Edinburgh Postnatal Depression Scale (EPDS)

What EPDS measures

The Edinburgh Postnatal Depression Scale is a 10-item self-report instrument developed by Cox, Holden and Sagovsky (1987) for screening depression in the perinatal period — pregnancy and the first 12 months after birth. It is the most widely used perinatal depression screen worldwide and is endorsed by NICE, RANZCOG, and ACOG-equivalent bodies.

It deliberately excludes somatic symptoms (sleep, appetite, fatigue) that overlap with normal pregnancy and postpartum, focusing on cognitive and affective symptoms.

Total score range: 0–30 ≥ 10 Possible depression — clinical assessment recommended ≥ 13 Probable depression — strong indication for evaluation Q10 > 0 Self-harm flag — same-day contact with healthcare

How scoring works

Each item is rated 0–3. Items 1, 2, and 4 are scored normally (best response = 0). Items 3, 5, 6, 7, 8, 9, and 10 are reverse-scored (best response = 0). The calculator handles this for you — just select the option that best matches the past 7 days.

What a positive screen means

EPDS is a screen, not a diagnosis. A score ≥10 means depression is possible and a fuller assessment is warranted. A score ≥13 has a positive predictive value of around 70–80% for major depression in postnatal populations — so most people with a score in this range do have a clinically significant condition, but a clinical interview is still required to confirm.

The standard pathway after a positive EPDS:

1. Discuss with GP, midwife, or health visitor — they will usually do a structured clinical interview.
2. Distinguish unipolar depression from anxiety, OCD, postpartum psychosis, bipolar. Different conditions, different treatments.
3. Treatment options include guided self-help, group programmes, individual psychotherapy (CBT, IPT), and — for moderate to severe cases — medication. Several SSRIs (sertraline, paroxetine) have substantial breastfeeding safety data.
4. Re-screen at intervals to track response.

Antenatal use

Cox 1996 and subsequent studies validated EPDS during pregnancy. NICE 2014 recommends asking the depression questions at the booking appointment and in late pregnancy. Antenatal depression is a strong risk factor for postnatal depression, and treating it during pregnancy improves both maternal and infant outcomes.

When the Q10 flag matters

Item 10 — “the thought of harming myself has occurred to me” — is treated separately from the total. Any non-zero answer is a clinical alert.

If you scored above 0 on Q10:

• UK Samaritans 116 123 (free, 24/7) · NHS 111 · in immediate danger 999
• USA 988 Suicide & Crisis Lifeline (call or text)
• EU 116 123 (Emotional Support Helpline, available in many countries)
• International directory findahelpline.com

You do not need to wait for an appointment. Same-day contact with healthcare or a crisis service is the right action.

Common myths

• “I’d know if I was depressed.” Postnatal depression often presents as irritability, anhedonia, intrusive worry about the baby, or a numb sense of disconnection — not always classic sadness. A standardized screen catches what self-perception misses.
• “Antidepressants will harm my baby.” Several SSRIs have extensive safety data in breastfeeding. The risk profile of untreated moderate-severe depression on infant attachment, language development, and behavioural outcomes is well-documented and material. Decisions are individual; the discussion belongs with a perinatal psychiatrist or your GP.
• “It will pass on its own.” Spontaneous remission does occur, but the median episode of untreated postnatal depression lasts 6–9 months — months during which infant interaction and partner relationships are affected. Treatment shortens the episode and improves trajectory.

Related calculators

• PHQ-9 depression test — general depression screen, useful in non-perinatal periods.
• GAD-7 anxiety test — perinatal anxiety often co-occurs with depression.
• Pregnancy due date calculator — anchor your perinatal screening calendar.

Limitations

• Cultural validity. EPDS has been translated into 60+ languages and validated in many cultures. Performance in some non-Western populations has shown lower sensitivity; if cultural context affects how distress is expressed, clinical judgment supplements the score.
• Bipolar disorder. EPDS does not screen for hypomania/mania. If you have a history of bipolar disorder or family history, mention this — postpartum is a high-risk window for relapse and for postpartum psychosis (rare but a medical emergency).
• Postpartum psychosis. Distinct from postnatal depression. Sudden onset (typically within 2 weeks of birth), confusion, hallucinations, paranoid thoughts, mania, or thoughts of harming the baby — this is a medical emergency requiring same-day psychiatric assessment, regardless of EPDS score.

Privacy

All calculations run in your browser. We never see, log, or store your individual answers. Only an anonymous event (locale, severity band, Q10 flag) is sent to a privacy-respecting analytics service.