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The 22-item Male Depression Risk Scale (MDRS-22) is a self-report instrument that can be used to identify adult men’s risk of depression, with a focus on externalising signs and symptoms (i.e., aggression & drug use; Rice et al., 2013). The MDRS-22 has a particular advantage over gender-neutral depression rating scales, as it specially measures factors empirically associated with depression and suicidality in men and emphasises maladaptive coping strategies.
Example MDRS-22 items:
The MDRS-22 is intended for use as a screening tool and has also been shown to be useful as a predictor of clinical characteristics such as depression or other psychiatric diagnosis (Walther et al., 2021). High scores on the MDRS-22 are associated with a history of recent suicide attempts (Rice et al., 2017). The scale shows sensitivity to longitudinal change for symptomatic men, and has been used to model depression symptom trajectories over time (Rice et al 2020). It is useful for clinicians in monitoring risk factors in men and the progression of treatment.
Scores consist of a total score (range 0 to 154) with higher scores indicative of a greater risk of significant depressive symptoms. A total score risk descriptor is presented to provide an indication of risk. Risk ranges are defined as follows (Rice et al., 2017):
A percentile is computed for the total score, comparing the respondents scores to a normative sample of men (Rice et al., 2017). Percentiles help contextualise the respondents pattern of responding in relation to a typical man, where a percentile of 50 represents average depression risk in men. This corresponds to an “elevated” depression risk according to the below risk ranges, highlighting that the typical man is at significant risk of depression
In addition, average scores are calculated for the total score and subscales scores, which represent the level of agreement on the likert scale, from 0 to 7. An average score of 0 equates to “Not at all” and 7 represents “Almost always” on the likert scale. Average scores allow patterns of responding to be directly compared across subscales with a common metric.
The subscales are listed below, with each subscale contributing to depression risk at a different level, as defined below. NovoPsych defined elevated risk for each subscale as being above the normative mean, with the exception of drug and alcohol use which was defined as elevated with any score above 0.
The MDRS-22 was developed by Rice and colleagues (2013) to provide a shorter and more psychometrically sound alternative to depressive symptom scales for men which focus specifically on externalising symptoms. Several psychometric studies of the MDRS-22 have been conducted and their results support the validity and reliability of the instrument.
Rice and colleagues (2015) observed alpha values ranging from .86 to .92 and test-retest correlations from .67 to .78. Similarly, a 2017 study found the total scale and all subscales displayed an alpha of .83 or higher (Rice et al., 2017). These results are consistent with later investigations using more accurate reliability estimators such as Guttman’s Lambda 2 and MacDonald’s Omega (Rice et al., 2020; Walther et al., 2021). An age validation was carried out by Herreen and colleagues (2022) comparing a younger (18-65) and an older sample (65-93 years), with results supporting the MDRS-22 for use with both populations.
Scores of 50 and above may be at significant risk of suicide attempts. The MDRS scores have been shown to outperform PHQ-9 cut off scores in identifying men with a recent suicide attempt to a sensitivity of 85% and a specificity of 78% (Rice et al., 2017). This research defined a recent suicide attempt as the responding yes to the item “In the past month, did you attempt suicide?”.
Normative data among a community sample of men was collected (Rice et al., 2017), with the following means and standard deviations found:
Based on this available data, NovoPsych defined elevated risk for each subscale as being above the mean, with the exception of drug and alcohol use which was defined as elevated with any score above 0.
Rice, S. M., Fallon, B. J., Aucote, H. M., Möller-Leimkühler, A., Treeby, M. S., & Amminger, G. P. (2015). Longitudinal sex differences of externalising and internalising depression symptom trajectories: Implications for assessment of depression in men from an online study. The International Journal of Social Psychiatry, 61(3), 236–240. https://doi.org/10.1177/0020764014540149
Rice, S. M., Fallon, B. J., Aucote, H. M., & Möller-Leimkühler, A. M. (2013). Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men. Journal of Affective Disorders, 151(3), 950-958. https://doi.org/10.1016/j.jad.2013.08.013
Herreen, D., Rice, S., Ward, L., & Zajac, I. (2022). Extending the Male Depression Risk Scale for use with older men: the effect of age on factor structure and associations with psychological distress and history of depression. Aging & Mental Health, 26(8), 1524–1532. https://doi.org/10.1080/13607863.2021.1947966
Rice, S. M., Ogrodniczuk, J. S., Kealy, D., Seidler, Z. E., Dhillon, H. M., & Oliffe, J. L. (2019). Validity of the Male Depression Risk Scale in a representative Canadian sample: sensitivity and specificity in identifying men with recent suicide attempt. Journal of Mental Health, 28(2), 132–140. doi: 10.1080/09638237.2017.1417565
Rice, S. M., Kealy, D., Seidler, Z. E., Oliffe, J. L., Levant, R. F., & Ogrodniczuk, J. S. (2020). Male-Type and Prototypal Depression Trajectories for Men Experiencing Mental Health Problems. International Journal of Environmental Research and Public Health, 17(19), 7322. https://doi.org/10.3390/ijerph17197322
Walther, A., Grub, J., Ehlert, U., Wehrli, S., Rice, S., Seidler, Z. E., & Debelak, R. (2021). Male depression risk, psychological distress, and psychotherapy uptake: Validation of the German version of the male depression risk scale. Journal of Affective Disorders Reports, 4, 100107. https://doi.org/10.1016/j.jadr.2021.100107
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