man sitting with therapist for depression testing
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There’s a distinct diagnostic challenge in mental health compared to other fields of medicine, and it’s right at the heart of the work: there’s no accurate or reliable test for a mental health disorder or condition, like there are for disorders and/or conditions in other specialties. We have specific tests for everything from flu to arthritis to diabetes to cancer, but no specific biological or physiological tests that rely on objective physical data exist for depression, anxiety, or other common mental health disorders.

It’s true there are tests designed to detect genetic markers in the research and development phase, but their clinical application is years away.

In the meantime, instead of objective tests based on quantifiable data, clinicians rely on administering questionnaires to diagnose mental health disorders. Patients answer questions themselves, or clinicians record the answers in a during an evaluation. Then, clinicians review the assessment and arrive at a diagnosis based on the answers given by the patient and what they observe themselves during the evaluation.

That process is not objective.

There are two layers of subjectivity: one from the patient, and one from the clinician. What this means is that psychiatry is the only area of medicine for which the diagnostic process is subjective, rather than objective, like all other areas of medicine.

In the field of mental health, an accurate diagnosis is essential. Inaccurate diagnoses can cause significant distress, extend treatment time, and may exacerbate disorders that inaccurate diagnoses fail to recognize.

That’s why consistent and accurate diagnostic tools are so important: they can make a substantial difference in effectiveness and duration of treatment. In the early years of depression treatment and diagnosis, providers relied on tests that focused solely on symptoms of depression, which was logical. However, as our knowledge of the various factors associated with depression increased and expanded, we began using what we refer to as multidimensional tests, like one developed in 2012 that’s in widespread use today: the Multidimensional Depression Assessment Scale (MDAS).

What is the Multidimensional Depression Assessment Scale (MDAS)?

The MDAS is an assessment designed to detect symptoms of depression in four primary categories, which the test refers to as domains. The domains include:

  1. This domain includes feelings associated with depression, such as hopelessness, sadness, irritability/anger, guilt/shame, and others.
  2. This domain includes thoughts and mental states associated with depression, including problems concentrating, negative self-attitude, suicidal ideation, and others.
  3. This domain includes physical characteristics or sensations associated with depression, including sleep disturbance, changes in appetite, pain, and others.
  4. This domain includes the elements of depression that impact relationships with others, including behaviors like self-isolation, irritability, social withdrawal, feeling loved/connected, and others.

Whent testing for depression, the MDAS asks patients over 50 questions from the four domains, which is a significant expansion from previous standard depression tests such as the Patient Health Questionnaire-9 (PHQ-9) and the Beck Depression Inventory (BDI), which include 9 questions and 21 questions, respectively. While these are effective, accurate tests, they lack the added domains that make the MDAS an important tool for clinicians.

Testing for Depression: Why Multidimensional Tests?

In a nutshell, we need robust multidimensional depression tests in order to gather more information about the patients who seek treatment and support for depression.

The comprehensive nature of the MDAS allows providers to understand not only the emotional features of the depressive disorder in each patient, but how the symptoms of the depressive disorder may – or may not – affect their thoughts, bodily sensations, and relationships with others. All this information helps providers design a treatment plan that’s tailored to the immediate, specific needs of each patient.

The general idea behind multidimensional tests like the MDAS is simple: the more we know, the better we can help.

Is the MDAS Different Than Other Depression Tests?

It is – and in an important way.

The creators of MDAS observed that all previous depression tests prioritized the cognitive, somatic, and emotional domains, with almost no weight or importance assigned to the interpersonal domain.

Before designing the MDAS, researchers reviewed the standard tests for depression and observed:

  • Only 8 tests included questions related to interpersonal issues, out of 15 tests reviewed.
  • The other 7 included a total of 11 questions in the interpersonal domain
  • Among the most common tests used to diagnose depression, 97% of the questions addressed cognitive, social, and emotional domains, with 3% addressing the interpersonal domain.

The research team that created MDAS saw this as a problem, and designed a test that would include information on the interpersonal domain to improve diagnostic accuracy. This enables providers to learn more about their patients before treatment starts, which puts both patient and provider one step ahead.

Testing for Depression: Other Common Approaches

The most common tests for depression include:

Clinicians use these scales regularly because they’re relatively short, scoring them is not complex, and despite the fact they’re not as comprehensive as the MDAS, research shows they’re incredibly accurate: all can predict depression accurately more than 90 percent of the time.

Why is an Accurate Assessment for Depression Important?

An accurate assessment for depression is important for the same reason accurate tests for physical disorders are important: the symptoms and biological markers for many conditions overlap. For instance, when a person takes a blood test or has regular lab work done at a yearly checkup, a clinician might see results that point to three or four possible conditions. When that happens, they order follow-up tests to rule things out until they arrive – through the process of elimination, most often – at an accurate diagnosis.

In the field of mental health, symptoms frequently overlap. For example, several symptoms are common to both depression and anxiety, such as irritability, withdrawal from friends and family, problems concentrating, and disrupted relationships – but medication and therapy designed for depression might not work for anxiety, and vice-versa.

That’s why an accurate assessment matters: it defines the treatment. And an accurate multidimensional assessment allows clinicians to arrive at the correct diagnosis and learn more about the full life of the patient during the process. As we mention above, this puts the patient and clinician one step ahead. It enables the healing process to begin more quickly, which can improve outcomes and improve the likelihood of long-term treatment success.