How this instrument works
Cox, Holden, and Sagovsky published the scale in 1987 after developing and testing it on 84 mothers, aiming for something short enough for routine use in a health visitor's or midwife's appointment. Several of the ten items are printed in reverse order on the original paper questionnaire — meaning the most-concerning answer isn't always the last option on the printed page — but every item's underlying score still runs 0 to 3 once correctly coded, which is what this calculator sums directly. The maximum total is 30.
Two different cutoffs are in real use, and they answer slightly different questions. The traditional threshold from the 1987 validation study is 13 or higher, where a score of 12/13 identified the mothers with a probable depressive illness at 86 percent sensitivity and 78 percent specificity. A lower threshold of 10 or higher has become common in contemporary screening programs, trading some specificity for sensitivity — catching milder or earlier presentations that a cutoff of 13 would miss, at the cost of more follow-up conversations that turn out not to be needed. Neither is simply 'more correct'; they serve different purposes, screening versus confirming.
Item 10 asks about thoughts of self-harm, and it stands apart from the other nine. Any answer above zero on that single item — even alongside an otherwise low total — calls for a prompt clinical conversation and safety assessment on its own. A total of 6, comfortably below both screening cutoffs, does not cancel out a nonzero answer on item 10; the two pieces of information are read separately, not blended into one figure that could quietly hide the more urgent one.
- Answer each of items 1 through 9 based on how the respondent has felt over the past 7 days, using the already-coded 0-3 scale for each.
- Answer item 10 (thoughts of self-harm) with the same care as the rest — this single item is read on its own regardless of the total.
- Read the total (0-30) alongside both the 10-point and 13-point screening thresholds.
Worked example — mixed moderate answers across all ten items
Answers of 1, 1, 2, 2, 1, 2, 2, 1, 1, and 0 across the ten items. Summed: 1+1+2+2+1+2+2+1+1+0 = 13.
A total of 13 lands exactly on the traditional 1987 cutoff, the threshold most strongly associated with a probable depressive illness in the original validation. It also clears the more sensitive contemporary threshold of 10. Because item 10 was answered 0 in this example, there's no separate safety flag here — but if that single answer had been 1, 2, or 3 instead, it would call for a prompt follow-up conversation regardless of where the total of 13 landed.
Questions
What score on the EPDS counts as 'positive'?
It depends which threshold a program uses. The original 1987 study validated 13 or higher as the cutoff most strongly tied to a probable depressive illness, at 86 percent sensitivity and 78 percent specificity. Many contemporary screening programs use a lower threshold of 10 or higher instead, trading some specificity for a better chance of catching milder or earlier symptoms.
What should happen if someone answers anything other than zero on item 10?
It calls for a prompt clinical conversation and safety assessment, on its own, regardless of the total score. Item 10 asks about thoughts of self-harm, and a low total elsewhere does not override a concerning answer here — this is the one part of the scale that isn't meant to be averaged away into a single number.
Why are some items reverse-scored on the printed questionnaire?
To reduce the chance that someone just answers straight down a column without reading each question, which is a known source of bad data on self-report scales. On the original paper form, the most-concerning response sits in a different position for those items — but the underlying score for every item still runs 0 to 3 once correctly coded, and that's the number this calculator adds.
How was the original scale developed?
Cox, Holden, and Sagovsky developed and tested it on 84 mothers in Edinburgh and Livingston, Scotland, publishing the ten-item result in the British Journal of Psychiatry in 1987. It was built specifically to focus on the cognitive and emotional symptoms of depression rather than physical ones like fatigue or appetite change, since those overlap heavily with normal postpartum recovery.
Does a high EPDS score mean a formal diagnosis of depression?
No — it's a screening result, not a diagnosis. A high total indicates a probable case that warrants a clinical follow-up conversation and, typically, a structured diagnostic interview; some people who screen positive won't meet full diagnostic criteria on closer assessment, and the scale itself was never intended to stand in for that assessment.
Can the EPDS be used during pregnancy, not just after birth?
Yes — despite the name, later validation work found the scale performs comparably well as a screening tool during pregnancy, and many perinatal programs now use it at multiple points across both pregnancy and the postpartum period rather than only after delivery.
References
Read this first: This instrument computes a screening figure from population formulas — it is not a diagnosis, and it cannot see the whole picture a clinician can. Use it to inform a conversation, not to replace one.