The Edinburgh Postnatal Depression Scale

The Edinburgh Postnatal Depression Scale (EPDS; Cox et al, 1987) is one of the most widely used self-report instruments to screen for depression in the post-partum and antenatal periods. As with all instruments, it is important for validity that the wording of a measure remains faithful to that described in the original validation study. While checking our EPDS against the original, we noticed a difference in the wording of one of the items. We believe that the EPDS used elsewhere may also contain the same anomaly. Item 4 on the EPDS provided in the paper by Cox et al (1987) is phrased: ‘I have been anxious or worried for no good reason’. However, the version reproduced in Cox & Holden's book (1994), which is also likely to be the source from which many centres copy their EPDS, is different: ‘I have felt worried and anxious for no very good reason’ (differences from the journal version italicised for clarity). In addition, the order of anxious and worried has been reversed. Personal communication with Professor Cox has confirmed that the wording in the journal paper is correct. That these mistakes have occurred in a book about the ‘use and misuse’ of the scale is somewhat ironic. Indeed, this makes us a little anxious and worried!

What effect might these differences have on the self-reports of women or men? It is hard to know — hopefully, none. It would not, however, be surprising if these alterations lead to differential responding and scores.

Over the many years of our involvement in this field, we have also noted usage where the EPDS preamble was omitted or altered, provenance (e.g. authors and date) was not acknowledged, and incorrect cut-off scores were inadvertently applied. We should all, therefore, be more rigorous in our use of this scale.