title: Can the DSM's major depression bereavement exclusion be validly extended to other stressors? Evidence from the NCS.
abstract: OBJECTIVE
  To evaluate whether the DSM's distinction between uncomplicated (normal) vs. complicated (disordered) bereavement-related depressive episodes can be validly extended to non-bereavement stressor-related depression (SRD). Previous findings supporting the uncomplicated/complicated SRD distinction's discriminant validity were criticized as tautological because of definitional biases (e.g., 'uncomplicated' requires brief duration, yet duration was a validator). We tested whether uncomplicated/complicated SRD validator differences are tautological or real.
  
  
  METHODS
  Using National Comorbidity Survey data, we compared uncomplicated SRDs, complicated SRDs, and endogenous/psychotic MDD on levels of eight pathology validators. We identified definitional biases affecting six validators, and corrected them by deleting the biasing definitional components and recalculating validator levels.
  
  
  RESULTS
  After correction of biases, uncomplicated SRDs had significantly lower pathology levels than both complicated SRDs and endogenous/psychotic MDD on seven of eight validators, disconfirming the tautology hypothesis. Regression analysis revealed that 'uncomplicated' cannot be equated with 'mild'. Extending the 'uncomplicated' durational threshold from 2 to 6 months yielded equal or stronger discriminant validity, suggesting the arbitrariness of the current durational criterion.
  
  
  CONCLUSIONS
  Uncomplicated SRDs' lower pathology levels are because of real syndromal differences, not definitional tautologies. The uncomplicated/complicated distinction has discriminant validity when extended to non-bereavement SRDs as an indicator of normality vs. disorder.
authors: Silver School of Social Work, New York University, New York, NY, USA; Department of Psychiatry, School of Medicine, New York University, New York, NY, USA; InSPIRES (Institute for Social and Psychiatric Initiatives-Research, Education and Services), New York University, New York, NY, USA; Division of Clinical Phenomenology, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors: J C
authors: JC
authors: Wakefield
authors: M F
authors: MF
authors: Schmitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000145:classification* / Q000175:diagnosis; D001601:Bereavement; D003863:Depression / Q000145:classification* / Q000175:diagnosis; D003866:Depressive Disorder / Q000145:classification* / Q000175:diagnosis; D003865:Major Depressive Disorder / Q000145:classification* / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055815:Young Adult
keywords: DSM-5; Major depression; bereavement exclusion; diagnostic validity; harmful dysfunction