Uncomplicated Depression, Suicide Attempt, and the DSM-5 Bereavement Exclusion Debate: An Empirical Evaluation

Purpose: To evaluate the claim, made repeatedly during Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition debatesover eliminating the bereavement exclusion (BE), that "uncomplicated" depressive reactions have elevated suicidality like othermajor depressive disorder (MDD), so exclusions risk missing suicidal cases. Method: We found no published evidence assessingsuicide risk specifically in uncomplicated depression. Using data from four epidemiological surveys, we calculated suicide attemptrates both concurrently and predictively for those with histories of no MDD, uncomplicated MDD, and standard MDD. Results: Both concurrently and predictively, uncomplicated MDD suicide attempt rates were no greater than no-MDD history rates andless than standard MDD rates. Discussion: Excluding uncomplicated cases from MDD poses no risk of missing elevated suicidalrates typical of depression. The "suicide" argument used to support BE elimination was spurious.