Edinburgh Depression Scale

Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report screening instrument developed to identify women suffering from postnatal depression (PND). It is designed for use by primary care health professionals to distinguish PND—a condition more severe than the common “baby blues” but less severe than puerperal psychosis—from typical mood changes following childbirth. The scale assesses the mother’s emotional state over the preceding seven days, providing a rapid, reliable method for identifying those who require further clinical assessment for a potential depressive illness.

Keywords

Edinburgh Postnatal Depression Scale, EPDS, postnatal depression, PND, maternal mental health, perinatal screening, depression assessment, psychological scale

Authors

J.L. Cox, J. Holden, R. Sagovsky

Purpose

The primary purpose of the EPDS is to serve as a screening tool for postnatal depression in mothers following childbirth. It was specifically created to assist primary care professionals in efficiently identifying mothers who are experiencing depressive symptoms that warrant a full clinical diagnosis. The instrument is quick to administer, typically taking less than five minutes to complete, making it suitable for routine use in clinical settings like child health clinics or during postnatal check-ups.

The scale aims to detect clinically significant depression, which affects an estimated 10% or more of women post-delivery. By identifying these cases early, the EPDS helps ensure that depressed mothers receive timely treatment, mitigating potential long-term negative effects on the mother, the infant, and the family unit. While effective for screening, the results of the EPDS should always be supplemented by a careful clinical judgement and comprehensive assessment to confirm any diagnosis.

Construct

The EPDS measures the severity of depressive and anxiety symptoms experienced by the mother during the perinatal period, specifically focusing on the previous seven days. The 10 items cover a range of affective and cognitive symptoms characteristic of depression, including:

• Anhedonia (loss of enjoyment and inability to laugh).
• Self-blame and guilt.
• Anxiety, worry, panic, and feeling overwhelmed.
• Sadness, misery, and crying.
• Sleep difficulties related to unhappiness.
• Suicidal ideation or self-harm thoughts.

The scale focuses on symptoms relevant to the postnatal context, avoiding somatic symptoms (such as appetite change or fatigue) that are often associated with normal physiological changes during the puerperium, thereby enhancing its specificity for depression rather than general physical discomfort.

Validity

The validation study conducted during the scale’s development established its effectiveness as a screening instrument. The primary method for establishing criterion validity involves setting a threshold score that correlates highly with a formal clinical diagnosis of depression based on psychiatric interview criteria.

The original validation study suggested that a cutoff score of 12/13 indicated that mothers were likely suffering from a depressive illness of varying severity. However, the scale is explicitly limited in scope; it is not designed to detect other mental health conditions such as anxiety neuroses, phobias, or personality disorders. Subsequent research has broadly confirmed the EPDS’s utility across different populations and cultures, and it has also been validated for use during pregnancy, expanding its utility throughout the perinatal period.

Reliability

While the source content does not provide specific statistical measures of reliability (such as Cronbach’s alpha), the extensive use and subsequent academic validation of the EPDS demonstrate strong psychometric properties, including good internal consistency and test-retest reliability when administered appropriately. The scale’s short, focused nature contributes to its high practical reliability in busy clinical settings.

Factor Analysis

The EPDS was initially designed as a unidimensional scale to measure overall depressive severity. However, subsequent psychometrics research using factor analysis often suggests a multidimensional structure, commonly identifying two primary factors: an “Anxiety/Panic” factor (including items related to worry and fear, like items 4 and 5) and a “Depression/Anhedonia” factor (including items related to sadness, self-blame, and loss of pleasure). Despite these factor variations, the total score remains the standard measure used clinically for screening purposes, consistent with the scale’s original design intent.

Instrument

Test Type: Self-report screening scale

Format: 10 items, 4-point Likert-style response scale (ranging from 0 to 3 based on severity)

Language Available: Originally English; widely translated and validated in numerous languages globally.

Population Group: Perinatal women (postnatal and pregnant women)

Age Group: Adult women (typically childbearing age)

Population Details: Mothers who have recently had a baby (used 6-8 weeks postpartum is common, though usage varies).

Test Methodology: The respondent circles the number next to the answer that best describes how she has felt during the past 7 days. Total scores range from 0 to 30. A score of 13 or above typically suggests the presence of a depressive illness.

Keywords

Postnatal, screening tool, depression scale, mental health, maternal health, EPDS scoring, clinical assessment, psychometrics

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

The EPDS was developed and published in 1987. Users are generally permitted to reproduce the scale without seeking further permission, provided they adhere strictly to the copyright requirements. Copyright for the scale remains with the British Journal of Psychiatry, the original publisher. Any reproduced copies must explicitly quote the names of the authors (Cox, Holden, and Sagovsky), the title of the instrument, and the source of the original paper.

The original PDF clinical guideline can be accessed here: Clinical Guideline. Another version is available here: http://www.bbmomsclub.com/uploads/1/0/2/9/10293797/edinburghscale._eng-sp.pdf.

Reference’s

• 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, 782-786.
• Murray D, Cox J. (1990). Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). J Reprod Infant Psychol; 8:99-107.
• Cox, J. L., & Holden, J. M. (1994) Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale. London: Gaskell.
• Cox, John L., Chapman, Gail., Murray, Declan., Jones, Peter. (1996). Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. Journal of Affective Disorder, 39(3); 185–189.
• Cox, John., Holden, Jeni. (2003). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS). London, England: Royal College of Psychiatrists Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS).
• Further resources: http://www.beyondtheblues.info/Docs/edinburgh%20english.pdf

Items of the Edinburgh Depression Scale

DATE COMPLETED_____________

As you have recently had a baby‚ we would like to know how you are feeling. Please CIRCLE the number next to the answer which comes closest to how you have felt IN

THE PAST 7 DAYS‚ not just how you feel today. Here is an example‚ already completed.

I have felt happy:

0 Yes‚ all the time.

1 Yes‚ most of the time.

2 No‚ not very often.

3 No‚ not at all.

In the past 7 days:

1. I have been able to laugh and see the funny side of things.

0 As much as I always could.

1 Not quite so much now.

2 Definitely not so much now.

3 Not at all.

2. I have looked forward with enjoyment to things.

0 As much as I ever did.

1 Rather less than I used to.

2 Definitely less than I used to.

3 Hardly at all.

3. I have blamed myself unnecessarily when things went wrong.

3 Yes‚ most of the time.

2 Yes‚ some of the time.

1 Not very often.

0 No‚ never.

4. I have been anxious or worried for no good reason.

0 No not at all.

1 Hardly ever.

2 Yes‚ sometimes.

3 Yes‚ very often.

In the past 7 days:

5. I have felt scared or panicky for no very good reason.

3 Yes‚ quite a lot.

2 Yes‚ sometimes.

1 No‚ Not much.

0 No‚ not at all.

6. Things have been getting on top of me.

3 Yes‚ most of the time I haven’t been able to cope at all.

2 Yes‚ sometimes I haven’t been coping as well as usual.

1 No‚ most of the time I have coped quite well.

0 No‚ I have been coping as well as ever.

7. I have been so unhappy that I have had difficulty sleeping.

3 Yes‚ most of the time.

2 Yes‚ sometimes.

1 Not very often.

0 No‚ not at all.

8. I have felt sad or miserable.

3 Yes‚ most of the time.

2 Yes‚ quite often.

1 Not very often.

0 No‚ not at all.

9. I have been so unhappy that I have been crying.

3 Yes‚ most of the time.

2 Yes‚ quite often.

1 Only occasionally.

0 No‚ never.

10. The thought of harming myself has occurred to me.

3 Yes‚ quite often.

2 Sometimes.

1 Hardly ever.

0 Never.