Introduction

The EPDS was developed over thirty years ago by JLC (transcultural/social psychiatrist), Jenifer Holden (psychologist and health visitor) and Ruth Sagovsky (part-time psychiatry trainee). Each of us knew at first hand about the mood disturbances that accompany childbirth. Each of us had clinical experience of the impact of perinatal depression on the family—and each of us had recognised that any screening scale must be acceptable to the mothers themselves and to the health professionals who administer it.

It is for these reasons that the EPDS is widely used in international clinical and research work, has been translated into over sixty languages, validated in most regions of the world and is recommended as a useful adjunct in the UK to the assessment of perinatal women.

Four of the papers published in this issue of the Journal illustrate the usefulness of the EPDS in an RCT of the effect of Motivational Interviewing on help seeking behaviour in Australia (Holt et al 2017), the caution required when interpreting cut off scores across cultural and language boundaries (Chiu et al. 2017), as well as the need for scholarly debate about its cut off scores—especially in the first week post-partum, when validity and reliability are uncertain (Matthey 2017, Merry 2017).

Sometimes the use of the EPDS in community and perinatal services, as well as in some published research, can be suboptimal—and occasionally dangerously misleading. It is for these reasons that a Ten Point Supplement to the Manual (Cox et al. 2014) was developed (Table 1).

Table 1 Optimal use of the EPDS: ten-point supplement to the published Manual (Cox et al. 2014)ᅟ
Full size table

Considering these recommendations will assist both clinicians and researchers at the outset of their work and (when supplemented by wider reading) will reduce the possibility of the EPDS being misused.

Epilogue

At first sight, it is a paradox that a self-report depression scale with a clinical pedigree has no items that tap directly the family relationships, is in no sense a check list of depressive symptoms, and converts a mood state into a numerical score. Yet, it is largely because of these deliberate omissions and its face and criterion validity that the EPDS has continued to be used widely thirty years after it was first published (Cox et al. 1987).

Elliott (1994), who with Jennifer Holden was a pioneer of Training the Trainers programmes, has aptly described the EPDS as ‘not a magic wand’. It is a useful adjunct to a clinical interview, a first stage screening instrument and also a conversation opener for a primary care worker trained in its use.

Within the context of a relationship based and existential biopsychosocial approach to research, public health and service delivery, the EPDS may remain useful for several decades to come.