Edinburgh Postnatal Depression Scale (EPDS)

EPDS – Questions and Scoring

The Edinburgh Postnatal Depression Scale is a 10-item self-report scale that has proven its reliability and effectiveness as screening tool for perinatal depression:

1. I have been able to laugh and see the funny side of things.
2. I have looked forward with enjoyment to things.
3. I have blamed myself unnecessarily when things went wrong.
4. I have been anxious or worried for no good reason.
5. I have felt scared or panicky for no very good reason.
6. Things have been getting on top of me.
7. I have been so unhappy that I have had difficulty sleeping.
8. I have felt sad or miserable.
9. I have been so unhappy that I have been crying.
10. The thought of harming myself has occurred to me.

The subject is asked to consider the feelings they have experienced in the past 7 days and all items must be answered by the mother alone without prompting.

The answers to items 1, 2 and 4 are scored from 0 to 3, so first answer is 0 points whilst last answer is 3 points.

The answers to items 3, then 5 to 10 are reverse scored (from 3 to 0), so first answer is awarded 3 points whilst last answer is 0 points.

EPDS scores range from 0 to 30. Mothers who obtain scores greater than 13 have an increased likelihood to be suffering from a depressive illness of varying severity. An in-depth clinical assessment should then be carried out to confirm the diagnosis based on accepted diagnostic criteria (DSM-IV-TR or ICD-10).

Where results from the scale are inconclusive, a repeat administration after 2 weeks is advisable. Follow-up may also be needed if scores on items 3, 4 and 5 suggest possible symptoms of anxiety.

Clinical gestalt is crucial, especially in cases where, despite a low score in the EPDS, the clinician has reasons to believe the mother is experiencing depressive symptoms. A very high EPDS score could suggest a crisis, birth trauma or other mental health issues.

The scale can be useful in identifying symptoms of childbearing linked anxiety and can identify mothers who may benefit from follow-up care, such as mental health assessment. Please also note that the scale does not detect anxiety neuroses, phobias or personality disorders.

The EPDS should be administered preferably twice, once in antenatal period and once in the postnatal period (ideally 6–12 weeks after the birth).

About the original study

The EPDS was developed by Cox et al. following a validation study that succeeded extensive pilot interviews on 84 mothers. The Research Diagnostic Criteria for depressive illness used was that from Goldberg's Standardised Psychiatric Interview.

The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time.

The self-report is simple to understand, easy to administered and time efficient as can be completed in about 5 minutes, thus offering a satisfactory and reproductible screening method for postpartum depression.

References

Original reference

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-6.

Other references

Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002; 347(3):194-9.

Cox JL, et al., A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry. 1993;163:27-31.

Wisner KL, Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013 May;70(5):490-8.