Edinburgh Postnatal Depression Scale (EPDS)

1. Abstract

The Edinburgh Postnatal Depression Scale (EPDS) is a globally established, 10-item self-report screening questionnaire engineered specifically to identify symptoms of perinatal mood disturbance, particularly postpartum depression and antenatal depression. Developed in 1987 by John L. Cox, Jenneifer M. Holden, and Ruth Sagovsky in Edinburgh and Livingston, Scotland, the instrument was conceived to address the profound psychometric limitations of generic depression inventories—such as the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS)—when deployed within perinatal populations. Conventional depressive inventories heavily evaluate somatic and neurovegetative criteria, including sleep fragmentation, appetite shifts, fatigue, and energy depletion. In postpartum populations, these neurovegetative presentations represent normative physiological adjustments secondary to the physiological demands of lactation, sleep disruption, and infant caregiving, yielding unacceptably elevated rates of false-positive classifications. The EPDS circumvents these somatic confounds by operationalizing psychological, cognitive, and affective symptoms of distress: anhedonia, blameworthiness, cognitive anxiety, panic, overwhelming affective burden, profound sadness, weeping, and self-injurious ideation.

Administered via a 4-point Likert scale (scored 0 to 3 per item), the total EPDS score ranges from 0 to 30. Extensive psychometric validation demonstrates robust internal consistency (Cronbach’s α typically spanning 0.82 to 0.88; McDonald’s ω > 0.85) and high split-half reliability (0.88). Criterion validity investigations utilizing standardized diagnostic interviews, such as the Research Diagnostic Criteria (RDC) and Structured Clinical Interview for DSM Disorders (SCID), show optimal clinical cut-off scores between 9/10 for community screening and 12/13 for clinical referral, yielding sensitivity rates between 80% and 90% and specificity rates between 78% and 95%. Although originally conceptualized as a unidimensional instrument, modern exploratory and confirmatory factor analyses repeatedly validate multidimensional latent structures, notably three-factor models isolating Depression, Anxiety (EPDS-3A), and Anhedonia dimensions. Validated in more than 60 languages, the EPDS remains the international reference standard for maternal mental health surveillance in both obstetric and primary care settings.

2. Keywords

Edinburgh Postnatal Depression Scale, EPDS, perinatal depression, postpartum mood disorders, maternal mental health, psychometric validation, anxiety screening, obstetric psychology, self-report inventory, clinical psychometrics, anhedonia, affective disorders.

3. Authors

The Edinburgh Postnatal Depression Scale was authored by a multidisciplinary team of psychiatric epidemiologists and clinical researchers at the University of Edinburgh and associated medical health boards in Scotland:

• John L. Cox, DM, FRCPsych, FRCP(Edin): Professor Emeritus of Psychiatry, School of Medicine, Keele University; formerly Senior Lecturer in Psychiatry, Department of Psychiatry, University of Edinburgh. A pioneer in transcultural psychiatry and perinatal mental health, Professor Cox served as President of the Royal College of Psychiatrists (2000–2004).
• Jenneifer M. Holden, MA: Research Psychologist and Fellow, Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland. Holden directed the primary community field tracking and qualitative interview components during the instrument’s inception.
• Ruth Sagovsky, MB, ChB, MRCPsych: Clinical Psychiatrist, Department of Psychiatry, University of Edinburgh, and Livingston Health Centre, West Lothian, Scotland. Dr. Sagovsky spearheaded clinical psychiatric evaluations, diagnostic calibration, and patient validation cohorts.

Inquiries regarding historic development and psychometric adaptation guidelines were coordinated through the Department of Psychiatry at the University of Edinburgh and published in the British Journal of Psychiatry under the auspices of the Royal College of Psychiatrists.

4. Purpose

4.1 Clinical and Diagnostic Screening Rationale

The primary clinical purpose of the EPDS is to serve as an economical, non-stigmatizing, and clinically sound screening instrument capable of identifying mothers suffering from postnatal depression within primary care, community maternal nursing, midwifery, and obstetric outpatient contexts. Postnatal depression affects approximately 10% to 15% of childbearing women worldwide, representing one of the most common morbidities associated with childbirth. Despite its profound impact on maternal well-being, maternal-infant bonding, and long-term neurocognitive and socioemotional child development, perinatal mood pathology historically suffered from substantial under-recognition. Clinicians frequently misattributed emotional distress to normal postpartum exhaustion, hormonal flux (“baby blues”), or standard parental acclimation.

The EPDS was constructed to overcome clinical hesitation and diagnostic inertia. By presenting a simple, 10-item self-report questionnaire that requires less than five minutes to complete, the scale enables health visitors, obstetricians, pediatricians, and general practitioners to systematically quantify depressive and anxious distress. Crucially, the EPDS is designed explicitly as a screening instrument rather than a definitive diagnostic test. A score exceeding clinical thresholds does not automatically confirm an episode of major depressive disorder; rather, it alerts the healthcare practitioner to mandate a comprehensive clinical interview to confirm or rule out diagnoses, evaluate psychosocial stressors, and formulate therapeutic interventions.

4.2 Research Applications

Beyond its bedside utility, the EPDS has emerged as the definitive epidemiological and clinical research instrument in perinatal psychiatry. It serves diverse methodological functions:

• Epidemiological Surveillance: Measuring point-prevalence, period-prevalence, and incidence of perinatal depressive symptoms across culturally, ethnically, and socioeconomically diverse populations globally.
• Longitudinal Cohort Investigations: Tracking affective trajectories from early gestation (antenatal testing) across serial postnatal intervals (6 weeks, 3 months, 6 months, 12 months, and into the second year postpartum).
• Clinical Trial Outcome Measures: Providing a sensitive, responsive metric to evaluate the efficacy of psychological interventions (e.g., Cognitive Behavioral Therapy, Interpersonal Psychotherapy) and pharmacological treatments (e.g., Selective Serotonin Reuptake Inhibitors, brexanolone, zuranolone).
• Paternal and Non-Gestational Partner Screening: Assessing affective pathology among fathers and secondary caregivers, whose perinatal mental distress correlates with family dysfunction and partner depressive recurrence.

4.3 The Critical Somatic Exclusion Rationale

The foundational psychometric breakthrough of the EPDS was the deliberate omission of somatic and physiological items typical of general depression inventories. Standard psychometric tools such as the BDI, Zung Self-Rating Depression Scale, and HDRS assign substantial point weight to symptoms such as disturbed sleep, subjective fatigue, decreased appetite, and psychomotor slowing. However, during the puerperium, sleep deprivation is virtually ubiquitous due to nocturnal infant care routines; fatigue is a predictable consequence of metabolic expenditure and hormonal recalibration; and appetite shifts can reflect the energy requirements of lactation. Retaining somatic questions within a perinatal psychometric tool inflates measurement error, causing substantial numbers of mentally healthy, fatigued mothers to cross clinical diagnostic thresholds. By restricting items to emotional, cognitive, and psychological domains, the EPDS isolates authentic depressive disturbance from expected puerperal physiological adaptation.

5. Psychological Construct

The EPDS operationalizes perinatal distress by focusing on affective, cognitive, and anxious markers of emotional dysregulation. While initially treated as a single unified construct of “postnatal depressive illness,” modern psychometrics recognizes the multidimensionality of perinatal distress captured across the instrument’s 10 indicators.

5.1 Anhedonia (Inability to Experience Pleasure)

Anhedonia represents a core diagnostic criterion of major depressive episodes according to both the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and the International Classification of Diseases (ICD-11). The EPDS measures this dimension through Items 1 and 2:

• Humor and Levity (Item 1): Evaluates the capacity to experience amusement, lightness, and laughter. Depressed perinatal individuals frequently describe an affective flattening where social stimuli and contextual humor elicit no emotional resonance.
• Anticipatory Pleasure (Item 2): Measures forward-looking enjoyment and motivation. Loss of anticipatory pleasure is an indicator of dopaminergic dysregulation within the mesolimbic reward system, impairing the mother’s natural positive anticipation regarding infant interactions and maternal identity.

5.2 Excessive Guilt, Self-Blame, and Perceived Incompetence

Cognitive distortions surrounding parental inadequacy and unworthiness are hallmarks of perinatal depression, encapsulated primarily by Items 3 and 6:

• Unnecessary Self-Blame (Item 3): Captures intrapunitive cognitive attributions. Mothers with depressive symptoms disproportionately assign internal, stable, and global culpability to themselves for normative infant challenges (e.g., infant colic, latching difficulties, unpredictable crying).
• Executive and Affective Overload (Item 6): Probes the feeling that “things have been getting on top of me.” This item operationalizes cognitive demoralization, perceived stress, and the exhaustion of personal coping resources in the face of cumulative parental demands.

5.3 Perinatal Anxiety, Panic, and Hyperarousal

Anxiety co-occurs in up to 75% of women experiencing postpartum depression, frequently presenting as anxious distress, intrusive concerns, or panic symptoms. The EPDS integrates this construct across Items 4 and 5:

• Free-Floating Anxiety and Generalized Worry (Item 4): Assesses anxious apprehension occurring “for no good reason,” distinguishing pathological rumination from justifiable maternal vigilance.
• Acute Panic and Autonomic Reactivity (Item 5): Measures discrete surges of panic, acute fright, or fear states without objective external threat, capturing severe somatic-affective surges characteristic of perinatal panic disorder.

5.4 Depressive Dysphoria, Sadness, and Emotional Lability

Subjective depressive feelings and dysregulated affective expression are measured through Items 7, 8, and 9:

• Sleep Interruption Secondary to Affective Distress (Item 7): Clinically, this item does not simply measure nighttime awakening caused by infant feeding. Rather, it specifies that the individual has been “so unhappy that I have had difficulty sleeping.” It evaluates insomnia secondary to cognitive rumination and depressive misery, thereby safeguarding against purely somatic misattribution.
• Pervasive Misery and Dejection (Item 8): Directly samples the core emotional state of profound dysphoria, subjective emotional pain, and sadness.
• Emotional Lability and Weeping (Item 9): Evaluates episodes of crying, which serve as an outward behavioral manifestation of acute affective distress and feelings of helplessness.

5.5 Self-Harm and Suicidal Ideation

Maternal suicide is among the leading causes of perinatal maternal mortality in high-income nations. The EPDS dedicates Item 10 to evaluating self-injurious and suicidal cognition:

• Suicidal and Self-Harm Ideation (Item 10): Inquires whether the thought of harming oneself has occurred. Endorsement of this item—even at the lowest positive threshold (score of 1)—indicates clinical severity that requires rapid diagnostic triage and immediate clinical assessment, irrespective of the total composite EPDS score.

6. Theoretical Framework

6.1 Cognitive Theory of Depression

The cognitive foundation of the EPDS is anchored in Aaron T. Beck’s Cognitive Theory of Depression. Beck postulated that depressive episodes are maintained by the “cognitive triad”: negatively biased, rigid schemas regarding the self, the personal world, and the future. In the context of the EPDS, the transition to parenthood triggers underlying latent maladaptive cognitive schemas. Items assessing self-blame (Item 3), inability to cope (Item 6), and despair (Items 8 and 9) directly capture Beckian cognitive distortions, such as personalization, catastrophizing, and selective abstraction. The mother interprets ordinary caregiving hurdles not as neutral external events, but as definitive proof of fundamental personal inadequacy.

6.2 Learned Helplessness and Attributional Style

The reformulated model of learned helplessness developed by Abramson, Seligman, and Teasdale provides an explanatory paradigm for the affective collapse measured by the EPDS. When mothers encounter intractable infant distress or challenging postpartum adjustments, an internal, stable, and global attributional style leads directly to hopelessness. Item 6 (“Things have been getting on top of me”) captures this loss of perceived behavioral control. When personal agency is perceived as depleted, maternal coping responses decline, giving rise to dysphoria, psychomotor withdrawal, and, in severe cases, the passive or active self-harm ideation assessed in Item 10.

6.3 Biopsychosocial and Evolutionary Models of Perinatal Transition

The EPDS was conceived under a comprehensive biopsychosocial paradigm. Biologically, the puerperium is characterized by steep drops in circulating estrogens, progesterone, and neuroactive steroids (such as allopregnanolone), accompanied by complex shifts in the hypothalamic-pituitary-adrenal (HPA) axis. These neuroendocrine shifts destabilize central serotonergic and gamma-aminobutyric acid (GABA)-ergic neurotransmission. Socially and relationally, the arrival of an infant alters domestic roles, shifts marital dynamics, increases social isolation, and introduces around-the-clock physical demands. Evolutionary models suggest that maternal mood systems function as evolutionary warning mechanisms: perceived deficits in social support or environmental safety can evoke emotional distress, social withdrawal, or anxious hyperarousal.

7. Validity

The psychometric validity of the EPDS has been evaluated across hundreds of empirical trials, cross-cultural comparative designs, and meta-analyses over more than three decades.

7.1 Criterion and Diagnostic Validity

Criterion validity was established in Cox, Holden, and Sagovsky’s original 1987 investigation involving 84 postpartum mothers residing in Edinburgh and Livingston. Using the standardized Research Diagnostic Criteria (RDC) based on the Goldberg Standardized Psychiatric Interview, researchers classified participants into major depressive illness, minor depressive illness, or non-depressed categories. The EPDS demonstrated strong sensitivity and specificity:

• Cut-off Score 9/10: Identified 100% of women meeting criteria for major depression (Sensitivity = 100%, Specificity = 78%). It served as the optimal cutoff for non-clinical, universal community screening where missing a potential case carries high clinical risk.
• Cut-off Score 12/13: Yielded a sensitivity of 86% and a specificity of 78% for major depression, functioning as an optimal cutoff for formal clinical referral and specialized psychiatric intervention, balancing false positives against diagnostic certainty.

A landmark Individual Participant Data Meta-Analysis (IPDMA) published in the BMJ by Levis et al. (2020), analyzing 58 validation studies comprising 15,557 participants, established summary diagnostic estimates against structured clinical interviews (such as SCID, DIS, and SCAN). Using the conventional cut-off score of 11 or higher, the EPDS demonstrated a pooled sensitivity of 0.81 (95% CI, 0.75–0.87) and specificity of 0.88 (95% CI, 0.85–0.91) for identifying Major Depressive Episode. Lowering the cut-off to 10 or higher yielded sensitivity of 0.85 (95% CI, 0.79–0.90) and specificity of 0.84 (95% CI, 0.79–0.88), reinforcing the diagnostic robustness of the scale across varying clinical contexts.

7.2 Convergent and Discriminant Validity

The convergent validity of the EPDS has been demonstrated via correlations with established depression and psychopathology inventories. Across clinical trials, EPDS composite scores exhibit strong correlations with:

• Beck Depression Inventory (BDI & BDI-II): Pearson r values consistently range between 0.73 and 0.80.
• Hamilton Depression Rating Scale (HDRS): Significant convergent associations ranging between r = 0.70 and 0.78.
• General Health Questionnaire (GHQ-12 & GHQ-28): Correlation coefficients spanning 0.65 to 0.74.
• Postpartum Depression Screening Scale (PDSS): High correlations, typically exceeding r = 0.79.

Discriminant validity is supported by lower correlations with measures of unrelated constructs. Although the EPDS shares variance with generalized anxiety inventories (such as the GAD-7 and the State-Trait Anxiety Inventory, where correlations frequently reach 0.60 to 0.70 due to anxious-depressive comorbidity), its correlations with purely physical somatic indices, physical disability scores, or transient situational fatigue measures remain modest (r < 0.35), confirming that the EPDS isolates emotional distress rather than physical postnatal convalescence.

8. Reliability

8.1 Internal Consistency

The internal consistency of the EPDS is consistently supported across diverse clinical and community cohorts. In the initial validation study conducted by Cox et al. (1987), split-half reliability calculated using the Spearman-Brown formula was 0.88. Contemporary investigations assessing Cronbach’s alpha report figures consistently ranging between α = 0.82 and 0.89:

• Antenatal Cohorts: Cronbach’s α values generally hover between 0.82 and 0.86, indicating that the instrument retains internal cohesion during pregnancy.
• Postnatal Cohorts: Estimates typically range from 0.84 to 0.88 within early (6-week) and late (6-month) puerperal assessments.
• McDonald’s Omega (ω): Recent structural equation modeling studies evaluating composite reliability demonstrate categorical omega coefficients exceeding 0.85, confirming that the scale maintains high internal reliability despite its brief item length.

8.2 Test-Retest Reliability

Given that depressive symptoms fluctuate across the perinatal period, evaluating test-retest reliability requires brief, clinically sensible intervals (typically 48 hours to two weeks):

• Over a 48-hour to 72-hour retest interval, Pearson correlation coefficients and Intraclass Correlation Coefficients (ICC) range from 0.85 to 0.90, demonstrating measurement stability in the absence of treatment.
• Over extended intervals of two to four weeks, retest reliability metrics range from 0.64 to 0.74. This moderate correlation reflects expected clinical fluctuation, spontaneous symptom resolution, or therapeutic response rather than psychometric instability.

9. Factor Analysis

Although the EPDS was originally formulated by Cox and colleagues as a unidimensional metric measuring general postpartum depressive disturbance, three decades of exploratory (EFA) and confirmatory factor analysis (CFA) have documented that its underlying latent structure is multidimensional.

9.1 Unidimensional vs. Multidimensional Structures

Early EFA models frequently extracted a single primary factor that accounted for 35% to 45% of total variance, with all 10 items loading significantly (> 0.40) on this overarching general distress dimension. However, modern CFA modeling reveals that unidimensional models frequently yield suboptimal goodness-of-fit indices (e.g., Comparative Fit Index [CFI] < 0.90; Root Mean Square Error of Approximation [RMSEA] > 0.08). Consequently, alternative bi-factor and multidimensional models have been developed and replicated internationally.

9.2 The Three-Factor Model

The most widely replicated structural framework is the three-factor model initially proposed by Tuohy and McVey (2008), and refined across independent cohorts by King (2012), Matthey (2008), and Phillips et al. (2009). This model categorizes the 10 items into three distinct, correlated latent factors:

• Factor 1: Depression / Dysphoria
  • Item 7: So unhappy had difficulty sleeping (factor loadings: 0.65–0.78)
  • Item 8: Felt sad or miserable (factor loadings: 0.78–0.86)
  • Item 9: So unhappy that crying (factor loadings: 0.72–0.82)
  • Item 10: Thoughts of harming self (factor loadings: 0.48–0.64)
• Factor 2: Anxiety (The EPDS-3A Subscale)
  • Item 3: Blamed myself unnecessarily (factor loadings: 0.52–0.66)
  • Item 4: Anxious or worried for no good reason (factor loadings: 0.74–0.84)
  • Item 5: Felt scared or panicky (factor loadings: 0.72–0.83)
• Factor 3: Anhedonia
  • Item 1: Able to laugh and see the funny side of things (factor loadings: 0.75–0.85)
  • Item 2: Looked forward with enjoyment to things (factor loadings: 0.78–0.88)

Item 6 (“Things have been getting on top of me”) exhibits complex cross-loadings, loading alternately onto the Depression dimension or the Anxiety dimension depending on translation, cultural context, and sample demographics.

9.3 Model Fit Indices in Structural Equation Modeling

Confirmatory factor analyses utilizing robust weighted least squares estimators (WLSMV) for categorical data demonstrate superior fit for the three-factor and bi-factor structures over unidimensional models:

• Comparative Fit Index (CFI): Ranges between 0.96 and 0.99 for the three-factor model (compared to 0.88–0.92 for the single-factor model).
• Tucker-Lewis Index (TLI): Consistently exceeds 0.95.
• Root Mean Square Error of Approximation (RMSEA): Sits between 0.035 and 0.052 (with 90% confidence intervals below 0.06), indicating close model fit.
• Standardized Root Mean Square Residual (SRMR): Maintains favorable values below 0.045.

10. Instrument / Measurement Tool

• Instrument Name: Edinburgh Postnatal Depression Scale (EPDS)
• Instrument Type: Self-administered psychological screening questionnaire / Clinical rating scale
• Target Population: Women throughout the perinatal continuum (antenatal pregnancy through 12 months postpartum). Validated also in secondary cohorts including fathers, non-gestational partners, and non-perinatal women.
• Administration Format: Paper-and-pencil questionnaire, digital web interface, tablet-based clinic portal, or clinician-facilitated interview.
• Completion Duration: Approximately 3 to 5 minutes.
• Number of Items: 10 self-report questions.
• Temporal Recall Period: The past 7 days (“In the past 7 days…”).
• Response Scale: 4-point Likert scale (scored 0 to 3; response option labels vary per item).
• Scoring Architecture:
  • Directly Scored Items (0, 1, 2, 3): Items 1, 2, and 4. Response options follow standard polarity where the lowest depressive response is scored 0 and the highest depressive response is scored 3.
  • Reverse Scored Items (3, 2, 1, 0): Items 3, 5, 6, 7, 8, 9, and 10. The first response option corresponds to the highest pathology (scored 3) and decrements down to the absence of pathology (scored 0).
  • Total Score Range: 0 to 30 points.
• Clinical Interpretive Thresholds:
  • Score 0–9: Depressive symptoms are not clinically prominent. Routine care and standard maternal well-being support indicated.
  • Score 10–12: Borderline or mild depressive and anxious symptomatology. Suggests repeating the screening within 2 to 4 weeks and conducting psychosocial inquiry.
  • Score 13–30: Marked depressive and anxious distress. Indicates potential moderate-to-severe perinatal depressive episode. Immediate clinical interview and diagnostic evaluation recommended.
• Safety Alert Rule (Item 10): Any endorsement of Item 10 other than “Never [0]” (i.e., a score of 1, 2, or 3) flags potential self-harm risk and mandates immediate clinical suicide risk assessment, irrespective of whether the composite score reaches the cutoff.

11. Permissions & Fee and Test Year

11.1 Publication Year

The Edinburgh Postnatal Depression Scale was published in 1987 by John L. Cox, Jenneifer M. Holden, and Ruth Sagovsky in the British Journal of Psychiatry.

11.2 Copyright, Permissions, and User Fees

The copyright of the original EPDS instrument is held by the Royal College of Psychiatrists. The authors and the copyright holder released the scale with open clinical access conditions:

• Non-Commercial Clinical and Academic Research Use: The EPDS may be reproduced, administered, and utilized without payment of licensing fees, provided that appropriate bibliographic attribution is accorded to Cox et al. (1987) and the Royal College of Psychiatrists.
• Commercial and Digital Redistribution: Ingestion of the EPDS into proprietary commercial software platforms, electronic medical record (EMR) vendor modules, pharmaceutical trials, or fee-generating clinical products may require explicit written authorization and licensing agreements through the Royal College of Psychiatrists (Head of Publications / Permissions Department).
• Integrity of Text and Translations: When utilizing translations (now available in over 60 languages), investigators are required to utilize validated forward-and-back translated linguistic versions without modifying item syntax, scale polarity, or anchor phrasing, as alterations compromise psychometric validity.

12. References

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782

Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119(5), 350–364. https://doi.org/10.1111/j.1600-0447.2009.01363.x

King, P. A. (2012). Towards an understanding of the multidimensional structure of the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders, 142(1-3), 346–351. https://doi.org/10.1016/j.jad.2012.04.040

Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data. BMJ, 371, m4022. https://doi.org/10.1136/bmj.m4022

Matthey, S. (2008). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depression and Anxiety, 25(11), 926–931. https://doi.org/10.1002/da.20415

Matthey, S., Henshaw, C., Elliott, S., & Barnett, B. (2006). Variability in use of cut-off scores of the Edinburgh Postnatal Depression Scale (EPDS): How does this affect reported prevalence of depression and validation dimensions? Social Psychiatry and Psychiatric Epidemiology, 41(8), 624–629. https://doi.org/10.1007/s00127-006-0078-7

Phillips, J., Charles, M., Sharpe, L., & Matthey, S. (2009). Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with early postnatal depression. Journal of Affective Disorders, 118(1-3), 206–212. https://doi.org/10.1016/j.jad.2009.02.010

Tuohy, A., & McVey, C. (2008). Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. British Journal of Clinical Psychology, 47(2), 153–169. https://doi.org/10.1348/014466507X241596

13. Items of the Scale (Questionnaire)