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Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Edinburgh Postnatal Depression Scale (EPDS) helps assess the likelihood of postnatal depression by asking individuals ten questions about their recent emotional experiences and moods. Participants respond using preset options that measure these feelings' frequency or intensity.

Each response is scored from 0 to 3, reflecting the severity indicated by the individual's answer:

- **Laughing and Seeing the Funny Side of Things:**
  - "As much as I always could": 0
  - "Not quite so much now": 1
  - "Definitely not so much now": 2
  - "Not at all": 3

- **Looking Forward with Enjoyment:**
  - "As much as I ever did": 0
  - "Rather less than I used to": 1
  - "Definitely less than I used to": 2
  - "Hardly at all": 3

- **Blaming Myself Unnecessarily:**
  - "Yes, most of the time": 3
  - "Yes, some of the time": 2
  - "Not very often": 1
  - "No, never": 0

- **Feeling Anxious or Worried:**
  - "No, not at all": 0
  - "Hardly ever": 1
  - "Yes, sometimes": 2
  - "Yes, very often": 3

- **Feeling Scared or Panicky:**
  - "Yes, quite a lot": 3
  - "Yes, sometimes": 2
  - "No, not much": 1
  - "No, not at all": 0

- **Things Getting on Top of Me:**
  - "Yes, most of the time I haven’t been able to cope": 3
  - "Yes, sometimes I haven’t been coping as well as usual": 2
  - "No, most of the time I have coped quite well": 1
  - "No, I have been coping as well as ever": 0

- **Difficulty Sleeping Due to Unhappiness:**
  - "Yes, most of the time": 3
  - "Yes, sometimes": 2
  - "Not very often": 1
  - "No, not at all": 0

- **Feeling Sad or Miserable:**
  - "Yes, most of the time": 3
  - "Yes, quite often": 2
  - "Not very often": 1
  - "No, not at all": 0

- **Crying Due to Unhappiness:**
  - "Yes, most of the time": 3
  - "Yes, quite often": 2
  - "Only occasionally": 1
  - "No, never": 0

- **Thoughts of Self-Harm:**
  - "Yes, quite often": 3
  - "Sometimes": 2
  - "Hardly ever": 1
  - "Never": 0

The cumulative score ranges between 0 and 30, offering insight into depression likelihood:

- A score of **13 or more** signifies a "High probability of depression."
- A score between **10 and 12** suggests "Depression is possible."
- A score of **9 or below** indicates a "Low probability of depression."

These results help pinpoint individuals who may need further evaluation or support.

The Edinburgh Postnatal Depression Scale (EPDS) is a clinical calculator used to screen for postnatal depression in women who have recently given birth. It is applicable to the postpartum population, typically within the first year after childbirth. The EPDS is a 10-item self-report questionnaire that assesses the severity of depressive symptoms, with a focus on the cognitive and affective features of depression rather than somatic symptoms. The clinical utility of the EPDS is to identify women who may be suffering from postnatal depression and who may benefit from further evaluation and treatment. It is not intended to diagnose depression, but rather to serve as an initial screening tool. The EPDS should not be used in isolation for diagnosis and should not replace clinical judgment. It is not suitable for use in women who are more than a year postpartum, or in those who have not recently given birth.

Edinburgh Postnatal Depression Scale (EPDS)

The Patient Health Questionnaire-9 (PHQ-9) is designed to evaluate the severity of depression across nine symptom areas. Each of these symptoms corresponds to a question with four possible answers, each indicating how frequently the symptom is experienced: "Not at all," "Several days," "More than half the days," and "Nearly every day." These responses are converted to numerical values, with "Not at all" scoring 0, "Several days" scoring 1, "More than half the days" scoring 2, and "Nearly every day" scoring 3.

To calculate the depression score:

1. Assign numerical values to each response based on the predefined scale.
2. Sum these values to obtain a total score.

The interpretation of the depression level is based on the total score, categorized as follows:

- Total score 0 – 4: Minimal depression
- Total score 5 – 9: Mild depression
- Total score 10 – 14: Moderate depression
- Total score 15 – 19: Moderately severe depression
- Total score 20 – 27: Severe depression

These categories provide a systematic approach to understanding the severity of depression and help in determining the appropriate level of intervention or further assessment needed.

The Patient Health Questionnaire-9 (PHQ-9) is a clinical calculator used to screen, diagnose, monitor, and measure the severity of depression. It is applicable to patients in a wide range of healthcare settings, including primary care and mental health clinics. The PHQ-9 is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders, and it scores each of the 9 DSM-IV criteria for depression as "0" (not at all) to "3" (nearly every day). 

The clinical utility of the PHQ-9 is to not only screen for the presence of depressive symptoms but also to provide a severity score that can help in treatment decisions. It can be used to monitor the efficacy of treatment over time, providing a quantitative measure of patient progress. 

There are no specific exclusion criteria for the use of the PHQ-9. However, it should be noted that it is a screening tool and not a definitive diagnostic tool. Therefore, a high score should be followed up with a comprehensive psychiatric evaluation. It may also be less accurate in populations with high rates of physical illness due to the somatic nature of several of the questions.

Patient Health Questionnaire-9 for depression severity (PHQ-9)

The Hamilton Depression Scale (HAM-D) is a clinical questionnaire designed to assess the severity of depression in individuals by evaluating a range of emotional and physiological symptoms. The scale involves several categories, with responses scored according to their severity. The total score then provides an overall understanding of the individual's depression level.

To compute the score, respondents choose from predefined options in each category:

- **Depressed Mood**: Ranges from no mood issues ("Absent") scoring 0 to extreme mood symptoms ("Extreme symptoms") scoring 4.
- **Feelings of Guilt**: Begins at "Absent" for 0 and extends to "Hallucinations of guilt" for 4.
- **Suicide**: Scores start at 0 for no suicidal thoughts and increase to 4 for "Attempts at suicide".
- **Initial Insomnia**: Difficulty falling asleep, scored between "Absent" (0) and "Frequent" (2).
- **Insomnia During The Night**: From "Absent" (0) to "Frequent" (2) interruptions during sleep.
- **Delayed Insomnia**: Early morning awakenings, scored 0 to 2.
- **Work and Interests**: Evaluates impact on productivity, with scores ranging from "No difficulty" (0) to "Unable to work" (4).
- **Retardation**: Slowness in thought and activity, scored from 0 for no retardation to 4 for "Complete stupor".
- **Agitation**: Emotional restlessness is measured from 0 to 2.
- **Psychiatric Anxiety**: Ranges from "Absent" (0) to "Fears" (4).
- **Somatic Anxiety**: Physical symptoms of anxiety range from 0 to 4 for "Incapacitating".
- **Gastrointestinal Somatic Symptoms**: Scored from "Absent" (0) to "Severe" (2).
- **General Somatic Symptoms**: Evaluates physical energy, also scored between 0 and 2.
- **Genital Symptoms**: Libido and related issues, scoring 0 to 2.
- **Hypochondriasis**: Relates to health worries, scored from 0 to 4 for "Hypochondriacal delusions".
- **Weight Loss**: Scores 0 for no loss to 2 for "Obvious".
- **Insight**: Self-awareness of illness, scored from 0 for complete insight to 2 for "Loss of insight".

The sum of these scores yields the HAM-D total score, which is interpreted as follows:
- A total score from 0 to 7 is considered "Normal", indicating no significant depression.
- Scores between 8 and 16 suggest "Mild depression".
- Scores from 17 to 23 indicate "Moderate depression".
- A score of 24 or higher signifies "Very severe depression". 

The HAM-D score provides clinicians with a comprehensive view of the depression severity, guiding potential treatment decisions.

The Hamilton Depression Scale, also known as the HAM-D scale, is a clinical calculator used to quantify the severity of depressive symptoms in patients diagnosed with depression. It is widely used in both clinical and research settings. The HAM-D scale assesses a variety of symptoms associated with depression such as mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms. 

The scale is typically used in adult populations, but can also be used in adolescents with modifications. The clinical utility of the HAM-D scale is to monitor the severity of depression and response to treatment in patients diagnosed with depressive disorder. It is not designed to diagnose depression, but rather to measure the severity of depressive symptoms in individuals already diagnosed with the condition. 

The HAM-D scale should not be used as a diagnostic tool for depression, and it may not be suitable for use in patients with cognitive impairment or severe communication difficulties due to the nature of the questions asked. It also may not capture all aspects of depression, such as atypical symptoms or depression with comorbid anxiety.

Hamilton depression scale (HAM-D scale)

The Major Depression Inventory (MDI) index evaluates the severity of depression by analyzing responses to 12 questions about various emotional and physical symptoms experienced. These questions cover aspects such as mood, interest in activities, energy levels, self-confidence, guilt, perceived worth of life, concentration, restlessness, subdued feelings, sleep disturbances, and changes in appetite.

Each response is scored on a scale from 0 to 5:
- At no time = 0
- Some of the time = 1
- Slightly less than half of the time = 2
- Slightly more than half of the time = 3
- Most of the time = 4
- All the time = 5

These individual scores are summed to generate a total score ranging from 0 to 60. This total score is then interpreted to assess the degree of depression:

- **0 to 19:** No depression
- **20 to 24:** Mild depression
- **25 to 29:** Moderate depression
- **30 to 60:** Severe depression

After gathering all responses, assign each to its corresponding numeric value, sum the scores, and compare this total against the specified score ranges to determine the level of depression. The final evaluation provides both the total score and a verbal interpretation, reflecting the severity of depressive symptoms based on the score.

The Major Depression Inventory (MDI) index is a self-report mood questionnaire developed by the World Health Organization. It is designed to assess the presence and severity of depressive symptoms in individuals, particularly those in a primary care setting or general population. The MDI index is used to identify major depressive disorder, as well as to measure the severity of depressive symptoms. It can be used to monitor changes in symptoms over time, making it a useful tool for evaluating the effectiveness of treatment interventions. The MDI index is not recommended for use in individuals with cognitive impairment or severe mental illness, as these conditions may affect the individual's ability to accurately self-report symptoms.

Major Depression Inventory index (MDI index)

Peripartum depression

Psychotherapy

Initial evaluation

Indications for screening

Screening tools

Antidepressants

Perinatal counseling

General principles

Electroconvulsive therapy

Hormonal therapy

Psychosocial support

Herbal products

Exercise

Preconception counseling

Updated 2024 SOGC guidelines for screening and management of perinatal mood and anxiety disorders


Peripartum depression

Background

Overview

Guidelines

Key sources