3DViT-GAT: a unified atlas-based 3D vision transformer and graph learning framework for major depressive disorder detection using structural MRI data

Major depressive disorder (MDD) is a prevalent mental health condition that negatively impacts both individual well-being and global public health. Automated detection of MDD using structural magnetic resonance imaging (sMRI) and deep learning (DL) methods holds increasing promise for improving diagnostic accuracy and enabling early intervention. Most existing methods employ either voxel-level features or handcrafted regional representations built from predefined brain atlases, limiting their ability to capture complex brain patterns. This paper develops a unified pipeline that utilizes Vision Transformers (ViTs) for extracting 3D region embeddings from sMRI data and Graph Neural Network (GNN) for classification. We explore two strategies for defining regions: (1) an atlas-based approach using predefined structural and functional brain atlases, and (2) an cube-based method by which ViTs are trained directly to identify regions from uniformly extracted 3D patches. Further, cosine similarity graphs are generated to model inter-regional relationships, and guide GNN-based classification. Extensive experiments were conducted using the REST-meta-MDD dataset to demonstrate the effectiveness of our model. With stratified 10-fold cross-validation, the best model obtained 81.51% accuracy, 85.94% sensitivity, 76.36% specificity, 80.88% precision, and 83.33% F1-score. Further, atlas-based models consistently outperformed the cube-based approach, highlighting the importance of using domain-specific anatomical priors for MDD detection.