Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity? Evidence from the National Comorbidity Survey

Jerome C. Wakefield, Mark F. Schmitz, Judith C. Baer

    Research output: Contribution to journalArticle

    Abstract

    The DSM's major-depression "bereavement exclusion" eliminates bereavement-related depressive episodes (BRDs) from diagnosis unless they are "complicated" by prolonged duration or certain severe symptoms. The exclusion was substantially narrowed in DSM-IV to decrease false-negative diagnoses, but the impact of this change remains unknown. We divided BRDs in the National Comorbidity Survey into uncomplicated versus complicated categories using broader DSM-III-R and narrower DSM-IV exclusion criteria. Using 6 pathology validators (symptom number, melancholic depression, suicide attempt, interference with life, medication for depression, and hospitalization for depression), we compared the validity of the 2 exclusion criteria sets using 2 tests: (1) which criteria set yielded less pathological uncomplicated cases or more pathological complicated cases; (2) which yielded the largest separation between uncomplicated and complicated pathology levels. Results of both tests indicated that the narrower DSM-IV criteria substantially decreased the exclusion's validity. These results suggest caution regarding the current proposal to eliminate the bereavement exclusion in DSM-5.

    Original languageEnglish (US)
    Pages (from-to)66-73
    Number of pages8
    JournalJournal of Nervous and Mental Disease
    Volume199
    Issue number2
    DOIs
    StatePublished - Feb 1 2011

    Fingerprint

    Bereavement
    Diagnostic and Statistical Manual of Mental Disorders
    Comorbidity
    Depression
    Pathology
    Suicide
    Hospitalization
    Surveys and Questionnaires

    Keywords

    • Bereavement
    • Depression
    • Diagnosis
    • DSM
    • Grief
    • Harmful dysfunction
    • Validity

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity? Evidence from the National Comorbidity Survey. / Wakefield, Jerome C.; Schmitz, Mark F.; Baer, Judith C.

    In: Journal of Nervous and Mental Disease, Vol. 199, No. 2, 01.02.2011, p. 66-73.

    Research output: Contribution to journalArticle

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