Edinburgh Postnatal Depression Scale (EPDS)
Screening for perinatal depression (past 7 days)
Sources last checked: 2026-10-13
Edinburgh Postnatal Depression Scale (EPDS)
Screening for perinatal depression (past 7 days)
Item 10 (thoughts of self-harm) is a safety item: any answer other than “Never” indicates thoughts of self-harm, whatever the total score, and is an indication for a direct suicide-risk assessment on the same day. English items reproduced with permission terms of the authors (Cox, Holden, Sagovsky 1987); German and Turkish item text here is an unofficial translation — the validated national version is the one for formal screening.
Interpretation
| 0–9 — below screening threshold | Depression unlikely. Item 10 is interpreted on its own, regardless of the total. |
|---|---|
| 10–12 — possible depression | Above the lower screening threshold (≥ 10, used for community screening); a screen, not a diagnosis. |
| 13–30 — probable depression | Above the 12/13 threshold of the original validation study: a depressive illness is likely. |
What is the Edinburgh Postnatal Depression Scale (EPDS)?
The Edinburgh Postnatal Depression Scale is a ten-item self-report questionnaire about the past seven days. Cox, Holden and Sagovsky developed it in 1987 in Edinburgh to detect postnatal depression; it deliberately avoids somatic symptoms that are normal after birth. Items are scored 0–3 (seven are reverse-scored), giving 0–30.
When to use it
- Screening for depression during pregnancy and in the first year after birth
- Repeat screening at antenatal and postnatal visits
- Screening partners and fathers (validated, with lower cut-offs in some studies)
When not to use it
- As a diagnosis — a positive score is a screening result, not a diagnosis
- To detect anxiety disorders, phobias or personality disorders specifically
How it is calculated
| Criterion | Points |
|---|---|
| 1. I have been able to laugh and see the funny side of things | |
| As much as I always could | 0 |
| Not quite so much now | 1 |
| Definitely not so much now | 2 |
| Not at all | 3 |
| 2. I have looked forward with enjoyment to things | |
| As much as I ever did | 0 |
| Rather less than I used to | 1 |
| Definitely less than I used to | 2 |
| Hardly at all | 3 |
| 3. I have blamed myself unnecessarily when things went wrong | |
| Yes, most of the time | 3 |
| Yes, some of the time | 2 |
| Not very often | 1 |
| No, never | 0 |
| 4. I have been anxious or worried for no good reason | |
| No, not at all | 0 |
| Hardly ever | 1 |
| Yes, sometimes | 2 |
| Yes, very often | 3 |
| 5. I have felt scared or panicky for no very good reason | |
| Yes, quite a lot | 3 |
| Yes, sometimes | 2 |
| No, not much | 1 |
| No, not at all | 0 |
| 6. Things have been getting on top of me | |
| Yes, most of the time I haven't been able to cope at all | 3 |
| Yes, sometimes I haven't been coping as well as usual | 2 |
| No, most of the time I have coped quite well | 1 |
| No, I have been coping as well as ever | 0 |
| 7. I have been so unhappy that I have had difficulty sleeping | |
| Yes, most of the time | 3 |
| Yes, sometimes | 2 |
| Not very often | 1 |
| No, not at all | 0 |
| 8. I have felt sad or miserable | |
| Yes, most of the time | 3 |
| Yes, quite often | 2 |
| Not very often | 1 |
| No, not at all | 0 |
| 9. I have been so unhappy that I have been crying | |
| Yes, most of the time | 3 |
| Yes, quite often | 2 |
| Only occasionally | 1 |
| No, never | 0 |
| 10. The thought of harming myself has occurred to me | |
| Yes, quite often | 3 |
| Sometimes | 2 |
| Hardly ever | 1 |
| Never | 0 |
Clinical pearls and limitations
- Item 10 (thoughts of self-harm) is a safety item: any answer other than “Never” indicates thoughts of self-harm, whatever the total score, and is an indication for a direct suicide-risk assessment on the same day. English items reproduced with permission terms of the authors (Cox, Holden, Sagovsky 1987); German and Turkish item text here is an unofficial translation — the validated national version is the one for formal screening.
- Item 10 is read separately; any positive answer is an indication for a same-day risk assessment.
- Cut-offs vary: ≥ 10 for community screening, 12/13 for probable depression in the original study; a 2020 IPD meta-analysis found ≥ 11 balanced sensitivity and specificity best.
- The EPDS scoring notes describe repeating the scale after two weeks in doubtful cases.
- The scale may be reproduced freely with the full citation of Cox, Holden and Sagovsky (1987).
Frequently asked questions
What EPDS score indicates postnatal depression?
13 or more suggests probable depression; 10–12 indicates possible depression. Any positive answer on item 10 is a safety signal, independent of the total.
Can the EPDS be used in pregnancy?
Yes. It is validated antenatally as well as postnatally; the same cut-offs are generally used.
Is the EPDS free to use?
Yes, it can be reproduced without permission provided the authors, title and source are cited.
Evidence and guidelines
- Primary source: Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-786.
- Levis B et al. Accuracy of the EPDS for screening to detect major depression among pregnant and postpartum women: IPD meta-analysis. BMJ 2020;371:m4022 (cut-off ≥ 11 maximised sensitivity + specificity).
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