Establishing valid cutoff scores for the Chinese version of the Montgomery-Åsberg Depression Rating Scale in Taiwanese patients with depression

BACKGROUND/PURPOSE: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used for assessing depression severity, but its validity and optimal cutoff scores have not been established for Taiwanese populations. This study aimed to determine cutoff scores for different levels of depression in Taiwanese patients. METHODS: A cross-sectional study was conducted with 101 entries from 92 psychiatric outpatients diagnosed with depression according to DSM-5 criteria. Participants completed the MADRS and the 17-item Hamilton Depression Rating Scale (HDRS). Internal consistency, concurrent validity, and discriminative validity were assessed. Receiver operating characteristic (ROC) curve analyses determined optimal cutoff scores for remission and major depressive episode (MDE). RESULTS: The MADRS demonstrated excellent internal consistency (Cronbach's α = 0.92) and strong correlations with the HDRS (r = 0.91, p < .001) and MDE classifications (r = 0.81, p < .001). ROC analyses showed excellent diagnostic accuracy (AUC = 0.97 for depression vs. remission; AUC = 0.96 for MDE vs. non-MDE). Optimal cutoff scores of 12 and 26 were identified for distinguishing remission and MDE, respectively, with high sensitivity and specificity. CONCLUSION: The MADRS is a reliable and valid tool for assessing depression severity in Taiwanese populations. The established cutoff scores provide clinicians with a practical reference for diagnosing and managing depression more effectively in this cultural context.