title: Is DSM-IV bereavement exclusion for major depression relevant to treatment response? A case-control, prospective study.
abstract: OBJECTIVE
  The aim of the bereavement exclusion criterion for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depressive episode (MDE) is to identify subjects with a modest, self-limited, "normal" depressive syndrome. One would therefore expect less severe depressive symptoms and a different and better outcome for bereaved subjects who were excluded from the diagnosis of MDE as compared to MDE controls. In a previous cross-sectional study, we have shown such expectations were not met. Herein, we further challenge the accuracy of the bereavement exclusion criterion regarding response to treatment.
  
  
  METHODS
  In a database of 12,615 subjects seeking treatment for depression, 1,138 (9.0%) individuals met DSM-IV MDE criteria except the bereavement exclusion criterion. This sample was matched for age, gender, educational level, and number of previous depressive episodes with 1,138 MDE patients. The bereavement exclusion and MDE groups were prospectively assessed for outcome after 6 weeks of treatment. Primary outcome measures included the number of DSM-IV MDE symptoms and the presence/absence of DSM-IV MDE Criterion A symptoms at follow-up.
  
  
  RESULTS
  The bereavement exclusion individuals had higher levels of DSM-IV MDE symptoms (P = .005) and self-rated depression (P < .0001) than MDE controls. Both groups had a similar 6-week outcome: 37.7% versus 39.9%, respectively, were responders to treatment, and 80.1% versus 82.2% no longer had the MDE DSM-IV symptom criteria at follow-up (P = .33).
  
  
  CONCLUSIONS
  The DSM-IV bereavement exclusion for MDE is inadequate according to response to treatment, at least in this sample of individuals seeking treatment for depressive symptoms. It is proposed that bereavement, just as any stressful event, could be noted but without its affecting the treatment decision.
authors.affiliation: Department of Psychiatry, Bicêtre University Hospital, 78 rue du General Leclerc-94275 Le Kremlin Bicêtre, France. emmanuelle.corruble@bct.aphp.fr
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Corruble
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.forename: Philip
authors.initials: P
authors.lastname: Gorwood
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D001601:Bereavement; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents