The EPDS test explained: how to self-score your postpartum depression risk

You filled in a form at your health visitor appointment. Ten questions. Took about three minutes. She glanced at the score, said everything looked fine and moved on.

That form was the Edinburgh Postnatal Depression Scale, and it is the most widely used screening tool for postpartum depression in the world. It is also deeply misunderstood, by the women who take it and sometimes by the professionals who hand it out.

Knowing what the EPDS actually measures, where it falls short and how to read your own score gives you something valuable: the ability to advocate for yourself when a number on a page does not tell the whole story.

What is the EPDS?

The Edinburgh Postnatal Depression Scale is a 10-item self-report questionnaire developed in 1987 by Cox, Holden and Sagovsky. It was designed as a screening tool, not a diagnostic instrument. That distinction matters. A high EPDS score does not mean you have postpartum depression. It means you need further assessment. A low score does not mean you are fine. It means you did not flag on that particular day with that particular set of questions.

The original British validation study found that the EPDS correctly identified nine out of ten women who were later diagnosed with postnatal depression by a psychiatrist, with 86% sensitivity and 78% specificity.

It has since been translated into over 60 languages and used in more than 30 countries. It is free, brief and does not require clinical training to administer. That accessibility is both its greatest strength and a source of its limitations.

What the 10 questions cover

Each question asks how you have felt over the past seven days. You choose from four responses scored 0 to 3. The total score ranges from 0 to 30.

The final question, about self-harm, carries particular weight. Any score other than zero on that item should prompt an immediate, gentle conversation with a clinician, regardless of the total score.

How to read your score

Different cutoff points are used depending on the context. Here is what the research supports:

A 2025 validation study published in Midwifery confirmed that a cutoff of 11/12 achieves the best balance of sensitivity (75%) and specificity (87.6%) for detecting postnatal depression.

For community screening, where the goal is to catch as many cases as possible, a lower cutoff of 9/10 is often used. In clinical research, where specificity matters more, a cutoff of 12/13 is standard.

"Nine out of ten women who were diagnosed by a psychiatrist as being depressed after giving birth were correctly identified in a blinded comparison with scores above a cutoff on the EPDS." - Cox, Holden & Sagovsky (1987), original validation study

What the EPDS does well

The EPDS is good at what it was designed to do: quickly identify women who may be experiencing postnatal depression in busy clinical settings. It is short, non-invasive and acceptable to most women.

It is also one of the few validated screening tools that does not include physical symptoms like fatigue, appetite changes or sleep disruption, which are universal in the postpartum period and would inflate scores in almost every new mother.

That deliberate exclusion makes the EPDS more specific to depression than general health questionnaires.

What the EPDS misses

This is where it gets important. The EPDS was designed to screen for depression. It was not designed to detect:

• Postpartum anxiety as a standalone condition (though three items touch on anxiety, they are not sufficient for a full anxiety screen)
• Postpartum PTSD from a traumatic birth
• Perinatal OCD and intrusive thoughts
• Postpartum psychosis
• Bonding difficulties or attachment disruption

A woman can score 7 on the EPDS and still be experiencing severe birth-related PTSD, debilitating intrusive thoughts or crippling anxiety that the test simply was not built to capture.

If your score came back low but something still feels wrong, trust that feeling. You know your mind better than a 10-item form does. You can read about postpartum PTSD and perinatal OCD to see whether those descriptions fit your experience more closely.

The problem with question 10

The self-harm question reads: "The thought of harming myself has occurred to me." A 2024 study published in the Journal of Psychosomatic Obstetrics and Gynecology found that many women misinterpret this item, reading "harming myself" as referring to non-suicidal self-harm rather than suicidal thoughts. This means the question may overestimate suicidal ideation in some women and miss it in others who interpret it differently.

The study also found that the EPDS without item 10 (the EPDS-9) correlated near-perfectly with the full version (r = 0.998 in postpartum women), suggesting that the self-harm item adds limited screening value for depression while introducing interpretation problems.

This does not mean the question is unimportant. Any mention of self-harm deserves attention. But clinicians should follow up with a direct, compassionate conversation rather than relying on the score alone.

When to take the EPDS

The EPDS can be used at any point from late pregnancy through the first year postpartum. Research supports screening at multiple time points rather than a single check:

• Late pregnancy (baseline)
• Two to four weeks postpartum
• Six to eight weeks postpartum (commonly aligned with the postnatal check)
• Three to six months postpartum, when symptoms can emerge or worsen

If you were screened once at six weeks and felt fine, that does not guarantee you will feel fine at four months. Postpartum depression does not always arrive early. Our trimester-by-trimester guide to postpartum recovery explains why symptoms can surface much later than expected.

How to use this information

You can complete the EPDS yourself. The full questionnaire is freely available and takes under five minutes. But the result is a starting point, not an answer.

If your score is 9 or above, or if question 10 is anything other than zero, speak to your GP, midwife or a perinatal mental health professional. You can also read about which type of provider to see and what treatment options look like so you walk into that appointment with context.

If your score is low but you still feel off, say so. The EPDS is a useful filter. It is not the final word on how you are doing. Your experience matters more than a number.

Sources and further reading

• 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.
• Buhagiar, R. et al. (2025). Validation of the EPDS and GAD-7 for screening postpartum depression and anxiety in Malta. Midwifery. pubmed.ncbi.nlm.nih.gov
• Taylor & Francis. (2024). The screening accuracy of the EPDS to detect perinatal depression with and without the self-harm item. Journal of Psychosomatic Obstetrics & Gynecology. tandfonline.com
• NCBI Bookshelf. A systematic review of studies validating the EPDS in antepartum and postpartum women. ncbi.nlm.nih.gov
• PMC. Reliability and validity of the EPDS for detecting perinatal common mental disorders in low-income countries. pmc.ncbi.nlm.nih.gov
• Park, S.H. & Kim, J.I. (2023). Predictive validity of the EPDS and other tools for screening depression in pregnant and postpartum women. Archives of Gynecology and Obstetrics, 307(5), 1331-1345.