Edinburgh Postpartum Depression Scale: Score and Chart It

Authored by Amara Collins, a clinical psychologist who writes about continuity of care: how a number from one perinatal visit has to still be readable at the next one.

She is six weeks out. The carrier is at her feet. You have a licensed copy of the scale in the folder, and about ten minutes before the hour turns into “we’ll keep an eye on it.”

That is the job of the Edinburgh postpartum depression scale in outpatient therapy. You already chose the instrument. You score it in this visit, you check item 10 before you trust the total, and you leave a chart note the next clinician can read without reopening the form. If you are still deciding between this scale and a PHQ-9, use the perinatal mental health screening path first. Do not average the two totals.

You will also see this called the postnatal depression scale EPDS. Same 10-item screen. Score the copy you are licensed to use. Do not rebuild the items from memory.

Educational content for licensed therapists, not clinical, obstetric, or legal advice. Screening is not diagnosis. Obtain a licensed copy and follow its terms. Adapt cutoff, cadence, collaterals, and disposition to your setting and supervision.

How you use the number in this hour

You are not running a population program. You are sitting with one client who already made it into therapy. The edinburgh postpartum depression scale still has to do three things before she leaves:

1. Name a load you can compare later, on this same scale.
2. Catch item 10, even when the total looks quiet.
3. Leave a written action: a booked return, a courtesy loop with consent, or a safety pathway.

Cox, Holden, and Sagovsky developed a 10-item self-report scale to screen for postnatal depression in the community. In their 1987 paper, a validation study on 84 mothers used Research Diagnostic Criteria from Goldberg’s Standardized Psychiatric Interview. They reported satisfactory sensitivity and specificity, sensitivity to change in severity over time, completion in about 5 minutes, and a simple method of scoring. The paper does not hand you a diagnosis, and it does not hand you permission to reprint the items.

Say the window out loud. Northstone, Joinson, and Emmett describe the scale as ten items about depressive symptoms in the past week, each with four responses scored 0 to 3, total 0 to 30 (their 2018 methods note). If she answers only this morning, the EPDS score is a different sample than the one you will compare next month.

Who was in the room matters as much as the arithmetic. Note pregnant or postpartum and the week, whether a partner was present, whether you needed an interpreter, and whether the infant was in the chair. A form completed with someone watching is not the same form completed alone.

Edinburgh depression scale scoring

You score the Edinburgh postpartum depression scale from the licensed key, then you write the number where Thursday’s clinician can find it. Edinburgh depression scale scoring is that addition. It is not a homemade legend.

• Confirm the past-week window before she marks anything.
• Score each item with the 0 to 3 key printed on the copy you are allowed to use. Do not assume the first printed line is 0.
• Add the ten item scores. The total runs from 0 to 30.
• Write the total, the cutoff you flagged, and the item 10 number on your own sheet.
• Leave the stems on the licensed copy. They do not belong in a blog, a handout, or a pasted block in the chart.

The Royal College of Psychiatrists states that all content it publishes is protected by copyright, including rating scales, and that permission to reproduce it is usually granted, though in many cases a fee is charged (College copyright and permissions). For journal excerpts and rating scales, the College points you to the permissions path on the article. The rating-scales list says to open the article and use the Request permissions button under the abstract (rating-scales list). That list names this scale, points to doi:10.1192/bjp.150.6.782, and says translations and guidance may be found in the 2014 EPDS manual.

Your sheet is original. It holds the administration window, the total, the cutoff flag, item 10, the same-day action, the referral, and the chart note. It is not a second copy of the instrument.

Which cutoff you flag

Write the cutoff you used next to the total. A later reader cannot audit a bare “positive.”

Levis and colleagues (2020) pooled individual participant data and found combined sensitivity and specificity were maximized at a cut-off of 11 or higher across reference standards. Among studies using a semi-structured interview, sensitivity and specificity were 0.81 (95% CI 0.75 to 0.87) and 0.88 (0.85 to 0.91) at 11 or higher. A cut-off of 13 or higher was less sensitive and more specific. They also note that cut-offs of 10 or higher and 13 or higher are commonly used. Accuracy was similar for pregnant and postpartum women.

Northstone and colleagues, citing Cox, Holden, and Sagovsky (1987), describe a score above 12 as strongly predictive of clinical depression in women. If your clinic still posts that older line, flag above 12 and say so. Do not silently swap 11, 12, and 13 across visits and call the series a trend.

Cutoff you flag today	What that cutoff means	What you do in the room
11 or higher	Combined sensitivity and specificity maximized (Levis 2020)	Interview. Do not stamp a diagnosis on the total
Above 12	Described, citing Cox 1987, as strongly predictive in women (Northstone 2018)	Use only if this is the cutoff your clinic posted, and write that
13 or higher	Less sensitive, more specific (Levis 2020)	Use when you want fewer false positives, and name that choice

A flagged Edinburgh postpartum depression scale total is a reason to talk, not a medication order and not a code. If the trend across visits is the question, keep the review habit in the measurement-based care practical guide. This visit still has to close before she reaches the parking garage.

Item 10 and the same-day action

Item 10 is the self-harm item. Wisner and colleagues assessed self-harm ideation on EPDS item 10, and any woman with a score of 20 or higher, or any response other than “none” on that item, was interviewed immediately for safety assessment and intervention planning (Wisner et al., 2013).

The ACOG perinatal mental health toolkit treats thoughts of self-harm, or a positive self-harm question on the EPDS or PHQ-9, as any response other than “never,” and it says to follow that response with a suicide-risk screener to further stratify risk.

So the rule you can defend is short. If item 10 is anything other than the never / none response, follow it immediately with a suicide-risk screener and complete a safety assessment. Choose the disposition from the assessed risk, not from the EPDS total. On that sheet, high risk means you do not leave her and the baby alone, or let them leave, until the assessment is complete. If that assessment finds imminent risk of harm to herself or others, refer to emergency services. Moderate risk is a plan for close monitoring and follow-up within 2 weeks. Low risk is not an automatic urgent evaluation or emergency visit, especially when risk factors are minimal and there is no plan or intent for suicide. A 7 with item 10 marked still needs the screener that hour. A 16 with item 10 at the quiet response is still a high load, and it is not a reason to skip the question when other risk signals show up in the hour.

A mild total does not settle the hour. If item 10 is not the never / none response, assess before you decide whether she leaves, stays for the rest of the visit, or goes to emergency care.

Use the suicide risk assessment template for the formulation and disposition language. The scale only flags the event. Write what she said, what you asked next, and what you decided from that assessment before she left: increased contact, a same-week return, a same-day consult, or emergency care. Name the risk level that drove the choice, and say it out loud.

Confusion, nights without sleep, or a belief that the infant is in danger does not wait for a routine return. Put it in the same-day assessment. Emergency services are for imminent risk of harm, after you have assessed it. Do not decide that from the waiting-room total.

What the chart note has to carry

Weak: “EPDS done.”

Stronger, and short enough to sign:

• Scale name, and that you used a licensed copy
• Administration window, mode, and who was in the room
• EPDS score, the cutoff you flagged, and whether it met that line
• Item 10 response, plus the risk response if it was not quiet
• The action you took today
• Who you notified, or that she declined a courtesy loop
• The next date the same scale will be repeated

Here is the line from the sheet at the top, written so a covering clinician can use it on Thursday:

That sentence is the chart note. The rest of the progress note can hold the sleep, the feeding, and the plan. If the note shape is the thing that keeps slipping, use best practices for writing progress notes after the score is already in the record. Do not let the format hunt replace the number.

Repeat the Edinburgh postpartum depression scale when you need a comparable EPDS score. Cox and colleagues reported that the scale was sensitive to change in severity over time. A PHQ-9 from another client on your caseload is not the comparison. Switch instruments and you have two stories, not a trend.

Download the selection matrix

The sheet above is the visit record. The matrix you can email is a different job: which brief measure to pick when you have not already committed to this scale.

Do not hand the matrix to her as a quiz. Do not start trauma processing on a first flagged total. Stabilize, consult if you need to, and write the action.

Where the next visit finds the score

The total, item 10, and the action have to sit in one record or Thursday starts from rumor. The Emosapien features page is the product view of that thread when you draft the note. You still pick the scale, read the key, run the risk pathway, and sign what is true.

Start your journey with Emosapien if you want the EPDS score, the item 10 response, and the return date in the same chart.

References

• Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782-786. https://doi.org/10.1192/bjp.150.6.782
• Northstone, K., Joinson, C., & Emmett, P. (2018). Dietary patterns and depressive symptoms in a UK cohort of men and women: a longitudinal study. Public Health Nutrition, 21, 831-837. https://www.cambridge.org/core/journals/public-health-nutrition/article/dietary-patterns-and-depressive-symptoms-in-a-uk-cohort-of-men-and-women-a-longitudinal-study/A2988455545D4AD34FEA0380C7F9C8A0
• Levis, B., et al. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women. BMJ, 371, Article m4022. https://doi.org/10.1136/bmj.m4022
• Wisner, K. L., et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. https://doi.org/10.1001/jamapsychiatry.2013.87
• American College of Obstetricians and Gynecologists. (2022). Assessing risk of suicide and patient safety screener (revision 02-22-22). Lifeline for Moms perinatal mental health toolkit. https://www.acog.org/-/media/project/acog/acogorg/files/forms/perinatal-mental-health-toolkit/assessing-risk-of-suicide-and-patient-safety-screener-2022.pdf
• Royal College of Psychiatrists. (n.d.). Copyright and permissions. https://www.rcpsych.ac.uk/about-us/contact-us/permissions
• Royal College of Psychiatrists. (n.d.). Rating scales. https://www.rcpsych.ac.uk/docs/default-source/about-us/publications/royal-college-of-psychiatrists-rating-scales_with-hyperlinks.pdf?sfvrsn=861e495e_7