Perinatal Mental Health: A Guide to the Edinburgh Postnatal Depression Scale

By John Cox and Jeni Holden
Published by Gaskell, June 2003


The Edinburgh Postnatal Depression Scale (EPDS) was designed by the authors as a simple means of screening for postnatal depression in health care settings. It can also be used by researchers seeking information on factors that influence the emotional well-being of new mothers and their families.

The scale has appeared in a number of languages and 20 of these translations are included here, together with the original English version.

This handbook is about the use of the EPDS and is designed for health professionals and researchers.

- Practical guide to using the EPDS.
- Using the EPDS for research.
- Background on postnatal depression and origins of the EPDS.
- Discussion of transcultural issues.
- Includes the EPDS in the definitive English version and in 20 other languages.


1. Postnatal Depression: An Overview

- Introduction
- Other Postnatal Psychiatric Disorders
- Women's Narratives
- Effects on Interactions with Infants
- Persistence of Effects on Children of Mothers with Depression
- Fathers and Postnatal Depression
- Clinical Perspectives
- Identifying Postnatal Depression
- Confirmation of the Diagnosis
- Causes
- Caring for Women with Postnatal Depression

2. The Origins and Development of the Edinburgh Postnatal Depression Scale

- Existing Scales
- Validating the Edinburgh Postnatal Depression Scale
- Reliability
- Comparison with Other Scales
- Other Uses of the EPDS

3. International and Cultural Issues

- Translation
- Validation

4. Using the Edinburgh Postnatal Depression Scale in Clinical Settings:  Research Evidence

- Routine Postnatal Screening
- Detection of Depression
- Acceptability of the EPDS
- Legitimising Feeling
- Antenatal Research and the EPDS
- Should the EPDS be Used as a Routine Screen in Pregnancy?
- Other Antenatal Prediction Measures
- Identifying Pregnant Women at Risk of Developing Puerperal Psychosis
- Conclusions from EPDS Screening Research

5. Counselling and Other Psychotherapeutic Intervention in Perinatal Depression

- The Edinburgh Counselling Intervention
- Outline of the Study
- What We Discovered
- Setting up the Study
- Training the Health Visitors
- Problems
- Extending Research Findings into Clinical Practice
- What We Learned from the Three-Centre Trial: Relevance to Clinical Practice
- The Cambridge Intervention Trials
- Health Visitor Counselling in Sweden
- Comparing Antidepressant Therapy and Cognitive Counselling
- Interpersonal Psychotherapy
- Telephone Counselling
- Group Interventions in Postnatal Depression
- Psychotherapy, Cognitive Therapy and Couple Counselling
- Massage and Support Groups
- Health - Visitor - Led Support / Therapy Groups
- Day Hospital Care
- Antenatal Interventions
- Antenatal Support and Information Groups
- Other Ways of Helping During the Perinatal Period
- Liaison with Other Agencies
- Partners and the Extended Family

6. Edinburgh Postnatal Depression Scale Screening and Intervention Services

- The Steering Committee
- A Shared Framework of Understanding
- Health Professionals' Knowledge
- The Role of Nurses in Postnatal Depression
- The Need for Clearly Indentified Referral Systems
- The Need for Specialist Psychiatric Services
- Implications of Scores on Item 10, Self-Harm
- Training and Support
- Counselling Training
- Conclusions

7. Using the Edinburgh Postnatal Depression Scale

- How to Use the EPDS
- Using the EPDS in Research
- Using the EPDS in Clinical Practice
- Honesty of Women's Responses
- What if Someone does not Wish to Complete an EPDS?
- When, Where and How Should the EPDS be Given?
- Using the EPDS with non-English Speakers
- Conclusions

Appendix 1. The Edinburgh Postnatal Depression Scale

Appendix 2. Translations of the Edinburgh Postnatal Depression Scale

- Arabic
- Chinese (Mandarin)
- Czech
- Dutch
- French
- German
- Greek
- Hebrew
- Hindi
- Icelandic
- Japanese
- Maltese
- Norwegian
- Portuguese
- Punjabi
- Slovenian
- Spanish
- Swedish
- Urdu
- Vietnamese



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