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Understanding EPDS Scoring: A Complete Guide for New Parents
What your score really means—and what happens next
Your doctor hands you a clipboard with a simple questionnaire. Ten questions. Each one asks how you've been feeling over the past week—about sleep, anxiety, sadness, even thoughts of harming yourself.
You stare at the questions, wondering: What do I say? What's the "right" answer? What happens if I'm honest?
If you've received this questionnaire—or are about to—you've encountered the Edinburgh Postnatal Depression Scale (EPDS), one of the most widely used screening tools for postpartum depression worldwide.
And you probably have questions:
- What do the scores actually mean?
- Is a high score a diagnosis?
- What happens if I screen "positive"?
- Why is my pediatrician asking about MY mood at my baby's checkup?
This guide answers all of it.
What You'll Learn:
- Exactly how EPDS scoring works (it's simpler than you think)
- What different score ranges mean—and what they don't
- Why anxiety questions are included
- What happens after you complete the screening
- How partners and fathers can be screened too
- Answers to the most common questions and concerns
Most importantly: screening positive is not a diagnosis. It's an invitation for support. And understanding the process can help remove some of the fear and stigma around it.
What Is the EPDS?
The Edinburgh Postnatal Depression Scale is a 10-question screening tool designed specifically for detecting depression during pregnancy and after birth.
It was developed in 1987 by Scottish researchers who recognized that existing depression screening tools missed many mothers. Why? Because symptoms like fatigue, appetite changes, and sleep disruption—hallmarks of depression in general—are also completely normal parts of having a newborn.
So they created something different.
What Makes EPDS Unique
Unlike general depression screenings, the EPDS:
- Focuses on emotional symptoms (sadness, anxiety, guilt, hopelessness) rather than physical symptoms that overlap with normal postpartum experiences
- Includes anxiety questions—recognizing that postpartum anxiety is just as common as depression and often occurs together
- Uses simple, non-clinical language that anyone can understand
- Takes less than 5 minutes to complete
- Can be administered by anyone—your OB/GYN, midwife, pediatrician, or even self-administered at home
Important: The EPDS isn't a diagnostic tool. It's a conversation starter. A high score doesn't mean you have postpartum depression—it means you deserve a closer look and support.
How EPDS Scoring Works
Understanding how the EPDS is scored can take away some of the mystery (and anxiety) around completing it.
The Basics
- 10 questions total
- Each question scored 0-3 based on how often you've experienced the symptom in the past 7 days
- Maximum possible score: 30
- Higher scores = more symptoms
How Questions Are Scored
Most questions follow this pattern:
- 0 = "No, not at all" or "As much as I always could"
- 1 = "Not quite so much now" or "Only occasionally"
- 2 = "Definitely not so much now" or "Yes, quite often"
- 3 = "Hardly at all" or "Yes, most of the time"
Reverse-Scored Questions
Some questions are "reverse-scored"—meaning the top answer scores 3 instead of 0. This includes questions about positive feelings like enjoyment, laughter, and looking forward to things.
Example - Question 1:
"I have been able to laugh and see the funny side of things"
- "As much as I always could" = 0
- "Not quite so much now" = 1
- "Definitely not so much now" = 2
- "Hardly at all" = 3
What the EPDS Asks About
The 10 questions cover:
1. Enjoyment — Can you still laugh?
2. Looking forward — Do you anticipate with enjoyment?
3. Self-blame — Unnecessary guilt?
4. Anxiety — Worried for no good reason?
5. Fear/panic — Scared or panicky?
6. Overwhelm — Things getting on top of you?
7. Sleep difficulty — Unhappy and can't sleep?
8. Sadness — Feeling sad or miserable?
9. Crying — So unhappy you've been crying?
10. Self-harm thoughts — Thoughts of harming yourself?
Important about Question 10: If you answer anything other than "never," your provider should follow up right away—not to judge you, but to make sure you're safe and to offer support.
What Your EPDS Score Means
Here's where things get clearer—and hopefully less scary.
Score Interpretation Ranges
| Score | What It Suggests | Typical Next Steps |
|---|---|---|
| 0-9 | Minimal distress; symptoms unlikely to interfere with daily functioning | Continue regular monitoring; rescreen if symptoms persist or worsen |
| 10-12 | Symptoms present that warrant attention; may indicate mild depression or significant anxiety | Repeat EPDS in 2-4 weeks; discuss concerns with provider; consider supportive resources |
| 13+ | Likely depressive illness of varying severity | Clinical evaluation recommended within 48 hours; discuss treatment options |
Important Caveats
A score is not a diagnosis.
The EPDS identifies mothers who may benefit from further evaluation. A score of 13 doesn't mean you "have" postpartum depression—it means a clinical interview is needed to confirm or rule out a diagnosis.
Conversely, a low score doesn't guarantee everything is fine. Some mothers minimize symptoms, answer based on how they think they "should" feel, or complete the screening on a rare "good day."
Cultural and individual factors matter. Research shows that optimal cutoff scores may vary across cultures and populations. Some providers use a cutoff of 10 (more sensitive, catches more cases) while others use 13 (more specific, fewer false positives). Your provider should use clinical judgment alongside your score—not treat the number as absolute.
Severity Spectrum
For those who score above threshold, severity generally breaks down as:
- 10-12: Possible mild depression or significant distress
- 13-14: Probable mild to moderate depression
- 15-19: Moderate depression
- 20-30: Severe depression
Higher scores correlate with greater symptom severity—but individual experiences vary widely. Some mothers with scores of 12 are barely functioning, while others with scores of 16 are managing reasonably well. The number matters less than your lived experience.
Why the EPDS Includes Anxiety Questions
Many mothers are surprised to find questions about worry, fear, and panic on a "depression" screening. There's a good reason.
Postpartum Anxiety Is Extremely Common
Research shows that postpartum anxiety affects up to 15-20% of new mothers—roughly the same rate as postpartum depression. And the two conditions frequently occur together.
Symptoms of Postpartum Anxiety:
- Constant worry (about baby's health, your parenting, everything)
- Racing thoughts that won't stop
- Difficulty relaxing even when baby is safe and sleeping
- Physical symptoms: heart pounding, difficulty breathing, dizziness
- Intrusive thoughts (unwanted, disturbing images or ideas)
- Hypervigilance—unable to let anyone else care for baby
- Sleep difficulty even when baby is sleeping
Why This Matters for Screening
Many traditional depression screenings (like the PHQ-9) focus primarily on depressive symptoms—low mood, anhedonia, fatigue. They can miss mothers whose primary struggle is anxiety.
The EPDS specifically includes items 3, 4, and 5 to capture:
- Anxious/worried feelings for no good reason
- Feeling scared or panicky
- Things getting on top of you (overwhelm)
By including these items, the EPDS catches mothers who might otherwise fall through the cracks.
What if anxiety is your main concern? If your EPDS score is elevated primarily due to anxiety questions—but you don't feel "depressed"—that's still important information. Postpartum anxiety is treatable. Your provider should discuss anxiety-specific treatment options with you.
When and Where You'll Be Screened
The EPDS can be administered at multiple points in your perinatal journey—and by different types of providers.
Common Screening Touchpoints
During Pregnancy
- Initial prenatal visit
- Second or third trimester
Prenatal screening is increasingly common because perinatal depression is a significant risk factor for postpartum depression.
After Birth
- Hospital stay (increasingly common before discharge)
- 2-week postpartum visit
- 6-week postpartum checkup
- Any postpartum OB/GYN appointment
At Pediatric Visits (Yes, Really!)
- Baby's well-child checkups (2 weeks, 1 month, 2 months, etc.)
Pediatricians see new mothers more frequently than OB/GYNs in the early months—and maternal mental health directly affects infant development.
Who Can Administer the EPDS?
The EPDS requires minimal training to administer. You might receive it from:
- OB/GYN or midwife (most common)
- Pediatrician (increasingly standard)
- Nurse or medical assistant (may hand you the form)
- Mental health provider (as part of intake or progress monitoring)
- Self-administered (at home, to bring to an appointment)
Note: While the person who hands you the form doesn't need special training, the person who interprets your score and decides next steps should be clinically qualified.
How Often Should You Be Screened?
The American College of Obstetricians and Gynecologists (ACOG) recommends screening at least once during pregnancy and at the postpartum visit. The American Academy of Pediatrics recommends screening at the 1, 2, 4, and 6-month well-child visits.
But screening can—and should—happen anytime you or your provider has concerns. If you were screened at 2 weeks and felt fine, but you're struggling at 4 months, ask to be screened again.
Postpartum depression can emerge at any point in the first year. Late-onset cases are just as real and deserve attention.
What Happens After a Positive Screen
This is the question that creates the most anxiety: What happens if I score high?
The short answer: You get support, not judgment.
Immediate Steps (In the Same Visit)
1. Question 10 Review (Self-Harm)
If you answered anything other than "never" to question 10 (thoughts of harming yourself), your provider will ask follow-up questions to assess safety, determine if thoughts are passive vs. active, and create a safety plan if needed. This is not about getting in trouble—it's about making sure you're safe.
2. Clinical Interview
Your provider will ask more questions about your symptoms: How long have you been feeling this way? How are you functioning day-to-day? Do you have support at home? Have you experienced depression before? This conversation—combined with your EPDS score—helps determine next steps.
3. Discussion of Options
Based on your symptoms and severity, your provider may recommend:
- Watchful waiting (for borderline scores): Rescreen in 2-4 weeks
- Referral to mental health provider: Therapy for mild-moderate symptoms
- Medication discussion: For moderate-severe symptoms
- Support groups: Peer support alongside treatment
- Practical resources: Help with sleep, childcare, household support
You have agency in this conversation. You can share your preferences, ask questions, and be part of the decision.
Treatment Pathways
If you're referred for treatment, typical pathways include:
Therapy
Often Cognitive Behavioral Therapy (CBT) or Interpersonal Therapy (IPT). Usually 12-16 weekly sessions. Can be done in person or via telehealth. Read more about CBT for PPD →
Medication
Usually SSRIs (like Zoloft or Lexapro). Most are safe while breastfeeding. Takes 2-4 weeks to feel effects. Read more about PPD medication →
Combined Treatment
For moderate-severe PPD, therapy + medication together is often most effective. 75-85% of women improve with combined treatment.
What Screening Is NOT
Let's address fears directly. Screening positive will NOT:
- Result in your baby being taken away
- Be reported to anyone without your consent (unless there's imminent danger)
- Mean you're "crazy" or a bad mother
- Be held against you in custody disputes
- Appear on your "permanent record" in any meaningful way
Screening positive means the healthcare system is working—identifying mothers who need support and connecting them with help.
Partners Can Be Screened Too
Postpartum depression doesn't only affect birthing parents. Partners—fathers, co-mothers, adoptive parents—also experience elevated rates of depression after a baby arrives.
The Statistics on Partner Depression
- 10-25% of new fathers experience paternal postpartum depression
- Risk is highest in the first 3-6 months after baby's arrival
- Partners of mothers with PPD have significantly higher risk—up to 50% in some studies
- Same-sex partners and adoptive parents experience similar rates
Why Partner Mental Health Matters
Parental depression affects the whole family:
- Increased marital/relationship conflict
- Reduced parenting engagement
- Negative impact on child development
- Higher rates of behavioral problems in children
When both parents are struggling, the family system is under tremendous strain. Screening and treating partner depression benefits everyone.
EPDS for Partners: Different Cutoffs
The EPDS can be used for partners/fathers with a lower cutoff score:
| Score | Interpretation for Partners |
|---|---|
| 0-4 | Unlikely depression |
| 5-9 | Some symptoms; may benefit from support |
| 10+ | Significant symptoms; evaluation recommended |
The lower threshold (5-6 vs. 10-13) reflects that men tend to underreport depressive symptoms and may express depression differently (irritability, anger, withdrawal, overwork).
Signs of Partner/Paternal Depression
Beyond EPDS scores, watch for:
- Withdrawal from baby and family
- Increased irritability or anger
- Working excessive hours (avoiding home)
- Substance use increases
- Loss of interest in activities they used to enjoy
- Feeling like a "failure" or inadequate parent
- Physical complaints (headaches, stomach issues)
Encouraging Partners to Get Screened
- Normalize it: "A lot of new dads/partners feel overwhelmed. There's even screening for it now."
- Make it easy: Many providers will screen partners at well-child visits if asked
- Model vulnerability: If you've been screened, share your experience
Treatment works just as well for partners as it does for birthing parents. Therapy, medication, and support groups are all effective options.
Common Questions About EPDS
"Is the EPDS a diagnosis?"
No. The EPDS is a screening tool, not a diagnostic instrument. A high score indicates you may have postpartum depression and warrants further evaluation—but the diagnosis itself requires a clinical interview with a qualified provider.
"Can I take the EPDS at home?"
Yes. The EPDS is freely available and you can complete it yourself. However, interpreting your score and deciding on next steps should involve a healthcare provider. If you're curious about your symptoms, taking the EPDS at home can help you prepare for a conversation with your doctor.
"What if I answered honestly and scored high?"
Good. That's exactly what the screening is for. Answering honestly—even when it feels scary—gets you access to help you deserve. A high score isn't a failure; it's the first step toward feeling better.
"Is my screening confidential?"
Yes. Your EPDS results are part of your medical record and protected by HIPAA. They cannot be shared without your consent, except in rare cases involving imminent danger. Results are not routinely shared with employers, insurance companies, family members, or child protective services.
"Why wasn't I screened?"
Unfortunately, universal screening isn't yet standard everywhere. If you weren't offered screening, you can ask your OB/GYN to administer the EPDS, complete it yourself and bring it to your appointment, or request screening at your baby's pediatric visits. Advocating for your own mental health care is valid and important.
"What if I screened fine earlier but I'm struggling now?"
Request rescreening. Postpartum depression can emerge at any point in the first year. If you screened negative at your 6-week checkup but feel something is wrong now, don't assume you "passed" and can't seek help. Tell your provider your symptoms have changed.
"Will this affect custody of my child?"
Seeking help for mental health does not put you at risk for losing custody. In fact, the opposite is true: untreated, severe mental illness that impairs parenting is more concerning to courts than a mother who recognizes she needs support and gets treatment. Completing an EPDS, scoring positive, and entering treatment demonstrates responsible parenting—not failure.
Bloom's Approach to Postpartum Screening
At Bloom Psychology, we believe screening should feel supportive, not scary.
What to Expect
Before Your First Session: You'll complete the EPDS (along with other intake questionnaires). This gives us a starting point—not a label.
During Your Session: We discuss your score in context. How long have symptoms been present? What's contributing to how you're feeling? What does your support system look like? What are your goals and preferences for treatment?
Throughout Treatment: We may readminister the EPDS periodically to track progress. Watching your score decrease over time can be incredibly motivating.
Our Philosophy
- Screening is a beginning, not an ending. A high score opens the door to support.
- Your experience matters more than the number. Two mothers with identical scores may have very different needs.
- Honesty is safe here. Whatever you're feeling—however dark—can be shared without judgment.
- Treatment works. The vast majority of mothers who engage in treatment for postpartum depression improve significantly.
Next Steps
If you've read this far, you're already taking your mental health seriously. Here's what you can do next:
If You Haven't Been Screened:
- Ask your OB/GYN or pediatrician to administer the EPDS
- Or complete it yourself and bring it to your next appointment
If You've Screened Positive:
- Know that this is the first step toward feeling better
- Follow up with recommended next steps from your provider
- Consider reaching out to a maternal mental health specialist
If You're Struggling But Haven't Reached Out Yet:
- You deserve support—symptoms of PPD are treatable
- Reaching out is a sign of strength, not weakness
- Help is available
Ready to Take the Next Step?
If you're in Texas and struggling with postpartum depression or anxiety, Dr. Jana Rundle offers specialized therapy using evidence-based approaches.
Phone: (512) 648-2722
Email: contact@bloompsychology.com
Virtual appointments available throughout Texas
Related Resources
On the Bloom Blog:
- The Complete Guide to CBT for Postpartum Depression →
- PPD Medication: Side Effects and What to Expect →
- How to Talk to Your OB/GYN About Postpartum Depression →
- PPD Timeline: When It Starts and How Long It Lasts →
External Resources:
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Dr. Jana Rundle
Clinical Psychologist