title: Bereavement and common mental disorders in middle-aged adults: results from the Brazilian longitudinal study of adult health (ELSA-Brasil).
abstract: BACKGROUND
  Although bereavement is accompanied with depression and anxiety symptoms, it is usually not associated with increased rates of mental disorders in North American and European samples. Data from low- and middle-income countries are, however, scarce. We therefore explored the prevalence of mental disorders after bereavement in Brazil.
  
  
  METHODS
  The Clinical Interview Schedule-Revised (CIS-R) was used for psychiatric assessment of 15,105 participants from the Brazilian Health Longitudinal Study (ELSA-Brasil). We asked whether the participant suffered loss of a first-degree relative/spouse within 6 and 12 months prior to the interview.
  
  
  RESULTS
  The prevalence within 6 and 12 months after bereavement for major depressive disorder (MDD, 4.3% for 6 and 12 months) and anxiety disorders (17.4% and 15.9%, respectively) did not differ compared to non-bereaved participants, except for panic disorder. Sociodemographic and clinical data were also similar. Conversely, we found increased 12-month prevalence of bereaved-related (vs. non-related) mixed anxiety and depressive disorder (15.7% vs. 12.5%, respectively) and common mental disorder (30.7% vs. 26.2%); diagnoses that are solely based on the number and severity of depression and anxiety symptoms.
  
  
  CONCLUSIONS
  Although this was a cross-sectional study, the sample size was large.
  
  
  CONCLUSIONS
  Bereavement was associated with greater psychopathological burden but not with increased prevalence of MDD and anxiety disorder diagnoses, therefore highlighting the need of carefully monitoring subjects whom recently experienced bereavement. Our findings also support and provide a "cultural validator" for excluding bereavement as an exclusionary criterion for MDD diagnosis.
authors.affiliation: Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.
authors.forename: Andre R
authors.initials: AR
authors.lastname: Brunoni
authors.forename: Maria Angélica
authors.initials: MA
authors.lastname: Nunes
authors.forename: Andrea Poyastro
authors.initials: AP
authors.lastname: Pinheiro
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D001601:Bereavement; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D019049:Developed Countries / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence
keywords: Anxiety disorders; Bereavement; Cohort study; Common mental disorder; Grief; Major depressive disorder