Skip to main content
Log in

Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale – implications for clinical and research practice

  • Original contribution
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Summary

Objectives: i) To highlight the increasing use in the literature of unvalidated cut-off scores on the Edinburgh Depression Scale (EDS/EPDS), as well as different wording and formatting in the scale; ii) to investigate and discuss the possible impact of using an unvalidated cut-off score; iii) to highlight possible reasons for these ‘errors’; and iv) to make recommendations to clinicians and researchers who use the EDS/EPDS.

Method: A convenience sample of studies that have used unvalidated cut-off scores, or different formatting, are cited as evidence that these types of ‘errors’ are occurring fairly frequently. Examination of previous data from one of the authors is undertaken to determine the effect of using an unvalidated cut-off score.

Summary: Many studies report rates of high scorers on the EDS/EPDS using different cut-off scores to the validated ones. The effect of doing this on the overall rate can be substantial. The effect of using different formatting is not known, though excluding items from the EDS/EPDS must also make a substantial difference.

Recommendations: We recommend that i) the validated score of 13 or more is used when reporting on probable major depression in postnatal English-speaking women, and 15 or more when reporting on antenatal English-speaking women; ii) that the wording used is “13 or more” (or equivalent), and not other terms that may cause confusion (e.g., ‘>12’; ‘more than 12’; ‘13’ etc), iii) if a different cut-off score to the validated one is used, a clear explanation is given as to why this has been done; and iv) that the scale should be worded and formatted as originally described by its authors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • F Adouard NMC Glangeaud-Freudenthal B Golse (2005) ArticleTitleValidation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France Arch Womens Ment Health 8 89–95 Occurrence Handle15883653 Occurrence Handle1:STN:280:DC%2BD2M3pvFOhsg%3D%3D Occurrence Handle10.1007/s00737-005-0077-9

    Article  PubMed  CAS  Google Scholar 

  • OY Alkar T Gencoz (2005) ArticleTitleCritical factors associated with early postpartum depression among Turkish women Contemp Fam Therapy 27 263–275 Occurrence Handle10.1007/s10591-005-4043-5

    Article  Google Scholar 

  • H Allen (1999) ArticleTitle“How was it for you?” Debriefing for postnatal women: does it help? Prof Care Mother Child 9 77–79

    Google Scholar 

  • H Austerberry M Wiggins H Turner A Oakley (2004) ArticleTitleEvaluating social support and health visiting Comm Pract 77 460–464

    Google Scholar 

  • B Barnett P Glossop S Matthey H Stewart (2005) Screening in the context of integrated perinatal care C Henshaw S Elliott (Eds) Screening for perinatal depression Jessica Kingsley Publishers London 68–82

    Google Scholar 

  • JØ Berle TF Aarre A Mykletun AA Dahl F Holsten (2003) ArticleTitleScreening for postnatal depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression J Affect Disord 76 151–156 Occurrence Handle12943945 Occurrence Handle1:STN:280:DC%2BD3svgsFKntA%3D%3D Occurrence Handle10.1016/S0165-0327(02)00082-4

    Article  PubMed  CAS  Google Scholar 

  • P Boyce J Stubbs A Todd (1993) ArticleTitleEdinburgh Postnatal Depression Scale: Validation for an Australian sample Aust N Z J Psychiatry 27 472–476 Occurrence Handle8250792 Occurrence Handle1:STN:280:ByuD2s7ns1Q%3D

    PubMed  CAS  Google Scholar 

  • A Buist J Milgrom C Morse S Durkin (2004) ArticleTitleMetropolitan regional differences in primary health care of postnatal depression Aust J Adv Nurs 21 20–27

    Google Scholar 

  • JT Condon P Boyce CJ Corkindale (2004) ArticleTitleThe First-Time Fathers Study: a prospective study of the mental health and wellbeing of men during the transition to parenthood Aust N Z J Psychiatry 38 56–64 Occurrence Handle14731195 Occurrence Handle10.1111/j.1440-1614.2004.01298.x

    Article  PubMed  Google Scholar 

  • J Cox J Holden (Eds) (1994) Perinatal psychiatry: use and misuse of the Edinburgh Postnatal Depression Scale The Royal College of Psychiatrists Gaskell, London

    Google Scholar 

  • J Cox J Holden (2003a) Perinatal Mental Health: a guide to the Edinburgh Postnatal Depression Scale (EPDS) The Royal College of Psychiatrists Gaskell, London

    Google Scholar 

  • J Cox J Holden (2003b) ArticleTitleLetter to the Editor: Author’s reply to Matthey et al: The Edinburgh Postnatal Depression Scale Br J Psychiatry 182 368 Occurrence Handle10.1192/bjp.182.4.368

    Article  Google Scholar 

  • J Cox J Holden R Sagovsky (1987) ArticleTitleDetection of postnatal depression: development of the 10 item Edinburgh Postnatal Depression Scale Br J Psychiatry 150 782–786 Occurrence Handle3651732 Occurrence Handle1:STN:280:BieD3c7it1E%3D

    PubMed  CAS  Google Scholar 

  • J Cubison J Munro (2005) Acceptability of using a postnatal questionnaire derived from the EPDS as a screening tool for postnatal depression C Henshaw S Elliott (Eds) Screening for perinatal depression Kingsley London 152–161

    Google Scholar 

  • BR Davies S Howells M Jenkins (2003) ArticleTitleEarly detection and treatment of postnatal depression in primary care J Adv Nurs 44 248–255 Occurrence Handle14641394 Occurrence Handle10.1046/j.1365-2648.2003.02799.x

    Article  PubMed  Google Scholar 

  • L Davis H Edwards H Mohay J Wollin (2003) ArticleTitleThe impact of very premature birth on the psychological health of mothers Early Hum Devel 73 61–70 Occurrence Handle10.1016/S0378-3782(03)00073-2

    Article  Google Scholar 

  • L Davis H Edwards H Mohay J Wollin (2004) ArticleTitleThe course of depression in mothers of premature infants in hospital and at home Aust J Adv Nurs 21 20–25

    Google Scholar 

  • C de Tychey E Spitz S Briancon J Lighezzolo F Girvan A Rosati A Thockler S Vincent (2005) ArticleTitlePre- and postnatal depression and coping: a comparative approach J Affect Disord 85 323–326 Occurrence Handle15780702 Occurrence Handle10.1016/j.jad.2004.11.004

    Article  PubMed  Google Scholar 

  • SA Elliott AJ Rugg JP Watson DI Brough (1983) ArticleTitleMood changes during pregnancy and after the birth of a child Br J Clin Psychol 22 295–308 Occurrence Handle6640180

    PubMed  Google Scholar 

  • J Evans J Heron H Francombe S Oke J Golding InstitutionalAuthorNameon behalf of the Avon Longitudinal Study of Parents and Children Study Team (2001) ArticleTitleCohort study of depressed mood during pregnancy and after childbirth Br Med J 323 257–260 Occurrence Handle1:STN:280:DC%2BD3MvjvFOqtQ%3D%3D Occurrence Handle10.1136/bmj.323.7307.257

    Article  CAS  Google Scholar 

  • E Felice J Saliba V Grech J Cox (2006) ArticleTitleValidation of the Maltese version of the Edinburgh Postnatal Depression Scale Arch Womens Ment Health 9 75–80 Occurrence Handle16172837 Occurrence Handle1:STN:280:DC%2BD287ivVartA%3D%3D Occurrence Handle10.1007/s00737-005-0099-3

    Article  PubMed  CAS  Google Scholar 

  • MP Freeman R Wright M Watchman RA Wahl DJ Sisk L Fraleigh (2005) ArticleTitlePostpartum depression assessments at Well-Baby visits: screening feasibility, prevalence, and risk factors J Womens Health 14 929–935 Occurrence Handle10.1089/jwh.2005.14.929

    Article  Google Scholar 

  • J Gerrard JM Holden SA Elliott P McKenzie J McKenzie JL Cox (1993) ArticleTitleA trainer’s perspective of an innovative programme teaching health visitors about the detection, treatment and prevention of postnatal depression J Adv Nurs 18 1825–1832 Occurrence Handle8288829 Occurrence Handle1:STN:280:ByuC3Mjns1Q%3D Occurrence Handle10.1046/j.1365-2648.1993.18111825.x

    Article  PubMed  CAS  Google Scholar 

  • K Gibbon (2004) ArticleTitleDevelopments in perinatal mental health assessments Br J Midwifery 12 754–760

    Google Scholar 

  • JM Green D Murray (1994) The use of the Edinburgh Postnatal Depression Scale in research to explore the relationship between antenatal and postnatal dysphoria J Cox J Holden (Eds) Perinatal Psychiatry: use and misuse of the Edinburgh Postnatal Depression Scale The Royal College of Psychiatrists Gaskell, London 180–198

    Google Scholar 

  • NK Grote SE Bledsoe HA Swartz E Frank (2004) ArticleTitleFeasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: a pilot study Res Soc Work Pract 14 397–407 Occurrence Handle10.1177/1049731504265835

    Article  Google Scholar 

  • N Guedeney J Fermanian (1998) ArticleTitleValidation study of the French version of the Edinburgh Postnatal Depression Scale (EPDS): new results about use and psychometric properties Eur Psychiatry 13 83–89 Occurrence Handle10.1016/S0924-9338(98)80023-0

    Article  Google Scholar 

  • B Harris P Huckle R Thomas S Johns H Fung (1989) ArticleTitleThe use of rating scales to identify post-natal depression Br J Psychiatry 154 813–817 Occurrence Handle2597888 Occurrence Handle1:STN:280:By%2BD1cbot1E%3D Occurrence Handle10.1192/bjp.154.6.813

    Article  PubMed  CAS  Google Scholar 

  • J Heron TG O’Connor J Evans J Golding V Glover InstitutionalAuthorNamethe ALSPAC Study Team (2004) ArticleTitleThe course of anxiety and depression through pregnancy and the postpartum in a community sample J Affect Disord 80 65–73 Occurrence Handle15094259 Occurrence Handle10.1016/j.jad.2003.08.004

    Article  PubMed  Google Scholar 

  • J Holden (1994) Using the Edinburgh Postnatal Depression Scale in clinical practice J Cox J Holden (Eds) Perinatal Psychiatry: use and misuse of the Edinburgh Postnatal Depression Scale The Royal College of Psychiatrists Gaskell, London 125–144

    Google Scholar 

  • T Inandi OC Elci A Ozturk M Egri A Polat TK Sahin (2002) ArticleTitleRisk factors for depression in postnatal first year in eastern Turkey Int J Epidem 31 1201–1207 Occurrence Handle10.1093/ije/31.6.1201

    Article  Google Scholar 

  • DTS Lee SK Yip HFK Chiu TYS Leung KPM Chan IOL Chau HCM Leung TKH Chung (1998) ArticleTitleDetecting postnatal depression in Chinese women Br J Psychiatry 172 433–437 Occurrence Handle9747407 Occurrence Handle1:STN:280:DyaK1cvhvFGntg%3D%3D Occurrence Handle10.1192/bjp.172.5.433

    Article  PubMed  CAS  Google Scholar 

  • N Letourneau (2001) ArticleTitleImproving adolescent parent-infant interactions: a pilot study J Ped Nurs 16 53–62 Occurrence Handle1:STN:280:DC%2BD3M3gs1CnsA%3D%3D Occurrence Handle10.1053/jpdn.2001.20554

    Article  CAS  Google Scholar 

  • SSK Leung IM Martinson D Arthur (2005) ArticleTitlePostpartum depression and related psychosocial variables in Hong Kong Chinese women: findings from a prospective study Res Nurs Health 28 27–38 Occurrence Handle15625707 Occurrence Handle10.1002/nur.20053

    Article  PubMed  Google Scholar 

  • S Matthey B Barnett (1997) Translation and validation of the Edinburgh Postnatal Depression Scale into Vietnamese and Arabic B Ferguson D Barnes (Eds) Perspective on transcultural mental health Transcultural Mental Health Centre Sydney 77–84

    Google Scholar 

  • S Matthey B Barnett P Howie DJ Kavanagh (2003) ArticleTitleDiagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74 139–147 Occurrence Handle12706515 Occurrence Handle10.1016/S0165-0327(02)00012-5

    Article  PubMed  Google Scholar 

  • S Matthey BEW Barnett DJ Kavanagh P Howie (2001) ArticleTitleValidation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners J Affect Disord 64 175–183 Occurrence Handle11313084 Occurrence Handle1:STN:280:DC%2BD3MvitlWgsw%3D%3D Occurrence Handle10.1016/S0165-0327(00)00236-6

    Article  PubMed  CAS  Google Scholar 

  • S Matthey DJ Kavanagh P Howie B Barnett M Charles (2004) ArticleTitlePrevention of postnatal distress or depression: an evaluation of an intervention at preparation for parenthood classes J Affect Disord 79 113–126 Occurrence Handle15023486 Occurrence Handle10.1016/S0165-0327(02)00362-2

    Article  PubMed  Google Scholar 

  • S Misri X Kostaras D Fox D Kostaras (2000) ArticleTitleThe impact of partner support in the treatment of postpartum depression Can J Psychiatry 45 554–558 Occurrence Handle10986574 Occurrence Handle1:STN:280:DC%2BD3cvptlOjsg%3D%3D

    PubMed  CAS  Google Scholar 

  • D Murray JL Cox (1990) ArticleTitleScreening for depression during pregnancy with the Edinburgh Depression Scale (EPDS) J Reprod Infant Psychol 8 99–107

    Google Scholar 

  • L Murray AD Carothers (1990) ArticleTitleThe validation of the Edinburgh Post-natal Depression Scale on a community sample Br J Psychiatry 157 288–290 Occurrence Handle2224383 Occurrence Handle1:STN:280:By6D38fltlA%3D

    PubMed  CAS  Google Scholar 

  • M Muzik CM Klier KL Rosenblum A Holzinger W Umek H Katschnig (2000) ArticleTitleAre commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Acta Psychiatr Scand 102 71–73 Occurrence Handle10892613 Occurrence Handle1:STN:280:DC%2BD3M%2FjtF2qsQ%3D%3D Occurrence Handle10.1034/j.1600-0447.2000.102001071.x

    Article  PubMed  CAS  Google Scholar 

  • LM O’Brien EG Heycock M Hanna PW Jones JL Cox (2004) ArticleTitlePostnatal depression and faltering growth: a community study Pediatrics 113 1242–1247 Occurrence Handle15121936 Occurrence Handle10.1542/peds.113.5.1242

    Article  PubMed  Google Scholar 

  • MW O’Hara AM Swain (1996) ArticleTitleRates and risk of postpartum depression – a meta-analysis Int Rev Psychiatry 8 37–54

    Google Scholar 

  • K Onozawa RC Kumar D Adams C Dore V Glover (2003) ArticleTitleHigh EPDS scores in women from ethnic minorities living in London Arch Womens Ment Health 6 IssueIDSuppl 2 s51–s55 Occurrence Handle14615923 Occurrence Handle10.1007/s00737-003-0006-8

    Article  PubMed  Google Scholar 

  • LE Ross EM Sellers SEG Evans MK Romach (2004) ArticleTitleMood changes during pregnancy and the postpartum period: development of a biopsychosocial model Acta Psychiatr Scand 109 457–466 Occurrence Handle15117291 Occurrence Handle1:STN:280:DC%2BD2c3hvFaksQ%3D%3D Occurrence Handle10.1111/j.1600-0047.2004.00296.x

    Article  PubMed  CAS  Google Scholar 

  • Sanderson C (1995) Notes for Sheffield Health Visitors about screening for postnatal depression. Department of Community Paediatrics, Sheffield Children’s Hospital.

  • CA Sanderson B Cowden DMB Hall EM Taylor RG Carpenter JL Cox (2002) ArticleTitle“Is postnatal depression a risk factor for sudden infant death?” Br J Gen Pract 52 636–640 Occurrence Handle12171221 Occurrence Handle1:STN:280:DC%2BD38vhslagsg%3D%3D

    PubMed  CAS  Google Scholar 

  • R Small J Lumley J Yelland (2003) ArticleTitleHow useful is the concept of somatization in cross-cultural studies of maternal depression? A contribution from the Mothers in a New Country (MINC) study J Psychosom Obstet Gynecol 24 45–52 Occurrence Handle1:STN:280:DC%2BD3s7mvValug%3D%3D

    CAS  Google Scholar 

  • R Suri VK Burt LL Altshuler J Zuckerbrow-Miller L Fairbanks (2001) ArticleTitleFluoxamine for postpartum depression (letter to the Editor) Am J Psychiatry 158 1739–1740 Occurrence Handle11579021 Occurrence Handle1:STN:280:DC%2BD3MrjtF2lsw%3D%3D Occurrence Handle10.1176/appi.ajp.158.10.1739

    Article  PubMed  CAS  Google Scholar 

  • S Watt W Sword P Krueger D Sheehan (2002) ArticleTitleA cross-sectional study of early identification of postpartum depression: implications for primary care providers from The Ontario Mother and Infant Survey BMC Family Practice 3 5 Occurrence Handle11950393 Occurrence Handle10.1186/1471-2296-3-5

    Article  PubMed  Google Scholar 

  • B Wickberg CP Hwang (1996) ArticleTitleThe Edinburgh Postnatal Depression Scale: validation on a Swedish community sample Acta Psychiatr Scand 94 181–184 Occurrence Handle8891084 Occurrence Handle1:STN:280:ByiD2cnhs1Y%3D

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matthey, S., Henshaw, C., Elliott, S. et al. Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale – implications for clinical and research practice. Arch Womens Ment Health 9, 309–315 (2006). https://doi.org/10.1007/s00737-006-0152-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-006-0152-x

Navigation