For providers · Clinical resource

Your patient scored 13 or higher on the EPDS — a 5-minute referral pathway

By Josephine W. Hazeley, MSN, PMHNP-BC
Board-certified psychiatric mental health nurse practitioner with a perinatal & postpartum focus — nearly two decades in psychiatric nursing, including research nursing on the trial behind the first FDA-approved postpartum-depression therapy. About your clinician

Clinically reviewed by Josephine W. Hazeley, PMHNP-BC on · Last updated

A patient who scores 13 or higher on the Edinburgh Postnatal Depression Scale (EPDS) likely has clinically significant depressive symptoms and needs a follow-up plan before she leaves your office — and in North Carolina that plan can be as simple as: check item 10, tell her what the score means, and send her contact details (with her consent) to a perinatal psychiatric prescriber who can typically see her within 1–3 business days. This page is that pathway, written to take five minutes or less.

Screening is the part obstetric care has largely solved: ACOG recommends screening for perinatal depression and anxiety with a validated instrument at the initial prenatal visit, later in pregnancy, and postpartum (ACOG patient-screening program). The gap is what happens after a positive screen: in a systematic review of the perinatal depression treatment cascade, an estimated 15.8% of women with postpartum depression received any treatment, and 6.3% received adequate treatment (Cox et al., 2016). The pathway below is designed to close that gap in the same visit the screen happens.

First: check item 10, every time

Item 10 of the EPDS asks about thoughts of self-harm (Cox, Holden & Sagovsky, 1987). Any positive response to item 10 requires a same-day safety assessment, whatever the total score.

  • Emergency now (active suicidal intent, thoughts of harming the baby, or any sign of postpartum psychosis — new confusion, hallucinations, delusional beliefs, mania): call or text 988, call 911, or send her to the nearest emergency department. Postpartum psychosis is a psychiatric emergency; it does not wait for an outpatient referral.
  • Urgent but stable: same-week psychiatric evaluation; say so explicitly when you refer.

The 5-minute pathway (EPDS ≥13, no emergency)

  1. Name the result, plainly and kindly. A score of 13 or higher means “your answers suggest you may be dealing with depression — it’s common, it’s treatable, and it’s not your fault.” A screen is not a diagnosis; the diagnostic evaluation is the specialist’s job, not the six-minute visit’s.
  2. Ask one question: “Would it be okay if a psychiatric clinician who specializes in pregnancy and postpartum reached out — or I give you their number?” Consent turns a screen into a referral.
  3. Make the referral — one call or email. Mindful Counseling & Wellness is a North Carolina telehealth psychiatric practice led by Josephine W. Hazeley, MSN, PMHNP-BC, and new patients are typically seen within 1–3 business days (current availability): (919) 739-3808 · info@mindfulcounselingandwellness.com. Telehealth means the pathway works the same whether your practice is in Raleigh or three hours from one.
  4. Tell her what to expect — a complete psychiatric evaluation, not an automatic prescription. Medication decisions in pregnancy and lactation are individualized risk–benefit conversations with a perinatal-trained prescriber; therapy she already has stays in place (how we care for perinatal patients).
  5. Expect to hear back. With the patient’s consent, we close the loop with the referring practice — what referral loops look like, and everything else about referring, is in the provider referral guide.

Make it a wall protocol

This pathway exists as a printable one-pager for exactly that purpose — pin it where your nurses and MAs triage screens. Ask us for it, or download it from this page once the practice is live. Scores of 10–12 deserve a plan too (repeat screening at the next visit at minimum); your clinical judgment always outranks any cutoff.

If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911. Postpartum Support International also maintains perinatal-specific support resources at postpartum.net.

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