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Assessment

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used and consistently recommended screening tool for postpartum depression (PPD).1-5 A valid and reliable self-report measure, the EPDS has a sensitivity of 86% and a specificity of 78% when a cutoff score of 10 or above is used.2, 6-8 Administering and scoring the EPDS is relatively simple,1, 9 and requires only basic familiarity with the instrument.7 The ten-question instrument is available in 23 languages,7 with an English version of the EPDS offered through the American Academy of Pediatrics’ web site. This version includes instructions on administering and scoring the EPDS.

Assessment Algorithm

Administer EPDS. If score <10: discuss results with mother, provide psycho-education about PPD; re-test in 4-6 weeks. If score is ≥10: discuss results with mother, provide psycho-education about PPD; conduct clinical interview to confirm PPD; discuss needs and treatment options. If question #10 score >0: Assess suicide risk, refer to crisis services if risk is high.

Assessment for PPD involves specific steps based on EPDS scores.

As is evident from the assessment algorithm above, specific steps follow administration and interpretation of the EPDS.2, 3 First, all women who are administered the EPDS may benefit from a discussion of the results and information about PPD.2, 3, 10 Second, regardless of the total EPDS score, endorsement of the self-harm question (item #10) necessitates immediate suicide assessment and referral.1-3 Next, if women score 10 or above, a clinical interview is necessary to confirm that symptoms of PPD meet DSM-IV-TR diagnostic criteria.2-4, 7 Finally, diagnostic decisions require the exclusion of a Differential Diagnosis, such as anemia or other Types of Postpartum Mood and Anxiety Disorders such as Postpartum Psychosis.1, 2

References

  1. Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Postpartum depression. The New England Journal of Medicine, 347(3), 194-199. doi: 10.1056/NEJMcp011542
  2. Neiman, S., Carter, S., Van Sell, S., & Kindred, C. (2010). Best practice guidelines for the nurse practitioner regarding screening, prevention, and management of postpartum depression. Critical Care Nursing Quarterly, 33(3), 212-218. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010713332&site=ehost-live&scope=site
  3. Registered Nurses’ Association of Ontario (2005). Nursing best practice guideline: Interventions for postpartum depression. Retrieved from http://www.rnao.org/Storage/11/600_BPG_Post_Partum_Depression.pdf
  4. Scottish Intercollegiate Guidelines Network. (2002). Postnatal depression and puerperal psychosis: A national clinical guideline. Retrieved from http://www.sign.ac.uk/pdf/sign60.pdf
  5. Boyd, R. C., Le, H. N., & Somberg, R. (2005). Review of screening instruments for postpartum depression. Archives of Women’s Mental Health, 8(3), 141-153. doi: 10.1007/s00737-005-0096-6
  6. Cox, J. L., Holden, J. M., Sagovsky, R., Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Edinburgh postnatal depression scale. British Journal of Psychiatry, 150, 782-786. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=hpi&AN=HaPI-310317&site=ehost-live&scope=site
  7. Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh postnatal depression scale (EPDS). London, UK: Gaskell. 
  8. Schumacher, M., & Zubaran, C. (2008). Screening tools for postpartum depression: Validity and cultural dimensions. International Journal of Psychiatric Nursing Research, 14(1), 1752-1765. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010258397&site=ehost-live&scope=site
  9. Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the edinburgh postnatal depression scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119(5), 350-364. doi: 10.1111/j.1600-0447.2009.01363.x
  10. American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. doi: 10.1542/peds.2010-2348

Last Updated July 24, 2011