title: Further evidence that the cutoff to define remission on the 17-item Hamilton Depression Rating Scale should be lowered.
abstract: 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).
authors.affiliation: Bayside Medical Building, Providence, Rhode Island 02905, USA. mzimmerman@lifespan.org
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martinez
authors.forename: Naureen
authors.initials: N
authors.lastname: Attiullah
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Cristina
authors.initials: C
authors.lastname: Toba
authors.forename: Daniela A
authors.initials: DA
authors.lastname: Boerescu
authors.forename: Moataz
authors.initials: M
authors.lastname: Rahgeb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012016:Reference Values; D015203:Reproducibility of Results; D055815:Young Adult