Postpartum Depression Screening
Edinburgh Postnatal Depression Scale (EPDS) — Validated Worldwide by Healthcare Providers
Edinburgh Postnatal Depression Scale (EPDS)
Please select the answer that comes closest to how you have felt in the past 7 days, not just how you feel today.
Understanding Postpartum Depression
What Is Postpartum Depression?
Postpartum depression (PPD) is a serious mood disorder that affects parents after childbirth. It goes far beyond the commonly experienced "baby blues," which typically resolve within two weeks of delivery. PPD involves persistent feelings of sadness, anxiety, exhaustion, and hopelessness that can interfere with daily life and the ability to care for yourself and your baby.
Baby Blues vs. Postpartum Depression
The baby blues affect up to 80% of new mothers and typically involve mood swings, crying spells, anxiety, and difficulty sleeping. These symptoms usually begin within the first few days after delivery and resolve on their own within two weeks.
Postpartum depression is more intense and longer lasting. Symptoms may appear anytime during the first year after birth, though they most commonly emerge within the first few weeks to months. Unlike the baby blues, PPD does not go away on its own and requires attention and often treatment.
How Common Is PPD?
Approximately 1 in 7 new mothers experience postpartum depression. Some studies suggest the rate may be even higher when milder forms are included. PPD can also affect fathers and adoptive parents, though it is most commonly studied in birth mothers.
When Does PPD Develop?
PPD can develop at any point during the first year after childbirth. Some women experience symptoms during pregnancy (prenatal depression), while others may not notice symptoms until several months postpartum. Early screening and detection lead to better outcomes.
PPD Is NOT Your Fault
Postpartum depression is a medical condition caused by a combination of hormonal changes, physical recovery, sleep deprivation, and emotional adjustment. It is not a sign of weakness, a character flaw, or an indication that you are a bad parent. With proper support and treatment, recovery is expected.
Risk Factors for Postpartum Depression
While any new parent can develop PPD, certain factors may increase the likelihood. Having one or more risk factors does not mean you will develop PPD, and some people develop PPD without any known risk factors.
Mental Health History
- Previous episode of depression or anxiety
- Prior postpartum depression
- Family history of depression or mood disorders
- History of premenstrual dysphoric disorder (PMDD)
Hormonal & Physical Changes
- Rapid drop in estrogen and progesterone after delivery
- Thyroid hormone fluctuations
- Difficult pregnancy or delivery complications
- Physical recovery from birth (pain, exhaustion)
Sleep & Lifestyle
- Severe sleep deprivation
- Difficulty with breastfeeding
- Lack of exercise or poor nutrition
- Substance use
Social & Environmental
- Lack of partner or family support
- Relationship problems or domestic violence
- Financial stress
- Social isolation
- Unplanned or unwanted pregnancy
Stressful Life Events
- Recent loss of a loved one
- Job loss or major career changes
- Moving to a new location
- Baby with health issues or special needs
- NICU stay
Birth Complications
- Emergency cesarean section
- Premature birth
- Traumatic birth experience
- Neonatal loss or stillbirth history
Treatment Options for Postpartum Depression
Postpartum depression is highly treatable. Most parents who receive appropriate treatment experience significant improvement. Treatment is often a combination of approaches tailored to individual needs.
Psychotherapy (Talk Therapy)
Cognitive Behavioral Therapy (CBT) helps identify and change negative thought patterns and behaviors. It is one of the most studied and effective treatments for PPD.
Interpersonal Therapy (IPT) focuses on improving relationships and communication, which is particularly useful during the major life transition of new parenthood.
Medication
SSRIs (selective serotonin reuptake inhibitors) such as sertraline (Zoloft) are commonly prescribed and considered compatible with breastfeeding by many medical guidelines. Your healthcare provider can discuss the benefits and risks based on your specific situation.
Brexanolone (Zulresso) is an FDA-approved IV infusion specifically for postpartum depression in severe cases.
Support Groups
Connecting with other parents experiencing PPD can reduce feelings of isolation and provide practical coping strategies. Postpartum Support International (PSI) offers online and in-person support groups across the country.
Self-Care Strategies
- Prioritize sleep when possible (accept help with nighttime feedings)
- Gentle exercise such as walking with baby
- Maintain social connections, even briefly
- Set realistic expectations for yourself
- Accept offers of help from family and friends
Partner Involvement
A supportive partner is an important part of recovery. Partners can help by sharing childcare duties, encouraging treatment, attending appointments together, and offering emotional support without judgment.
A Note About Breastfeeding and Medication
Many parents worry about taking antidepressants while breastfeeding. Several SSRIs have been extensively studied and are considered compatible with breastfeeding by ACOG and the Academy of Breastfeeding Medicine. The risks of untreated depression often outweigh the minimal risks of medication. Always discuss your options with your healthcare provider.
Supporting a Partner with PPD
Signs to Watch For
- Persistent sadness, crying, or emotional numbness
- Withdrawal from the baby, you, or friends and family
- Difficulty sleeping even when the baby is sleeping
- Loss of interest in activities they previously enjoyed
- Expressing guilt, worthlessness, or feeling like a bad parent
- Significant changes in appetite or energy
- Excessive worry or anxiety about the baby
- Any mention of self-harm or not wanting to be alive
How to Help
- Listen without trying to fix or minimize their feelings
- Encourage them to talk to their healthcare provider
- Offer to attend appointments with them
- Take on additional household and childcare responsibilities
- Arrange for practical support (meals, cleaning, errands)
- Be patient — recovery takes time
- Educate yourself about PPD so you understand what they are experiencing
What NOT to Say
- "You should be happy — you just had a baby."
- "Just snap out of it."
- "Other mothers manage just fine."
- "It's just hormones, it will pass."
- "You're overreacting."
These statements minimize a real medical condition and can discourage someone from seeking help. Instead, validate their experience and express concern.
When to Encourage Professional Help
Encourage your partner to see a healthcare provider if symptoms persist beyond two weeks, interfere with daily functioning or bonding with the baby, or if they express thoughts of self-harm. If your partner is in crisis, call 988 or take them to the nearest emergency room.
Resources for Partners
- Postpartum Support International: postpartum.net — resources for partners and families
- PSI Helpline: 1-800-944-4773 (call or text)
- Dad's Support: PSI also offers support groups specifically for fathers and partners
Frequently Asked Questions
The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire developed in 1987 by Cox, Holden, and Sagovsky at the University of Edinburgh. It was specifically designed to screen for postpartum depression and has become the most widely used screening tool for this purpose worldwide. It can be completed in under 5 minutes and is used by obstetricians, midwives, pediatricians, and family physicians as part of routine postnatal care.
The EPDS has been extensively validated across dozens of studies and cultures. Using a cutoff score of 10 or higher, it has a sensitivity of approximately 86% and specificity of approximately 78% for detecting major depression. However, it is a screening tool, not a diagnostic instrument. A positive screen should always be followed by a thorough clinical evaluation by a qualified healthcare provider.
Yes. The EPDS has been validated for use during pregnancy as well as the postpartum period. Prenatal (antenatal) depression affects approximately 10-15% of pregnant women and is a significant risk factor for postpartum depression. ACOG recommends screening at least once during the perinatal period using a validated tool like the EPDS. Early detection during pregnancy allows for earlier intervention.
A total score of 9 or higher warrants a conversation with your healthcare provider. Scores of 12-13 indicate a fairly high possibility of depression, and scores above 13 suggest likely depression requiring professional evaluation. However, any score on question 10 other than "Never" should prompt immediate discussion with a healthcare provider or contact with a crisis resource, regardless of the total score.
Yes, postpartum depression is highly treatable. With appropriate care, most parents experience significant improvement. Treatment options include psychotherapy (particularly CBT and IPT), medication (SSRIs that are compatible with breastfeeding), support groups, and self-care strategies. The earlier treatment begins, the better the outcomes. Without treatment, PPD can persist for months or even years and can affect bonding with your baby, your relationships, and your overall health.
Postpartum depression can develop at any time during the first year after childbirth. While many cases emerge within the first few weeks to three months, some parents do not experience symptoms until 6 months or more after delivery. Some research suggests that symptoms can begin during pregnancy itself (perinatal depression). This is why ongoing awareness and screening throughout the postpartum period is important, not just at the six-week checkup.
Medical Disclaimer
This EPDS screening tool is provided for educational and informational purposes only. It is not a medical diagnosis and is not intended to replace professional medical advice, diagnosis, or treatment.
- The EPDS is a screening tool, not a diagnostic instrument. Only a qualified healthcare provider can diagnose postpartum depression or other perinatal mood disorders.
- A high score does not necessarily confirm depression, and a low score does not guarantee its absence.
- If you are experiencing distressing symptoms, please consult your obstetrician, midwife, primary care provider, or a mental health professional.
- If you are having thoughts of harming yourself or your baby, please contact 988 (Suicide & Crisis Lifeline), 1-800-944-4773 (Postpartum Support International), or go to your nearest emergency room.
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References
- Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry. 1987;150:782-786. PubMed
- ACOG Committee Opinion No. 757. Screening for Perinatal Depression. Obstetrics & Gynecology. 2018;132(5):e208-e212. PubMed
- O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annual Review of Clinical Psychology. 2013;9:379-407. PubMed
- Wisner KL, Sit DK, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013;70(5):490-498. PubMed
Edinburgh Postnatal Depression Scale (EPDS): J.L. Cox, J.M. Holden, R. Sagovsky. Department of Psychiatry, University of Edinburgh.