Edinburgh Postnatal Depression Scale (EPDS)

What is postpartum depression?

Postpartum depression, also known as postnatal depression, is a type of clinical depression that can develop in women after giving birth. Unlike the "baby blues," which is a mild and temporary mood disturbance, postpartum depression is a more severe and longer-lasting form of depression that can significantly impair a woman's ability to function and care for herself and her baby (Banti et al., 2011).

Symptoms of depression with an onset during or after pregnancy can include persistent feelings of sadness, loss of interest or pleasure in activities, excessive guilt or worthlessness, fatigue, changes in appetite, difficulty sleeping, and, in severe cases, suicidal thoughts (American Psychiatric Association, 2013).

It is important to note that depression among pregnant and postpartum women is not a character flaw or a sign of weakness. Postpartum depression, along with perinatal depression, is a treatable medical condition that requires professional help and support.

What is the Edinburgh Postnatal Depression Scale (EPDS)?

The Edinburgh Depression Scale is a widely used screening tool for identifying possible depression in the general population. It is a self-report questionnaire that assesses various symptoms associated with depression.

The EPDS is a specific version of the Edinburgh Depression Scale that has been adapted and validated for screening postpartum depression in new mothers. It is a 10-item self-report questionnaire that assesses symptoms of depression experienced within the past seven days (Banti et al., 2011).

The EPDS has been evaluated for its positive predictive values in identifying postpartum depression, providing reliable diagnostic accuracy.

The EPDS was developed to identify women who may have postnatal depression, which is a significant public health concern affecting many women during the postpartum period. Unlike the general Edinburgh Depression Scale, the EPDS focuses on symptoms that are particularly relevant to the postpartum period and difficulty coping with everyday tasks related to caring for a newborn.

How to use the Edinburgh Postnatal Depression Scale (EPDS)

Using the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression can be done with the following steps:

Step 1: Administration

The EPDS is a 10-item self-report questionnaire that should be given to the mother to complete herself. Ensuring that the mother understands the instructions and feels comfortable answering the questions honestly is important.

Step 2: Scoring and interpretation

Each item in the EPDS is scored on a scale of 0 to 3, with a maximum total score of 30. Higher scores indicate a greater likelihood of depression. The EPDS scores' positive predictive values help determine the likelihood of postpartum depression, enhancing the accuracy of the screening process.

Step 3: Clinical judgment

It is crucial to understand that the EPDS is a screening tool and should not override clinical judgment on its own. The score should be interpreted in conjunction with careful clinical assessment, considering factors such as the presence of other mental health conditions, the severity of symptoms, and the overall clinical picture.

Step 4: Follow-up and support

For women who screen positive for EPDS or who express concerns about their mental health, it is important to provide appropriate follow-up care, which may include referral to a mental health professional, support groups, or other resources.

Scoring and interpretation

Each item has its own unique answer set. Mothers must pick one answer from each set based on their feelings for the last seven days before answering the scale. Each item can get a possible score of 0 to 3, and it will depend on their answer choice.

Items 1, 2, and 4 are scored 0 to 3. The answers are arranged as such:

• The first choice is worth 0 points
• The second choice is worth 1 point
• The third choice is worth 2 points
• The last choice is worth 3 points

Items 3 and 5 to 10 are scored 3 to 0, meaning they are reverse-scored. The first choice is worth 3 points, the second is worth 2 points, the third is worth 1 point, and the last is equal to 0. Add up to get the total EPDS score. The possible maximum score that each patient can get is 30.

The Edinburgh Postnatal Depression Scale doesn’t have a single optimal cut-off value. There are only two things you need to consider when interpreting the scores on the scale:

• A score of 10 to 30 means that the mother possibly has depression symptomatology, so you will need to conduct a careful clinical assessment and use clinical judgment before diagnosis (Navaratne et al., 2016).
• The last item deals with self-harm. If they tick the first or second answer choice, that’s a cause for concern. Even if the total score from Items 1 to 9 is 0, but they picked the first or second answer choice for Item 10, you must find a way to address their thoughts of self-harm.

This downloadable EPDS Scoring Handout can be a helpful tool in this stage of the assessment process.

When would you typically use the Edinburgh Postnatal Depression Scale (EPDS)?

The Edinburgh Postnatal Depression Scale is typically used as a screening tool for postpartum depression in the weeks and months following childbirth. However, there are certain situations or circumstances where it may be particularly important or beneficial to administer the EPDS:

When mothers are experiencing difficulties

If a new mother is exhibiting signs or symptoms of postpartum depression, such as persistent sadness, loss of interest, difficulty bonding with the baby, or struggles with daily tasks, it is recommended to screen her with the EPDS to assess the severity of her symptoms and determine if further evaluation or support is needed.

When other mental health disorders are suspected or present

Women with pre-existing mental health conditions, such as anxiety disorders, bipolar disorder, or other personality disorders, may be at higher risk for developing postpartum depression. In these cases, regular screening with the EPDS can help monitor their mental health and provide early intervention if necessary.

When there are known risk factors

Certain factors, such as a history of depression, lack of social support, or stressful life events, can increase a woman's risk of developing postpartum depression. Healthcare providers may choose to screen more frequently or at earlier time points for women with these risk factors.

When there are concerns from family or caregivers

If a partner, family member, or caregiver expresses concerns about a new mother's mental health or behavior, it may be appropriate to administer the EPDS to assess for potential postpartum depression.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.

Banti, S., Mauri, M., Oppo, A., Borri, C., Rambelli, C., Ramacciotti, D., Montagnani, M. S., Camilleri, V., Cortopassi, S., Rucci, P., & Cassano, G. B. (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Comprehensive Psychiatry, 52(4), 343–351. https://doi.org/10.1016/j.comppsych.2010.08.003

Navaratne, P., Foo, X. Y., & Kumar, S. (2016). Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes. Scientific Reports, 6, 33544. https://doi.org/10.1038/srep33544