Perinatal Mental Health
PHQ-9 Perinatal Depression Screen
9-item depression screen for pregnancy and postpartum. PHQ-9 vs EPDS, score interpretation, when to seek urgent help, treatment options (CBT, antidepressants), how to support partners. NICE NG192.
Last reviewed 2 June 2026
PHQ-9 — perinatal depression screen
Over the last 2 weeks, how often have you been bothered by…
Each item asks how often over the past 2 weeks. Answer honestly — there are no wrong answers. ACOG (2023) recommends this screen at least once during pregnancy and at the postpartum visit; AAP additionally recommends at 1-, 2-, 4-, and 6-month well-child visits.
Answer all 9 questions to see your total score.
Am I depressed or just exhausted?
Both are real and can overlap.
Normal tiredness: exists alongside baseline ability to enjoy moments, feel some warmth toward baby/partner; emotions vary day-to-day.
Depression: persistent low mood + loss of interest/pleasure MOST OF THE DAY, NEARLY EVERY DAY, for 2+ weeks. Often with guilt, hopelessness, self-harm thoughts.
NOT “baby blues” (which resolves in 2 weeks).
PHQ-9 vs EPDS
- EPDS (Edinburgh Postnatal Depression Scale): 10 items; excludes physical symptoms (sleep, fatigue) to avoid false positives in new mothers. Designed for perinatal. UK favourite.
- PHQ-9: 9 items mapped to DSM-5 MDD criteria; includes physical symptoms. Wider validation. US favourite. USPSTF-endorsed.
Either acceptable. Use whichever your service offers.
How common is PND?
~10-15% of new mothers (some studies up to 20%). Risk higher if: previous depression, family history, traumatic birth, NICU baby, lack of support, financial stress, partner strain, sleep deprivation, fertility journey trauma.
Also affects ~10% of new dads. Recognise and screen partners too.
PHQ-9 score interpretation
- 0-4: minimal / not depression.
- 5-9: mild.
- 10-14: moderate.
- 15-19: moderately severe.
- 20-27: severe.
Any active thoughts of self-harm (item 9): URGENT review.
≥10: likely depression, GP referral.
≥15: moderate-severe, urgent referral, consider antidepressants.
Postpartum psychosis — emergency
Rare (~1 in 1,000) but EMERGENCY. Symptoms within first 2 weeks postpartum: confusion, paranoia, hallucinations, delusions, severe mood swings, mania, insomnia.
Higher risk: previous psychosis, bipolar disorder, family history. Call 999 / 111 / perinatal mental health team immediately.
When to be screened
- Booking (first midwife appointment).
- 28 weeks pregnancy.
- 6-8 weeks postpartum (6-week check).
- 3-4 months postpartum.
- Whenever concerned.
Treatment options
- Talking therapy — CBT, IPT. NHS Talking Therapies free. NICE first-line for mild-moderate.
- Antidepressants — SSRIs (sertraline first-line in pregnancy + breastfeeding). Risks vs benefits weighed.
- Social support — peer groups (Pandas Foundation, NCT).
- Self-care — sleep, eat, light, gentle movement.
- Partner + family involvement.
- Perinatal mental health team for severe cases.
Antidepressants in pregnancy / breastfeeding?
Untreated depression has REAL risks: growth issues, preterm birth, attachment problems.
SSRI risks in pregnancy: small. Sertraline first choice (lowest milk transfer). Risks of NOT treating typically outweigh risks of treating.
Shared decision with mental health team. WHO advice: continue established treatment in pregnancy unless safer alternative available.
Self-harm thoughts — urgent help
- Don’t be alone — call partner, family, friend.
- NHS 111 in UK or 988 / 911 in US.
- Perinatal mental health crisis line (varies by area).
- GP same-day or A&E.
Postpartum psychosis is a medical emergency. PND with suicidal thoughts is also emergency.
Intrusive thoughts (unwanted thoughts of harming baby in OCD-like manner) common in PND/anxiety; not the same as wanting to harm — speak to GP. You are NOT a bad mother for these thoughts.
Different scenarios — perinatal depression
Scenario 1: First-time mum, 8 weeks postpartum, exhausted + tearful
Could be baby blues (early) or PND. Health visitor screening. PHQ-9 + EPDS. Refer if ≥10. Support practical (sleep, partner help, support groups).
Scenario 2: Previous PND, planning second pregnancy
Preconception planning with GP. Consider preventive antidepressant 2nd-3rd trimester. Specialist perinatal mental health team referral. Birth plan includes mental health monitoring.
Scenario 3: 28 weeks pregnant, anxious + low mood
Antenatal PND / anxiety. PHQ-9 + GAD-7. CBT via NHS Talking Therapies free. SSRI if moderate-severe. Birth plan adaptations (partner support, less stimulating environment).
Scenario 4: Postpartum psychosis symptoms at day 5
Emergency. 999 / out-of-hours psychiatric service. Mother-and-baby unit admission usually. Excellent recovery rate with treatment.
Scenario 5: New dad struggling, withdrawn, irritable
Paternal PND. PHQ-9 screen. GP referral. CBT via Talking Therapies. Pandas Foundation peer support. Don’t overlook partner.
Care guidance — perinatal mental health
- Routine screening at booking, 28 wk, 6-8 wk postpartum.
- Tell midwife / GP / HV if struggling.
- Self-harm thoughts: urgent help — 111 / 999 / crisis line.
- Talking therapy first-line (NHS Talking Therapies free).
- Sertraline first-line SSRI in pregnancy + breastfeeding.
- Don’t stop established treatment without consultation.
- Screen partners — paternal PND ~10%.
- Previous PND: proactive plan for next pregnancy.
- Support charities: Pandas Foundation, Mind, Maternal Mental Health Alliance.
- NOT YOUR FAULT; treatment helps.
Sources
- NICE NG192. Antenatal and postnatal mental health.
- ACOG Clinical Practice Guideline No. 4 (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001.
- Cox JL, Holden JM, Sagovsky R. Edinburgh Postnatal Depression Scale (EPDS). Br J Psychiatry 1987.
- NHS Maternal Mental Health Alliance. maternalmentalhealthalliance.org.
- Pandas Foundation. pandasfoundation.org.uk.
Recommended for this calculator
Frequently asked questions
Am I depressed or just exhausted from being pregnant / new mum?
BOTH are real and can overlap. NORMAL pregnancy/postpartum tiredness: exists alongside baseline ability to enjoy moments, find meaning, feel some warmth toward baby/partner; emotions vary day-to-day. DEPRESSION: persistent low mood + loss of interest/pleasure (anhedonia) MOST OF THE DAY, NEARLY EVERY DAY, for 2+ WEEKS. Often accompanied by: persistent guilt, hopelessness, thoughts of self-harm, persistent inability to enjoy anything. NOT 'baby blues' (which resolves in 2 weeks). Tools like PHQ-9 or EPDS help distinguish. If unsure: SCORE TOOLS + speak with GP / midwife / health visitor / perinatal mental health team.
What's the difference between PHQ-9 and EPDS?
BOTH screen perinatal depression. EPDS (Edinburgh Postnatal Depression Scale, 1987): 10 items; DELIBERATELY EXCLUDES physical symptoms (sleep loss, fatigue, low energy) because those are nearly universal in new mothers, causing false positives. Designed specifically for perinatal. PHQ-9: 9 items mapped directly to DSM-5 Major Depressive Disorder criteria; INCLUDES physical symptoms. Wider validation across all primary-care contexts. USPSTF endorses for perinatal screening; ACOG accepts either. EPDS more popular in UK; PHQ-9 more popular in US. CHOOSE whichever your service uses. RESULTS compared either way.
How serious is postnatal depression (PND)?
VERY common AND treatable. AFFECTS ~10-15% of new mothers (some studies up to 20%). RISK HIGHER if: previous depression, family history, traumatic birth, NICU baby, lack of support, financial stress, partner relationship strain, sleep deprivation, fertility journey trauma. UNTREATED PND IMPACTS: baby development (attachment, cognitive); maternal physical health; partner relationship; future pregnancies. ALSO: PND can affect FATHERS (~10%); recognise and screen partners too. TREATED EARLY: usually fully recovered within months.
What about postpartum psychosis?
VERY DIFFERENT from PND. Rare (~1 in 1,000 births) but EMERGENCY. Symptoms within first 2 weeks postpartum usually: confusion, paranoia, hallucinations (seeing/hearing things), delusions (strong false beliefs), severe mood swings, mania, insomnia not just from baby. INCREASED RISK: previous psychosis, bipolar disorder, family history, schizoaffective disorder. URGENT: 999 / A&E / perinatal mental health team (in pregnancy: contact specialist perinatal mental health team). NOT IMMEDIATELY DANGEROUS to baby usually but mother at risk; needs urgent psychiatric admission. RECOVERY usually good with treatment.
When should I be screened?
UK NICE / NHS recommends: AT BOOKING (first midwife appointment); 28 WEEKS pregnancy; 6-8 WEEKS POSTPARTUM (health visitor 6-week check); 3-4 MONTHS POSTPARTUM; whenever concerned. Whittington Hospital / RCOG NHS England target: routine screening at each contact. NEW DAD also worth screening — paternal PND is real. SCREENING IS NOT DIAGNOSING — high score → diagnostic interview by GP / mental health professional.
What does my score mean?
PHQ-9 SCORING: 0-4 minimal / not depression; 5-9 mild; 10-14 moderate; 15-19 moderately severe; 20-27 severe. IN PREGNANCY/POSTPARTUM: any score with active thoughts of self-harm (item 9: 'thoughts that you would be better off dead, or hurting yourself') → URGENT review. ≥10 → likely depression, GP referral. ≥15 → moderate-severe depression, urgent referral, consider antidepressants. EPDS: ≥10 mild risk; ≥13 strong indicator. POSITIVE SCREEN: full clinical assessment for diagnosis.
What treatment is available?
(1) TALKING THERAPY — CBT (Cognitive Behavioural Therapy), IPT (Interpersonal Therapy). NHS Talking Therapies (formerly IAPT) free; private also. NICE first-line for mild-moderate depression. (2) MEDICATION — antidepressants. SSRIs (sertraline, fluoxetine, citalopram) considered safest in pregnancy + breastfeeding. ALL SSRIs cross placenta + into milk; risk-benefit decision. Treatment effective. (3) SOCIAL SUPPORT — peer groups (Pandas Foundation, PANDAS, NCT). (4) SELF-CARE — sleep when possible, eat, light exposure, gentle exercise. (5) PARTNER + FAMILY involvement essential. (6) PERINATAL MENTAL HEALTH TEAM for severe cases.
Should I avoid antidepressants in pregnancy / breastfeeding?
NOT NECESSARILY. UNTREATED depression has REAL RISKS: baby growth issues, preterm birth, attachment problems, possibly suicide. SSRI risks in pregnancy: small (~0.4% increase in cardiac defects with paroxetine; less with sertraline/fluoxetine); neonatal adaptation syndrome possible (~1/3 of SSRI-exposed newborns mildly affected with jitteriness — settles in days). SERTRALINE FIRST CHOICE in pregnancy + breastfeeding (lowest milk transfer). Risks of NOT treating typically outweigh risks of treating. SHARED DECISION with mental health team / specialist perinatal mental health team. WHO advice: continue established treatment in pregnancy unless safer alternative available.
What if I'm having thoughts of hurting myself or my baby?
URGENT HELP: (1) DON'T BE ALONE — call partner, family, friend; (2) NHS 111 in UK or 988 / 911 in US; (3) PERINATAL MENTAL HEALTH crisis line (varies by area); (4) GP same-day or A&E. NOT YOUR FAULT. POSTPARTUM PSYCHOSIS is a medical emergency. POSTNATAL DEPRESSION with suicidal thoughts is also emergency. INTRUSIVE THOUGHTS (unwanted thoughts of harming baby in OCD-like manner) common in PND and ANXIETY, not the same as wanting to harm — speak to GP. YOU ARE NOT A BAD MOTHER for these thoughts. Treatment helps.
What about anxiety in pregnancy/postpartum?
OFTEN co-exists with depression. PERINATAL ANXIETY affects ~15-20%. Forms: GAD (generalised anxiety), panic disorder, OCD, PTSD (after traumatic birth/loss), social anxiety. SYMPTOMS: persistent worry, can't relax, racing heart, sleep disturbance, intrusive thoughts. SCREEN with GAD-7 (perinatal version available — see /calculators/gad7-perinatal). TREATMENT: CBT, mindfulness, SSRIs, peer support. PARTNERS / family often notice anxiety even when depression less obvious. NHS Talking Therapies covers anxiety free.
Will having PND affect my baby?
TREATED PND: minimal long-term effect. UNTREATED moderate-severe PND: small but real effect on attachment, emotional regulation development, language acquisition. HOWEVER: this is reversible with treatment + ongoing support. RECOVERED MOTHER + supportive partner = good outcomes for child. KEY: EARLY DETECTION + treatment + support. Many high-achieving adults had mothers with PND — outcomes depend on overall environment, not single factor. GUILT not useful — TREATMENT is.
Can dads / partners get postnatal depression?
YES. PATERNAL PND affects ~10% of new dads. RISK higher if: mother also depressed, financial stress, relationship strain, lack of leave/support. SYMPTOMS: similar to maternal PND — low mood, irritability, withdrawal, hopelessness. SCREENING: PHQ-9 or EPDS for partners too. RECOGNITION poor — partners often invisible in maternity care. SUPPORT: Pandas Foundation supports both parents; some areas have specific dads' groups. WHEN TO REFER: significantly affecting family function, parenting, work; or partner expressing distress.
What support is available?
UK: (1) GP — first port of call. (2) Health visitor — universal contact, screens routinely. (3) MIDWIFE — antenatal. (4) PERINATAL MENTAL HEALTH TEAMS — specialist (referral usually via GP/midwife). (5) NHS Talking Therapies (free CBT/IPT). (6) Mind charity helpline. (7) Pandas Foundation (PND specialist). (8) PANDAS — partner / siblings support. (9) Maternal Mental Health Alliance. (10) Samaritans 116 123 (24/7). (11) Sands (bereavement). EMERGENCY: 999 / 111 / A&E for crisis.
Can mental health affect breastfeeding?
BIDIRECTIONAL. DEPRESSION often makes breastfeeding feel harder; difficulty breastfeeding can worsen depression. SOME RESEARCH suggests breastfeeding-protective against PND, but quitting breastfeeding isn't a 'cause' of PND — and exclusively bottle-feeding mothers also recover. MOST ANTIDEPRESSANTS compatible with breastfeeding (sertraline safest). DOMPERIDONE (galactagogue) sometimes withheld in psychiatric concerns. PROTECT mental health > exclusive breastfeeding sometimes — formula is fine, fed is best.
What if I had PND with previous baby?
RISK ~50% in next pregnancy. PROACTIVE PLANNING: (1) Discuss with GP before/during this pregnancy; (2) Plan support network early; (3) Some women restart antidepressants 2nd-3rd trimester preventively; (4) Specialist perinatal mental health team referral antenatally; (5) Birth plan includes postpartum mental health monitoring; (6) Partner education about signs; (7) Plan postpartum support — meals, childcare for older child, reduced visitors. EARLY INTERVENTION often prevents severity escalation.
How does this relate to other calculators on BumpBites?
Companion: /calculators/postpartum-depression-quiz (EPDS); /calculators/gad7-perinatal for anxiety; /calculators/postpartum-mood-warning for red flags; /calculators/postpartum-thyroiditis (often confused with PND); /calculators/postpartum-hair-loss; /calculators/postpartum-weight-loss; /calculators/breastfeeding-latch; /calculators/birth-plan-builder (mental health plan).