To score the Edinburgh Postnatal Depression Scale (EPDS), add its 10 items, each rated 0 to 3, for a total of 0 to 30. Under Australia's 2023 perinatal guideline, 13 or more calls for further assessment, 10 to 12 for a repeat in two to four weeks, and any positive item 10 answer for immediate assessment.
The EPDS is a screening tool, not a diagnosis. The scoring takes a minute; the judgement around it is where most of the documentation and risk sits. This guide covers both, using the Australian guideline as the reference point rather than the cut-offs you will see quoted on US sites.
How do you score the EPDS?
The EPDS was developed by Cox, Holden and Sagovsky (1987) to screen for postnatal depression in the community. The respondent answers 10 statements about how they have felt over the past seven days, not just today. Each item has four response options scored 0 to 3.
The scoring direction is not the same for every item, which is the most common source of hand-scoring errors. On the standard printed form (COPE scoring guide):
- Items 1, 2 and 4 score 0, 1, 2, 3 from the top response down.
- Items 3 and 5 to 10 score 3, 2, 1, 0 from the top response down.
Add the 10 item scores for a total between 0 and 30. Higher scores mean more symptoms.
Two practical points. First, record the item 10 response separately from the total, because it triggers its own action regardless of the total (see below). Second, use the scale exactly as published. Matthey and colleagues (2006) highlighted studies using different wording and formatting, warned that excluding items must make a substantial difference to results, and recommended that the scale be worded and formatted as its authors described. A shortened or reworded EPDS is no longer the instrument the cut-offs were validated on.
What does an EPDS score mean?
The EPDS has no official mild, moderate or severe bands. What Australian practice uses instead are action thresholds from Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline (2023), developed by the Centre of Perinatal Excellence (COPE):
- 13 or more: arrange further assessment (evidence-based recommendation 2, graded strong).
- 10 to 12: monitor and repeat the EPDS in two to four weeks, as the score may change. The 2023 revision added "use clinical judgement in planning monitoring and further care" (consensus recommendation vi).
- Any score above 0 on item 10: immediate further mental health assessment (consensus recommendation iii).
COPE's practitioner guidance on the EPDS adds a timing distinction for scores of 13 or more. In pregnancy, repeat the EPDS in two to four weeks in line with clinical judgement, and refer (ideally to the woman's usual GP) if the second score is also 13 or more. After the birth, arrange referral or ongoing care.
Below 10, the guideline sets no score-based action, but COPE is explicit that a low score can coexist with depressive symptoms, and a very high score can reflect a crisis, another mental health problem or unresolved trauma. Language, fear of what happens if depression is identified, and stigma all shift scores.
Why do sources quote different EPDS cut-offs?
You will see 10, 11, 12, 13 and 15 all described as "the" EPDS cut-off. They answer different questions.
The largest accuracy study is an individual participant data meta-analysis by Levis and colleagues (2020, BMJ), covering 15,557 pregnant and postpartum participants. Against semi-structured diagnostic interviews:
- 10 or more: sensitivity 0.85, specificity 0.84
- 11 or more: sensitivity 0.81, specificity 0.88 (the best combined accuracy)
- 13 or more: sensitivity 0.66, specificity 0.95
So the Australian 13-or-more threshold is the specific end of the trade-off. On those figures it misses roughly a third of people who meet criteria for major depression at interview, which is exactly why the 10 to 12 "repeat in two to four weeks" rule matters. A score of 11 or 12 is not a clear result; it is a reason to look again.
Matthey and colleagues (2006) recommended 13 or more for probable major depression in English-speaking postnatal women and 15 or more in pregnancy, and asked that cut-offs be written as "13 or more" rather than ">12" to avoid confusion. If your service uses a different threshold, write down which one and why.
What should you do when EPDS item 10 is positive?
Item 10 reads "The thought of harming myself has occurred to me". Any response other than "Never" (a score of 1, 2 or 3) is positive, whatever the total.
The guideline asks for immediate further mental health assessment and, if suicidal ideation is disclosed, urgent action under local protocol. COPE's guidance also asks clinicians to assess the safety of the woman and any children in her care, which is a step a general adult risk assessment can skip.
Document what you asked, what was disclosed, protective factors, the safety plan and who was contacted. Our guide to documenting a suicide risk assessment covers the record itself.
Can the EPDS screen for anxiety?
Partly. Items 3, 4 and 5 (self-blame, anxiety or worry, feeling scared or panicky) tend to cluster on an anxiety factor, often called the EPDS-3A, scored 0 to 9. In an Australian sample at six weeks postpartum, Matthey (2008) found the optimum EPDS-3A cut-off for women was 6 or more, and 4 or more for men (noting the factor structure may differ for men).
The 2023 guideline keeps anxiety in the broader clinical assessment and recommends using anxiety items from the EPDS or other validated tools alongside structured psychosocial assessment such as the Antenatal Risk Questionnaire (ANRQ). If depression is not the main presentation, a dedicated measure such as the GAD-7 gives more detail.
What EPDS cut-off should you use for fathers and partners?
Lower than for mothers. The 2023 guideline added recommendations for non-birthing parents: offer mental health screening as early as practicable in pregnancy and three to six months after the birth, and, when using the EPDS with male parents, use a cut-off of 10 or more, noting responses to individual items.
The guideline is candid about the evidence: seven studies, all low or very low quality, only one Australian, and no consensus on the right cut-off. That Australian study, Matthey and colleagues (2001), found fathers endorsed seven of the ten items less often than their partners (most markedly the crying item), and that a 5/6 cut-off was optimal for detecting depression or anxiety caseness. The two numbers screen for different things, so state which you used.
When should the EPDS be given?
COPE's guidance is that every woman completes the EPDS at least once, preferably twice, in pregnancy and again after the birth, ideally six to twelve weeks postpartum. The guideline pairs it with a psychosocial assessment as early as possible in pregnancy.
Explain beforehand that it is not a diagnosis and that it covers the past seven days. For Aboriginal and Torres Strait Islander women and those from culturally and linguistically diverse backgrounds, COPE notes that scores used to identify possible depression are generally lower, and translations developed in consultation with Aboriginal communities have identified slightly more women with depressive symptoms than the English form.
Can you use the EPDS for a Mental Health Treatment Plan?
Yes, but read the MBS rules carefully. The MBS descriptor for GP Mental Health Treatment Plans leaves the outcome tool to clinical discretion, but the only examples it names are the K10 and DASS 21. At review it requires re-administration of the outcome measurement tool used in the assessment stage.
So if a GP referred a postnatal client with a K10 or DASS-21 score, keep collecting that measure for the review and run the EPDS alongside it for perinatal tracking. Our guide to Mental Health Treatment Plan referrals covers the rest of the referral rules.
Is the EPDS free to use?
For clinical use, yes. The guideline's administrative report describes the EPDS as "a free tool for use in clinical and research settings". COPE's version carries the full Cox, Holden and Sagovsky (1987) citation with "Reproduced with permission". Keep that citation on any copy you use, and do not alter the wording or layout.
How should you record EPDS results in clinical notes?
A useful EPDS entry lets the next clinician act without rescoring the form. Record:
- Date, total score and the cut-off you applied (and why, if not 13 or more).
- Perinatal timepoint, for example 28 weeks pregnant or 8 weeks postpartum.
- Item 10 response and the action taken, even when it is 0.
- EPDS-3A subscore if anxiety is in question.
- Language version used and any interpretation concerns.
- The plan: repeat date, referral, or treatment change.
Repeated scores are only useful if they sit together. PractaLuma is AI-native practice management software for Australian mental-health practices, and its standardised assessments feature keeps results with the client record so you can review repeated scores alongside your notes. See features and pricing.
Frequently asked questions
What is a normal EPDS score?
There is no "normal" range. Scores below 10 attract no score-based action under the Australian guideline, but a low score does not rule out depression if the clinical picture says otherwise.
What does an EPDS score of 12 mean?
It sits in the 10 to 12 range: monitor and repeat the EPDS in two to four weeks, using clinical judgement. At a cut-off of 11, the most accurate threshold in the BMJ meta-analysis, a 12 would screen positive.
What does an EPDS score of 13 mean?
It meets the Australian threshold for further assessment. In pregnancy COPE suggests repeating the EPDS in two to four weeks and referring if it stays at 13 or more; after the birth, arrange referral or ongoing care.
Is the EPDS a diagnostic test?
No. It screens for possible depression over the past seven days. Diagnosis needs a clinical assessment against DSM or ICD criteria.
Can the EPDS be used outside the perinatal period?
It has been, but its cut-offs were validated in perinatal samples. For general adult depression screening, the PHQ-9 is the more common choice.
This article is general information for health professionals, not clinical advice. Always apply clinical judgement and local protocols.