Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning
Abstract
The main goal in the treatment of major depressive disorder (MDD) is to achieve remission, defined as the resolution of symptoms and the return to normal levels of functionality. However, the clinical assessment of remission is usually merely based on scores of symptomatic rating scales. One of the most widely used scales to measure remission is the HAM-D(17), in which remission is defined as a score ≤ 7. Nevertheless, several studies have shown that this cutoff could be too high when also functioning is considered. This is a post-hoc analysis of a 6-month prospective study, performed over a sample of 292 Spanish patients with MDD, in order to find the optimal cutoff in the HAM-D(17) scale, considering normal levels of functionality, evaluated by the SOFAS; by means of plotting Receiver Operating Characteristics (ROC) curves. Our results show that a score of ≤ 5 maximized both sensitivity and specificity for identifying normal levels of functionality with respect to other scores, and thus agree with previous works, which suggest that a cutoff ≤ 7 might be too high to consider remission in patients with MDD, when normal levels of functioning are taken into account.
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One study (Romera et al. 2011) did not find an increased risk of relapse/recurrence with subthreshold symptoms.
“One study (Romera et al. 2011) did not find this increased risk.”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Romera et al. 2011
Cites
Frank, E. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810330075011 · Cited by 1,959 · cited 1× · see citing works
“Based on the HAM-D17 scale, remission has been traditionally defined by scores from ≤12 to ≤6, although since 1991 there is a consensus on using a score of ≤7 (Frank et al., 1991).”
MethodReport by the ACNP Task Force on Response and Remission in Major Depressive Disorder
Rush, A. J., Kraemer, H. C., Sackeim, H. A., Fava, M., Trivedi, M. H., Frank, E., Ninan, P. T., Thase, M. E., Gelenberg, A. J., Kupfer, D. J., et al. (2006) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301131 · Cited by 707 · cited 2× · see citing works
“On this basis, on 2006 the American College of Neuropsychopharmacology (ACNP) recommended both using scores of ≤7 or ≤5 (Rush et al., 2006; Moller, 2008).”
MethodResidual symptoms in depressed patients who respond acutely to fluoxetine
Nierenberg, A. A., Keefe, B. R., Leslie, V. C., Alpert, J. E., Pava, J. A., Worthington, J. J., Rosenbaum, J. F., & Fava, M. (1999) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v60n0403 · Cited by 470 · cited 2× · see citing works
“, 2007), or the presence of residual symptoms of depressionwith even a cutoff score of 7, as pointed out by other authors (Nierenberg et al., 1999).”
ResultKeller, M. B. (2003) · JAMA · doi:10.1001/jama.289.23.3152 · Cited by 388 · see citing works
Remission in depressed outpatients: More than just symptom resolution?
Zimmerman, M., McGlinchey, J. B., Posternak, M. A., Friedman, M., Boerescu, D., & Attiullah, N. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.09.004 · Cited by 98 · cited 1× · see citing works
“Zimmerman et al. (2008) also found that symptom severity, functional impairment from depression, and quality of life were significantly and highly inter-correlated.”
BackgroundPintor, L., Torres, X., Navarro, V., Matrai, S., & Gastó, C. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.11.008 · Cited by 76 · see citing works
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Vinckier, F., Gourion, D., & Mouchabac, S. (2017) · European Psychiatry · doi:10.1016/j.eurpsy.2017.02.485 · Cited by 201 · see citing works
de Zwart, P. L., Jeronimus, B. F., & de Jonge, P. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000227 · Cited by 189 · see citing works
Reduced default mode network suppression during a working memory task in remitted major depression
Bartova, L., Meyer, B. M., Diers, K., Rabl, U., Scharinger, C., Popovic, A., Pail, G., Kalcher, K., Boubela, R. N., Huemer, J., et al. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.02.025 · Cited by 135 · see citing works
Patient-reported outcome measures: Are they patient-generated, patient-centred or patient-valued?
Trujols, J., Portella, M. J., Iraurgi, I., Campins, M. J., Siñol, N., & Cobos, J. P. D. L. (2013) · Journal of Mental Health · doi:10.3109/09638237.2012.734653 · Cited by 129 · see citing works
Levin, F. R., Mariani, J., Brooks, D. J., Pavlicova, M., Nunes, E. V., Agosti, V., Bisaga, A., Sullivan, M. A., & Carpenter, K. M. (2013) · Addiction · doi:10.1111/add.12108 · Cited by 89 · see citing works
Culpepper, L., Muskin, P. R., & Stahl, S. M. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.07.001 · Cited by 77 · see citing works
Cognitive Control as a 5-HT1A-Based Domain That Is Disrupted in Major Depressive Disorder
Langenecker, S. A., Mickey, B. J., Eichhammer, P., Sen, S., Elverman, K. H., Kennedy, S. E., Heitzeg, M. M., Ribeiro, S. M., Love, T. M., Hsu, D. T., et al. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00691 · Cited by 18 · see citing works
Sicras-Mainar, A., Maurino, J., Cordero, L., Blanca-Tamayo, M., & Navarro-Artieda, R. (2012) · Annals of General Psychiatry · doi:10.1186/1744-859x-11-22 · Cited by 11 · see citing works
Sacchetti, E., Frank, E., Siracusano, A., Racagni, G., Vita, A., & Turrina, C. (2015) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000074 · Cited by 11 · see citing works
- Authors
- Romera, I., Pérez, V., Menchón, J. M., Polavieja, P., & Gilaberte, I.
- Affiliations
- Eli Lilly (Spain) (ES)
- Hospital de Sant Pau (ES)
- Bellvitge University Hospital (ES)
- Corresponding author
- Romera, Irene
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 186
- Issue
- 1
- Pages
- 133-137
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2159468490
- Cited by
- 50
- References
- 6
- Citations by year
- 2026: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 5 · 2017: 1 · 2016: 2 · 2015: 8 · 2014: 2 · 2013: 9 · 2012: 4
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- major depressive disorder, remission, Hamilton Depression Rating Scale, HAM-D-17, cut-off values, social functioning, occupational functioning, SOFA, receiver operating characteristic, sensitivity and specificity, functional recovery
- MeSH terms
- Adult, Aged, Depression, Employment, Female, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, ROC Curve, Social Adjustment, Area Under Curve
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