1EPDS Score Interpretation — Cutoff Reference
Total EPDS scores range from 0 to 30. There is no single universally agreed cutoff; clinicians use the ranges below as a guide alongside clinical assessment.
| Total Score | Category | Interpretation | Suggested Action |
|---|---|---|---|
| 0–8 | Low Probability | Depressive illness unlikely | Routine care; repeat screening at next scheduled visit |
| 9–12 | Possible | Possible depressive symptoms — borderline | Clinical interview recommended; consider repeat EPDS in 2 weeks |
| 13+ | Probable | Probable depressive illness of varying severity | Full clinical assessment; consider referral to mental health services |
| Item 10 >0 | Safety Flag | Any thoughts of self-harm reported | Immediate further enquiry — regardless of total score |
2EPDS — Clinical Reference Guide
What is the Edinburgh Postnatal Depression Scale?
The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item self-report questionnaire, first developed in 1987 by Cox, Holden, and Sagovsky at health centres in Edinburgh and Livingston, Scotland. It was designed to screen for depressive symptoms during pregnancy and the postpartum period. Unlike general depression screening tools such as the PHQ-9, the EPDS focuses on emotional and cognitive symptoms rather than physical symptoms — since features like fatigue and sleep disturbance are common in normal pregnancy and the postpartum period and would otherwise inflate scores.
How EPDS Scoring Works
Each of the 10 items is scored from 0 to 3, giving a total score range of 0 to 30. Items 1, 2, and 4 are scored in the standard direction (0, 1, 2, 3 from the top response to the bottom). Items 3 and 5 through 10 are reverse scored (3, 2, 1, 0). Higher total scores indicate more depressive symptoms. The questionnaire takes approximately 5 minutes to complete and asks the woman to describe how she has felt over the past 7 days, not just on the day of testing.
When to Use the EPDS
The EPDS can be administered at any point during pregnancy and is most commonly used between 6 and 8 weeks postpartum, though many services also screen at the booking visit, in the third trimester, and at routine postnatal follow-ups. Because mood can change over time, the EPDS may need to be repeated on further occasions as clinically warranted — a single low score does not rule out depression developing later.
EPDS vs Other Depression Screening Tools
| Feature | EPDS | PHQ-9 | BDI |
|---|---|---|---|
| Designed for perinatal use | ✓ Purpose-built | ✗ General | ✗ General |
| Excludes physical symptoms | ✓ | ✗ | ✗ |
| Number of items | 10 | 9 | 21 |
| Includes self-harm item | ✓ Item 10 | ✓ Item 9 | ✓ |
| Time to complete | ~5 minutes | ~3 minutes | ~10 minutes |
| Validated for antenatal use | ✓ | ✓ | ✓ |
Important Clinical Notes
- The EPDS is a screening tool, not a diagnostic instrument. A score above the cutoff should always be followed by a full clinical assessment to confirm or exclude a depressive illness.
- Item 10 (thoughts of self-harm) should be reviewed before the woman leaves the consultation. Any response other than "never" requires immediate further enquiry into the nature and level of risk, regardless of the total score, with appropriate safeguarding for both mother and baby.
- The EPDS has been validated and translated into many languages and is used internationally as a primary perinatal depression screening tool.
- A raised score may also reflect anxiety symptoms, since several EPDS items overlap with anxiety — clinical interview helps distinguish between depressive and anxiety presentations.
- Results should be interpreted alongside the broader clinical picture: history, risk factors, social support, and presentation — the EPDS score should never override clinical judgement.