To the Editor.
—Dr Neugebauer and colleagues1 have rendered a valuable contribution with their work on the incidence of major depressive disorder after miscarriage. As they correctly point out, their results should encourage physicians to observe patients carefully following miscarriage for indications that mental health intervention may be needed. However, their use of the diagnosis "major depressive disorder" may be inappropriate, at least for some of their subjects.The authors report that 72% of their subjects were diagnosed within 1 month of the loss. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),2 following the death of a loved one, "the diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present 2 months after the loss." Similarly, the Diagnostic Interview Schedule, the instrument used by Neugebauer and associates,1 considers whether the symptoms began within 2 months of the death
Lynch DJ, Johnson LW. Major Depressive Disorder Following Miscarriage. JAMA. 1997;277(19):1517. doi:10.1001/jama.1997.03540430029021