Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity? Evidence from the National Comorbidity Survey

Jerome C. Wakefield, Mark F. Schmitz, Judith C. Baer

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)66-73
Number of pages8
JournalJournal of Nervous and Mental Disease
Volume199
Issue number2
DOIs
StatePublished - Feb 2011

Keywords

  • Bereavement
  • DSM
  • Depression
  • Diagnosis
  • Grief
  • Harmful dysfunction
  • Validity

ASJC Scopus subject areas

  • Psychiatry and Mental health

Fingerprint Dive into the research topics of 'Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity? Evidence from the National Comorbidity Survey'. Together they form a unique fingerprint.

  • Cite this