Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to Assess Increased Risk of Depression among Postpartum Women

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Figure 1.
Study diagram. EPDS, Edinburgh Postnatal Depression Scale; PHQ, Patient Health Questionnaire; PP, postpartum; F/U, follow-up.
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Figure 2.
Comparison of EPDS and PHQ-9 scores by categories of risk. Darkly shaded areas are concordant between the level of risk identified by the EPDS and the PHQ-9. The lightly shaded area represents those who fall into the PHQ-9 group that have “mild symptoms and require repeat PHQ-9.”⁴² EPDS, Edinburgh Postnatal Depression Scale; PHQ, Patient Health Questionnaire.

Table 1.

Categories of Edinburgh Postnatal Depression Scale (18) and Patient Health Questionnaire-9 (42) scores

EPDS Score	Interpretation	PHQ-9
EPDS Score	Interpretation	Score	Interpretation
0-9	“Normal”	0-4	“Normal”
10, 11	“Slightly increased risk”	5-9	“Mild depressive symptoms”; “repeat PHQ-9 at follow-up”
12-15	“Increased risk”	10-14	“Moderate depressive symptoms”
≥16	“Likely depression”	≥15	“Moderately severe to severe depressive symptoms”

Table 2.

Response to Suicidal Ideation Questions on Screeners

Screening Tool	Suicidal Issues	Response
EPDS	Never	Normal
	Hardly ever	Suicidal ideation requiring evaluation
	Sometimes	Suicidal ideation requiring evaluation
	Often	Suicidal ideation requiring evaluation
PHQ-9	Not at all	Normal
	Several days	Suicidal ideation requiring evaluation
	>Half the days	Suicidal ideation requiring evaluation
	Nearly every day	Suicidal ideation requiring evaluation

Table 3.

Demographics of Women Completing EPDS and PHQ-9 (n = 481)

Age	Married^*	Completed High School^†	Employed Outside Home^‡	Income >$30,000/year^§
18 to 19 (n = 57)	21 (36.8)	46 (80.7)	18 (31.6)	6 (10.5)
20 to 24 (n = 154)	78 (50.6)	125 (81.1)	71 (46.1)	29 (18.8)
25 to 29 (n = 137)	97 (70.8)	119 (86.9)	65 (47.4)	72 (52.6)
30 to 34 (n = 86)	71 (82.6)	81 (94.2)	50 (58.1)	58 (67.4)
≥35 (n = 46)	33 (71.7)	42 (91.3)	28 (60.9)	28 (60.9)

Table 4.

EPDS Versus PHQ-9 Scores by Category (n = 481)

EPDS Score	PHQ-9 Score
EPDS Score	≤4; “Normal”	5-9; “Reevaluate”	10-14; “Increased Risk of Depression”	≥15; “Very Likely to Have Depression”
<0-9; “normal”	249 (51.8)	77 (16.0)	15 (3.1)	2 (0.4)
10, 11; “slightly increased risk”	11 (2.2)	17 (3.5)	7 (1.5)	1 (0.2)
12-15; “increased risk”	11 (2.2)	22 (4.6)	20 (4.2)	11 (2.3)
≥16; “marked risk”	0	4 (0.8)	12 (2.5)	22 (4.6)

Table 5.

Comparison of Suicidal Ideation from EPDS and PHQ-9

EPDS “The thought of harming myself has occurred to me”	PHQ-9 “Thoughts that you would be better off dead, or of hurting yourself in some way”
EPDS “The thought of harming myself has occurred to me”	Not at All	Several Days	More Than Half the Days	Nearly Every Day
Never	435	10	1	0
Hardly ever	12	10	0	0
Sometimes	3	5	4	0
Often	0	0	0	1