How to Screen for Postpartum Depression

The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression (PPD) with a validated tool, which may reduce the duration or severity of depressive symptoms.1-5

Using a validated tool

ACOG recommends using a validated screening tool. Below are 2 examples of tools that can be used to identify symptoms of PPD6:

EPDS

Edinburgh Postnatal Depression Scale

Number of questions:
10 (~5 minutes)6
Time span covered:
Past 7 days7
Focus of questions:
How the patient felt and how often she experienced certain symptoms7
Scoring:
Responses for the EPDS are scored from 0 to 3, with a total EPDS score that ranges from 0 to 30. A woman scoring 12/13 or above is most likely suffering from depression in the peripartum period. Data suggest that lowering the threshold to a score of 9/10 may increase the detection of symptoms of PPD.7
PHQ-9

Patient Health Questionnaire-9

Number of questions:
9 + 1 follow-up qualifier (~5 minutes)6,8
Time span covered:
Past 2 weeks8
Focus of questions:
How often the patient has been bothered by symptoms8
Scoring:
Responses for the PHQ-9 are scored from 0 to 3, with a total PHQ-9 score that ranges from 0 to 27. A woman scoring above 9 could be suffering from moderate to severe depression.8
PHQ-9 was specifically designed to detect symptoms of major depressive disorder, but is commonly used to detect symptoms of PPD.

Keep in mind

  • Any woman answering the self-harm question affirmatively should be referred to a psychiatrist immediately9
  • Women screening positive for symptoms of PPD should be further assessed by a health care provider to confirm whether or not clinical depression is present. Screening tools are not a substitute for this clinical assessment, and scores just below the cutoff should not be taken to indicate the absence of depression, especially if the health care provider has other reasons to consider this diagnosis.7
  • ACOG recommends a comprehensive postpartum visit to be scheduled no later than 12 weeks after birth10
  1. Avalos L, Raine-Bennett T, Chen H, Adams AS, Flanagan T. Improved perinatal depression screening, treatment, and outcomes with a universal obstetrics program. Obstet Gynecol. 2016;127(5):917-925.
  2. Larun L, Fønhus MS, Håvelsrud K, Brurberg KG, Merete Reinar L. Screening for depression in pre- or postnatal women. Norwegian Centre for Health Services at The Norwegian Institute of Public Health, 2013.
  3. O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and postpartum women: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315(4):388-406.
  4. van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, IJzerman MJ, Haasnoot-Smallegange RME, Reijneveld SA. Post-up study: postpartum depression screening in well-child care and maternal outcomes. Pediatrics. 2017;140(4):pii:e20170110 [epub ahead of print Sep 7, 2017].
  5. Siu A; for the US Preventive Services Task Force. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387.
  6. Screening for Perinatal Depression. ACOG Committee Opinion No. 757. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;132:e208-212.
  7. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786.
  8. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
  9. Moses-Kolko EL, Roth EK. Antepartum and postpartum depression: healthy mom, healthy baby. J Am Med Womens Assoc. 2004;59(3):181-191.
  10. Optimizing Postpartum Care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e140-150.