Extending the Bereavement Exclusion for Major Depression to Other Losses: Evidence From the National Comorbidity Survey | Depressive Disorders | JAMA Psychiatry | JAMA Network
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Spitzer  RLWakefield  JC DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem?  Am J Psychiatry 1999;1561856- 1864PubMedGoogle Scholar
Regier  DAKaelbar  CTRae  DSFarmer  MEKnauper  BKessler  RCNorquist  GS Limitations of diagnostic criteria and assessment instruments for mental disorders: implications for research and policy.  Arch Gen Psychiatry 1998;55109- 115PubMedGoogle ScholarCrossref
Clayton  PJHerjanic  MMurphy  GEWoodruff  R  Jr Mourning and depression: their similarities and differences.  Can Psychiatr Assoc J 1974;19309- 312PubMedGoogle Scholar
Horowitz  MJSiegel  BHolen  ABonanno  GAMilbrath  CStinson  CH Diagnostic criteria for complicated grief disorder.  Am J Psychiatry 1997;154904- 910PubMedGoogle Scholar
Prigerson  HGFrank  EKasl  SVReynolds  CFAnderson  BZubenko  GSHouck  PRGeorge  CJKupfer  DJ Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses.  Am J Psychiatry 1995;15222- 30PubMedGoogle Scholar
Lichtenthal  WGCruess  DGPrigerson  HG A case for establishing complicated grief as a distinct mental disorder in DSM-V Clin Psychol Rev 2004;24637- 662PubMedGoogle ScholarCrossref
Jackson  SW Melancholia and Depression: From Hippocratic Times to Modern Times.  New Haven, Conn: Yale University Press;1986;
Radden  Jed The Nature of Melancholy: From Aristotle to Kristeva.  New York, NY: Oxford University Press; 2000;
MacDonald  M Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England.  New York, NY: Cambridge University Press;1981;
Clayton  PJ The model of stress: the bereavement reaction. Dohrenwend  BPed. Adversity, Stress, and Psychopathology. New York, NY: Oxford University Press; 1998;96- 110Google Scholar
Clayton  PJedDarvish  HSedRose  RMedKlerman  GLed Course of depressive symptoms following the stress of bereavement. Barrett  JE Stress and Mental Disorder. New York, NY: Raven Press;1979;Google Scholar
Kessler  RC The effects of stressful life events on depression.  Annu Rev Psychol 1997;48191- 214PubMedGoogle ScholarCrossref
Booth  AAmato  P Divorce and psychological stress.  J Health Soc Behav 1991;32396- 407PubMedGoogle ScholarCrossref
Bruce  ML Divorce and psychopathology. Dohrenwend  BP ed. Adversity, Stress, and Psychopathology. New York, NY: Oxford University Press;1998;219- 232Google Scholar
Bruce  MLKim  KLeaf  PJJacobs  S Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample.  Am J Psychiatry 1990;147608- 611PubMedGoogle Scholar
Kessler  RCTurner  JBHouse  JS Unemployment, reemployment, and emotional functioning in a community sample.  Am Sociol Rev 1989;54648- 657Google ScholarCrossref
Price  RHChoi  JNVinokur  AD Links in the chain of adversity following job loss.  J Occup Health Psychol 2002;7302- 312PubMedGoogle ScholarCrossref
Dooley  DPrause  JHam-Rowbottom  KA Underemployment and depression: longitudinal relationships.  J Health Soc Behav 2000;41421- 437PubMedGoogle ScholarCrossref
Chen  HChung  HChen  TFang  LChen  JP The emotional distress in a community after the terrorist attack on the World Trade Center.  Community Ment Health J 2003;39157- 165PubMedGoogle ScholarCrossref
Galea  SAhern  JResnick  HKilpatrick  DBucuvalas  MGold  JVlahov  D Psychological sequelae of the September 11 terrorist attacks in New York City.  N Engl J Med 2002;346982- 987PubMedGoogle ScholarCrossref
Knudsen  HKRoman  PMJohnson  JADucharme  LJ A changed America? the effects of September 11 on depressive symptoms and alcohol consumption.  J Health Soc Behav 2005;46260- 273PubMedGoogle ScholarCrossref
Kleinman  AGood  B Introduction: culture and depression. Kleinman   AGood   BedsCulture and Depression. Berkeley: University of California Press;1985;1- 33
Archer  J The Nature of Grief: The Evolution and Psychology of Reactions to Loss.  New York, NY: Routledge & Kegan Paul Plc; 1999;
Keller  MCNesse  RM Is low mood an adaptation? evidence for subtypes with symptoms that match precipitants.  J Affect Disord 2005;8627- 35PubMedGoogle ScholarCrossref
Nesse  RM Is depression an adaptation?  Arch Gen Psychiatry 2000;5714- 20PubMedGoogle ScholarCrossref
Wakefield  JC Evolutionary versus prototype analyses of the concept of disorder.  J Abnorm Psychol 1999;108374- 399PubMedGoogle ScholarCrossref
Wakefield  JC The concept of mental disorder: on the boundary between biological facts and social values.  Am Psychol 1992;47373- 388PubMedGoogle ScholarCrossref
Wakefield  JC Disorder as harmful dysfunction: a conceptual critique of DSM-III-R's definition of mental disorder.  Psychol Rev 1992;99232- 247PubMedGoogle ScholarCrossref
Kessler  RCMcGonagle  KAZhao  SNelson  CBHughes  MEshleman  SWittchen  HUKendler  KS Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey.  Arch Gen Psychiatry 1994;518- 19PubMedGoogle ScholarCrossref
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition  . Washington, DC: American Psychiatric Association;1987;
Narrow  WERae  DSRobins  LNRegier  DA Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates.  Arch Gen Psychiatry 2002;59115- 123PubMedGoogle ScholarCrossref
Wakefield  JCSpitzer  RL Lowered estimates—but of what?  Arch Gen Psychiatry 2002;59129- 130[published correction appears in Arch Gen Psychiatry. 2002;59:416]PubMedGoogle ScholarCrossref
Cohen  J A power primer.  Psychol Bull 1992;112155- 159Google ScholarCrossref
Zisook  SShuchter  SRPedrelli  PSable  JDeaciuc  SC Bupropion sustained release for bereavement: results of an open trial.  J Clin Psychiatry 2001;62227- 230PubMedGoogle ScholarCrossref
Brown  GW Social roles, context and evolution in the origins of depression.  J Health Soc Behav 2002;43255- 276PubMedGoogle ScholarCrossref
Dohrenwend  BP The role of adversity and stress in psychopathology: some evidence and its implications for theory and research.  J Health Soc Behav 2000;411- 19PubMedGoogle ScholarCrossref
Original Article
April 2007

Extending the Bereavement Exclusion for Major Depression to Other Losses: Evidence From the National Comorbidity Survey

Author Affiliations

Author Affiliations: School of Social Work, New York University, New York (Dr Wakefield); School of Social Administration, Temple University, Philadelphia, Pa (Dr Schmitz); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Biometrics Research Department, New York State Psychiatric Institute, New York (Dr First); and Department of Sociology and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ (Dr Horwitz).

Arch Gen Psychiatry. 2007;64(4):433-440. doi:10.1001/archpsyc.64.4.433

Context  Symptoms of intense bereavement-related sadness may resemble those of major depressive disorder (MDD) but may not indicate a mental disorder. To avert false-positive diagnoses, DSM criteria for MDD exclude uncomplicated bereavement of brief duration and modest severity. However, the DSM does not similarly exempt depressive reactions to other losses, even when they are uncomplicated in duration and severity.

Objective  To test the validity of the DSM exclusion of uncomplicated depressive symptoms only in response to bereavement but not in response to other losses.

Design  Community-based epidemiological study.

Participants  From the National Comorbidity Survey (NCS) of 8098 persons aged 15 to 54 years representative of the US population, we identified individuals who met MDD symptom criteria and whose MDD episodes were triggered by either bereavement (n = 157) or other loss (n = 710).

Intervention  We divided the bereavement and other loss trigger groups into uncomplicated and complicated cases by applying the NCS algorithm for uncomplicated bereavement to the reactions to other losses. We then compared uncomplicated bereavement and uncomplicated reactions to other losses on a variety of disorder indicators and symptoms.

Main Outcome Measures  Nine disorder indicators, as follows: number of symptoms, melancholic depression, suicide attempt, duration of symptoms, interference with life, recurrence, and 3 service use variables.

Results  Episodes of uncomplicated depression triggered by bereavement and by other loss have similar symptom profiles and are not significantly different for 8 of 9 disorder indicators. Moreover, uncomplicated reactions, whether triggered by bereavement or other loss, are significantly lower than complicated reactions on almost all disorder indicators.

Conclusion  The NCS data do not support the validity of uniquely excluding uncomplicated bereavement but not uncomplicated reactions to other losses from MDD diagnosis.