first person

I Know Exactly How to Pass the Postpartum Depression Quiz

Five minutes in the waiting room is all it takes.

Photo: art-4-art/Getty Images
Photo: art-4-art/Getty Images

When I checked my son in at his 2-month appointment late last month, the receptionist sat up with a start and said, “Oh! We need to give you the Edinburgh!” I cooed at the baby and murmured oh yes to show her I knew the drill.

“The Edinburgh” is the Edinburgh Postnatal Depression Scale, a ten-item questionnaire used as a screening tool for postpartum women. With this baby — my second — I have taken it, so far, seven times: before discharge at the hospital after his birth; at the baby’s one-week and one-month pediatrician appointments; at two separate visits with a lactation consultant; and when I saw my OB/GYN two and then six weeks postpartum. I don’t remember exactly, how many times I took the questionnaire (or if I took it at all?) the first time around, but I do know I only had the standard six-week postpartum appointment. This time, it seems like I’ve spent two months going to doctor’s appointments and reporting with surprise how okay I feel.

At the pediatrician’s office, the receptionist finished rifling through her papers, spun around in her chair, and handed me the clipboard. “We used to just do it at one month,” she said, shrugging in apology, “but we started doing it now, too.”

“Oh!” I said, embarrassed for both of us. “Well, it’s important.” I tried to sound buoyant and authoritative, hugging the clipboard to my soft body while I performed loving eye contact with the baby, as if she might stop us and say, “You know what? Forget it. You guys look so happy you don’t even need to take it.” Instead, I maneuvered the stroller one-handed over to a row of unnecessarily hideous chairs and hunched over the now-familiar quiz.

The Edinburgh is brief: There are ten multiple-choice questions, with each option conversational variations of Always, Often, Sometimes, or Never. “I have been so unhappy I’ve felt like crying,” for instance. “No, not at all.” “Hardly ever.” “Yes, quite often.” “Only occasionally.” Answering all ten questions is meant to take about five minutes, the span of time, in an ideal world, the mother of an infant might sit in the waiting room before her name is called. Before the end of your appointment, a doctor or nurse scores the test; the darker your answers, the higher your score. If you score higher than an established cut-off, a flag is raised. It’s not meant to diagnose postpartum depression or anxiety, rather to screen and suggest further evaluation. The Edinburgh was developed in 1987 in Scotland, and it’s now used in 23 countries. When analyzed in English-speaking countries, the questionnaire has been found to reliably identify 86 percent of respondents who go on to be diagnosed with a postpartum mood disorder.

Not unlike a Myers-Briggs personality test or Harry Potter house-sorting quiz (INFP; Slytherin), I know how to answer the questions to get the results I want (which is not to imply that anybody WANTS to be a Slytherin, or that I have read Harry Potter). After my first son’s birth four years ago, I had what I then called “a very hard time” and what my therapist has suggested might have been postpartum anxiety and possibly depression and mild PTSD from childbirth. And while you can’t anecdotally diagnose yourself in retrospect, now that I’ve experienced the postpartum period feeling okay, I have little doubt that what I experienced the first time was more than a hard time.

Which is to say, I try to take this test seriously. I clear my throat and furrow my brow and lean over the clipboard, doing my soul-searching. I try to read each question like I’m reading it for the first time and have not read it out loud to my husband in an official-sounding voice: “In the past seven days, I have been able to laugh and see the funny side of things: As much as I always could? Not quite so much now? Definitely not so much now? Or, Not at all?”

He and I laughed darkly to ourselves. A few tearful scenes played out in my head and I wondered which one he was picturing. Me sobbing on the couch because our older son kept jumping on the bed next to the baby? Me snapping because he drove over the speed bumps too quickly on the way home from the hospital? Me crying hatefully in his general direction because he dared to sit up and eat crackers in the middle of the night while I nursed his son?

“Not quite so much now,” he said, and we both started laughing (did that count?).

With one nervous eye on the baby, waiting for him to start screaming or shit himself, I breezed through the questions. In the last seven days have I looked forward with enjoyment to things, as much as I ever did, rather less than I used to, definitely less than I used to, or hardly at all? I paused, contemplating the blank space ahead of me, a wide swath of unknown, save for the certainty of diapers, breast milk, and naps never long enough to accomplish anything.

Have I blamed myself unnecessarily when things went wrong? Yes, most of the time? Yes, some of the time … Didn’t I always do that? Don’t a lot of people? Shouldn’t everyone be subjected this perfectly absurd, perfectly worded, seemingly off-the-cuff, conversational interrogation into my mental state, like the quiz and I are just two friends chatting about our feelings over coffee and then casually veering the conversation to suicidal ideation? The thought of harming myself has occurred to me rather often. (It has not occurred to me, unless you count smashing my head against a wall. Hardly ever.)

All of the Edinburgh’s questions are so canny and so incisive and so evocative, the kinds of questions I’d love to be asked by someone who really wanted to know the answers. I’d like to sit with an emotionally intelligent person and laugh over these questions, pick them apart, and then talk about how I’m doing for a long time. But this was not, is not, never was, that.

I breezed through the rest of the quiz, insisting to an imaginary nagging authority figure I was fine. I am fine! And then the nurse swung open the door and called my son’s name. I leapt up, hugging the clipboard again as I wheeled us around the maze of unnecessarily hideous chairs. I could feel my shorts riding up between my thighs but grinned ear-to-ear at the baby under the evaluative eye of the office staff. I’m fine! I’m great! We’re bonded!

“Should I bring this with me to finish?” I stopped in my tracks near the receptionist and held up the clipboard. She nodded and waved her hand like, of course of course, and off we went cruising down the endless hallway.

“Look at him looking at you!” the nurse remarked, the way I’d hoped she would. I didn’t say a word, just nodded an exaggerated encouraging nod at my son, mentally urging him to smile.

Then I did as I was told and stripped him down to a clean diaper, grinning and talking in a high-pitched, breathy voice all the while, mentally pleading with him to coo, to be a good baby, to appear healthy, to weigh enough, to have good blood, good genes, good organs, a good brain. Be good, be cute, be beautiful be perfect make me seem good and beautiful and perfect, make them think well of me, make them praise me, tell me I have done a good job, that things will be easier now, since I’ve done so well and my baby is so good, my giant-veined breasts were not milked in vain; we’re about to turn a corner, thanks to my hard work we will now be rewarded!

“How often are you feeding him?”

Every two hours — “

“Still every two hours?”

“Well, two to three…”

“Two to three, okay, great.”

“And he sleeps well at night …”

“Okay, great. The doctor should be in soon.”

The nurse left the room without acknowledging my proud pronouncement on his sleep. Didn’t she want to know how long his stretches of sleep are? And the exact details of his bedtime routine? And what I do, every time, when he wakes up?

The baby smiled and laughed at me. I felt happy. Happy-imprisoned. It’s good. It’s fine. It’s temporary. Everything is fine! If you score less than ten, you “pass” the Edinburgh Postnatal Depression Scale. You are probably not depressed. Officially.

In the 30-plus years since its creation, the Edinburgh has also been found to: not work quite so well in translation (cultural differences) and not work quite so well with low-income women. Multiple studies have tried to determine what the cut-off score should be for further evaluation. Some say as low as 5, some say 13 (the highest possible score is 30).

I got a 7 at my two-week postpartum visit. My doctor circled the 7 for emphasis when she scored it in the hallway before coming in to talk to me and look at my incision. “The cut off is 10,” she said. “We’ll test you again at six weeks.” Of course I was crying, of course I was blaming myself, of course I was still seeing the lighter side of things because everything was a joke and my hormones were, as the doctor put it, “plummeting.” Plummeting. I laughed when she said this. Yup. I’m fine. It’s fine.

“But of course give us a call right away if you feel any different, if anything gets worse, okay?”

Of course, of course. I nodded obediently, eager to move along to something empirical. Like was my incision infected? (It was.)

I gave the quiz — the test? the scale? — to the receptionist on the way out of the pediatrician’s office and she said, “Oh thanks. Did they score it?” “No, but …” I said, and then shrugged like, No, but … I’m fine. I passed. I purposely passed.

We’re doing great, the quiz will tell you. I’m doing great. If no one will tell me that I’ll tell it to myself. I’ll pass your test with flying colors. You can feel good about giving it to me. You can feel like you’re looking out for the mental health of postpartum women, for once. Give them the quiz! It has reliability, specificity. It has predictive value. These are science terms. Scientists have studied the Edinburgh with populations all over the world, eager to engineer, it seems, the most efficient, cost-effective way to find us. Five minutes in the waiting room is all it takes, apparently.

This is what we’re willing to do, or what we’re able to do for postpartum women: Existential questions, offered bureaucratically. In between measuring the baby and giving him vaccinations, the pediatrician turned to me, pausing for a minute, albeit perfunctorily. I liked her. “What about you,” she said, “how are you coping — are you feeling overwhelmed?”

“Oh no, I’m great,” I said, laughing at the idea and swaying with the baby and kissing his head with possessiveness. “I mean — no, yeah I’m fine.” She nodded and then looked back at her computer and clicked a box.