Perinatal mental health

10 items

3-5 minutes

EPDS Scoring and Interpretation: Edinburgh Postnatal Depression Scale

Ten items, 0-30, the international standard screen for perinatal depression — including item 10, which is a self-harm screen.

EPDS scoring guide Track EPDS scores over time

What the EPDS measures

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used perinatal depression screen in the world. Ten items ask about the past seven days, each scored 0 to 3, giving a total from 0 to 30.

It was designed specifically for pregnancy and the postpartum period, which is why it deliberately omits somatic items such as fatigue, appetite and sleep disturbance — symptoms that are near-universal with a newborn and would produce false positives on a general depression measure.

Item 10 asks directly about thoughts of self-harm. It must be reviewed on every completed form, regardless of the total score.

How to score the EPDS

Score range: 0-30 (ten items scored 0-3; items 3, 5, 6, 7, 8, 9 and 10 are reverse-scored)

1Items 1, 2 and 4 are scored 0, 1, 2, 3 from top to bottom as printed.
2Items 3, 5, 6, 7, 8, 9 and 10 are reverse-scored: 3, 2, 1, 0 from top to bottom.
3Add the ten item scores for a total from 0 to 30.
4Record item 10 separately as a self-harm indicator, whatever the total.

EPDS score interpretation

EPDS score ranges and their clinical meaning
Score	Severity	What it means clinically
0-8	Low likelihood of depression	Screen negative. Continue routine care and rescreen at the next scheduled point; perinatal mood can change quickly.
9-11	Possible depression	Borderline. Offer support, discuss symptoms, and rescreen in 2-4 weeks. Some services treat 9 or 10 as the action threshold in high-risk populations.
12-13	Probable depression	At or above the most commonly used cut-off of 13 (and above the 12 used in many services). Arrange a diagnostic assessment and discuss treatment options.
14-30	Likely moderate-to-severe depression	Screen strongly positive. Arrange prompt assessment and treatment, review social supports and infant safety, and consider psychiatric referral at the higher end.

What specific EPDS scores mean

What does an EPDS score of 10 mean?

Ten sits just below the classic cut-off of 13 and above the more sensitive threshold of 9 or 10 used in many services. It means possible depression: have a symptom conversation, offer support, and rescreen in two to four weeks rather than treating the score as negative.

What does an EPDS score of 11 mean?

Eleven is a borderline positive. It is above the 10-or-higher threshold used for possible minor depression and below the 13 cut-off for probable major depression. A diagnostic conversation is appropriate now, not at the next visit.

What is a positive EPDS score?

The original validation used 13 or higher for probable major depression. Many national guidelines use 10 or higher to trigger further assessment because it detects more cases, accepting more false positives.

What if item 10 is endorsed but the total is low?

Any endorsement of item 10 requires a same-visit risk assessment regardless of the total. A low total with a positive item 10 is a positive screen for the purpose of safety.

Is a score of 30 possible?

Yes — 30 is the maximum. Very high totals indicate severe symptoms and warrant urgent assessment, including consideration of postpartum psychosis if there is any confusion, agitation, or unusual beliefs.

Which cut-off should you use?

Thirteen or higher comes from the original validation and is the more specific threshold for probable major depression. Ten or higher is used widely in national guidance and in services that would rather over-refer than miss a case.

Neither is wrong. What matters is choosing one per service, documenting it, and pairing it with a clear pathway for what happens on a positive screen. A screening programme with no follow-up pathway does not improve outcomes, whichever cut-off it uses.

Item 10 is not part of the severity story

Item 10 asks whether the thought of harming herself has occurred to the patient in the past seven days. Treat it as a separate screen rather than one-tenth of a total.

Endorsement at any level should trigger a structured risk conversation in the same visit — current thoughts, intent, plan, means, protective factors, and infant safety — plus a documented safety plan and follow-up interval.

What the EPDS misses

Anxiety is only partly captured. Perinatal anxiety is at least as common as depression; add the GAD-7.
Bipolar disorder is not screened. A positive EPDS with a history of mania or a family history of bipolar disorder needs assessment before an antidepressant is started.
Postpartum psychosis is a different, urgent presentation and will not be identified by this scale.
Trauma related to birth is not covered. Where birth trauma is suspected, add the PCL-5.

Who the EPDS is for

Pregnancy and postpartum visits — the recommended screening points are at least once in pregnancy and again in the postpartum period
Paediatric and family medicine visits, where the parent is often seen more often than in obstetric care
Behavioural health services treating perinatal mood and anxiety disorders
Partners and non-birthing parents, for whom the EPDS has also been validated with a lower cut-off

Administration and re-testing

Self-report about the past seven days. Give it to the patient to complete privately; completion in front of a partner materially changes answers about self-harm and about the relationship.
Review item 10 before the patient leaves. Any score above 0 requires a same-visit safety conversation.
Screen at least once in pregnancy and at least once postpartum, and repeat if circumstances change. Many services screen at 6 weeks, 3 months and 6 months.
A positive screen is a prompt for diagnostic assessment, not a diagnosis. Also screen for anxiety, which is common perinatally and only partially captured here.

Reliability and validity

The original validation reported sensitivity of 86% and specificity of 78% at a cut-off of 13 for probable major depression.
Internal consistency is good, with alpha typically reported between 0.80 and 0.90 across translations.
The EPDS has been translated and validated in more than 20 languages, making it usable across diverse populations.
For partners and non-birthing parents, a lower cut-off (commonly 10) performs better than the maternal threshold.

Licensing and use

The EPDS may be reproduced without permission provided the authors, title and source are cited (Cox, Holden and Sagovsky, 1987).

Frequently asked questions

How do you score the EPDS?

Score items 1, 2 and 4 from 0 to 3 top to bottom, and reverse-score items 3, 5, 6, 7, 8, 9 and 10 from 3 to 0. Add all ten for a total from 0 to 30, and review item 10 separately as a self-harm screen.

What EPDS score indicates postnatal depression?

Thirteen or higher indicates probable major depression in the original validation. Many guidelines act on 10 or higher to avoid missing cases.

What does an EPDS score of 10 mean?

Possible depression. It is above the sensitive threshold used by many services and below the classic cut-off of 13, so it calls for a symptom conversation and a rescreen in two to four weeks.

Which EPDS items are reverse-scored?

Items 3, 5, 6, 7, 8, 9 and 10 are reverse-scored. Items 1, 2 and 4 are scored as printed.

Can the EPDS be used in pregnancy?

Yes. Despite the name, it is validated antenatally as well as postnatally, and screening at least once in pregnancy is widely recommended.

Is the EPDS free to use?

Yes, it may be reproduced without permission as long as the authors, title and source are cited.

References

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This page is clinical reference information for professionals and the public. It is not medical advice, and no assessment score is a diagnosis. Discuss any result with a licensed clinician. Read our medical disclaimer.