Perinatal Mental Health Screening: What Tools Are Used and What Can Doulas Do?

By Birth & Baby University · Last updated: October 2026 · 3 min read

Clients are often handed a questionnaire at a prenatal or postpartum visit and told their score. Some doulas are asked to share screening forms in community programs. Understanding what screens can and cannot tell you helps you support the client, make good referrals and avoid either over- or under-reacting to a number.

Key takeaways

• An individual-participant meta-analysis of the EPDS found a cut-off of 11 or higher maximized combined sensitivity and specificity for major depression, with 0.81 sensitivity and 0.88 specificity against semi-structured interviews.
• A 2024 review found the EPDS alone is not perfectly suitable for detecting major depression in pregnancy and that evidence for most other tools, especially for anxiety, is very uncertain.
• A 2019 study found that neither the EPDS nor the GAD-7 could be recommended for widespread perinatal anxiety screening, while a clinically derived 13-item tool performed better.
• Screening starts a conversation. Diagnosis and treatment decisions belong to clinicians, and a positive screen needs follow-up.

What the research says

The EPDS for depression

A 2020 BMJ individual participant data meta-analysis from 58 studies (15,557 participants, 2,069 with major depression) found that combined sensitivity and specificity were maximized at a cut-off of 11 or higher. Against semi-structured interviews, a cut-off of 10 or higher gave sensitivity 0.85 and specificity 0.84, 11 or higher gave 0.81 and 0.88, and 13 or higher gave 0.66 and 0.95. Accuracy was similar for pregnant and postpartum women. The authors suggested that a cut-off of 13 or higher identifies people with higher symptom levels, and lower cut-offs avoid false negatives. This means that at any cut-off some people with depression score below it and some without score above it.

Screening in pregnancy and for anxiety

A 2024 systematic review of 16 test accuracy studies in pregnancy in Western countries found that an EPDS cut-off of 10 or higher gave sensitivity 0.84 and specificity 0.87 for major depression, concluded the EPDS alone is not perfectly suitable, and found so few studies of the PHQ-9, PHQ-2, GAD-2, Whooley questions and mood questions that their usefulness remained very uncertain. Most studies had moderate to high risk of bias. The authors suggested case-identification may best complement a broader dialogue between clinicians and patients. A 2019 study of 310 Canadian women at about three months postpartum found that only the 13-item Anxiety Disorder tool (AD-13) reached an AUC above 0.8, and that neither the EPDS and its anxiety subscale nor the GAD-7 and GAD-2 could be recommended for widespread perinatal anxiety screening. That is one study from one country, so the finding is a caution, not a final ranking.

Guidelines

ACOG Clinical Practice Guideline No. 4 gives recommendations on screening and diagnosis for depression, anxiety, bipolar disorder, suicidality and postpartum psychosis, graded by strength and quality of evidence. Per ACOG’s own page it replaces Committee Opinion 757 (2018) on screening for perinatal depression. Its recommendation text is a member benefit, so this article cites its scope and not its specific recommendations. The 2019 USPSTF recommendation on preventing perinatal depression found convincing evidence that counseling interventions are effective in prevention, and recommends that clinicians provide or refer people at increased risk to counseling. This article read the USPSTF statement’s abstract.

What this means for doulas

• Explain, do not interpret. If a client shares a screening result, ask how they feel about it and what their provider said. Do not tell them what their score “means.”
• Remember what screens miss. Scores can be low in a person who is struggling and high in one who is not. Pay attention to how they are doing.
• Do not use screens as diagnostic tools. If your program or role includes sharing a questionnaire, follow its protocol and the referral pathway, and tell clients what will happen with their answers.
• Act on any thought of self-harm immediately. This does not wait for a score.

Putting the evidence into practice

• Ask how the client’s screening went at their medical visits and whether they have follow-up.
• If concerned, share your observations with the client, and offer to help them contact their provider, a perinatal mental health clinician or a hotline such as 988 or the National Maternal Mental Health Hotline (1-833-852-6262).
• Know which local clinicians accept referrals and how long waits are.
• Follow up after a referral without pressure.

The bottom line

Screening tools help clinicians identify who needs further assessment, but no tool is perfect, and anxiety screening is especially uncertain. Doulas contribute by listening, noticing and linking clients to assessment and care, without turning a number into a conclusion.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Levis B, et al. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ 2020. Read the source
• Rondung E, et al. Identification of depression and anxiety during pregnancy: a systematic review and meta-analysis of test accuracy. Acta Obstetricia et Gynecologica Scandinavica 2024. Read the source
• Fairbrother N, et al. Screening for perinatal anxiety disorders: Room to grow. Journal of Affective Disorders 2019. Read the source
• ACOG Committee on Clinical Practice Guidelines-Obstetrics. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology 2023. Read the source
• US Preventive Services Task Force. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA 2019. Read the source
• National Institute of Mental Health. Perinatal Depression. NIH web page, read 16 October 2026 (National Maternal Mental Health Hotline, 1-833-852-6262; 988 Suicide and Crisis Lifeline). Read the source
• Office on Women’s Health, U.S. Department of Health and Human Services. Postpartum depression. Web page (page dated October 17, 2023), read 16 October 2026. Read the source

Knowing what screening means, and what to do next, is part of professional postpartum preparation. See the training and mentorship options on the For Doulas page.

More for professionals: the Professionals Blog.