Male Depression Risk Scale (MDRS-22)

The Male Depression Risk Scale (MDRS‑22) is a self-report instrument developed by Simon Rice and colleagues (2013) to assess depression risk in men, capturing both conventional internalizing symptoms and male-typical externalizing behaviors that may be underdetected by standard depression measures. Traditional tools, such as the PHQ-9, can overlook depression in men due to gender-related differences in symptom expression, including irritability, substance use, or risk-taking behaviors.

The MDRS‑22 consists of 22 items, each rated on an 8-point Likert scale (0 = “Not at all” to 7 = “Almost always”), reflecting experiences over the past month. Total scores range from 0 to 154, with higher scores indicating a greater level of depression-related risk. The scale addresses a spectrum of behavioral, emotional, and physical indicators that have been empirically associated with male depression, including emotion regulation, substance and alcohol use, interpersonal irritability, somatic complaints, and engagement in potentially risky behaviors.

Validation studies demonstrate that the MDRS‑22 has strong psychometric properties, including high internal consistency (Cronbach’s α >0.80–0.90), reliable test-retest performance, and convergent validity with established depression measures and suicide risk indicators. It has been shown to outperform traditional scales in identifying recent suicide attempts (AUC = 0.837) and effectively stratifying risk profiles among men.

The MDRS‑22 is freely available for non-commercial use and is suitable for clinical screening, research, and primary care applications. A brief version, the MDRS‑7, is also available for situations requiring rapid assessment. Integrating the MDRS-22 with conventional depression measures can improve detection of depression in men and support early intervention.

Depression in men presents a significant public health concern, with unique epidemiological, clinical, and behavioral characteristics. Epidemiological data indicate that while women report higher overall rates of depression, men experience comparable lifetime prevalence but are more likely to exhibit underdiagnosed or atypical presentations. Sociocultural factors, including masculine norms that discourage emotional disclosure, contribute to lower help-seeking behaviors and may mask traditional depressive symptoms such as sadness or tearfulness.

Clinically, male depression often manifests with externalizing behaviors, which can include irritability, anger outbursts, risk-taking, substance use, and social withdrawal. Somatic complaints—such as fatigue, sleep disturbances, gastrointestinal symptoms, or unexplained pain—are also frequently reported and can serve as indirect indicators of depressive states. These patterns can complicate diagnosis, as standard screening tools primarily emphasize internalizing symptoms and may not fully capture male-specific presentations.

Research indicates that men with depression are at elevated risk for adverse outcomes, including occupational impairment, relationship difficulties, and suicide. Suicide rates among men are consistently higher than among women, highlighting the importance of accurate assessment and early intervention. Evidence suggests that gender-sensitive screening instruments, alongside conventional measures, improve detection and facilitate targeted interventions.

Treatment approaches for male depression benefit from a combination of pharmacological, psychotherapeutic, and lifestyle interventions. Cognitive-behavioral therapies adapted for male coping styles, substance use management, and psychoeducation around emotion regulation are particularly effective. Understanding the behavioral and somatic dimensions of male depression is critical for clinicians, researchers, and public health practitioners to ensure timely identification, appropriate care, and reduction of associated morbidity and mortality.

References

• 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. M., 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
• Owsiany, M. T. (2022). Validity evidence for the Male Depression Risk Scale‑22 (MDRS‑22) in younger and older adult males (Master’s thesis). West Virginia University. https://doi.org/10.33915/etd.11617
• Herreen, D., Rice, S. M., & Zajac, I. (2022). Brief assessment of male depression in clinical care: Validation of the Male Depression Risk Scale short form in a cross‑sectional study of Australian men. BMJ Open, 12, e053650. https://doi.org/10.1136/bmjopen‑2021‑053650