Outcome Measure
Male Depression Risk Scale
What it measures?
- The Male Depression Risk Scale (MDRS) measures the risk of depression in men by assessing externalizing and male-specific depression symptoms. Six symptom domains are assessed, including emotion suppression, drug use, alcohol use, anger and aggression, somatic symptoms and risk-taking.
Who is it for?
Males aged 18 years +
Instrument Quality
- The Male Depression Risk Scale (MDRS) has been the subject of several validation studies, indicating its potential as a tool for assessing male depression risk (Rice et al., 2017). Rice and colleagues conducted a study validating the MDRS in a representative Canadian sample, demonstrating its sensitivity and specificity in identifying men with recent suicide attempts (Rice et al., 2017). Similarly, Herreen et al. (2022) validated the MDRS-22 in a cross-sectional study of Australian men, further supporting its efficacy in assessing male depression risk (Herreen et al., 2022). These studies highlight the MDRS-22 as the first male-sensitive depression scale to be psychometrically validated using confirmatory factor analysis (CFA) techniques in independent and cross-national samples.
Structure
- 22 items
- 8-point Likert scale
- Respondents indicate how frequently (0 = “0 Not at all”; 7 = “7 Almost always”) each item (e.g. “I covered up my difficulties”) has applied to them in the past month.
- Validation studies have supported the six-domain factor structure of the MDRS, assessing emotion suppression, drug use, alcohol use, anger and aggression, somatic symptoms and risk-taking (Rice,, Fallon & Aucote, 2013).
Scoring instructions
- Raw scores across all items are summed to derive a full-scale score
- Groups of items can be summed to derive subscale scores (supported by factor analytics research) as follows:
- Emotion Suppression: 1, 2, 8, 17
- Drug Use: 13, 22, 18
- Alcohol Use: 3, 10, 11, 15
- Anger & Aggression: 12, 19, 20, 21
- Somatic Symptoms: 5, 6, 7, 9
- Risk-Taking: 4, 14, 16
| Subscale | Item number |
|---|---|
Full-scale (MDRS-22) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22 |
Emotion Suppression |
1,2,8,17 |
Drug Use |
13,18,22 |
Alcohol Use |
3,10,11,15 |
Anger & Aggression |
12,19,20,21 |
Somatic Symptoms |
5,6,7,9 |
Risk-Taking |
4,14,16 |
Score Interpretation
What higher scores mean?
- Higher scores on the MDRS indicate a greater risk and severity of depression in men. Higher scores on MDRS also may also indicate elevated risk of suicide. Rice and colleagues (2017) found that a cutoff score of 51 correctly identified 85% of men with a recent suicide attempt, able to correctly identify recent suicide attempt—with a sensitivity of 84.62% and a specificity of 77.51%.
Identifying risk
A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.
| Item number | Item content |
|---|---|
| 4 | I drove dangerously or aggressively |
| 14 | I stopped caring about the consequences of my actions |
| 16 | I took unnecessary risks |
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Low | 0 | |
| Elevated | 32 | |
| Major Depressive Disorder (Suicide Risk) | >=51 | Provisional Diagnosis |
| High | 51 | |
| Extreme | 87 | |
| Maximum | 154 |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 10.88 | |
| 1 SD above normative mean | 18.4 | |
| 2 SD above normative mean | 25.92 | |
| Maximum | 28 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 20.58 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 10.88 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 5.6 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 7.52 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.69 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 1.89 | |
| 1 SD above normative mean | 6.42 | |
| 2 SD above normative mean | 10.95 | |
| Maximum | 21 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 3.9 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 1.89 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 6.67 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 4.53 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.8 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 4.5 | |
| 1 SD above normative mean | 11.39 | |
| 2 SD above normative mean | 18.28 | |
| Maximum | 28 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.73 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 4.5 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 7.34 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 6.89 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.72 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 5.57 | |
| 1 SD above normative mean | 12.29 | |
| 2 SD above normative mean | 19.01 | |
| Maximum | 28 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 7.72 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 5.57 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 6.3 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 6.72 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.8 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 5.97 | |
| 1 SD above normative mean | 12.42 | |
| 2 SD above normative mean | 18.87 | |
| Maximum | 28 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 7.42 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 5.97 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 6.19 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 6.45 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.73 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 2.98 | |
| 1 SD above normative mean | 7.26 | |
| 2 SD above normative mean | 11.54 | |
| Maximum | 21 |
Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.72 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 2.98 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.13 | Rice and colleagues (2020) employed a sample of 234 Australian men self-reporting a mental health problem. Among these, 101 indicated that they were not receiving treatment. We have chosen to report the mean and sd corresponding to this subsample (i.e. N = 101). |
| Normative | 4.28 | Rice and colleagues (2019) evaluated a large Canadian sample (N = 1000). The sample was stratified to ensure that the composition represented the underlying distribution of the Canadian male population by age and province, as indicated by 2011 Census data. |
Reliability
| Value | Comments |
|---|---|
| 0.64 | * Test-retest reliability coefficient applies to a subsample of males over a 12-week interval (Rice et al., 2025). |
Instrument developers
- 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.
Refrences
*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. *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. *Herreen, D., Rice, S., & 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(3), e053650. *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.*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.*Owsiany, M. T. (2022). Validity Evidence for the Male Depression Risk Scale-22 (MDRS-22) in Younger and Older Adult Males.*Stewart, R. A. (2020). Men’s externalizing depression: invariance of the male depression risk scale and latent symptom profiles among African American and European American men.*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.*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.* Herreen, D. A. (2022). Externalising and Prototypic Depressive Symptomology in Older Men: Implications for Depression Screening in Men across the Lifespan (Doctoral dissertation).*Eggenberger, L., Fordschmid, C., Ludwig, C., Weber, S., Grub, J., Komlenac, N., & Walther, A. (2021). Men’s psychotherapy use, male role norms, and male-typical depression symptoms: examining 716 men and women experiencing psychological distress. Behavioral Sciences, 11(6), 83.*Zajac, I. T., Rice, S., Proeve, M., Kealy, D., Oliffe, J. L., & Ogrodniczuk, J. S. (2022). Suicide risk, psychological distress and treatment preferences in men presenting with prototypical, externalising and mixed depressive symptomology. Journal of mental health, 31(3), 309-316.*Rice, S. M., Kealy, D., Oliffe, J. L., & Ogrodniczuk, J. S. (2019). Externalizing depression symptoms among Canadian males with recent suicidal ideation: A focus on young men. Early intervention in psychiatry, 13(2), 308-313*Chodkiewicz, J., & Miniszewska, J. (2016). Male depression–the concept, measurement tools and relationships with suicidal behaviours. Journal of Psychiatry and Clinical Psychology, 16(1), 33.*Rice, S. M., Oliffe, J. L., Kealy, D., & Ogrodniczuk, J. S. (2018). Male depression subtypes and suicidality: Latent profile analysis of internalizing and externalizing symptoms in a representative Canadian sample. The Journal of nervous and mental disease, 206(3), 169-172.* Proudfoot, J., Fogarty, A. S., McTigue, I., Nathan, S., Whittle, E. L., Christensen, H., ... & Wilhelm, K. (2015). Positive strategies men regularly use to prevent and manage depression: a national survey of Australian men. BMC Public Health, 15(1), 1-14.
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Severity ranges
*Scores in the 'elevated' range indicate sub-threshold at-risk status (Rice et al., 2019). The primary cut-off score of 51 was optimal for inferring a suicide attempt in the past two weeks. Among the 13 men who disclosed a recent suicide attempt, 11 (84.62%) scored above the primary cut-off score. In addition, 67.9% of cases in the 'extreme' range experienced recent suicidal ideation.
Provisional diagnosis
Reliable change and clinically significant improvement
Research by Rice and colleagues (2020) indicated that the MDRS may be better able to differentiate men’s treatment response to mental health intervention than the PHQ-9. Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation
Reliability