Postpartum depression screening: when it happens, the EPDS, and what a score means

If you are thinking about hurting yourself or others, call or text 988 or chat at 988lifeline.org. You can also call 911 or the local emergency number or go to the hospital emergency room. (MedlinePlus)

What perinatal and postpartum depression are

Perinatal depression is depression during pregnancy and the postpartum period, the first 12 months after delivery. (USPSTF, 2023) Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1 to 3 weeks after childbirth. (ACOG FAQ) Besides feeling sad or losing interest in activities, symptoms in this period may include difficulty bonding with the baby, persistent doubt in parenting abilities, and thoughts of death, suicide, self-harm, or harm to the baby. (USPSTF, 2023)

The baby blues are mild, short-lasting mood changes and feelings of worry, unhappiness and exhaustion that many women have in the first 2 weeks after giving birth. Mood changes that are severe or last longer than 2 weeks may be signs of postpartum depression. (NIMH)

Who is screened, and when

• All adults, including pregnant and postpartum people (USPSTF): the USPSTF recommends depression screening (grade B, 2023). It found no evidence on the best frequency; a pragmatic approach might include screening adults who have not been screened before, using clinical judgment on risk factors and life events to decide on more screening, and ongoing assessment of risks that may develop during pregnancy and the postpartum period. (USPSTF, 2023)
• In pregnancy and at the postpartum visit (ACOG): as the USPSTF summarizes it, ACOG recommends screening at least once during the perinatal period for depression and anxiety symptoms with a standardized, validated tool, and a full assessment of mood and emotional well-being, including screening for postpartum depression and anxiety with a validated instrument, at the comprehensive postpartum visit. (USPSTF, 2023) ACOG's 2023 guideline covers screening and diagnosis of depression, anxiety, bipolar disorder, postpartum psychosis and suicidality during pregnancy and postpartum. (ACOG CPG 4, 2023)
• At the baby's checkups (AAP): the AAP says pediatric medical homes should set up a system for postpartum depression screening at the 1-, 2-, 4- and 6-month well-child visits. (AAP, 2019) The Bright Futures schedule lists maternal depression screening at the by-1-month, 2-month, 4-month and 6-month visits. (AAP Bright Futures, 2025)
• In the UK (NICE): at the first contact or booking visit and in the early postnatal period, consider asking 2 depression identification questions about feeling down, depressed or hopeless and about having little interest or pleasure in doing things. If the answer to either is yes, or there is clinical concern, consider the EPDS or PHQ-9 as part of a full assessment, or referral. At later contacts in pregnancy and the first year after birth, consider asking the questions again and using the EPDS or PHQ-9 as part of monitoring. (NICE CG192)

Risk factors the USPSTF lists for perinatal depression include life stress, low social support, a history of depression, marital or partner dissatisfaction, and a history of abuse. (USPSTF, 2023) Separately from screening, the USPSTF recommends that people at increased risk be provided or referred to counseling during pregnancy and after birth (grade B, 2019); a 2025 draft keeps grade B and is not final. (USPSTF, 2019)(USPSTF draft, 2025) Other checks during pregnancy: pregnancy screenings by week.

The Edinburgh Postnatal Depression Scale (EPDS)

The EPDS is a 10-item self-report scale developed to screen for postnatal depression in the community. It can be completed in about 5 minutes and has a simple method of scoring. (Cox et al., 1987) It is the most commonly used depression screening tool in perinatal care, (Levis et al., 2020) and the USPSTF names it among commonly used tools for pregnant and postpartum people. (USPSTF, 2023) This page does not reproduce the questions; your clinic gives you the form.

The PHQ-9 is also used. (NICE CG192) In the USPSTF evidence review, the accuracy of the EPDS was similar to that of the PHQ-2, with sensitivity from 81% to 90% and specificity from 83% to 88% at cut-offs of 11 and 12. (USPSTF, 2023) How PHQ-9 scores are read: depression screening: what to expect. For anxiety questionnaires: anxiety screening (GAD-7).

What EPDS cut-offs mean

A cut-off is the score at or above which a screen counts as positive and leads to a fuller assessment. The USPSTF does not specify an EPDS cut-off; 10 or higher and 13 or higher are the ones most often used. (Levis et al., 2020) A 2020 analysis of individual data from 58 studies (15,557 participants) compared EPDS scores with diagnostic interviews: (Levis et al., 2020)

Lower cut-offs could be used to avoid missing people; accuracy was similar in pregnancy and after birth, so the same cut-off can be used in both. (Levis et al., 2020) At 11 or higher, and where 5% to 25% of people have major depression, between 26% and 69% of positive screens were true depression, and between 93% and 99% of negative screens were truly negative. (Levis et al., 2020) Counting everyone above 10 or 13 overestimates how many people have depression compared with a diagnostic interview. (Levis et al., 2021) More on why screens give false positives: false positives and overdiagnosis.

Screening vs diagnosis: what happens next

A positive screen is followed by further evaluation to find out whether depression is present. (Levis et al., 2020) There is no single test to diagnose postpartum depression; diagnosis is based on the symptoms you describe, and your provider may order blood or urine tests to check for a physical illness causing depression. (MedlinePlus) A provider can determine whether symptoms are due to perinatal depression or something else. (NIMH) ACOG says to call your ob-gyn or another health care professional right away if you think you may have postpartum depression, or if your partner or family members are concerned that you do, and not to wait until your postpartum checkup. (ACOG FAQ)

Postpartum psychosis is different: it can bring delusions, hallucinations, mania, paranoia and confusion. NIMH calls it a psychiatric emergency and says to call 911 or go to the nearest emergency room. (NIMH) NICE advises being alert for it in the first 2 weeks after birth in people with past or present severe mental illness or a close family history of severe perinatal mental illness. (NICE CG192)

Where they differ:

• USPSTF (US, 2023): screen all adults, including pregnant and postpartum people (grade B); no set schedule, because there is no evidence on the best frequency; no EPDS cut-off specified. (USPSTF, 2023)(Levis et al., 2020)
• ACOG (US): at least once during the perinatal period with a validated tool, plus a full mood assessment at the comprehensive postpartum visit, as summarized by the USPSTF. (USPSTF, 2023)
• AAP (US, 2019): screen the parent at the baby's 1-, 2-, 4- and 6-month well-child visits, in the pediatric office. (AAP, 2019)(AAP Bright Futures, 2025)
• NICE (UK, 2014, updated 2020): starts with 2 depression identification questions and the GAD-2 for anxiety, and uses the EPDS or PHQ-9 as part of a full assessment or for monitoring, rather than as the first step. (NICE CG192)

Your doctor decides what your result means for you.

This page does not give treatment advice. If you have an abnormal result, see after an abnormal screening result.

Questions people ask

When is postpartum depression screening done?

The USPSTF recommends depression screening for adults, including pregnant and postpartum people, and found no evidence on the best frequency. ACOG recommends screening at least once during the perinatal period and a full mood assessment at the comprehensive postpartum visit. The AAP recommends screening parents at the baby's 1-, 2-, 4- and 6-month well-child visits. (USPSTF, 2023) (AAP, 2019)

What is the EPDS?

The Edinburgh Postnatal Depression Scale is a 10-item questionnaire you fill in yourself. It was built to screen for depression after birth, takes about 5 minutes and is simple to score. It is the most commonly used depression screening tool in perinatal care. (Cox et al., 1987) (Levis et al., 2020)

What EPDS score is positive?

There is no single agreed cut-off: the USPSTF does not specify one. Cut-offs of 10 or higher and 13 or higher are used most often. A large 2020 analysis found that 11 or higher gave the best balance of sensitivity and specificity. A positive screen leads to further evaluation, not a diagnosis. (Levis et al., 2020)

Is a high EPDS score a diagnosis of depression?

No. MedlinePlus says there is no single test to diagnose postpartum depression; diagnosis is based on the symptoms you describe to your provider. Studies also show EPDS scores above the common cut-offs count more people than a diagnostic interview finds. (MedlinePlus) (Levis et al., 2021)

How are the baby blues different from postpartum depression?

The baby blues are mild, short-lasting mood changes in the first 2 weeks after birth. Mood changes that are severe or last longer than 2 weeks may be signs of postpartum depression, which can start up to a year after birth. (NIMH) (ACOG FAQ)

Related

• Depression screening: what to expect and PHQ-9 scores
• Depression screening: who should be screened
• Anxiety screening (GAD-7)
• Pregnancy screenings by week
• Mental health and substance use screenings by age
• False positives and overdiagnosis
• After an abnormal screening result