Report on the effect of the introduction of the Edinburgh Post Natal Depression Scale

Judy Cousins            Julie Payne

Feb 2000

(Health Visitors based at Ely Bridge Surgery at the time of this report)

In the last decade several studies have provided substantial confirmation that the months following childbirth are frequently characterized by psychiatric disorder, and that at least 10-15% of mothers experience a marked depressive illness at this time. The finding that the children of such depressed mothers may show behaviour defects at 3 years, (Wrate et al, 1985) or cognitive defects at 4 years, (Coghill et al, 1986) suggest that post-natal depression may have a long-term negative impact on the family.

The Edinburgh Post-natal Depression scale (E.P.N.S.) has been developed  to assist Primary Care Teams to detect such mothers with post-natal depression. The EPNS consists of 10 statements which relate to symptoms of post-natal depression. The mother is asked to underline the reply which comes closest to how she has been feeling during the past week. The EPNS was developed at baby clinics, and tested at health centres in Livingston and Edinburgh. The validation study showed that mothers who scored 12 or more on the scale were suffering from a depressive illness.

As a result of an Outcome Based Service Contract Project involving the multidisciplinary team at Ely Bridge Surgery, it was decided to implement the EPNS depression scale to detect post natal women suffering from depression. The implementation of the scale was performed by the Health Visitors with full support and assistance from the GPs and Practice Manager. Justification for this project was provided by research demonstrating the effectiveness of Health Visitors providing non-directive counselling sessions to women suffering with post-natal depression. The project was also deemed appropriate in working towards the Health Gain Target identified in the Protocol for Investment in Health Gain ie: "No mother [is] to suffer an unsupported episode of emotional ill-health associated with pregnancy." (WHPF, 1991)

A protocol was agreed upon, the aims of which were:-

To improve the recognition and treatment of post-natal depression

To assist early recovery

To minimise the impact of PND on the family


Screening to commence from 1/1/98

Health Visitors to offer screening to all post-natal women in the practice population using the Edinburgh Post-Natal Depression Scale.

Health Visitors to identify ante-natal vulnerability factors and to liaise with the midwife, GP and Practice Nurses.

Health Visitors to offer information on PND and EPNDS during ante-natal contact using PND leaflet.

If no ante-natal contact possible then Health Visitors to offer information, using PND leaflet at the Primary Birth Visit.

Health Visitors to screen all mothers between 4-8 weeks post-natally and 12-16 weeks post-natally. EPNDS to be repeated at 8-12  months with high scoring mothers when clinical judgment indicates.

Mothers to complete the EPNDS preferably at a home visit.

All scores to be documented in the Health Visitor Family Record and all scores will be recorded on appropriate Data Information Sheet for inclusion in Computerised GP records by the Practice Manager. (Data Information will assist evaluation of the project.)

Two-way feedback is expected between GP/PN/Midwife/Health Visitor and other team members when appropriate.

Screening Interventions

Score 0-8

No additional Health Visitor intervention unless clinical judgment indicates.

Score 9-12

Increased Health Visitor contacts/home visits:- a minimum of 2 additional contacts will be offered within 3 weeks. Liaison with GP.

Score 13+

Increased Health Visitor Intervention. A minimum of one half-hour visit will be offered every 6 weeks.

Liaison with GP and GP assessment offered to consider:-

    - use of medication

    - referral for counselling

    - referral to CPN/Psychiatrist/CMHT

A positive response to question 10 ie, self-harm, necessitates immediate GP liaison and assessment.

EPND Results