# Optimal GRID-HAM-D7 cut-off scores for defining remission in older Thai adults with depression

## TL;DR

This study identifies optimal GRID-HAM-D7 cut-off scores for depression remission in older Thai adults, suggesting higher thresholds improve diagnostic accuracy.

## Contribution

The paper proposes population-specific remission thresholds for the GRID-HAM-D7 in elderly Thai patients with depression.

## Key findings

- A GRID-HAM-D7 score of ≤4 optimally defines remission for any depressive disorder in elderly Thai adults.
- For major depressive disorder, a score of ≤6 provides high sensitivity and specificity.
- Higher cut-off scores outperformed conventional thresholds in diagnostic accuracy.

## Abstract

The 7-item Hamilton Depression Rating Scale (HAM-D7) is commonly used to assess depression severity and remission; however, its standard cut-off scores may not be optimal for elderly populations. This study aimed to establish GRID-HAM-D7 remission thresholds among elderly Thai patients diagnosed with depressive disorders, including both any depressive disorder and major depressive disorder (MDD).

A total of 803 elderly participants were recruited from four tertiary care hospitals across Thailand as part of a larger psychiatric study. Diagnoses were determined using the Mini International Neuropsychiatric Interview, and depression severity was assessed via the GRID-HAM-D7. Statistical analyses, including sensitivity, specificity, predictive values, and Receiver Operating Characteristic curves, were performed to determine optimal remission cut-off scores.

For any depressive disorder, a GRID-HAM-D7 score of ≤ 4 yielded sensitivities of 88.86% and specificity of 77.66%. In major depressive disorder, the optimal threshold was ≤ 6, resulting in 91.68% sensitivity and 79.73% specificity. Both values surpassed the diagnostic accuracy of conventional lower thresholds. These results suggest that higher GRID-HAM-D7 remission cut-offs better reflect depressive symptomatology in older adults.

The study underscores the necessity of tailoring standardized assessment tools for specific populations to enhance clinical management and decision-making in geriatric psychiatry.