S Zisook1, S R Shuchter. 1. Department of Psychiatry, University of California, San Diego School of Medicine.
Abstract
BACKGROUND: This paper evaluates the validity of the distinction between the depressive syndrome associated with uncomplicated bereavement and major depression by following the course, associated symptoms, and impairment associated with depressive episodes occurring in bereaved widows and widowers. METHODS: Two hundred fifty-nine widows/widowers were interviewed and completed the San Diego Widowhood Questionnaire at 2, 13, and 25 months after the deaths of their spouses. Subjects were diagnosed as depressed or not depressed on the basis of DSM-III-R criteria. RESULTS: Fifty-nine (23%) of subjects met symptomatic criteria for a major depressive syndrome at 2 months. Because of the close proximity to the death, the symptoms in these 59 subjects were considered to represent "uncomplicated bereavement" rather than major depression. Compared with widows/widowers who did not manifest an early depressive syndrome, the "depressed" group was more likely to have past or family histories of major depression, present treatment with antidepressant medication, feelings of worthlessness and suicidal ideation, poor health and job satisfaction, and major depression 1 and 2 years later. CONCLUSION: When a full depressive syndrome is present soon after the death of a spouse, the symptoms may often be prolonged and associated with substantial morbidity. We recommend that future conceptualizations of uncomplicated bereavement exclude persons with major depressive episodes.
BACKGROUND: This paper evaluates the validity of the distinction between the depressive syndrome associated with uncomplicated bereavement and major depression by following the course, associated symptoms, and impairment associated with depressive episodes occurring in bereaved widows and widowers. METHODS: Two hundred fifty-nine widows/widowers were interviewed and completed the San Diego Widowhood Questionnaire at 2, 13, and 25 months after the deaths of their spouses. Subjects were diagnosed as depressed or not depressed on the basis of DSM-III-R criteria. RESULTS: Fifty-nine (23%) of subjects met symptomatic criteria for a major depressive syndrome at 2 months. Because of the close proximity to the death, the symptoms in these 59 subjects were considered to represent "uncomplicated bereavement" rather than major depression. Compared with widows/widowers who did not manifest an early depressive syndrome, the "depressed" group was more likely to have past or family histories of major depression, present treatment with antidepressant medication, feelings of worthlessness and suicidal ideation, poor health and job satisfaction, and major depression 1 and 2 years later. CONCLUSION: When a full depressive syndrome is present soon after the death of a spouse, the symptoms may often be prolonged and associated with substantial morbidity. We recommend that future conceptualizations of uncomplicated bereavement exclude persons with major depressive episodes.