Can the DSM's major depression bereavement exclusion be validly extended to other stressors? Evidence from the NCS

Jerome C. Wakefield, M. F. Schmitz

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate whether the DSM's distinction between uncomplicated (normal) vs. complicated (disordered) bereavementrelated depressive episodes can be validly extended to non-bereavement stressor-related depression (SRD). Previous findings supporting the uncomplicated/complicated SRD distinction's discriminant validity were criticized as tautological because of definitional biases (e.g., 'uncomplicated' requires brief duration, yet duration was a validator). We tested whether uncomplicated/complicated SRD validator differences are tautological or real. Method: Using National Comorbidity Survey data, we compared uncomplicated SRDs, complicated SRDs, and endogenous/psychotic MDD on levels of eight pathology validators. We identified definitional biases affecting six validators, and corrected them by deleting the biasing definitional components and recalculating validator levels. Results: After correction of biases, uncomplicated SRDs had significantly lower pathology levels than both complicated SRDs and endogenous/psychotic MDD on seven of eight validators, disconfirming the tautology hypothesis. Regression analysis revealed that 'uncomplicated' cannot be equated with 'mild'. Extending the 'uncomplicated' durational threshold from 2 to 6 months yielded equal or stronger discriminant validity, suggesting the arbitrariness of the current durational criterion. Conclusion: Uncomplicated SRDs' lower pathology levels are because of real syndromal differences, not definitional tautologies. The uncomplicated/complicated distinction has discriminant validity when extended to non-bereavement SRDs as an indicator of normality vs. disorder.

Original languageEnglish (US)
Pages (from-to)294-305
Number of pages12
JournalActa Psychiatrica Scandinavica
Issue number4
StatePublished - 2013


  • Bereavement exclusion
  • DSM-5
  • Diagnostic validity
  • Harmful dysfunction
  • Major depression

ASJC Scopus subject areas

  • Psychiatry and Mental health

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