BACKGROUND AND METHOD: In the otherwise a-theoretical diagnostic manual, the DSM-III and IV bereavement exclusion for the diagnosis of major depression (MDD) stands out as the sole exception to the rule. No other life event excludes the diagnosis of any other axis I disorder. Since this diagnostic convention has important diagnostic and treatment implications, it is important to evaluate the validity of this exception. By comparing multiple features of bereavement related to non-bereavement related MDD, this prospective community study critically evaluates the validity of the bereavement exclusion. RESULTS: The prevalence of conditional criteria was common in the total sample (N=685) and did not differ between bereaved and non-bereaved groups. The global 'symptom profile' of depressed individuals was similar in both groups. 'Duration' was found to be longer in the bereaved group. Among all conditional criteria required by DSM-IV to accept bereavement-related episodes under the category of MDD, only 'marked dysfunction' predicted treatment. Neither the 'four conditional symptoms' nor the 'duration' criterion predicted marked dysfunction. The 'risk for recurrence' was similar whether the first episode was bereavement related or not. LIMITATIONS: 'Psychotic symptoms' were not assessed, and 'marked dysfunction' was not assessed on a continuous scale. The number of DSM-IV excluded episodes was too small to allow for generalization. CONCLUSION: Our results suggest that the conditional criteria do not seem to serve the purpose of the originators of the bereavement exclusion criteria. The 'conditional symptoms' and the 'duration' criterion seem not to be markers of severity. We propose that the descriptive and etiologically neutral approach the DSM presumes in reaching a diagnosis should be applied in the case of MDD until more convincing data point to the contrary.
BACKGROUND AND METHOD: In the otherwise a-theoretical diagnostic manual, the DSM-III and IV bereavement exclusion for the diagnosis of major depression (MDD) stands out as the sole exception to the rule. No other life event excludes the diagnosis of any other axis I disorder. Since this diagnostic convention has important diagnostic and treatment implications, it is important to evaluate the validity of this exception. By comparing multiple features of bereavement related to non-bereavement related MDD, this prospective community study critically evaluates the validity of the bereavement exclusion. RESULTS: The prevalence of conditional criteria was common in the total sample (N=685) and did not differ between bereaved and non-bereaved groups. The global 'symptom profile' of depressed individuals was similar in both groups. 'Duration' was found to be longer in the bereaved group. Among all conditional criteria required by DSM-IV to accept bereavement-related episodes under the category of MDD, only 'marked dysfunction' predicted treatment. Neither the 'four conditional symptoms' nor the 'duration' criterion predicted marked dysfunction. The 'risk for recurrence' was similar whether the first episode was bereavement related or not. LIMITATIONS: 'Psychotic symptoms' were not assessed, and 'marked dysfunction' was not assessed on a continuous scale. The number of DSM-IV excluded episodes was too small to allow for generalization. CONCLUSION: Our results suggest that the conditional criteria do not seem to serve the purpose of the originators of the bereavement exclusion criteria. The 'conditional symptoms' and the 'duration' criterion seem not to be markers of severity. We propose that the descriptive and etiologically neutral approach the DSM presumes in reaching a diagnosis should be applied in the case of MDD until more convincing data point to the contrary.
Authors: D A Brent; J Perper; G Moritz; C Allman; A Friend; J Schweers; C Roth; L Balach; K Harrington Journal: J Am Acad Child Adolesc Psychiatry Date: 1992-07 Impact factor: 8.829
Authors: D A Brent; J A Perper; G Moritz; L Liotus; J Schweers; R Canobbio Journal: J Am Acad Child Adolesc Psychiatry Date: 1994-02 Impact factor: 8.829
Authors: Koen Demyttenaere; Ronny Bruffaerts; Jose Posada-Villa; Isabelle Gasquet; Viviane Kovess; Jean Pierre Lepine; Matthias C Angermeyer; Sebastian Bernert; Giovanni de Girolamo; Pierluigi Morosini; Gabriella Polidori; Takehiko Kikkawa; Norito Kawakami; Yutaka Ono; Tadashi Takeshima; Hidenori Uda; Elie G Karam; John A Fayyad; Aimee N Karam; Zeina N Mneimneh; Maria Elena Medina-Mora; Guilherme Borges; Carmen Lara; Ron de Graaf; Johan Ormel; Oye Gureje; Yucun Shen; Yueqin Huang; Mingyuan Zhang; Jordi Alonso; Josep Maria Haro; Gemma Vilagut; Evelyn J Bromet; Semyon Gluzman; Charles Webb; Ronald C Kessler; Kathleen R Merikangas; James C Anthony; Michael R Von Korff; Philip S Wang; Traolach S Brugha; Sergio Aguilar-Gaxiola; Sing Lee; Steven Heeringa; Beth-Ellen Pennell; Alan M Zaslavsky; T Bedirhan Ustun; Somnath Chatterji Journal: JAMA Date: 2004-06-02 Impact factor: 56.272
Authors: D A Brent; J Perper; G Moritz; C Allman; L Liotus; J Schweers; C Roth; L Balach; R Canobbio Journal: J Am Acad Child Adolesc Psychiatry Date: 1993-11 Impact factor: 8.829
Authors: Elie G Karam; Zeina N Mneimneh; Hani Dimassi; John A Fayyad; Aimee N Karam; Soumana C Nasser; Somnath Chatterji; Ronald C Kessler Journal: PLoS Med Date: 2008-04-01 Impact factor: 11.069
Authors: Stephen E Gilman; Joshua Breslau; Nhi-Ha Trinh; Maurizio Fava; Jane M Murphy; Jordan W Smoller Journal: J Clin Psychiatry Date: 2011-08-23 Impact factor: 4.384