Bereavement related and non-bereavement related depressions: a comparative field study.
METHODS
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.


CONCLUSIONS
'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.


CONCLUSIONS
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.
Karam
Elie G
EG
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon. egkaram@idraac.org
Tabet
Caroline C
CC
Alam
Donna
D
Shamseddeen
Wael
W
Chatila
Yasmine
Y
Mneimneh
Zeina
Z
Salamoun
Mariana M
MM
Hamalian
Marc
M
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001601:Bereavement; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D003625:Data Collection; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D007861:Lebanon; D008016:Life Change Events; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D014857:Warfare