Edinburgh Postnatal Depression Scale (EPDS)
Ten-item screen for depression in pregnancy and after birth, built to avoid the somatic items that confound depression scales in the perinatal period.
Last reviewed: May 2026
The EPDS was developed by Cox, Holden and Sagovsky (1987) to screen for depression in the perinatal period. Its ten items ask how a person has felt over the past seven days, covering low mood, anhedonia, anxiety, guilt and thoughts of self-harm.
Scoring & Interpretation
Each of the ten items is rated 0 to 3 over the past seven days, with several items reverse-scored, for a total of 0 to 30. ClientForms applies the reverse-scoring and sums the responses for you. A score of 13 or above is the most widely cited cut-off for probable depression, while a lower threshold of 10 or above is often used to capture milder or anxiety presentations for monitoring. Item 10 (thoughts of self-harm) is reviewed alongside the total whatever the score.
| Score Range | Severity | Clinical Action |
|---|---|---|
| 0-9 | Low likelihood | Low likelihood of depression: routine review |
| 10-12 | Possible | Possible depression or anxiety: monitor, repeat, consider assessment |
| 13-30 | Probable | At or above the cut-off of 13: probable depression, assess further |
| Item 10 above 0 | Self-harm item | Any positive response to item 10: review risk regardless of the total |
At a cut-off of 13 or above the EPDS has a pooled sensitivity of around 0.85 and specificity of around 0.84 for major depression in a large individual-participant meta-analysis (Levis et al., BMJ 2020). Internal consistency is acceptable to good (Cronbach's alpha around 0.83 in the original validation; Cox et al., 1987). Sensitivity and specificity shift with the cut-off chosen and with translation, so the threshold should match the validated version in use.
When to Use This vs Alternatives
Use PHQ-9 when…
You are screening outside the perinatal period, or want a depression severity score mapped to the diagnostic criteria. The PHQ-9 includes somatic items that the EPDS deliberately omits to avoid confounding scores in pregnancy and early parenthood.
View PHQ-9 →Use K-10 when…
You want a single index of general psychological distress rather than a perinatal-specific depression screen. The K-10 indexes distress across the common disorders; the EPDS is purpose-built for pregnancy and the postnatal year.
View K-10 →Use DASS-21 when…
You want depression, anxiety and stress as separate subscales in a general adult presentation. The DASS-21 is a general measure; the EPDS is the validated screen for the perinatal period and includes a self-harm item.
View DASS-21 →See It in Action
- 1Total perinatal screen score on the 0-to-30 scale with its band
- 2Reverse-scored items handled automatically in the total
- 3Item 10 (thoughts of self-harm) flagged for review beside the total
- 4One-click PDF export and email delivery for the patient record
What It Measures
The EPDS was developed by Cox, Holden and Sagovsky (1987) to screen for depression in the perinatal period. Its ten items ask how a person has felt over the past seven days, covering low mood, anhedonia, anxiety, guilt and thoughts of self-harm. It deliberately leaves out the sleep, appetite and fatigue items that are normal in pregnancy and early parenthood and that inflate scores on general depression scales, which is why it remains the standard perinatal screen worldwide.
When to Use the EPDS
Use the EPDS to screen for depression and anxiety in pregnancy and across the first postnatal year, at the points recommended by perinatal mental health guidelines. It is brief enough to repeat at antenatal and postnatal visits. It is a screen, not a diagnosis: a raised score indicates symptoms that warrant assessment, while the diagnosis remains the practitioner's judgement. Item 10 asks about thoughts of self-harm, so review any positive response to it regardless of the total.
Who It's For
Pregnant and postnatal women, validated antenatally and across the first postnatal year; it has also been used to screen fathers and partners. Self-report: the patient completes it themselves. Items 3, 4 and 5 form a recognised anxiety subscale (EPDS-3A). Cut-offs vary by setting and language, so confirm the threshold a service uses before comparing scores.
Frequently Asked Questions
What does the EPDS measure?
The EPDS is a ten-item self-report screen for depression and anxiety in pregnancy and the postnatal year. It omits the sleep, appetite and fatigue items that are normal in the perinatal period and would otherwise inflate scores.
How is the EPDS scored, and what is the cut-off?
Each item is rated 0 to 3, with several items reverse-scored, for a total of 0 to 30. A score of 13 or above is the most widely cited cut-off for probable depression; a threshold of 10 is often used to capture milder or anxiety presentations.
Which EPDS items are reverse-scored?
Items 3 and 5 to 10 are reverse-scored (3, 2, 1, 0) while items 1, 2 and 4 are scored 0, 1, 2, 3. ClientForms applies the reverse-scoring automatically so the total is correct without hand-calculation.
What does item 10 of the EPDS assess?
Item 10 asks about thoughts of self-harm in the past week. Any positive response warrants review regardless of the total score. ClientForms flags item 10 beside the total so it is not missed.
Is the EPDS free to use?
Yes. The EPDS may be reproduced without permission provided the authors, title and source are cited (Cox, Holden and Sagovsky, 1987). It is distributed freely by perinatal mental health services.
Can the EPDS be used antenatally and for partners?
Yes. The EPDS is validated for use during pregnancy as well as after birth, and has been used to screen fathers and partners, though cut-offs may differ. It is a screen rather than a diagnosis.
Use the EPDS in your practice
New accounts get 30 days of full Professional access, no card. After that it stays on the Free plan. Scored the moment patients submit.