Depression is more than just emotional symptoms, but until recently, multidimensional depression tests were missing some key cultural and interpersonal considerations.

Depression is often misrepresented — even in clinical assessment tools. Because it’s linked to feelings of sadness and low mood, diagnostic assessments sometimes overlook other relevant symptoms.

In other words, depression is much more than “feeling down.” It’s a condition that can cause sleep disturbances, physical aches and pains, restlessness, irritability, relationship difficulties, and trouble concentrating. It can negatively impact how you relate to and interact with others.

Multidimensional depression tests are those that cover these areas, including more than just emotional assessment. One of the most recent versions, the Multidimensional Depression Assessment Scale (MDAS), fills in some gaps seen in previous models.

The MDAS is a depression screening tool developed in 2012 by researchers Ho Nam Cheung and Michael J Power.

It’s a 52-item, self-administered questionnaire that covers depression features across four domains:

  • emotional (sadness, anger, shame, guilt)
  • cognitive (lack of pleasure experience, self-blame, difficulty concentrating)
  • somatic (sleep, energy level, appetite, physical distress)
  • interpersonal (aggression, social withdrawal, avoidance)

The MDAS isn’t the first multidimensional depression test. Other formats have been used for many years as tools to support diagnostic guidebooks, like the Diagnostic and Statistical Manual of Mental Disorders (DSM).

These tests are a way to ensure all aspects of depression are considered, not just more typically reported or presumed symptoms of depression.

“Multidimensional tests are used to identify depression because the symptoms of depression are seen in many different aspects of one’s experience and behavior,” explains Dr. John Dolores, a clinical psychologist and chief operating officer at TMS & Brain Health, Los Angeles.

“Depression doesn’t look the same for everyone, so it’s important to look at many different levels of a person’s life to accurately identify depression symptoms.”

Using multidimensional depression tests can also help guide your treatment process, adds Megan Tangradi, a licensed professional counselor and clinical director at Achieve Wellness & Recovery, in Northfield, New Jersey.

Depression can be complex. You may have experienced trauma or loss, for example. Maybe stress, physical illness, or substance misuse is playing a role.

Different treatment approaches may be more suited in some situations than others, even though all of them are addressing the same clinical diagnosis of depression.

Multidimensional depression tests help bring these subtleties to light.

Cheung and Power explain the MDAS is set apart from other multidimensional depression tests by the inclusion of interpersonal symptoms, which are relevant across genders and cultures.

It scores in areas such as:

  • social withdrawal
  • feeling worse than others
  • social avoidance
  • hypersensitivity to criticism
  • feeling less attractive than others
  • feeling let down by others
  • aggression toward others
  • decrease in activities
  • inability to love others
  • feel too sensitive to others
  • feeling like a burden to others

Your answers to many of these items can vary based on gender and cultural norms.

In cultures where entire families live in the same household, for example, “feeling like a burden” may mean something very different compared to what someone feels who doesn’t come from a background with generational living.

“Most depression scales used today were developed in Western societies and are considered by many to have cultural limitations because of this,” says Dolores. “MDAS was developed with a global focus and an emphasis on how depression symptoms look in collectivistic cultures.”

Example of the success of MDAS across cultures has emerged in recent research.

A 2020 study looked at depression among pregnant women in inner Mongolia. According to the authors, this population is often subject to a unique and sometimes unfavorable cultural environment that can influence depression expression.

Compared to other depression tests, the MDAS was concluded to be the most valid scale among Chinese and Mongolian pregnant women in the research, especially in areas more heavily influenced by collective lifestyle.

More recent research by Cheung demonstrates the MDAS has consistent validity across male and female genders, as well as at least four ethnicities which the study labels: Caucasian, Asian, Black, and Hispanic.

There’s no single standard test for depression, but Tangradi says one of the most commonly used is the Beck Depression Inventory (BDI).

“It’s a self-report questionnaire that measures symptoms of depression such as sadness, guilt, worthlessness, and other cognitive and emotional issues,” she explains. “The BDI can be used for ages 13 and up, making it an effective tool for adolescents and adults.”

According to Tangradi, the inventory contains 21 questions with multiple choice options, and it typically takes no more than 10 minutes to complete.

Other tests that may be used to assist depression diagnosis include:

  • Patient Health Questionairre-9 (PHQ-9)
  • Montgomery-Asberg Depression Scale (MADRS)
  • Hamilton Depression Rating Scale (Ham-D)
  • The Edinburgh Postnatal Depression Scale (EPDS)
  • Sheehan’s Disability Scale (SDS)
  • Work Stress Survey (WSS)
  • Work-Family conflict (WFC) scale and the 5-item Family-Work conflict scale (FWC)
  • Social Functioning Scale-subscale (SFS subscale)
  • The Significant Others Scale Short Version (SOS)
  • Hospital Anxiety and Depression Scale (Depression subscale)
  • Centre for Epidemiologic Studies Depression Scale (CES-D)
  • University Student Depression Inventory (USDI)
  • Geriatric Depression Scale (GDS)

“It’s important to not rely solely on a single depression scale; each one has its limitations, and using multiple scales is a good way [to gain the most accurate assessment],” Dolores concludes.

Multidimensional depression tests are tools used to compliment clinical diagnostic criteria.

They help ensure that within the clear definitions of a diagnosis, there’s room to consider the full depth and circumstances around symptoms.

Depression tests like the MDAS can take into account unique societal pressures that may contribute to depression. They can help recognize culturally relevant symptoms and guide treatment options.