Citation

Wakefield JC, Schmitz MF, Baer JC. J. Nerv. Ment. Dis. 2011; 199(2): 66-73.

Affiliation

*Silver School of Social Work, New York University, New York, NY; †Department of Psychiatry, School of Medicine, New York University, New York, NY; ‡InSPIRES (Institute for Social and Psychiatric Initiatives-Research, Education and Services), New York University, New York, NY; §School of Social Administration, Temple University, Philadelphia, PA; and ¶School of Social Work, Rutgers-The State University of New Jersey, New Brunswick, NJ.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/NMD.0b013e31820840c5

PMID

21278534

Abstract

The DSM's major-depression "bereavement exclusion" eliminates bereavement-related depressive episodes (BRDs) from diagnosis unless they are "complicated" by prolonged duration or certain severe symptoms. The exclusion was substantially narrowed in DSM-IV to decrease false-negative diagnoses, but the impact of this change remains unknown. We divided BRDs in the National Comorbidity Survey into uncomplicated versus complicated categories using broader DSM-III-R and narrower DSM-IV exclusion criteria. Using 6 pathology validators (symptom number, melancholic depression, suicide attempt, interference with life, medication for depression, and hospitalization for depression), we compared the validity of the 2 exclusion criteria sets using 2 tests: (1) which criteria set yielded less pathological uncomplicated cases or more pathological complicated cases; (2) which yielded the largest separation between uncomplicated and complicated pathology levels. Results of both tests indicated that the narrower DSM-IV criteria substantially decreased the exclusion's validity. These results suggest caution regarding the current proposal to eliminate the bereavement exclusion in DSM-5.

Language: en