EPDS Scoring: Edinburgh Postnatal Depression Scale Scorer and Guide

The EPDS has no official severity bands. The scoring guidance published with the scale says a score of 10 or more indicates the likelihood of depression but not its severity, and that the score is designed to assist, not replace, clinical judgment.

A 2020 individual participant data meta-analysis in the BMJ notes that cut-offs of 10 or higher and 13 or higher are most often used. Against semi-structured interviews, 11 or higher maximized combined sensitivity and specificity, while 13 or higher was less sensitive but more specific. The authors say lower cut-offs could be used if the intention is to avoid false negatives. Use the cut-off your service has adopted, and name it in the note.

Item 10 asks about thoughts of self-harm. The guidance published with the scale says that if any number other than 0 is picked for item 10, further assessment is required right away. Because item 10 is reverse scored, go by the score, not by where the mark sits on the page. The scorer flags item 10 as soon as it scores above 0, whatever the total.

When it is positive, complete and document a suicide risk assessment under your setting's protocol and record the item 10 score on its own line. See how to document a C-SSRS screen for the structure, and where needed, build a safety plan with the client. This page does not set out a triage procedure.

Because the scale is copyrighted and its terms require permission to republish it, the scorer does not show the items or the responses. On a completed form each item has four printed responses. For each item, choose which one was marked, counting from the top, and the scorer applies the published key: on items 1, 2 and 4 the first response scores 0 and the fourth scores 3, and on items 3 and 5 to 10 the order is reversed. Each choice shows the points it is worth, so you can check the key against your copy.

Once all ten items are answered, the scorer shows the total out of 30, which of the two most common cut-offs it reaches, and a sentence to paste into the note. It is deterministic, it runs in your browser, and nothing you enter is sent, stored or tracked. If your copy prints the responses in a different order or already shows item scores, score from that copy instead. It is a screening aid, not a diagnosis.

The guidance published with the scale says the score should not override clinical judgment and that a careful clinical assessment should be carried out to confirm the diagnosis. It also says the scale will not detect anxiety neuroses, phobias or personality disorder. The score describes the past 7 days, and the guidance says that in doubtful cases the scale may be usefully repeated after 2 weeks.

The 1987 paper reports that the scale was sensitive to change in the severity of depression over time, so repeated administrations can show a trend. Record each total with its date, and use a depression measure your setting has adopted for ongoing tracking. For diagnosis codes once you have made a diagnosis, see the depression diagnosis code guide.

The EPDS is copyright of the Royal College of Psychiatrists. Older copies, including the one the New Jersey Department of Health publishes, say users may reproduce the scale without further permission provided they quote the authors, the title and the source of the 1987 paper.

Later terms from the College, as quoted in the CamCOPS documentation (2013), say individual researchers or clinicians may photocopy the scale for their own use without seeking permission, that it must be copied in full with the source acknowledged, and that written permission must be obtained from the College for copying and distribution to others or for republication in print, online or by any other medium. The College's EPDS manual (2nd edition, 2014) includes the original scale and a score sheet. Because online republication needs written permission, WellNotes does not reproduce the items or responses, and the scorer uses topic labels and response positions only. Confirm the current terms with the Royal College of Psychiatrists.