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Postpartum depression: screening early, the thresholds, and who to call

A score of 11 or higher on the EPDS is not a diagnosis: it is a signal, meant to open a conversation and access to support. In the US, screening for perinatal depression and anxiety is recommended at several points in care, and the services that answer are free. Here is what the guidance says.

What screening guidance says in the US

The American College of Obstetricians and Gynecologists recommends screening for depression and anxiety with standardized, validated instruments, at the initial prenatal visit, later in pregnancy, and at postpartum visits (ACOG Clinical Practice Guideline No. 4, June 2023). The recommendation covers everyone receiving well-woman, prepregnancy, prenatal and postpartum care. Perinatal depression starts nearly as often before pregnancy, in pregnancy and postpartum, which is why one visit is not enough (ACOG, 2023).

The US Preventive Services Task Force recommends screening for depression in the general adult population, including pregnant and postpartum women (B recommendation, 2023). It also recommends counseling interventions for pregnant and postpartum people at increased risk of perinatal depression (B recommendation, 2019).

The instruments used most often include the EPDS, the PHQ-9, and the GAD-7 (ACOG, 2023). The EPDS is a 10-item self-report questionnaire that targets symptoms over a defined recent window (BMJ, 2020; ACOG, 2023). Screening is a process, not a single form: ACOG says it should run inside systems that ensure timely assessment and treatment.

The thresholds: 11 and 13

An individual participant data meta-analysis pooled 58 studies and 15,557 participants. A cutoff of 11 or higher maximized combined sensitivity and specificity across diagnostic interviews: 81% sensitivity and 88% specificity against semi-structured interviews (BMJ, 2020).

A cutoff of 13 or higher is less sensitive (66%) but more specific (95%), so it flags fewer people who are not depressed. The positive predictive value of a positive screen at 11 ranges from 26% to 69% depending on how common depression is in the group screened (BMJ, 2020).

Accuracy was similar in pregnancy and postpartum (BMJ, 2020). What a score does not do is diagnose: positive screening results should lead to additional assessment that considers severity and other conditions (USPSTF, 2023).

How common it is in the US

About 1 in 8 women with a recent live birth report symptoms of postpartum depression (CDC, PRAMS data). In the 2018 PRAMS survey across 31 states, 13.2% reported postpartum depressive symptoms, with responses collected about four months after birth (CDC, MMWR, 2020).

The same survey found gaps in who gets asked: about 1 in 5 women said a provider did not ask about depression during prenatal visits, and 1 in 8 during postpartum visits (CDC, 2020).

Baby blues is not the same thing

Feeling down, anxious or irritable for a few days after birth is very common. It is sometimes called the baby blues, and it usually goes away within two weeks (NHS, 2026).

If it continues, gets worse, or becomes hard to cope with, the NHS says to get help, even if you have only some of the signs. Postnatal depression usually gets better within three to six months, and it is more likely to improve with treatment (NHS, 2026). The baby blues does not usually need treatment; postnatal depression can be treated with talking therapies and antidepressants, and many antidepressants are safe while breastfeeding (NHS, 2026).

Fathers and partners can also experience depression after a baby is born (NHS, 2026).

Where to get help: US and UK

In the US, the National Maternal Mental Health Hotline (HRSA) is free, confidential and staffed 24/7. It is for pregnant and postpartum people and their families, including partners who are worried about someone else. It is not a crisis line: for a suicidal crisis, contact 988.

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