EPDS Scoring and Interpretation: What Your Score Means

The short answer: The EPDS is a 10-question screening questionnaire about the past seven days, scored from 0 to 30. Many clinics treat a total around 10 or above as a reason for a follow-up conversation, and any answer other than "never" on question 10 (thoughts of harming yourself) as needing attention right away, whatever the total. It's a screening result, not a diagnosis; what it means for you comes from the conversation afterward.

The nurse handed you a clipboard at your six-week visit. Ten questions, a minute to fill out, and a number at the bottom nobody explained. Maybe they said "that's a little high" and moved on. Maybe they said nothing, and you went home and googled it, which is probably how you got here.

The Edinburgh Postnatal Depression Scale is the most common screening tool for postpartum depression, and I use it in my own practice. Here's what the number means, what it doesn't, and what to do with it.

What is the Edinburgh Postnatal Depression Scale (EPDS)?

The EPDS was published in 1987 by John Cox, Jenifer Holden and Ruth Sagovsky as a short self-report questionnaire for spotting postnatal depression in everyday community care. It was designed to take just a few minutes and to be simple to score (Cox et al., 1987).

You'll run into it in pregnancy as well as after birth, despite "postnatal" in the name:

• Your OB or midwife. ACOG recommends screening for depression and anxiety at the first prenatal visit, again later in pregnancy, and at postpartum visits, using a standardized, validated tool. The EPDS is one of the screeners on ACOG's perinatal mental health page (ACOG).
• Your baby's pediatrician. The American Academy of Pediatrics recommends that pediatric practices screen mothers for postpartum depression at the 1-, 2-, 4- and 6-month well-child visits (Earls et al., 2019). That's why someone at your baby's checkup may be asking about your mood.

What it measures: the 10 EPDS questions

The EPDS is ten questions about the past seven days: how often you've been able to laugh, whether you've blamed yourself unnecessarily, whether anxiety or sadness has kept you from sleeping, and so on. Each answer scores 0 to 3, so the total runs from 0 to 30. Higher means more symptoms reported.

It is a screening questionnaire, not a diagnosis. Its only job is to flag that someone should look more closely. It can't tell you what's wrong or what treatment you need, and it doesn't ask about everything that matters, like rage, intrusive thoughts, or feeling disconnected from your baby.

What the ten questions cover

I'm not going to reprint the questionnaire here (your provider's version is the one that counts), but in broad strokes the ten items cover:

Area	What it's getting at
Enjoyment	Whether you can still find things funny
Looking forward	Whether things still feel worth anticipating
Self-blame	Blaming yourself when things go wrong
Worry	Feeling anxious or worried without a clear reason
Fear or panic	Feeling scared or panicky
Overwhelm	Whether things are getting on top of you
Sleep	Unhappiness bad enough to affect your sleep
Sadness	Feeling sad or miserable
Crying	Being unhappy enough that you've been crying
Self-harm thoughts	Whether the thought of harming yourself has come up (question 10)

Notice what's missing: tiredness, appetite and broken sleep in general. Those are part of having a newborn for almost everyone, so the scale leans on mood instead.

How EPDS scoring works

Your provider adds up the ten answers. One detail trips people up: the answer options don't all run in the same direction. On some questions the first option scores 0, and on others it scores 3. So you can't work out your total by counting which column you circled, which is one more reason to go over it with whoever gave it to you.

Three of the items (the worry, fear and self-blame ones) tend to cluster together as an anxiety signal, and some clinicians look at that cluster separately (Matthey, 2008). That's one reason a "depression" score can come back raised when what you mostly feel is anxious. If that sounds like you, this post on depression vs. anxiety may help.

EPDS score interpretation: what the number means

Most clinics treat 10 or above as worth a follow-up conversation, and 13 or above as a stronger signal of probable depression. Different services use slightly different cutoffs; the Australian COPE guidelines, for example, describe 13 as the flag. Nobody should treat any of these as a wall between "fine" and "not fine."

Two things I say to every mom who brings me a score:

A lower number does not cancel your distress. Moms underscore constantly: because the question didn't quite fit, because they were embarrassed, because "I've been managing" felt like the right answer when it wasn't. If you scored a 7 and you feel awful, trust how you feel over the 7.

A higher number is information. It means "let's talk," and often it means "this is treatable and we're catching it early."

Why cutoffs vary

A cutoff is a trade-off, not a verdict. Set it lower and you catch more people who are struggling but flag more who turn out to be okay. Set it higher and the opposite happens.

A large 2020 analysis pooled individual data from 58 studies and more than 15,000 pregnant and postpartum women. It compared EPDS scores with diagnostic interviews and found that 11 or higher gave the best overall balance. A cutoff of 13 or higher missed more women who did meet criteria for depression, but flagged fewer who didn't (Levis et al., 2020, BMJ). In plain terms: at any cutoff, some people above the line aren't depressed and some people below it are. That's exactly why the number starts a conversation instead of ending one.

The scoring sheet ACOG links to (from the Lifeline for Moms program) counts 10 or higher, or any answer other than "never" on the last question, as a positive screen (ACOG).

Is there a "dishonesty factor" in EPDS scoring?

No. Standard EPDS scoring doesn't adjust for honesty. There's no hidden correction. The total is simply the sum of what you marked.

What people usually mean is underreporting, and that part is real. If you softened your answers because you were scared of what would happen, your score is probably lower than how you feel. You can go back and say, "I don't think I answered that honestly." That's a normal thing to tell a provider, and it's useful information.

Question 10 is different

The last question asks whether you've thought of harming yourself. Any answer other than "never" needs attention right away, whatever the total. ACOG's guidance is that a positive answer there should be assessed immediately, and I agree. If that's your situation and you can't keep yourself safe, call 911 or go to the nearest emergency room, or call or text 988. Don't wait for a routine appointment to talk about it.

Why does this one item override the total? Because your total can be low while this answer isn't, and the total can't tell anyone how safe you are right now. Answering it honestly doesn't automatically mean you'll be sent to the hospital. It means someone will check in with you right away. ACOG describes the follow-up as an assessment of how likely, how urgent and how serious the risk is, with a plan matched to what's actually going on (ACOG). That assessment decides the next step, not the checkbox on its own.

Question 10 asks about harming yourself. Unwanted, frightening thoughts about something happening to your baby are a different thing. They're common, and they're still worth talking about. I wrote about them in scary postpartum thoughts.

Screening vs. diagnosis

A screen asks, "Should someone look more closely?" A diagnosis comes from that closer look: a clinical conversation about how long this has been going on, how much it's affecting your days, your history, and what else might explain it. Researchers check the EPDS by comparing it with full diagnostic interviews (Levis et al., 2020), because the questionnaire alone can't make that call.

A raised score can also reflect anxiety, grief or a brutal week. A "positive" screen is a reason for an assessment, not a label you now carry.

What happens after an EPDS screening?

It depends on the setting, but ACOG's position is that screening should come with a real path to assessment, diagnosis, treatment and follow-up (ACOG). In practice that might be a longer conversation that day, a plan to repeat the screen in a few weeks, a referral to a therapist or psychiatrist, or a same-day safety check if question 10 came up. If your OB is the one reviewing it, this guide to talking with your OB/GYN has a script.

What to say at the follow-up

If someone reviews your score with you, these sentences help:

• "This covers the last week, but I've felt this way for a lot longer than that."
• "I marked a low answer on one of these because I was embarrassed. Can I explain it?"
• "I'm getting everything done, but it's taking everything I have."
• "What happens next, and who do I call if things change?"

If you took the questionnaire somewhere else, bring the result and the name of the form. If nobody has reviewed it with you at all, that's a gap in your care, and the score still deserves a look.

Can you retake the EPDS?

Yes. Providers often repeat it over time. It only covers the past seven days, so your score can move from one week to the next, and the original study found it picked up changes in severity over time (Cox et al., 1987). That's why ACOG and the AAP recommend screening at several points rather than once. A low score at six weeks doesn't rule out a hard stretch at four or eight months.

Over time

In treatment, I repeat the EPDS every so often as one data point among several. It's useful for seeing the trend. It's useless as a weekly report card, and I'll ask you not to use it that way. The things that tell me you're getting better are usually smaller and more human: you slept, you laughed at something, you went outside.

The EPDS for partners and dads

The EPDS has been studied in fathers too. In one Australian study of couples at six weeks postpartum, the score that best flagged depression or anxiety in fathers was lower than the one for mothers, and the dads in that study endorsed most items, crying especially, less often than mothers did (Matthey et al., 2001). So a partner's lower score can still deserve a conversation. Postpartum Support International notes that depression and anxiety symptoms in the first year affect dads as well as moms (PSI). More on that in postpartum depression in dads and partners.

Talking to me

A screening score is a reason to have a conversation. Please don't try to interpret it alone at midnight. If you'd like to talk, book a free 15-minute consultation and bring the number if you have it. You can also read about how I treat postpartum depression or what a first session is like.

I see clients in person in North Austin and virtually across Texas and many other states through PSYPACT. You can also read more about postpartum depression support.

You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.

If you need help right now

• National Maternal Mental Health Hotline, free and 24/7: call or text 1-833-852-6262
• Suicide and crisis support: call or text 988
• If you can't keep yourself safe, call 911 or go to the nearest emergency room
• Information and referrals (not an emergency line): the PSI HelpLine, 1-800-944-4773

Sources

1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 1987. PubMed
2. American College of Obstetricians and Gynecologists. Perinatal Mental Health: Screening and Diagnosis (patient screening tools and scoring sheets). acog.org
3. Levis B, et al. Accuracy of the EPDS for screening to detect major depression among pregnant and postpartum women: systematic review and individual participant data meta-analysis. BMJ, 2020. PubMed
4. Earls MF, et al.; American Academy of Pediatrics. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics, 2019. PubMed
5. Matthey S, et al. Validation of the EPDS for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 2001 (PubMed); and Matthey S. Using the EPDS to screen for anxiety disorders. Depression and Anxiety, 2008 (PubMed).
6. Postpartum Support International. Perinatal depression. postpartum.net