title: Depression and the medicalization of sadness: conceptualization and recommended help-seeking.
abstract: BACKGROUND
  Critiques of the validity of the DSM diagnostic criteria for depressive disorder argue that it fails to differentiate between abnormal sadness due to internal dysfunction or depression (sadness without an identifiable cause), and normal sadness (sadness with a clear cause).
  
  
  OBJECTIVE
  and
  
  
  METHODS
  A population survey was undertaken in adult education centres in Spain aiming to explore beliefs about depression and normal sadness. Two hypothetical case vignettes portrayed individuals experiencing deep sadness, both fulfilling criteria for major depressive disorder (DSM-IV), one with a clear cause, the other without an identifiable cause. Three hundred and forty-four (344) questionnaires were obtained (95% response rate).
  
  
  RESULTS
  Participants statistically significantly differentiated between the sadness-with-cause vignette, seen more frequently as a normal response, while the one without a cause was seen as pathological. Help-seeking behaviour recommendations followed this distinction: a medical option was statistically significantly more common when there was no cause for sadness. Socio-cultural variation in how people understand and deal with sadness was also found.
  
  
  CONCLUSIONS
  This study emphasizes the importance of taking into account the context in which depressive symptoms occur as it seems that the absence of an appropriate context is what makes people conceptualize them as abnormal. It also raises questions about the lack of face validity of the current diagnostic classification for depressive disorder that exclusively uses descriptive criteria.
authors.affiliation: Research Department of Mental Health Sciences, University College London, London, UK. duravila@doctors.org.uk
authors.forename: Glòria
authors.initials: G
authors.lastname: Durà-Vilà
authors.forename: Roland
authors.initials: R
authors.lastname: Littlewood
authors.forename: Gerard
authors.initials: G
authors.lastname: Leavey
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002965:Classification / Q000379:methods; D003469:Culture; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D062528:Medicalization; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011580:Psychological Techniques / Q000592:standards*; D012044:Regression Analysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D009626:Terminology as Topic