This summary reviews evidence comparing the effectiveness of the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) in detecting postpartum depression. The EPDS was specifically developed for postpartum women, contains questions relevant to new mothers, and has been shown to more accurately detect postpartum depression compared to the BDI. However, more research is still needed to validate these scales. The EPDS has a recommended cut-off score of 9 in the immediate postpartum period and 3 or higher to detect risk, but using additional anxiety scales can help identify more women with issues. While the BDI has good sensitivity, the EPDS has better positive predictive value. Overall, the EPDS appears

1. Group 8: Helena McComiskey, Elizabeth Swanson, Lauren Rice, Chandler Davis, Sophie Collins, & Kaitlyn Gallaspy
Auburn University College of Nursing
NURS 4290:001 - Evidence-Based Practice in Nursing
In postnatal women, how effective is the Edinburg Postnatal Depression Scale compared to the Beck Depression
Inventory in detecting postpartum depression?
P
Postpartum depression (PPD) is a serious mental
illness that can cause extreme depressive symptoms
in women during their postpartum period. PPD can
be characterized by emotional lability, intense
depressive symptoms, and difficulty bonding with
one’s baby. Left untreated, this condition can
progress to postpartum psychosis, and can have
fatal outcomes (Mayo Foundation for Medical
Education and Research, 2022).
The evidence suggests that the EPDS is
more effective at detecting PPD than the
BDI, but more research is needed to ensure
the validity of both of these scales. Due to
the nature of PPD, it is critical to have the
most accurate results in order to avoid
potentially fatal outcomes in these
vulnerable populations in the future.
●
● The BDI is a 21-question, multiple choice
questionnaire that measures symptoms of
depression, with a maximum score being
63 (American Psychological Association,
2020).
● The BDI was developed to measure
severity of general depressive
symptoms, but has shown high
specificity and sensitivity for detecting
PPD (Vogeli et al., 2018).
American Psychological Association. (2020, June). Beck Depression Inventory (BDI).
https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/beck-depression
Barassi, F., & Grealish, A. (2022). Validity of the Edinburgh Postnatal Scale for screening pregnant and
postpartum adolescents: a systematic review. Australian Journal of Advanced Nursing, 39(2), 65.
https://doi.org/10.37464/2020.392.446
Ezirim, N., Younes, L. K., Barrett, J. H., Kauffman, R. P., Macleay, K. J., Newton, S. T., Tullar, P. (2021).
Reproducibility of the Edinburgh Postnatal Depression Scale during the postpartum period. American
Journal of Perinatology, 40(2), 194-200. https://doi.org/10.1055/s-0041-1727226
Hoberg, M. G., Demirci, J. R., Sereika, S. M., Levine, M. D., & Dabbs, A. D., (2022). Descriptive exploratory
study to understand postpartum anxiety using multiple measures. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 52(1), 50–61. https://doi.org/10.1016/j.jogn.2022.09.003
Mayo Foundation for Medical Education and Research. (2022, November 24). Postpartum depression. Mayo
Clinic.
https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
O'Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016).
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, 315(4), 388–406.
https://doi.org/10.1001/jama.2015.18948
Vogeli, J. M., Hooker, S. A., Everhart, K. D., & Kaplan, P. S. (2018). Psychometric properties of the postpartum
depression screening scale beyond the postpartum period. Research in Nursing & Health, 41(2), 185-194.
https://doi.org/10.1002/nur.21861
Szpunar, M. J., Crawford, J. N., Baca, S. A., & Lang, A. J. (2020). Suicidal Ideation in Pregnant and
Postpartum Women Veterans: An Initial Clinical Needs Assessment. Military Medicine, 185(1/2),
e105-e111. https://doi.org/10.1093/milmed/usz171
c
Background
Beck Depression Inventory (BDI)
Search for evidence Conclusions
References
● On CINAHL, we used the search terms
postpartum, postnatal, Edinburgh, Beck,
scale, inventory, and questionnaire.
● We also used MEDLINE and searched
Edinburgh and Beck separately.
● Our search was simplified by excluding
articles outside of the US, before 2016,
and non-research articles.
● A combination of six articles met the
criteria and contributed to the PICOT
findings: two systematic reviews, a
longitudinal observational study, mixed
methods study, and a correlational
analysis and descriptive study.
Edinburgh Postnatal Depression Scale
● A sample of scores at the immediate PP period and the 6-week check-up, it was found that in the immediate
postpartum period, 87 women were shown to be at risk for PPD (score of 3 or greater), while 132 women were
shown to have PPD at the 6-week check-up (score of 9 or higher). Convenience sampling was used, and the article
is a level 4 on the hierarchy of evidence (Ezirim et al., 2021).
● The article by Hoberg et al. (2022) compared a generalized anxiety scale and a depression scale with a specific
postpartum anxiety scale and the Edinburgh Postnatal Depression Scale for efficiency in detecting postpartum
anxiety and depression. Convenience sampling was used and the article is a level of 4 evidence.
Beck Depression Inventory
● In a level 4 study, scores of postpartum women were calculated after questionnaires were distributed in a study.
(Vogeli et al., 2018).
● The BDI is more effective in measuring depressive symptoms in the general population, but it can be inaccurate in
recognizing PPD. The BDI adequately screens for sensitivity, specificity, and positive predicted value in general
populations, but these findings are not consistent with PPD (Barassi & Grealish, 2022; Vogeli et al., 2018).
● The BDI’s variant, the Beck Hopeless Scale (BHS) showed similar results in a group of PP women in a level 5
study (Szpunar et al., 2020).
Comparison
● The available evidence suggests that the EPDS is more effective in detecting PPD than the BDI as result of catering
the questions to the concentrated population of postpartum women (Ezirim et al., 2021; Hoberg et al., 2022).
● In relation, only using the EPDS would have identified the smallest number of women with anxiety or depression
making it insufficient compared to using both an anxiety tool and depression tool with it (Hoberg et al., 2022;
O’Connor et al., 2016).
● The BDI does have a high sensitivity value, but the EPDS demonstrates higher positive predictive values (Barassi
& Grealish, 2022; Vogeli et al., 2018).
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Summary and synthesis
Rcommendations for EBP
Edinburgh Postnatal Depression Scale (EPDS)
● The EPDS is a 10-item scale in which each
item is scored by the mother as a 0 to 3.
The higher the total score, the more at risk
the new mother is that she is experiencing
or will experience symptoms of PPD
(Ezirim et al., 2021).
● The EPDS was developed directly for
detecting PPD.
● It takes into account typical life struggles
and difficulties of becoming a mother.
● The cut-off score of the EPDS in the
immediate postpartum period that indicates
PPD is a total score of 9. A study suggests
that a cut-off score of 3 or greater during the
immediate postpartum period would detect
more women who are at risk of developing
PPD in the future (Ezirim et al., 2021).
● Even though the EPDS has been shown to be
more effective in detecting PPD, there needs
to be more research done to evaluate if there
could be another scale that would more
accurately detect PPD.
● In clinical practice, the recommendation is to
also look at a patient’s history to see if they
are at a greater risk of PPD.