Normal vs. disordered bereavement-related depression: Are the differences real or tautological?

Jerome C. Wakefield, M. F. Schmitz

    Research output: Contribution to journalArticle

    Abstract

    Objective: To evaluate whether the DSM distinction between uncomplicated (normal) and complicated (disordered) bereavement-related depression (BRD) has discriminant validity on a range of pathology indicators. The DSM's major depression bereavement exclusion (BE) excludes BRDs from diagnosis when they are uncomplicated (defined by brief duration, non-severe impairment, and lack of certain pathosuggestive symptoms) but classifies all other ("complicated") BRDs as major depression. A previous report seemed to support the uncomplicated/complicated distinction's discriminant validity. However, those arguing for eliminating the BE from DSM-5 dismiss the findings as 'tautological,' attributing the validator differences to definitional biases (e.g. 'uncomplicated' requires 'no suicidal ideation,' yet 'lifetime suicide attempt' was a validator). This study empirically tests whether the uncomplicated/complicated differences are real or tautological. Method: Using National Comorbidity Survey data, confounds between definitional criteria for 'uncomplicated' and pathology validators were identified and corrected by deleting the biasing criteria and recalculating the corresponding validator's outcome. Results: Six validators (interference with life, suicide attempt, melancholic depression, duration, hospitalization, and number of symptoms) were reanalyzed using unbiased definitions for 'uncomplicated.' All still yielded significantly lower pathology levels for uncomplicated BRDs, disconfirming the 'tautology' hypothesis. Regression analysis revealed that 'uncomplicated' offered incremental validity over severity alone in predicting pathology, so 'uncomplicated' cannot be equated with 'mild.' Conclusion: Uncomplicated BRDs' lower pathology validator levels are because of real syndromal differences, not definitional tautologies, supporting the BE's validity.

    Original languageEnglish (US)
    Pages (from-to)159-168
    Number of pages10
    JournalActa Psychiatrica Scandinavica
    Volume127
    Issue number2
    DOIs
    StatePublished - Feb 1 2013

    Fingerprint

    Bereavement
    Depression
    Pathology
    Suicide
    Suicidal Ideation
    Comorbidity
    Hospitalization
    Regression Analysis

    Keywords

    • Bereavement
    • Diagnostic validity
    • DSM-5
    • Harmful dysfunction
    • Major depression

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Normal vs. disordered bereavement-related depression : Are the differences real or tautological? / Wakefield, Jerome C.; Schmitz, M. F.

    In: Acta Psychiatrica Scandinavica, Vol. 127, No. 2, 01.02.2013, p. 159-168.

    Research output: Contribution to journalArticle

    Wakefield, Jerome C. ; Schmitz, M. F. / Normal vs. disordered bereavement-related depression : Are the differences real or tautological?. In: Acta Psychiatrica Scandinavica. 2013 ; Vol. 127, No. 2. pp. 159-168.
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