Uncertainty-Gated SHAP-Dirichlet Refinement for MRI-Based Depression Classification

Structural MRI-based classification of major depressive disorder (MDD) remains challenging due to subtle, heterogeneous anatomical changes. We propose uncertainty-gated SHAP-Dirichlet refinement, a post-hoc reliability layer that improves predictions without retraining the classifier. The method retrieves similar labeled SHAP explanations, constructs Dirichlet class evidence, and selectively refines uncertain predictions through probabilistic fusion, while allowing unreliable cases to be deferred for expert review. We evaluate five classifiers on 504 SRPBS subjects (252 controls and 252 MDD patients) using 159 anatomical features and repeated nested cross-validation. Refinement improved accuracy across all 8 repetitions for TabM and ResNet, yielding mean gains of 1.04 and 0.45 percentage points (sign test p=0.008), while modifying at most 8.3% of predictions. Gains were concentrated among low-confidence cases, with significant improvements in calibration. The method also benefited an RBF support vector machine but not logistic regression or random forests. Ablations confirmed the importance of uncertainty gating and soft fusion. Dirichlet evidence identified baseline errors (AUROC 0.62), while deferring 50% of cases increased retained-case accuracy to approximately 75%. These findings support selective explanation-guided refinement as a practical approach to improving prediction reliability and facilitating expert triage in MDD classification.