Edinburgh Postnatal Depression Scale (EPDS): Scoring & Interpretation Guide

The office of your doctor is silent. The nurse gives you a clipboard containing ten questions that are not very long. Just answer honestly, she says smiling. There are no wrong answers.” You look at the paper and are left wondering what you will know about yourself as a mother having answered it.

The Edinburgh Postnatal Depression Scale is on that clipboard and it is among the most popular screening instruments of postpartum depression in the world. Every year it is filled in by millions of new moms. However, the majority of them are unaware of how it is graded and what their scores mean.

This is a guide of taking you through each part of the EPDS. You will know all about what score each question measures, how many points you gain, what various ranges of scores indicate, and what your physician does with your scorecard. No surprises. No fear. Just clarity.

What Edinburgh Postnatal Depression Scale Is.

The EPDS isn’t a diagnosis. And that is the first thing you have to know. It is a screening device, and it implies that it assists physicians in identifying red flags. A good score does not put a stamp on you. It just lets your provider know that you may require a closer examination.

This scale was developed in Edinburgh, Scotland in the year 1987 by researchers John Cox, Jeni Holden, and Ruth Sagovsky. They created it in such a way that it was targeted at the new mothers since the ordinary version of the depression questionnaire did not reflect the true feelings of postpartum emotion. Such aspects as sleeplessness and changes in appetite are observed by any young mother, and thus the EPDS does not touch on any such physical symptoms.

Rather, the Edinburgh Postnatal Depression Scale is emotionally oriented. It enquires about guilt, sadness, anxiety, and whether you can find pleasure in your daily life. This recommendation has now been adopted by the American College of Obstetricians and Gynecologists that all new mothers are to be screened at least once in the course of the postpartum period. Most of the practices do it at the six-week check, but others do it sooner.

Knowledge of postpartum depression and its causes can help to make this whole process less frightening. The EPDS is merely a fragment of the puzzle that your physician provides to you.

An inspection of each of the 10 questions.

The majority of moms are anxious even prior to the questions. And now remove that mystery of mine. The EPDS deals with 10 distinct emotional domains, and each of them requests you to consider the last seven days. Not yesterday. Not the past month. Just the last seven days.

The following are the areas of interest of each question:

Question 1 and 2: Your Power to laugh and look forward.

The first one is whether you have been capable of laughing and finding the funny side of things. The second one inquires whether you have anticipated things with pleasure. These two questions are a test to determine if you are still able to experience pleasure and anticipation. When one loses that ability, doctors refer to it as anhedonia.

Question 3, 4 and 5: Guilt, Anxiety and Fear.

Question 3 inquires whether you have unnecessarily blamed yourself when things have gone wrong. Question 4 inquires whether one feels anxious or worried without a good reason. Question 5 goes further to ask whether you have been scared or panicky. These three questions combined will help design your anxiety and guilt levels which tend to skyrocket after childbirth.

Question 6 and 7:Feeling Overwhelmed.

Question 6 inquires whether or not things have been piling on you. Question 7 will enquire whether you have felt unhappy to the extent of having difficulty with sleeping, even when your baby is asleep. That second part is key. All new mothers are deprived of sleep due to the baby. However, it is a different thing to lose sleep due to your mind being too active.

Question 8 and 9: Sadness and Crying.

Question 8 would require you to determine whether you have been sad or miserable. Question 9 inquires whether you have been crying or not. These are face to face emotional check-ins. Most mothers underestimate such emotions as they believe that crying is hormonal. Sometimes it is. However, the EPDS assists in determining when it can be more.

Question 10: Self-harm Ideation.

This question will be whether you have had thoughts of self-harm. I shall go into it in great detail below since it has a particular weight in the interpretation of your results by your doctor.

How the Scoring System Works

This is where it is interesting. All the ten questions provide you with four options to answer them. These responses give 0, 1, 2 or 3 points. The overall score is possible to be between 0 and 30. So far, that sounds simple. However, there is a twist that is not known to many people.

The Reverse Scoring Trick

Questions 1 and 2 involve reverse scoring. It means that the answer that is most positive is rated at 0, and the answer that is most negative is rated at 3. However in questions 3 to 10, there is an inversion of the scoring. The initial answer is rated at 3, and the final answer is rated at 0. This is automatically taken care of by the scoring sheet of your doctor and you need not take care of this.

The presence of this reverse system is motivated by the fact that questions 1 and 2 were formulated in a positive manner. They inquire on laughing and anticipating things. The rest of the eight questions are phrased in the form of negativity. They query on blame, fear, sadness and panic. The scoring is modified in such a way that, regardless of the question, the higher the number, the more distress.

Adding It All Up

All the scores of the ten questions are summed up by your provider. Your overall score in EDPS is the last figure. The time required to take the test is less than five minutes, and the time to score is approximately thirty seconds. One reason is that it is so widespread in use. It is part of postnatal care in the United Kingdom and practices in the United States have also implemented it.

What Your Score Range Reality Checks.

Your overall score is within one of a range of scores. The level of concern in each range would be different. This is a simple inventory in case you can see where you are at.

The Cutoff Score Debate

The cutoff point used in most researches is 13. The fact that you scored 13 or more is a very strong indicator that you are dealing with a depression that must be addressed by a professional. The clinicians however utilize 10 as a cutoff point to diagnose milder forms at an earlier stage. This is why you will get different figures with various providers.

This is the thing that the majority of the articles will not tell you. Your score will be varying every week. Bad night, a stressful quarrel with your partner, even physical pains can temporarily increase your score. That is the reason why most doctors are fond of screening more than once before coming up with any conclusions. A single score on a single day does not make you to be mentally healthy.

When your score comes out to be 9 to 11, do not dismiss it. These borderline figures are usually indications of early postpartum depression that you cannot be complacent about. The sooner you are able to catch things, the better opportunity you have to be cured fast.

The reason that Question 10 should have a separate conversation.

The majority of scoring discussions consider ten questions as equal. But in the clinical practice, question 10 is different in reality. This question is related to the thoughts of self-harm, and your doctor is particularly attentive to it in spite of the overall score.

Although your total score may not be very high, a positive answer when answering question 10 would result in an immediate follow-up discussion. That your provider does not write it and go. They will talk to you right on the situation of the mood and gauge whether you require immediate assistance. It is normal procedure everywhere this tool is applied.

A lot of mothers are so scared to give this answer directly. They fear that someone will criticize them, get rid of their baby, or consider that they are incompetent. Be this as it may, be clear about this. The honesty of the answer will not make your baby be taken. This question is asked by healthcare providers as they are concerned with your safety. Honest response of you assists them to assist you.

Notable Well, in case you are experiencing thoughts of damaging yourself nowadays, then contact us immediately. Dial 988 Suicide and Crisis lifeline (call or text 988) or call Postpartum Support International helpline at 1-800-944-4773. You need to get the immediate support.

Self-harm thoughts do not mean that you are a bad mother. They imply that your brain is working under the giant pressure, and this is what can be assisted by a professional. To get the complete emotional picture, you should look at this list of postpartum depression signs and symptoms in its entirety.

By What and at What Time Does the Screening occur.

You may ask who is in the position to give you this questionnaire. The answer to this is in the affirmative and there are many providers who can do it. Any of your OB-GYN, midwife, family doctor, pediatrician, or postpartum nurse is able to screen you with the EPDS. Even some hospitals administer it prior to discharge following delivery.

Common Screening Timeline

It has no exact time to screen. However, the majority of the practices have a general pattern. The EPDS may be obtained at your two week follow up visit, your six week checkup, or when your baby is during his early childhood doctor visits. In fact, the American Academy of Pediatrics advises that pediatricians screen the mothers with depression on the baby during the well-child visits of the baby at the ages of 1, 2, 4, and 6 months.

The second one startles a lot of moms. The doctor that screens you may not be your doctor, but the doctor of your baby. This is due to the fact that pediatricians visit new mothers quite often throughout that first very important year. They are usually in an ideal position to observe change with time.

One Thing the Majority of the People are Unaware of.

Biological mothers are not the only ones who can take the EPDS. Partners can take it too. It is also found that fathers and other non-birthing parents are also not exempt when it comes to postpartum depression. According to a study that was published in JAMA Pediatrics, about 8 to 10 percent of new fathers exhibit depressive symptoms. The Edinburgh Postnatal Depression Scale has been verified to be valid when working with the fathers however the cutoff scores might be slightly different.

The screening does not only work once birth has occurred but also during pregnancy. Prenatal depression is not that rare as some may think. There are even providers who screen in the third trimester in order to identify issues even before the baby is born.

What happens really upon your calculation of your score.

This is the aspect which causes most anxiety. You answered the questions. The nurse added up your score. Now what? The follow-up process is something that can relieve you of a great burden.

If Your Score Is Low (0 to 8)

Your provider will most probably report that everything is good. They will urge you to be back in case any changes take place. You will be used to postpartum checkups. A poor score does not imply that you have to cease paying attention to your mental health, however. As the weeks go by things may change.

In case Your Score is Borderline (9 to 11).

During the same visit, your doctor is likely to question you on some follow-up questions. They would like to know what circumstances were behind your responses. Maybe you had a terrible week. Perhaps you are operating on two hours of sleep. They will probably have another screening in a couple of weeks to determine whether the score increases, decreases or remains the same.

Should Your Score also be High (12 and Above)?

A big score provides an entry into a further discussion. Your doctor will not simply tell you that you have a depression and send you home with your prescription. A complete clinical interview will be performed by them. They will enquire about your history, how you everyday operate, what kind of support you have and how you sleep. It is upon this critical assessment that they shall discuss with you options.

Those may be an option of therapy, medication, lifestyle changes, or a combination of all. This step-by-step tutorial to CBT in postpartum depression provides an exceptionally clear picture of what therapy would look like. And in case you should dive deeply into the subject, you may get acquainted with the top methods of treating postpartum depression to become more ready to discuss the topic.

The EPDS opens a door. It doesn’t close one. Regardless of your score, you are also given the option of deciding your further actions with your provider.

Fears and Myths That Keep Moms from Being Honest

Here is the unpleasant fact. The EPDS can only be effective when you give the right answers. And too many mothers don’t. The reason why they reduce their symptoms is that they fear what telling the truth may cost them. I would like to break some of the biggest myths that contribute to that fear.

Myth: Higher Score the Higher the Chance You Will lose Custody.

This fright makes so many moms silent. However, it is not its working of the system. The EPDS is a medical device, not a legal device. Your physician uses it to provide you with support and not to turn you in. Child protective services do not intervene since a mother has a high score in a depression screening. Providers are on your side.

Myth You Must Wait Till You Feel Like you are really bad.

Other moms do not tell the truth since they believe that their issues are not severe enough. They place themselves in worse contexts and conclude that they do not deserve help. However, it is always easier to intervene at the early stages than at the late stages. It is much easier to treat depression at the score of 10 as compared to at the score of 25. Knowing the maximum time that postpartum depression takes makes it clear that it is so much more important to act in time.

Myth: The Test Gives Your Personality to the Motherhood.

The questionnaire number does not tell anything about you liking your child. It does not mention your parenting ability. It will just give an emotional picture of one week. That’s it. You are not your score.

Pro Tip: In case of the fear of forgetting how you have been feeling, make a brief note in your phone daily in the week prior to your appointment. Only one line concerning your mood every day. This will assist you to give more correct answers and will provide your doctor with better things to deal with.

When You Have to Find Some Help Immediately.

Certain cases do not require time to screen or have follow-up appointment. In case any of the following occur to you, contact your doctor or visit your closest emergency room immediately.

In case you are experiencing continuous thoughts of self-harming or killing the baby, you are to seek immediate help. This is also true of hearing or seeing things that other people do not. The sense of total disconnection with reality, or the conviction that your baby would be happier without you is also an issue of immediate concern. This may be indicative of post partum psychosis or intense depression, which is treatable but requires urgent intervention.

You do not need a piece of paper to tell you what your gut is saying is true. When something does not seem right, have confidence in that. Just as any screening tool, your instincts are important. Use the helpline of the Postpartum Support International 1-800-944-4773 or text the message HELP to allow reaching a trained volunteer who understands what you are going through.

You aren’t being dramatic. You aren’t overreacting. You are saving your own and that is a real thing to do.

Frequently Asked Questions

Your Rating Is Only a Starting Point.

The following are the main points to take up under this guide:

• The ten-question screening tool is not a diagnosis but the EPDS. It only evaluates how you have been feeling in the seven days before.
• With a score of 13 and above, it reflects that you need to have a more in-depth discussion with your provider. A score between 9-12 should be given a follow-up screening.
• The question 10 concerning self-harm is always given special attention. Any reply above zero will result in automatic check-in regardless of your cumulative points.
• The only way this tool is able to assist you is through honesty. Your responses will not work against you. They’ll be used to support you.

Your single step action plan on the day: assuming you have not been screened yet and your baby is below the age of one year; ask your doctor or midwife about the EPDS next time you visit him/her. You may even make a call in advance and order it.

You were filled out that questionnaire in a drab doctor’s office; because somebody cared enough to inquire about how you were going. That matters. And whatever your reply, you should have help and encouragement and a straight road ahead.

This paper is informational and is not a substitute of professional medical advice. You can always consult your doctor or provider of health care.