Bereavement related and non-bereavement related depressions: A comparative field study

• Published in: Journal of affective disorders Vol. 112; no. 1; pp. 102 - 110
• Main Authors: Karam, Elie G, Tabet, Caroline C, Alam, Donna, Shamseddeen, Wael, Chatila, Yasmine, Mneimneh, Zeina, Salamoun, Mariana M, Hamalian, Marc
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.01.2009; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Age of Onset; Aged; Bereavement; Biological and medical sciences; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Conditional criteria; Data Collection; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Diagnostic and Statistical Manual of Mental Disorders; DSM; Dysfunction; Humans; Lebanon; Life Change Events; Medical sciences; Middle Aged; Mood disorders; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Prospective Studies; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Recurrence; Reproducibility of Results; Risk Factors; Symptoms; Time Factors; Warfare; Lebanon; Depression; Bereavement; Conditional criteria; DSM; Mood disorder; Criterion; Mourning; Comparative study
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2008.03.016

Abstract Background and Method 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. Limitations ‘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. Conclusion 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.