Edinburgh Postnatal Depression Scale (EPDS)

What the Edinburgh Postnatal Depression Scale Is

The Edinburgh Postnatal Depression Scale (EPDS) is a ten-question form that takes about five minutes to fill in. It is the most widely used screening tool for depression in pregnancy and after birth anywhere in the world, and it has been translated into dozens of languages.

It was published in 1987 by John Cox, Jeni Holden and Ruth Sagovsky in the British Journal of Psychiatry, and copyright sits with the Royal College of Psychiatrists.

That copyright is worth understanding, because it explains something you will notice. The original paper said users could reproduce the scale as long as the authors were credited, and that sentence got copied onto thousands of handouts. The College’s current position is narrower: distributing it to others or republishing it in print or online requires written permission. That is why the form circulates as clinic PDFs rather than as an interactive test on health websites.

One thing to hold onto before anything else: the EPDS is a screening tool, not a diagnosis. A score is a signal that a conversation is warranted. It cannot tell you whether you have postpartum depression, and a clinician who treats it as a verdict is using it wrong.

What the Ten Questions Ask

Each question asks how you have felt in the past seven days — not today, and not since the birth. That window matters, and people get it wrong constantly.

Broadly, the ten items ask whether, over the past week, you have been able to:

1. Laugh and see the funny side of things
2. Look forward to things with enjoyment
3. Blame yourself unnecessarily when things go wrong
4. Feel anxious or worried for no good reason
5. Feel scared or panicky for no good reason
6. Feel that things have been getting on top of you
7. Sleep badly because you have been unhappy
8. Feel sad or miserable
9. Feel unhappy enough to cry
10. Have thoughts of harming yourself

Each has four answer options. On some questions the most severe answer comes first, on others it comes last. You pick the one closest to how you have been, not how you think you should have been.

We describe the questions here rather than reproducing the form, for two reasons. The first is the copyright position above. The second matters more: the EPDS is designed to be completed alongside someone who can respond to the answers, particularly the last one. A validated instrument filled in alone at 2am with nobody on the other end is not the thing it was built to be.

If you want to do this properly, ask your ob-gyn, midwife or your baby’s pediatrician for the form — they have it, and completing it with them is the intended use. How screening works covers what that appointment looks like.

How the EPDS Is Scored

Every answer is worth 0, 1, 2 or 3 points. The total runs from 0 to 30.

The part that trips people up: the direction of scoring flips between questions.

• Questions 1, 2 and 4 are scored top to bottom — the first answer is 0, the last is 3.
• Questions 3, 5, 6, 7, 8, 9 and 10 are reverse scored — the first answer is 3, the last is 0.

This is why hand-scoring goes wrong so often, and why an online calculator or a clinician’s scoring sheet is worth using rather than adding it up in your head.

EPDS Scoring Calculator

Have your completed form in front of you. For each question, pick the answer in the position you ticked — first, second, third or fourth down the list. The calculator flips the reverse-scored items for you.

Because the scale itself is under copyright, this calculator scores your form rather than reproducing it. The question labels below are our own plain-language descriptions, not the validated wording.

What Your Score Means

There is no single official cutoff, and anyone who tells you otherwise is simplifying. Different services use different thresholds on purpose, depending on whether they would rather catch more people or be more certain about the ones they catch.

The most rigorous evidence on this comes from a 2020 analysis in The BMJ that pooled individual data from 58 studies and 15,557 participants. According to PubMed, it found:

A cutoff of 11 or higher balanced the two best. A cutoff of 13 or higher was the original threshold and is still used where the goal is to be more certain — but it misses about a third of the people who do have major depression, which is worth knowing if your score came back at 11 and you were told it was fine.

Cutoffs in use range from 9 to 13. The American Academy of Pediatrics form refers anyone scoring 9 or more, or anyone who scores above zero on question 10, for follow-up; 13 or more is the traditional marker of likely depression.

Question 10 Is Different From the Other Nine

The tenth question asks whether the thought of harming yourself has occurred to you. It is scored like the others, but it is not treated like the others.

Any answer other than “never” should trigger a response the same day, no matter what the total score is. A person can score 6 overall — comfortably in the reassuring range — and still have answered that question in a way that matters more than the other nine combined.

If you have answered it honestly and nothing happened, that is a failure of the system, not a sign that your answer was unimportant. Call or text 988, the Suicide & Crisis Lifeline, or go to an emergency room.

What the EPDS Does Not Catch

The EPDS is good at what it was built for. It was built to find depression, and the postpartum period produces a great deal that is not depression.

• Postpartum anxiety. Three of the ten items — questions 3, 4 and 5 — ask about anxiety, and clinicians sometimes score those separately as a short anxiety subscale. But a person whose main problem is fear rather than sadness can finish with a total in the clear while those three items tell the real story. If that is you, take the GAD-7 instead — seven questions, scored instantly here, and it asks about worry directly.
• Postpartum rage. There is no anger item. Irritability can be a prominent part of a postpartum mood disorder and the EPDS does not ask about it at all.
• Postpartum OCD. Intrusive thoughts are not asked about, and question 10 is about self-harm, not about unwanted images of harm coming to the baby. Those are different things, and people conflate them at cost.
• Birth trauma and postpartum PTSD. Not covered.
• Postpartum psychosis. Not covered, and it would not be caught by a self-report form anyway, because insight is usually lost.

It also performs differently across translations and cultural contexts, and the validated cutoff in one language is not automatically the right cutoff in another.

None of this makes the EPDS a bad tool. It makes it one tool. A low score is not a closed door.

EPDS or PHQ-9?

Both get used perinatally, and they are not interchangeable.

The important difference is the third row. The PHQ-9 asks about broken sleep, low energy and appetite change — all of which describe ordinary life with a newborn. That can inflate a new mother’s score for reasons that have nothing to do with depression. The EPDS deliberately leaves those out, which is why it is the usual choice in the perinatal period. If you want a score right now rather than at an appointment, the PHQ-9 and GAD-7 are both free to take here — read the caveat on the PHQ-9 page about those four physical items before you trust the total.

When You Will Be Given It

In the United States you are most likely to be handed the EPDS at a prenatal appointment, at your postpartum checkup, or at one of your baby’s early well-child visits — pediatric practices screen parents too, and many people are first identified there rather than at their own doctor.

Routine screening in this period is recommended by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the American Academy of Family Physicians. Separately, the US Preventive Services Task Force recommends in a 2019 B-grade statement that clinicians refer pregnant and postpartum people at increased risk of perinatal depression to counseling — that is prevention, offered on the basis of risk factors rather than a score.

If nobody has offered you a screen and you want one, you can ask. It is a five-minute form and no clinician will find the request strange.

“If I Answer Honestly, Will They Take My Baby?”

This is the reason the EPDS is under-reported, and almost nothing written about the test will say so plainly.

Saying that you are depressed, anxious, exhausted, or that you have had a frightening thought is not grounds for removing a child. Postpartum depression is a common, treatable illness. Clinicians who screen for it expect to find it — that is the point of screening — and the ordinary result of a high score is a referral, not an investigation.

What clinicians are actually watching for is a small set of specific things: a baby who is not safe right now, a plan to harm yourself or the child, or a parent who has lost contact with reality. Intrusive thoughts that horrify you are not in that category, and it is worth saying so out loud when you report them: “I keep having a thought that frightens me, and I do not want to act on it.” Clinicians hear that constantly and it reassures rather than alarms them.

Answering the form the way you think you are supposed to has one guaranteed outcome: you get no help and nothing changes. It is the most common way a screening program fails.

Where to Find the Official Form

Clinics and health departments hold licensed copies of the form.

• Ask your ob-gyn, midwife, or your baby’s pediatrician — they will have it, and completing it with them is how it is meant to be used.
• The StatPearls chapter on perinatal depression, hosted on the NIH Bookshelf, covers screening in clinical detail and reproduces the scale itself.
• Once you have the completed form, our scoring calculator above will total it for you. MDCalc hosts a clinician-facing version as well.
• The citation that must accompany any copy: Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 1987;150:782–786.

What to Do With Your Score

• Take the number to a person. A score is the start of an appointment, not the end of one. Your ob-gyn, midwife, primary care doctor or your baby’s pediatrician are all legitimate doors.
• Bring what the form missed. If anger, intrusive thoughts, panic or flashbacks are the real problem, say that directly — the questionnaire did not ask.
• Find a therapist who treats perinatal conditions. It is a specialty, and it makes a difference.
• Talk to someone today if you want to. Postpartum Support International runs a free HelpLine at 1-800-944-4773, and you can text “Help” to 800-944-4773 in English or 971-203-7773 in Spanish.
• In a crisis, call or text 988.

Frequently Asked Questions

What is a normal EPDS score?

There is no single “normal,” because the scale measures symptoms over one particular week rather than a fixed trait. A score of 6 in a week that was unusually hard means something different from a 6 in an ordinary one.

Is a score of 10 bad?

It sits right at the threshold most services use to look more closely. The best available evidence suggests a cutoff of 11 balances accuracy best, so a 10 is a reason for a follow-up conversation rather than either alarm or dismissal.

Can I take the EPDS while pregnant?

Yes. Despite the name, it is validated for use in pregnancy as well as after birth, and around half of postpartum depressive episodes begin before delivery. See depression during pregnancy.

How often should it be repeated?

Symptoms move. A single screen captures one week. Many services rescreen at intervals across pregnancy and the first postpartum year, and if your circumstances change there is no reason to wait for the next scheduled one.

Does a low score mean nothing is wrong?

No. The EPDS misses anxiety-led presentations, rage, intrusive thoughts and trauma. If the number did not match your experience, your experience is the more reliable of the two.

Can my partner take it?

The EPDS was validated on mothers, and it has also been used in research on fathers, sometimes with a lower cutoff. It is not a substitute for a proper assessment in either case. Postpartum depression in men is real and under-recognized.