The operational criterion and its validity of remission of major depressive disorder

Objective To explore the optimal cutoff point defining remission on 17-item Hamilton Depression Scale (HAMD17) for major depressive disorder (MDD), and examine the validity of this cutoff point. Method We interviewed 251 MDD responders with the HAMD17, Global Assessment of Functioning, Generic Quality of Life Inventory. Results After acute phase treatment for MDD, even the HAMD17 scored 7 or less, 92.3% (203/220) of remitters had at least one subthreshold depressive symptoms, 48.6% (107/220) of them also experienced functioning impairment, when psychosocial functioning taken into account, a cutoff of ≤3 might be the operational criterion of MDD remission. Compared to MDD patients scoring 4-14 on HAMD17, patients scoring 0-3 had significantly better psychological functioning, social functioning and physical functioning (separately 60.1±15.4 vs. 52.0±12.3, 62.0±11.2 vs. 54.0±11.0, 60.5±14.3 vs. 52.7±10.2; t=3.307, 4.119, 3.626, all P<0.01). Compared to 4-14 score group, the rate of ones with psychosocial functioning being normal in 0-3 score group was higher (74.2% vs. 12.6%; χ2=97.10, P<0.01). Conclusion The results indicate that patients with MDD whose score of ≤3 on HAMD17 after the acute phase treatment may have better psychosocial functioning than those whose score of >3, suggesting this criterion be valid. Key words: Major depressive disorder; Hamilton Depression Scale; Validation studies