New way of identifying men at risk of depression and suicide

‘A whole subset’ of men with depression who otherwise might have escaped diagnoses could soon be receiving treatment, thanks to a new screening tool developed by Australian researchers.
 
Publishing their results in BMJ Open, the researchers set out to examine the effectiveness of the new short-form Male Depression Risk Scale (MDRS-7) tool and how it correlates with the already widely validated MDRS-22.
 
Specifically, the collaborative team from the University of Adelaide CSIRO, Orygen and Freemasons Centre for Male Health and Wellbeing, wanted to see how well it could identify men at risk of depression and suicide who could be missed by mental health assessment tools currently being used by GPs to screen for the condition.
 
According to lead author and PhD candidate Danielle Herreen, the results were striking.
 
In particular, men who scored high on both traditional measures, including the Kessler Psychological Distress Scale (K10) and the Patient Health Questionnaire (PHQ-9), as well as the MDRS-7, were found to potentially have up to 30 times the risk of suicidal thinking.
 
‘Around 10% of men with depression score below the threshold for this disorder on traditional tests but will flag high on the Male Depression Risk Scale,’ Ms Herreen said.
 
‘This represents a whole subset of men who could have been flying under the radar and can now be detected.’
 
With time being a major limiting factor in the utility of the longer MDRS-22 in practice, the short-form MDRS-7 consists of seven brief questions to ensure timely completion and assesses men across a spectrum of domains commonly overlooked by traditional measures.
 
The authors say standard practice involves assessing symptoms such as low mood, loss of interest in activities, appetite changes, difficulty concentrating and feelings of worthlessness. But this approach fails to recognise a unique and different set of red flags pointing to underlying psychological distress in some men.
 
‘We found some men who may have depression or who are at risk of suicide express their distress in different ways to what we typically look for,’ Ms Herreen said.
 
‘This often appears as behaviours that may be perceived as more stereotypically masculine.’
 
The areas assessed by MDRS-7 include aggression, anger, emotion suppression, alcohol use, drug use, somatic symptoms and risk-taking.
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, told newsGP the study highlights what many GPs already intuitively know.
 
‘Men who avoid acknowledging emotions and distress, particularly grief and depression, frequently numb themselves with drugs and alcohol and this can unleash repressed anger and impulsivity, with the latter associated with suicidality,’ Dr Andronis said.
 
‘Anger can be a helpful emotion when it signals danger or hurt that is then proactively, safely and effectively dealt with, often with support of caring others.  
 
‘However, left unchecked or unacknowledged, it can explode negatively into aggression towards self or others, especially under the influence of drugs.’
 
Dr Andronis says taking a good history and being able to sensitively enquire about anger is crucial in identifying men at risk, but the MDRS-7 is a welcome ‘quick screening tool for GPs’.
 
According to the authors of the study, the new scale is not designed to replace the current approach, but to add value, allowing for a more comprehensive reading of an individual’s psychological state.
 
‘Our research shows that combining traditional screening methods with these new questions, gives a much stronger indication of a person’s overall risk of depression and suicide,’ co-author and clinical psychologist, Dr Simon Rice, said.
 
‘It may be beneficial for GPs and other health professionals to add the Male Depression Risk Scale to their assessments of male patients.’
 
The authors hope to encourage clinicians working in a role that involves one-on-one male mental health assessments to consider adopting the MDRS-7 as part of their standard practice.
 
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depression men's health mental health suicide