journal article·2025-07-25Open access

Determining Factors for the Diagnosis of Multidimensional Depression and Its Representation: A Composite Indicator Based on Linear Discriminant Analysis

Matheus Pereira Libório, Angélica C. G. Santos, Marcos Flávio Silveira Vasconcelos D’angelo, Hasheem Mannan, Cristiane Neri Nobre, Ariane Carla Barbosa da Silva, Petr Iakovlevitch Ekel, Allysson Steve Mota Lacerda

Applied Sciences· Volume 15· Issue 15

Abstract

This study proposes a novel approach to constructing composite indicators, utilizing discriminant analysis to identify the determining factors for the diagnosis of multidimensional depression and to provide an index that represents the multidimensionality of this construct. By focusing solely on factors that significantly correlate with the diagnosis of multidimensional depression, this method provides a more precise and objective representation of the problem. The application of the method to the 2019 Brazilian Health Survey data demonstrated its effectiveness, resulting in a composite indicator that separates individuals who self-declare as having depression from individuals who self-declare as not having depression. The results highlight individuals who have a limiting chronic condition, high levels of education, less support from friends and family, perform unhealthy work, and are male. In contrast, individuals with the opposite characteristics are associated with a negative multidimensional depression diagnosis. The proposed composite indicator not only improves the measurement accuracy but also offers a new means of visualizing and understanding the multidimensional nature of depression diagnosis, providing valuable information for the formulation of targeted public health policies aimed at reducing the time for which people show symptoms of depression.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Mental Health Research Topics · Mental Health Treatment and Access · Health disparities and outcomes

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Postgraduate Program in Computational Modeling and Systems, State University of Montes Claros, Montes Claros 39401-089, Brazil

University College Dublin School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Ireland University College Dublin, Belfield, Dublin 4, D04 C1P1 Dublin, Ireland

Postgraduate Program in Informatics, Pontifical Catholic University of Minas Gerais, Belo Horizonte 30535-901, Brazil

Funding

National Council for Scientific and Technological Development of Brazil (CNPq) · Foundation for Research Support of Minas Gerais State (FAPEMIG)

References (100+)

Show source-provided references
1. Does uncertainty in single indicators affect the reliability of composite indexes? An application to the measurement of environmental performances of Italian regions10.1016/j.ecolind.2021.107740 ↗
2. Representing social exclusion in geographic space: Interpretability or informational power?10.1016/j.seps.2025.102262 ↗
3. OECD, European Union, and Joint Research Centre (2008). Handbook on Constructing Composite Indicators: Methodology and User Guide, OECD Publishing.
4. Analysis of tourism sustainability synthetic indicators. A case study of Aragon10.1016/j.heliyon.2023.e15206 ↗
5. Saisana, M. (2024). Composite Indicator (s). Encyclopedia of Quality of Life and Well-Being Research, Springer International Publishing.10.1007/978-3-031-17299-1_504 ↗
6. Composite indicators as decision making tools: The joint use of compensatory and noncompensatory schemes10.1142/S0219622021500231 ↗
7. De Montis, A., Serra, V., Calia, G., Trogu, D., and Ledda, A. (2021). To weight or not to weight, that is the question: The design of a composite indicator of landscape fragmentation. Appl. Sci., 11.10.3390/app11073208 ↗
8. COINr: An R package for developing composite indicators10.21105/joss.04567 ↗
9. Building composite indicators for the territorial quality of life assessment in European regions: Combining data reduction and alternative weighting techniques10.1007/s10668-023-04116-w ↗
10. Fernandez, E.J., and Martos, M.J.R. (2020). Review of some statistical methods for constructing composite indicators. Stud. Appl. Econ., 38.10.25115/eea.v38i1.3002 ↗
11. Principal component analysis for constructing socio-economic composite indicators: Theoretical and empirical considerations10.1007/s43545-024-00920-x ↗
12. A new composite indicator for assessing energy poverty using normalized entropy10.1007/s11205-022-02938-1 ↗
13. Enhancing the comprehensibility of multidimensional phenomena: The optimal-entropy method for constructing composite indicators. A new index to measure the quality of the public health system in the municipalities of Minas Gerais10.1016/j.sctalk.2024.100414 ↗
14. One for all? Assessing the quality of Italian hospital care with the “benefit of the doubt” composite indicator methods10.1186/s13561-024-00559-7 ↗
15. Building composite indicators using multicriteria methods: A review
16. A composite indicator of social inclusion for EU based on the inverted BoD model10.1016/j.seps.2023.101654 ↗
17. A well-defined composite indicator: An application to corporate social responsibility10.1007/s10957-020-01701-1 ↗
18. Drago, C. (2021). The analysis and the measurement of poverty: An interval-based composite indicator approach. Economies, 9.10.3390/economies9040145 ↗
19. Economic analysis through alternative data and big data techniques: What do they tell about Brazil?10.1007/s43546-022-00387-z ↗
20. The performance of OECD’s composite leading indicator10.1002/ijfe.2784 ↗
21. Gómez-Limón, J.A., Arriaza, M., and Guerrero-Baena, M.D. (2020). Building a composite indicator to measure environmental sustainability using alternative weighting methods. Sustainability, 12.10.3390/su12114398 ↗
22. A composite indicator to measure sustainable water use in Portugal: A compromise programming approach10.1016/j.jenvman.2022.114791 ↗
23. Service level provision in municipalities: A flexible directional distance composite indicator10.1016/j.ejor.2020.04.012 ↗
24. Cost of doing business index in Latin America10.1007/s11135-021-01221-8 ↗
25. A new composite indicator for Manufacturing efficiency10.1016/j.procs.2022.12.329 ↗
26. Conceptualizing and measuring “industry resilience”: Composite indicators for postshock industrial policy decision-making10.1016/j.seps.2022.101448 ↗
27. Mammeri, A., Tiri, A., Belkhiri, L., Salhi, H., Brella, D., Lakouas, E., Tahraoui, H., Amrane, A., and Mouni, L. (2023). Assessment of surface water quality using water quality index and discriminant analysis method. Water, 15.10.3390/w15040680 ↗
28. Girardi, G.C., Rubbo, P., Broday, E.E., Arnold, M., and Picinin, C.T. (2024). Comparative Analysis between Quality of Life and Human Labor in Countries Belonging to G7 and BRICS Blocks: Proposition of Discriminant Analysis Model. Economies, 12.10.3390/economies12050124 ↗
29. Bernick, C., Shan, G., Bennett, L., Alberts, J., and Cummings, J. (2021). Assessing clinical change in individuals exposed to repetitive head impacts: The repetitive head impact composite index. Front. Neurol., 12.10.3389/fneur.2021.605318 ↗
30. Community-based model for dementia risk screening: The Beijing Aging Brain Rejuvenation Initiative (BABRI) brain health system10.1016/j.jamda.2020.12.024 ↗
31. Developing a Methodology for Identifying Urban Neighborhoods with Severe Housing Deprivation in Iran10.1007/s11205-023-03297-1 ↗
32. Hohls, J.K., König, H.H., Quirke, E., and Hajek, A. (2021). Anxiety, depression and quality of life—A systematic review of evidence from longitudinal observational studies. Int. J. Environ. Res. Public Health, 18.10.3390/ijerph182212022 ↗
33. The growing burden of major depressive disorders (MDD): Implications for researchers and policy makers10.1007/s40273-021-01040-7 ↗
34. Time for united action on depression: A Lancet–World Psychiatric Association Commission10.1016/S0140-6736(21)02141-3 ↗
35. Economic burden of depression in Brazil: A cost-of-illness study based on productivity losses and healthcare costs between 2010 to 201810.1080/14737167.2023.2154659 ↗
36. Subjective Social Status as an Important Mediator in the Association Between Socioeconomic Status and Mental Health10.34172/ehsj.26084 ↗
37. Spatial variations and influencing factors of Cumulative Health Deficit Index of elderly in China10.1186/s41043-023-00403-4 ↗
38. Psychological distress with relationship satisfaction is moderated by anticipatory relational savoring among non-deployed military partners10.1111/pere.12469 ↗
39. Measurement invariance of the Multidimensional Depression Assessment Scale (MDAS) across gender and ethnic groups of Asian, Caucasian, Black, and Hispanic10.1016/j.jad.2022.04.035 ↗
40. The Gender Invariance of Multidimensional Depression Assessment Scale in Adolescents10.1007/s10862-023-10040-0 ↗
41. Lunansky, G., Van Borkulo, C.D., Haslbeck, J.M., Van der Linden, M.A., Garay, C.J., Etchevers, M.J., and Borsboom, D. (2021). The mental health ecosystem: Extending symptom networks with risk and protective factors. Front. Psychiatry, 12.10.3389/fpsyt.2021.640658 ↗
42. Kara, P., Valentin, J.B., Mainz, J., and Johnsen, S.P. (2022). Composite measures of quality of health care: Evidence mapping of methodology and reporting. PLoS ONE, 17.10.1371/journal.pone.0268320 ↗
43. Association between socio-economic deprivation and AHRQ composite indicator during pandemic10.1093/eurpub/ckac129.154 ↗
44. Developing a novel composite index for monitoring occupational health and wellbeing: A case study in the rail sector in Great Britain10.1016/j.ssci.2021.105446 ↗
45. Perspectives from the National Institutes of Health on multidimensional mental health disparities research: A framework for advancing the field10.1176/appi.ajp.21100969 ↗
46. Correlated physical and mental health composite scores for the RAND-36 and RAND-12 health surveys: Can we keep them simple?10.1186/s12955-022-01992-0 ↗
47. Santos, A.C., Silva, A., Libório, M., Nobre, C.N., Mannan, H., and D’Angelo, M.F.S. (2025). Propensity to childhood anxiety and depression due to exposure to adversity: A multidimensional construct. PLoS ONE, 20.10.1371/journal.pone.0326239 ↗
48. All for one and one for all: Mental disorders in one dimension10.1176/appi.ajp.2018.17121383 ↗
49. Maksimov, S.A., Kotova, M.B., Gomanova, L.I., Shalnova, S.A., Balanova, Y.A., Evstifeeva, S.E., and Drapkina, O.M. (2023). Mental health of the Russian Federation population versus regional living conditions and individual income. Int. J. Environ. Res. Public Health, 20.10.3390/ijerph20115973 ↗
50. Interpretability of composite indicators based on principal components10.1155/2022/4155384 ↗
51. Goal-based participatory weighting scheme: Balancing objectivity and subjectivity in the construction of composite indicators10.1007/s11135-022-01546-y ↗
52. A goal-based weighting for composite indicators constructed through ordered weighted averaging (OWA) operator10.1016/j.mex.2024.102575 ↗
53. The Association of a Geographically Wide Social Media Network on Depression: County-Level Ecological Analysis10.2196/43623 ↗
54. Du, M., Dai, W., Liu, J., and Tao, J. (2022). Less social participation is associated with a higher risk of depressive symptoms among Chinese older adults: A community-based longitudinal prospective cohort study. Front. Public Health, 10.10.3389/fpubh.2022.781771 ↗
55. Sleep and APOE-ε4 have a synergistic effect on plasma biomarkers and longitudinal cognitive decline in older adults10.1111/cns.14558 ↗
56. Xu, Y., Yan, Z., and Liu, L. (2024). Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: Insights from NHANES. Front. Nutr., 11.10.3389/fnut.2024.1406656 ↗
57. Identifying depressive symptoms in patients with type 2 diabetes mellitus: The role of glucose variability and concomitant hypothyroidism
58. Higuchi, M., Nakamura, M., Shinohara, S., Omiya, Y., Takano, T., Mizuguchi, D., Sonota, N., Toda, H., Saito, T., and So, M. (2022). Detection of major depressive disorder based on a combination of voice features: An exploratory approach. Int. J. Environ. Res. Public Health, 19.10.3390/ijerph191811397 ↗
59. A novel multi-dimensional clinical response index dedicated to improving global assessment of pain in patients with persistent spinal pain syndrome after spinal surgery, based on a real-life prospective multicentric study (PREDIBACK) and machine learning techniques10.3390/jcm10214910 ↗
60. A cultural validation of the Chinese version of multidimensional depression assessment scale (MDAS) in clinically depressed patients in Inner Mongolia10.1007/s12144-020-01107-2 ↗
61. Cheung, H.N., Chan, S.W., and Williams, J.M. (2020). Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy. PLoS ONE, 15.10.1371/journal.pone.0227944 ↗
62. Major depression, physical health and molecular senescence markers abnormalities10.1038/s44220-023-00033-z ↗
63. Clinical manifestations of anxiety and depression in sepsis-associated encephalopathy and multi-omics identification of cluster of differentiation 38 as an early biomarker10.5498/wjp.v15.i6.105889 ↗
64. Foong, H.F., Hamid, T.A., Ibrahim, R., and Haron, S.A. (2021). The intersectional effects of ethnicity/race and poverty on health among community-dwelling older adults within multiethnic Asian populace: A population-based study. BMC Geriatr., 21.10.1186/s12877-021-02475-5 ↗
65. Li, D., Su, M., Guo, X., Liu, B., and Zhang, T. (2023). The association between chronic disease and depression in middle-aged and elderly people: The moderating effect of health insurance and health service quality. Front. Public Health, 11.10.3389/fpubh.2023.935969 ↗
66. Quittschalle, J., Pabst, A., Lobner, M., Luppa, M., Heser, K., Wagner, M., van den Bussche, H., Hajek, A., Konig, H.-H., and Wiese, B. (2021). Association of alcohol and tobacco consumption with depression severity in the oldest old: Results from the age different old age cohort platform. Int. J. Environ. Res. Public Health, 18.10.3390/ijerph18157959 ↗
67. Effects of team sports on anxiety, depression, perceived stress, and sleep quality in college students10.1080/07448481.2019.1707836 ↗
68. Depression among pet owners and non-pet owners: A comparative cross-sectional study in Dhaka, Bangladesh10.12688/f1000research.53276.1 ↗
69. Correlates of depression among lower-income minority older adults living in urban subsidized housing10.1093/geroni/igx004.4198 ↗
70. Social determinants of depression in systemic lupus erythematosus: A systematic scoping review10.1177/09612033221135145 ↗
71. Belo, P., Navarro-Pardo, E., Pocinho, R., Carrana, P., and Margarido, C. (2020). Relationship between mental health and the education level in elderly people: Mediation of leisure attitude. Front. Psychol., 11.10.3389/fpsyg.2020.00573 ↗
72. Raniti, M., Rakesh, D., Patton, G.C., and Sawyer, S.M. (2022). The role of school connectedness in the prevention of youth depression and anxiety: A systematic review with youth consultation. BMC Public Health, 22.10.1186/s12889-022-14364-6 ↗
73. Sexual orientation and gender differences in aging perceptions and concerns among older adults10.1093/geroni/igy036 ↗
74. Gender, emotion regulation, and cognitive flexibility as predictors of depression, anxiety, and affect in healthy adults10.1007/s12144-024-07240-6 ↗
75. Loneliness, age at immigration, family relationships, and depression among older immigrants: A moderated relationship10.1177/02654075211061279 ↗
76. Does retirement trigger depressive symptoms? A systematic review and meta-analysis10.1017/S2045796021000627 ↗
77. Ha, J.W.Y., Yip, W., Ge, L., Yap, C.W., and Pereira, M.J. (2024). Association of social isolation and depressive symptoms with workplace productivity loss in a multi-ethnic Asian study. Sci. Rep., 14.10.1038/s41598-024-73272-4 ↗
78. Mendes, F., Pereira, J., Zangao, O., Pereira, C., and Bravo, J. (2021). The relationship between depression and risk of violence in Portuguese community-dwelling older people. BMC Public Health, 21.10.1186/s12889-022-13474-5 ↗
79. Recognizing depression in the elderly: Practical guidance and challenges for clinical management10.2147/NDT.S347356 ↗
80. The association between depression and quality of life in the elderly10.1093/eurpub/ckac131.125 ↗
81. The effect of sleep deprivation and restriction on mood, emotion, and emotion regulation: Three meta-analyses in one10.1093/sleep/zsaa289 ↗
82. Associations between depressive symptoms, appetite and food intake among hospitalized older adults10.1093/geroni/igaa057.3376 ↗
83. Better together: How group-based physical activity protects against depression10.1016/j.socscimed.2021.114337 ↗
84. Pet ownership and symptoms of depression: A prospective study of older adults10.1016/j.jad.2019.11.134 ↗
85. From stress to resistance: Challenging the capitalist underpinnings of mental unhealth in work and organizations10.1111/ijmr.12293 ↗
86. Independent associations of apathy and depressive symptoms with perceived social support in healthy older adults10.1080/13607863.2020.1768217 ↗
87. Remes, O., Mendes, J.F., and Templeton, P. (2021). Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sci., 11.10.3390/brainsci11121633 ↗
88. A nationwide population-based study of depression in Brazil10.1016/j.jad.2015.12.038 ↗
89. Depression in Brazilian farmers: Prevalence and associated factors10.1080/09638237.2022.2069701 ↗
90. How much time of sedentary behavior is associated with depressive symptoms in community-dwelling older adults in southern Brazil?10.1016/j.gerinurse.2022.12.014 ↗
91. Torres, L.S.S., Oliveira, A.C.D.S., Araújo, M.P.D., de Carvalho, M.D.S., Barbosa, L.B.D.S.F., Dantas, B.A.D.S., Martínez, C.S.G., de Miranda, F.A.N., Mendes, F.R.P., and Torres, G.d.V. (2023). Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal. PLoS ONE, 18.10.1371/journal.pone.0287163 ↗
92. Prevalence of depressive disorder in the adult population of Latin America: A systematic review and meta-analysis
93. Instituto Brasileiro de Geografia e Estatística (IBGE) (2025, July 21). Censo demográfico 2022. Dados nacionais; Brazil, 2023, Available online: https://censo2022.ibge.gov.br/.
94. Mertler, C.A., Vannatta, R.A., and LaVenia, K.N. (2021). Advanced and Multivariate Statistical Methods: Practical Application and Interpretation, Routledge.10.4324/9781003047223 ↗
95. The use of multiple measurements in taxonomic problems10.1111/j.1469-1809.1936.tb02137.x ↗
96. Thomas, E., Ali, F.B., Tolambiya, A., Chambellant, F., and Gaveau, J. (2023). Too much information is no information: How machine learning and feature selection could help in understanding the motor control of pointing. Front. Big Data, 6.10.3389/fdata.2023.921355 ↗
97. Linear discriminant analysis10.1038/s43586-024-00346-y ↗
98. Backhaus, K., Erichson, B., Gensler, S., Weiber, R., and Weiber, T. (2023). Discriminant analysis. Multivariate Analysis: An Application-Oriented Introduction, Springer Fachmedien Wiesbaden.10.1007/978-3-658-40411-6 ↗
99. Alves, M.V., Maciel, L.I., Ramalho, R.R., Lima, L.A., Vaz, B.G., Morais, C.L., Passos, J.O., Pegado, R., and Lima, K.M. (2021). Multivariate classification techniques and mass spectrometry as a tool in the screening of patients with fibromyalgia. Sci. Rep., 11.10.1038/s41598-021-02141-1 ↗
100. Discriminant analysis of occupational performance characteristics in patients with major depressive disorders and healthy individuals