Screening

Edinburgh Postnatal Depression Scale Form

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Edinburgh Postnatal Depression Scale Form

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Patient Name
Jane Martinez
Date of Screening
03/15/1985
Baby's Date of Birth
03/15/1985
Able to Laugh and See Funny Side
Option A
Option B
Option C
Looked Forward to Things with Enjoyment
Option A
Option B
Option C
Blamed Self Unnecessarily
Option A
Option B
Option C
Anxious or Worried for No Good Reason
Option A
Option B
Option C
Felt Scared or Panicky
Option A
Option B
Option C
Things Have Been Getting on Top of Me
Option A
Option B
Option C
Difficulty Sleeping Due to Unhappiness
Option A
Option B
Option C
Felt Sad or Miserable
Option A
Option B
Option C
Thought of Harming Self
Option A
Option B
Option C
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The Edinburgh Postnatal Depression Scale (EPDS) Form is a widely validated 10-item self-report questionnaire designed to screen for postnatal depression in women during the postpartum period. Unlike general depression scales, the EPDS was specifically developed to exclude somatic symptoms common in the normal postpartum experience, such as fatigue and sleep disruption, focusing instead on the cognitive and emotional aspects of depression including anxiety, anhedonia, self-blame, and suicidal ideation.

Each item is scored on a four-point scale based on how the mother has felt during the past seven days. The form includes a total score calculation with established clinical thresholds that guide provider decision-making. A score of 10 or above indicates possible depression warranting further clinical assessment, while the presence of any positive response on the self-harm question triggers an immediate safety flag for urgent follow-up.

Recommended by ACOG and the AAP for universal perinatal mood screening, this form is essential for OB/GYN practices, midwifery clinics, pediatric offices (during newborn visits), postpartum home visit programs, and maternal mental health services. Early detection through EPDS screening enables timely treatment that benefits both maternal well-being and infant bonding and development.

What's included

  • Complete 10-item EPDS standardized questionnaire
  • Four-point response scale for each screening item
  • Total score calculation with clinical threshold guidance
  • Self-harm question with immediate safety flag protocol
  • Baby's birth date and postpartum timing documentation
  • Provider assessment and referral recommendation section

Who uses this template

  • Postpartum depression screening at OB/GYN follow-up visits
  • Perinatal mood assessment during pediatric newborn visits
  • Maternal mental health screening in midwifery practices
  • Home visit postpartum wellness evaluation programs

All form fields

12 fields across 1 page. Customize any field after signing up.

Patient NameText
Date of ScreeningDate
Baby's Date of BirthDate
Able to Laugh and See Funny SideMultiple Choice
Looked Forward to Things with EnjoymentMultiple Choice
Blamed Self UnnecessarilyMultiple Choice
Anxious or Worried for No Good ReasonMultiple Choice
Felt Scared or PanickyMultiple Choice
Things Have Been Getting on Top of MeMultiple Choice
Difficulty Sleeping Due to UnhappinessMultiple Choice
Felt Sad or MiserableMultiple Choice
Thought of Harming SelfMultiple Choice
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