Premium
Further evidence that the cutoff to define remission on the 17‐item Hamilton Depression Rating Scale should be lowered
Author(s) -
Zimmerman Mark,
Martinez Jennifer,
Attiullah Naureen,
Friedman Michael,
Toba Cristina,
Boerescu Daniela A.,
Rahgeb Moataz
Publication year - 2012
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.20870
Subject(s) - psychosocial , hamd , depression (economics) , rating scale , cutoff , anxiety , hamilton rating scale for depression , quality of life (healthcare) , psychology , clinical psychology , psychiatry , medicine , major depressive disorder , mood , psychotherapist , developmental psychology , physics , quantum mechanics , economics , macroeconomics
Background In 1991, the recommendations of a consensus conference were that a cutoff of 7 on the 17‐item Hamilton Depression Rating Scale (HAM‐D) be used to define remission from depression, and since then this has been the most commonly used definition of remission. The cutoff was not derived from empirical study. In the present report from the MIDAS project, we examined the level of current psychosocial morbidity in depressed patients identified as being in remission according to different thresholds on the 17‐item HAM‐D. Methods We interviewed 274 depressed outpatients in ongoing treatment. The patients completed measures of depressive and anxious symptoms, psychosocial functioning, and quality of life. Results Compared to patients scoring 3–7 on the HAM‐D, patients scoring 0–2 had significantly lower levels of depression and anxiety on self‐report symptom scales, better psychosocial functioning, better quality of life, and greater satisfaction with their mental health. Similar results were found comparing patients scoring 0–2 versus 3–5. Conclusions The results of this study indicate that significant heterogeneity exists among patients scoring 7 and below on the HAM‐D. Whatever cutoff score is used to define remission on a symptom severity scale such as the HAM‐D, some error will be inherent in dichotomizing a continuously distributed variable. We propose distinguishing between patients who are highly likely to be in remission (0–2 on the HAMD) from patients who are possibly in remission (scoring 3–7). Depression and Anxiety 0:1–7, 2011.© 2011 Wiley‐Liss, Inc.