Longitudinal sex differences of externalising and internalising depression symptom trajectories: Implications for assessment of depression in men from an online study.

BACKGROUND: Clinical reports indicate that men tend to engage in a range of externalising behaviours in response to negative emotional states. Such externalising behaviours have been theorised to reflect a male sub-type of depression that is inconsistent with current diagnostic criteria, resulting in impeded detection and treatment rates of depressed men. AIMS: In addressing previous study design limitations, this article presents self-report longitudinal data for the multidimensional Male Depression Risk Scale (MDRS-22) against ratings of diagnostic criteria for major depressive disorder as assessed by the Patient Health Questionnaire-Depression Module (PHQ-9). Longitudinal psychometric properties of the MDRS-22 are reported and symptom trajectories described. METHOD: A sample of 233 adults (males = 125; 54%) completed measures of externalising and prototypic depression symptoms at Time 1, and again at Time 2 (15 weeks later). Psychometric properties were examined and within-subjects analyses undertaken. RESULTS: The MDRS-22 demonstrated stable internal consistency and test-retest correlations equivalent to those observed for the PHQ-9. Both prototypic and externalising depression symptoms increased with experiences of recent negative life events. Marked gender differences were observed. Males experiencing ≥ 2 stressful negative life events reported significantly higher MDRS-22 scores at both Time 1 and Time 2 relative to comparable females. CONCLUSION: Findings contribute to the validity of the MDRS-22 as a measure of externalising depression symptoms. Results suggest that while both males and females experience externalising depression symptoms, these symptoms may be particularly elevated for men following experiences of negative life events. Findings suggest that externalising symptoms may be a special feature of depression for men. Given the problematic nature of such externalising symptoms (e.g. excessive substance use, aggression, risk-taking), their clinical assessment appears warranted.

Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men.

BACKGROUND: The last decade has seen the burgeoning publication of male-specific depression rating scales designed to assess externalising depression symptoms (e.g., substance use, risk-taking, and aggression). These symptoms are theorised to reflect the behavioural manifestation of depression amongst men who rigidly conform to masculine norms. To date, research findings from these scales have been mixed, and each scale is limited by psychometric shortcomings or constrained assessment of symptom sub-domains. METHODS: The Male Depression Risk Scale (MDRS-22) was developed from online, non-clinical, community samples. Following best-practice recommendations, initial scale items were subject to expert review. Study 1 (male n=386) reduced the item pool via exploratory factor analysis while Study 2 (male n=499, female n=291) refined and validated the factor structure using confirmatory factor analysis. Sex and masculinity comparisons were evaluated. RESULTS: Goodness of fit indices validated the six-factor solution with subscales assessing: emotional suppression, drug use, alcohol use, anger and aggression, somatic symptoms and risk-taking. Between-groups analyses indicated higher MDRS-22 scores for males reporting higher conformity to masculine norms. LIMITATIONS: Data were drawn from an online community sample without use of diagnostic interview. Test-retest correlations were not evaluated. Future research should look to examine longitudinal typical-externalising symptom trajectories across a range of clinical and non-clinical settings. CONCLUSIONS: The MDRS-22 reports satisfactory preliminary psychometric properties with validated subscales enabling multidimensional assessment of theorised externalising symptom sub-domains. MDRS-22 scale brevity may facilitate use in primary care settings enabling better identification of at-risk males.