Edinburgh Postnatal Depression Scale

The Edinburgh Postnatal Depression Scale is a 10-item self-report questionnaire that screens for perinatal depression. Each item is scored from 0 to 3 and refers to the preceding 7 days, giving a total from 0 to 30. It was developed for the postnatal period and is also used in pregnancy.

It avoids the somatic items that overlap with normal pregnancy and early parenthood, such as sleep and appetite change, which makes it more specific than general depression scales in this population.

It is a screening tool and does not diagnose depression. A raised score prompts a clinical interview.

Usage. It is used in antenatal and postnatal care, commonly at around 6 to 8 weeks after birth, and at other points when mood concerns arise.

Indications. Routine perinatal mental health screening, a mood concern raised by the woman or her clinician, and monitoring of response over time.

Preparation and technique. The woman completes the scale in private, in a language she understands, and the clinician reviews each answer, particularly the self-harm question. The responses reflect the last 7 days, so the timing of completion matters.

Contraindications and precautions. Limited literacy and acute psychosis reduce reliability. The scale is also used with fathers and partners, with thresholds that may differ from those for women.

Interpretation.

• A score of 10 or more indicates possible depression and requires clinical assessment.
• A score of 13 or more indicates probable depression in many services.
• Thresholds vary between populations and languages, and the local validated threshold is applied.
• The self-harm question is reviewed regardless of the total score.

Causes of a raised score. Major depressive disorder, anxiety disorders, bipolar disorder, adjustment difficulties, thyroid dysfunction, and anaemia.

Critical values and findings needing immediate action.

• Any positive response to the self-harm question requires a same day risk assessment by a clinician.
• Symptoms of psychosis, such as confusion, hallucinations or thoughts of harming the infant, require immediate specialist psychiatric assessment.

Limitations and artefacts. A single score is a snapshot of one week. Cultural differences in how distress is described affect results. Postnatal psychosis and bipolar disorder are not reliably detected by this scale.

Follow up tests. A structured clinical interview, thyroid function tests, full blood count and serum ferritin where physical causes are possible.

Special groups. Adolescent mothers, women with a history of mood disorder, and women after pregnancy loss or traumatic birth have a higher prior risk. Fathers and partners are screened using thresholds validated for them.