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Evidence From the National Comorbidity Survey

Jerome C. Wakefield, PhD, DSW; Mark F. Schmitz, PhD; Michael B. First, MD; Allan V. Horwitz, PhD

Arch Gen Psychiatry. 2007;64(4):433-440.

Context  Symptoms of intense bereavement-related sadness may resemble those of major depressive disorder (MDD) but may not indicate a mental disorder. To avert false-positive diagnoses, DSM criteria for MDD exclude uncomplicated bereavement of brief duration and modest severity. However, the DSM does not similarly exempt depressive reactions to other losses, even when they are uncomplicated in duration and severity.

Objective  To test the validity of the DSM exclusion of uncomplicated depressive symptoms only in response to bereavement but not in response to other losses.

Design  Community-based epidemiological study.

Participants  From the National Comorbidity Survey (NCS) of 8098 persons aged 15 to 54 years representative of the US population, we identified individuals who met MDD symptom criteria and whose MDD episodes were triggered by either bereavement (n = 157) or other loss (n = 710).

Intervention  We divided the bereavement and other loss trigger groups into uncomplicated and complicated cases by applying the NCS algorithm for uncomplicated bereavement to the reactions to other losses. We then compared uncomplicated bereavement and uncomplicated reactions to other losses on a variety of disorder indicators and symptoms.

Main Outcome Measures  Nine disorder indicators, as follows: number of symptoms, melancholic depression, suicide attempt, duration of symptoms, interference with life, recurrence, and 3 service use variables.

Results  Episodes of uncomplicated depression triggered by bereavement and by other loss have similar symptom profiles and are not significantly different for 8 of 9 disorder indicators. Moreover, uncomplicated reactions, whether triggered by bereavement or other loss, are significantly lower than complicated reactions on almost all disorder indicators.

Conclusion  The NCS data do not support the validity of uniquely excluding uncomplicated bereavement but not uncomplicated reactions to other losses from MDD diagnosis.

Author Affiliations: School of Social Work, New York University, New York (Dr Wakefield); School of Social Administration, Temple University, Philadelphia, Pa (Dr Schmitz); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Biometrics Research Department, New York State Psychiatric Institute, New York (Dr First); and Department of Sociology and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ (Dr Horwitz).

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