# The Edinburgh Postnatal Depression Scale (EPDS), Explained _Ten questions, a score out of 30, and one item that is read on its own._ - Source: https://proba.baby/en/blog/edinburgh-postnatal-depression-scale-explained - Published: 2026-09-05 - Author: ProbaBaby Team - Category: Baby & Postpartum - Tags: mental-health, mom-recovery - Language: English > The EPDS is the questionnaire your midwife, health visitor or OB hands you after birth. Here is what each of the 10 questions is getting at, what a score of 10 or 13 actually signals, why question 10 is treated separately, and what happens next. > **Medical disclaimer.** This article explains a screening questionnaire; it is not a diagnosis and not a substitute for care. If you are having thoughts of harming yourself or your baby, get help today: in the US call or text 988, or the National Maternal Mental Health Hotline on 1-833-852-6262; in the UK contact your GP, midwife or health visitor, or call 111. If anyone is in immediate danger, call your local emergency number. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-question form about how you have felt over the **past week**. Every answer scores up to 3, so the highest possible total is 30, and a higher number means more depressive symptoms. Its authors reported that it "can be completed in about 5 minutes." It is a *screen*, not a diagnosis: its whole job is to decide whether a longer conversation needs to happen. Below is what the questions are actually asking, what 10 and 13 mean, and why one item is read on its own. ## Where the scale came from The EPDS was published in 1987 by John Cox, Jenifer Holden and Ruth Sagovsky in the *British Journal of Psychiatry*. They validated it in 84 mothers against Research Diagnostic Criteria for depressive illness taken from Goldberg's Standardised Psychiatric Interview, and reported that it "can be completed in about 5 minutes and has a simple method of scoring." That brevity is the point, and so is what the items leave out. Read the ten questions below and you will notice how little they ask about the body: appetite and energy — which are upside-down for almost every new parent, depressed or not — do not appear at all, and the one item that mentions sleep ties it to unhappiness rather than to the baby's schedule. ## The ten questions, in plain language Each item offers four answers, scored 0 to 3. Roughly, they ask whether in the last week you have: 1. Been able to laugh and see the funny side of things 2. Looked forward to things with enjoyment 3. Blamed yourself unnecessarily when things went wrong 4. Felt anxious or worried for no good reason 5. Felt scared or panicky for no good reason 6. Felt that things were getting on top of you 7. Been so unhappy that you have had trouble sleeping 8. Felt sad or miserable 9. Been so unhappy that you have been crying 10. Had thoughts of harming yourself Two things are worth knowing before you answer. The score always runs one way — more symptoms, higher number — but the answer options are not always printed in the same order: some items list the cheerful answer first and the bleakest last, others do the reverse, which is why people who tick down a column quickly sometimes end up with a total that surprises them. And two of the ten items (4 and 5) ask directly about anxiety and panic rather than low mood, so an anxious week can lift the total on its own. ## What the score bands actually mean Two thresholds do most of the work in clinics: **10 or higher** and **13 or higher**. A score of 13 or higher is the one usually described as the basis for further clinical assessment, while many institutions refer on a total above 9 or 10, or on any sign of suicidal ideation. The best evidence on which cut-off to use comes from a 2020 individual participant data meta-analysis in *The BMJ*, which pooled 58 studies and 15,557 participants. Within the 36 of those studies (9,066 participants) that used a semi-structured diagnostic interview as the reference standard, it found: - **10 or higher** — sensitivity 0.85, specificity 0.84 - **11 or higher** — sensitivity 0.81, specificity 0.88 (the best combined accuracy) - **13 or higher** — sensitivity 0.66, specificity 0.95 Read that bottom row carefully, because it is the one people misread. A cut-off of 13 almost never labels a well person as unwell — but it misses roughly a third of those who do meet criteria for major depression. So a score of 11 is not "a pass." It is squarely inside the range where a clinician should look closer. That is the trade the paper itself frames: 11 or higher maximised combined sensitivity and specificity, 13 or higher was less sensitive but more specific, and — in the authors' words — "if the intention is to avoid false negatives and capture all participants who might meet diagnostic criteria based on further evaluation, a lower cutoff value might be preferred." Catching more people costs more false positives — a reasonable price when the next step is a conversation rather than a treatment. ## What a score does not mean A number on this form does not diagnose anything. Diagnosis comes from a clinical assessment, and the EPDS exists to trigger one. It also cuts both ways. A low total does not mean you are fine. It means these ten questions, answered about the last seven days, did not pick anything up — and plenty of people underreport on a form they are filling in with a baby on their chest and a midwife waiting. If you feel wrong, say so out loud even if the score looks reassuring. And the scale was built to detect depression. It is not a screen for postpartum psychosis, which is rare — the DSM-5-TR estimates psychotic features in 1 in 500 to 1 in 1,000 deliveries — but is a medical emergency with different signs, and clinical guidance treats suicide risk and psychosis as emergencies needing immediate treatment, whatever a questionnaire says. ## Question 10 is read on its own Item 10 asks about thoughts of harming yourself. It is scored inside the total, but it is also read on its own: clinical reviews describe services referring on the total score **and/or on suicidal ideation**, and say every postnatal visit should assess mood, suicide risk and psychosis. So a positive answer here matters even if the total comes out low. This matters because the two are genuinely independent. Someone can be functioning well enough to score under 10 and still have had those thoughts this week. The NHS lists "thoughts of suicide, harming yourself or your baby" among the symptoms of postnatal depression and says to speak to your GP, midwife or health visitor; for urgent help it points to 111, and to 999 or A&E if a life is at risk. The NIMH points to 988 in the US, and to 911 in life-threatening situations. Frightening, unwanted thoughts about harm coming to the baby are not the same thing as wanting to act, and clinicians are used to hearing about both. Say either out loud — that is what gets you assessed properly, and assessment is what treatment follows. ## Who asks you to fill it in, and when In the US, the Preventive Services Task Force recommends screening for depression "in the adult population, including pregnant and postpartum persons" at Grade B, and names the EPDS as an instrument used in pregnant and postpartum people. ACOG, the American Academy of Pediatrics and the American Academy of Family Physicians all recommend screening every patient for perinatal depression with the EPDS, in pregnancy and after birth. In the UK, the NHS says you may be asked to fill in a questionnaire about your symptoms when you raise it with your GP, midwife or health visitor. Timing is the part worth internalising. The NHS draws the line at two weeks: short-lived low mood in the first fortnight is usually the baby blues, while symptoms that stick around, or that start later, are worth a conversation. Postnatal depression can begin during pregnancy and at any point in the first year, so one screen at one appointment is a snapshot, not an all-clear. Ask to redo it if things change — and go to your [postpartum check-up](/doctor-visit) with your symptoms written down, because they are easier to describe on paper than out loud. ## Partners and dads The original 1987 validation was done in new mothers, so the familiar 10 and 13 cut-offs are not calibrated for anyone else. A partner's total is not directly comparable, and no one should use this scale to decide a partner is or is not unwell. But the underlying reality is not gender-specific. Reviews of perinatal depression say attention should also be given to fathers with postpartum blues, because it can impair father-infant bonding, and cite a French study that put its prevalence at 17.5% in new fathers. If the ten questions above describe your week, the next step is the same one — your own GP or doctor. [Bringing a partner into the day-to-day](/family) also changes the load that produces some of these scores in the first place. ## What happens after a high score Usually less drama than people fear: a longer conversation, some questions about how long this has been going on, and a plan. The NIMH describes treatment for perinatal depression as "therapy, medication, or a combination of therapy and medication," and the CDC's line is worth repeating verbatim — "most people, even those with the most severe forms of depression, can get better with treatment." Scale matters here too. The CDC reports that about **1 in 8 women** with a recent live birth experience symptoms of postpartum depression. A positive screen puts you in very ordinary company. ## How ProbaBaby helps ProbaBaby includes the standard 10-question EPDS screening inside its Mom Recovery module, with four options per question and the usual bands — high at a total of 13 or higher, moderate at 10 or higher — each carrying its own recommendation rather than a bare number. Between screens, a daily mood check-in records a 5-level rating alongside a 15-symptom checklist covering things like anxiety, intrusive thoughts, bonding difficulty and hopelessness, so what you logged between visits is there when the next appointment comes. Mom Recovery itself is a four-tab module — Recovery, Safety, Program and Resources — and it carries region-selected mental-health and crisis support contacts, which the app ships for 128 countries. All of that regional data lives inside the app, so looking up a hotline does not depend on having signal. You can see how the rest of the [postpartum and mom-recovery module](/postpartum) fits together. ## FAQ **What is the Edinburgh Postnatal Depression Scale?** The EPDS is a 10-question self-report screen for depressive symptoms in pregnancy and after birth, published by Cox, Holden and Sagovsky in 1987. Each answer scores 0 to 3, so totals run from 0 to 30, and it takes about five minutes to complete. **What is a normal EPDS score?** There is no single normal number, because the scale measures symptoms rather than sorting people into healthy and unhealthy. Most services treat a total under 10 as low concern, but a low score never overrules how you actually feel. **What does an EPDS score of 13 or higher mean?** It means your symptom level is high enough that a clinician should assess you properly. In a 2020 individual participant data meta-analysis, measured against semi-structured diagnostic interviews, a cut-off of 13 or higher was 66% sensitive and 95% specific for major depression — so it rarely flags someone who is well, but it misses about a third of those who are unwell. **Why is question 10 on the EPDS treated differently?** Question 10 asks about thoughts of harming yourself. It is read on its own as well as inside the total, because a person can answer it positively and still finish with a low total. Clinical reviews describe services using the total score and/or suicidal ideation as the referral trigger, and say suicide risk should be assessed at every postnatal visit. **Can the EPDS diagnose postpartum depression?** No. It is a screening questionnaire, not a diagnostic interview. A high score is a prompt for a proper clinical assessment, which is where a diagnosis is made. **Can dads and partners take the EPDS?** The original validation was done in new mothers, so the familiar 10 and 13 cut-offs are not calibrated for partners. A partner who recognises themselves in the questions should still speak to their own doctor. **How often should the EPDS be repeated?** Depression can start in pregnancy and at any point in the first year after birth, so one screen is a snapshot rather than an all-clear. Repeating it when things change, and telling your provider between screens, matters more than the exact schedule. ## Sources - 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(6):782-786 — the original validation in 84 mothers; "can be completed in about 5 minutes": https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/detection-of-postnatal-depression/E18BC62858DBF2640C33DCC8B572F02A - Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD — Accuracy of the EPDS for screening to detect major depression: individual participant data meta-analysis — BMJ 2020;371:m4022 — 58 studies, 15,557 participants; the cut-off accuracy figures are from the 36 studies (9,066 participants) using semi-structured interviews: https://pmc.ncbi.nlm.nih.gov/articles/PMC7656313/ - US Preventive Services Task Force — Depression and Suicide Risk in Adults: Screening — 2023, Grade B — screening "in the adult population, including pregnant and postpartum persons"; names the EPDS: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-adults - Carlson K, Mughal S, Azhar Y, Siddiqui W — Perinatal Depression (StatPearls, NCBI Bookshelf) — Updated 22 January 2025 — EPDS is a 10-item questionnaire, maximum score 30; who screens, and referral thresholds: https://www.ncbi.nlm.nih.gov/books/NBK519070/ - NHS — Postnatal depression — Symptoms, the two-week baby-blues line, and who to tell: https://www.nhs.uk/mental-health/conditions/postnatal-depression/ - NHS — Where to get urgent help for mental health — Get advice from 111; call 999 or go to A&E if someone's life is at risk: https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/ - CDC — Symptoms of Depression Among Women — About 1 in 8 women with a recent live birth report postpartum depressive symptoms; 988 and 1-833-852-6262: https://www.cdc.gov/reproductive-health/depression/index.html - National Institute of Mental Health — Perinatal depression — Treatment is "therapy, medication, or a combination of therapy and medication"; 988 crisis guidance: https://www.nimh.nih.gov/health/publications/perinatal-depression --- ProbaBaby (listed on the App Store as “Pregnancy & Baby Tracker - PB”) is a free iPhone, iPad and Apple Watch app for pregnancy, newborn and postpartum tracking, built for twins, in 32 in-app languages, with an optional AI baby-face prediction that computes Mendelian genetics (Punnett squares) from the traits you enter before any image is generated. Tracking, tools, PDF reports and family sharing are free; only AI predictions use credits — 5 starter credits cover your first Scientific prediction — and no subscription is required. Requires iOS 26 or later. Not available on Android.