title: The fallacy of thresholds used in defining response and remission in depression rating scales.
abstract: Response and remission are determined by the proportion of people who fall below a threshold score on depression rating scales. This calculation implies a possibility of false positives (FP) and false negatives (FN) depending on sensitivity and specificity of the threshold used, but also on response and remission rates. A simulation illustrates the methodological consequences of this phenomenon in a comparative trial where response and remission rates differ between groups: the probability of being misclassified differs between groups, and measures of association (relative risk and odds ratio) are biased. Alternatives are proposed to cope with this misclassification bias.
authors.affiliation: INSERM U669, Paris, France; Université de Rennes 1, EA-425 Unité Comportement et Noyaux Gris Centraux, Rennes, France; Centre d'Investigation Clinique CIC-P INSERM 0203, Hôpital de Pontchaillou, Centre Hospitalier Universitaire de Rennes & Université de Rennes 1, Rennes, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Naudet
authors.forename: Bruno
authors.initials: B
authors.lastname: Millet
authors.forename: Jean
authors.initials: J
authors.lastname: Michel Reymann
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D016206:Databases, Bibliographic; D003863:Depression / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: major depressive disorder; misclassification bias; remission; response; threshold
references.citation: J Clin Epidemiol. 2003 Jul;56(7):618-21
references.pmid: 12921929
references.citation: Int J Methods Psychiatr Res. 2005;14(2):92-101
references.pmid: 16175878
references.citation: BMJ. 2003 Sep 27;327(7417):716-9
references.pmid: 14512479
references.citation: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD007954
references.pmid: 19588448
references.citation: BMC Psychiatry. 2007 Feb 06;7:7
references.pmid: 17284321
references.citation: Int Clin Psychopharmacol. 2004 Jul;19(4):215-20
references.pmid: 15201568
references.citation: Lancet. 1993 Aug 14;342(8868):418-21
references.pmid: 8101908
references.citation: J Nerv Ment Dis. 2005 Mar;193(3):170-5
references.pmid: 15729106
references.citation: J Psychiatr Res. 2011 Jan;45(1):96-103
references.pmid: 20537348
references.citation: Arch Gen Psychiatry. 1991 Sep;48(9):851-5
references.pmid: 1929776
references.citation: J Clin Psychopharmacol. 2007 Oct;27(5):531-4
references.pmid: 17873700
references.citation: BMJ. 2000 May 27;320(7247):1468
references.pmid: 10827061
references.citation: Contemp Clin Trials. 2007 Jul;28(4):348-51
references.pmid: 17182286
references.citation: J Affect Disord. 1998 Sep;50(2-3):97-108
references.pmid: 9858069
references.citation: Int J Methods Psychiatr Res. 2014 Dec;23(4):469-73
references.pmid: 24038349
references.citation: J Affect Disord. 2003 Sep;76(1-3):127-35
references.pmid: 12943942
references.citation: Arch Gen Psychiatry. 2012 Jun;69(6):572-9
references.pmid: 22393205