Postnatal Depression Scale

Is the EPDS free to use?

Yes. The published administration sheet permits reproduction and use when copies credit the authors, instrument title, and original publication. That permission does not necessarily cover every adaptation or commercial digital implementation.

Do providers need special training to use the EPDS?

No formal training or certification is required. Providers should be trained and know how to discuss sensitive disclosures, interpret perinatal symptoms, and assess a positive self-harm response before introducing the screening. They should also seek clinical supervision for additional support.

What is a normal EPDS score?

There is no universal “normal” score. Lower totals generally suggest fewer reported symptoms, but interpretation depends on the setting’s cutoff and a full clinical picture.

Can the EPDS be used during pregnancy?

Yes. It’s validated for use during pregnancy, and dedicated antenatal applications are widely published.

Can the EPDS diagnose postpartum depression?

No. The EPDS identifies people who may need further assessment. It cannot establish postpartum depression or determine treatment by itself. Diagnosis requires a full clinical evaluation by a qualified licensed professional.

Keep in mind, too, that postpartum depression is not a standalone DSM-5-TR diagnosis. The diagnosis is major depressive disorder with the specifier "with peripartum onset," which applies when onset is during pregnancy or within four weeks of delivery.

What is the maximum EPDS score?

30. Each of the 10 items scores 0–3, with seven items reverse-scored.

Can clients complete the EPDS online?

Yes. Digital EPDS administration is common and can help automate scoring and reporting. In U.S. clinical practice, use a HIPAA-compliant system, ideally connected to the clinical record, rather than an unsecured form.

What if a client scores high but says they feel fine?

Discuss the discrepancy openly, considering whether the client may be minimizing symptoms. Re-screen soon to establish a trend, and document your reasoning either way.

How Headway helps providers turn screening into care

Positive screens need effective followthrough. Headway connects clinical and administrative tools to help providers move from assessment to ongoing care. Headway’s features include:

  • Built-in assessments: An EHR built for therapists brings assessments, documentation, and billing together. (Note: The EPDS is not yet available within Headway.)
  • Structured templates: Insurance-ready templates help organize documentation.
  • AI-assisted notes: Optional AI assistance helps finish documentation after an unhurried conversation about a positive result.
  • Scheduling: Reminders support repeat appointments and follow-up screens.
  • Telehealth: Secure video visits offer follow-up without travel for clients or providers.
  • Referral and specialty filters: Insurance and postpartum-specialty searches help clinicians identify potential in-network providers.
  • Insurance operations: Credentialing happens in as few as 30 days, while claims submission and consistent biweekly payments reduce administrative work.
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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

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