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May 21, 1997

Major Depressive Disorder Following Miscarriage-Reply

Author Affiliations

New York State Psychiatric Institute New York
Columbia University School of Public Health New York, NY
New York University New York, NY
Russell Sage College Troy, NY

JAMA. 1997;277(19):1517. doi:10.1001/jama.1997.03540430029022

In Reply.  —The letter from Drs Lynch and Johnson affords us a welcome opportunity to clarify the diagnostic logic underlying our approach to major depressive disorder following miscarriage. Lynch and Johnson recommend that following a miscarriage, women with an episode of uncomplicated bereavement should be distinguished from those with an episode of major depressive disorder. The former category would include women whose depressive symptoms start within 1 month of the loss and remit within 2 months of the loss, and who are free of morbid preoccupation with worthlessness. To be fully consistent with the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), suicidal ideation and psychomotor retardation also should be absent.1Whatever the clinical merits of this categorization, we believe it is not appropriate for the epidemiologic design and analysis of our study. We intended to estimate the contribution of miscarriage to risk of severe, enduring depressive symptoms.