What Is the Edinburgh Postnatal Depression Scale (EPDS)?

What Is the Edinburgh Postnatal Depression Scale?

The Edinburgh Postnatal Depression Scale (EPDS) is a screening instrument that is frequently used to identify women who might be experiencing depression during pregnancy and after giving birth. Postpartum depression (PDD) is a mood disorder that can occur after childbirth and is characterized by symptoms including sadness, irritability, insomnia, appetite changes, and difficulty bonding with the baby. 

It is a common but serious condition, so it is important to be able to detect mood disorders accurately in order to ensure that women receive appropriate and effective treatment. Untreated depression that occurs during and after pregnancy can have negative consequences for women and children. 

Should You Take the EPDS?

The United States Preventive Services Task Force recommended in 2016 that all women are given an EPDS screening during and after pregnancy. Your doctor may ask you to complete an EPDS screening, especially if you have certain risk factors or if you are experiencing symptoms of depression two or more weeks after childbirth. Some risk factors for postpartum depression include:

• A history of depression
• Being a younger mother
• Having a multiple birth (twins, triplets, etc.)
• Having a child with health issues
• Poor family and social support

Some symptoms of depression that might prompt a screening include:

• Changes in appetite
• Changes in sleep
• Difficulty bonding with the baby
• Difficulty managing everyday tasks
• Depressed mood or mood swings
• Excessive crying
• Fear of harming yourself or your baby
• Feelings of guilt
• Feeling hopeless
• Thoughts of death or suicide
• Trouble concentrating
• Withdrawing from loved ones

Uses

The Edinburgh Postnatal Depression Scale was first developed in 1987 by Scottish health professionals in Edinburgh and Livingston. It was designed to be used in outpatient or home visit settings or during the postpartum checkup that typically occurs between six and eight weeks after giving birth. Today, it can be given during and after pregnancy at any time. The scale consists of 10 questions that correspond to clinical symptoms of depression.

While the EPDS is not a diagnostic tool, research has found that it is both sensitive and specific enough to identify symptoms of postpartum depression. The scale is easy to administer and most women are able to complete it in five minutes or less.

The test's ability to effectively identify women who may be in need of help and its ease of use are reasons why it has become one of the most widely used postpartum depression screening instruments.

Studies have also found that it can be a useful screening tool for identifying depression that occurs during pregnancy — known as perinatal depression — as well as symptoms of anxiety.

One study found that an abbreviated three-question version of the scale that is known as the anxiety subscale of the EPDS can also be effectively used to screen for postpartum depression.

Some of the types of items included on the Edinburgh Postnatal Depression Scale focus on:

• Whether you have been able to laugh and focus on the bright side of things
• Whether feelings of unhappiness interfere with sleep
• Whether you have experienced thoughts of self-harm

For each item on the scale, women select the response that best matches how they have been feeling. Each item has four responses which are scored between a 0 and a 3. 

The cutoff score is usually a 12, although a score of 10 or higher and an affirmative response on the question pertaining to suicidal thoughts can be indicative of postpartum depression. An affirmative response on the question of whether an individual has experienced thoughts of self-harm, no matter the severity, is enough to warrant further evaluation and possible intervention.

It is also important to remember that a high score may not necessarily confirm that a person has depression, and some people may score below a 10 and still be exhibiting depressive symptoms that can interfere with well-being and functioning.

Mental health professionals must use their judgment to determine if a woman needs further mental health assessment and treatment for symptoms of depression.

Impact 

It is recommended that all women should complete the EPDS screening at least once during pregnancy and at least once after giving birth. 

While the scale can be found and utilized online, it is important to remember that only your doctor can diagnose postpartum depression. In order to do this, your doctor may administer a screening questionnaire such as the EPDS, talk to you about the symptoms that you have been experiencing, and conduct an exam and lab tests to check for medical conditions that might be playing a role in your symptoms.

While postnatal depression is quite common, many women do not talk to anyone about their symptoms. This is often because people feel embarrassed or guilty for having feelings of depression during a time that they assume they should feel happy.

Women may fear that they will be viewed as bad mothers. Because of the stigma still associated with these feelings, the use of screening tools such as the EPDS can help healthcare professionals identify women who may be in need of help.

Potential Concerns

There are some things that healthcare providers should watch for when administering the EPDS. These include:

• It is important for women to choose the responses that indicate how they have been feeling over the previous seven days.
• All items on the scale need to be completed.
• Women should complete the scale themselves (unless they are unable to for some reason).
• Women should avoid discussing the questions and their responses with other mothers who will also be completing the scale.

Mood fluctuations are very common both during and after pregnancy, but they can be particularly volatile during the first week after giving birth. Research suggests that between 60% to 80% of all new mothers experience symptoms of the postpartum blues—usually referred to as the "baby blues"—during the first week after having a baby. 

Symptoms of the baby blues include sudden changes in mood, unexplained crying, impatience, irritability, anxiety, loneliness, and feelings of vulnerability. While these feelings are often milder than postpartum depression and often resolve on their own, they can progress into more serious depression. 

These early mood fluctuations during the days after childbirth can complicate screenings. However, research also suggests that screening with the EPDS during the first week post-birth can be useful for identifying women who are more at risk of developing postpartum depression. One study found that women who score a 9 or greater on the Edinburgh Postnatal Depression Scale were 30 times more likely to have postpartum depression a month after giving birth.