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 language | English (US) |
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Pages (from-to) | 66-73 |
Number of pages | 8 |
Journal | Journal of Nervous and Mental Disease |
Volume | 199 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2011 |
Keywords
- Bereavement
- DSM
- Depression
- Diagnosis
- Grief
- Harmful dysfunction
- Validity
ASJC Scopus subject areas
- Psychiatry and Mental health