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Recurrence of Depression After Bereavement-Related Depression: Evidence for the Validity of DSM-IV Bereavement Exclusion From the Epidemiologic Catchment Area Study

Wakefield, Jerome C. PhD, DSW*†‡§; Schmitz, Mark F. PhD‡∥

The Journal of Nervous and Mental Disease: June 2012 - Volume 200 - Issue 6 - p 480–485
doi: 10.1097/NMD.0b013e318248213f
Original Article

The DSM-IV diagnostic criteria for major depressive disorder exclude bereavement-related depressive episodes that are brief and lack certain severe symptoms and are thus better explained as normal grief responses. However, the DSM-5 Task Force proposes to eliminate this exclusion because of a lack of evidence that such episodes differ relevantly from standard major depression. Using the two-wave longitudinal Epidemiologic Catchment Area Study, we compared 1-yr depression recurrence rates at wave 2 of four groups at wave 1 baseline: (1) those with no history of depressive disorder (n = 18,239), (2) those who had only lifetime excludable bereavement-related depression (n = 25), (3) those with brief-episode (≤2 months duration) lifetime standard depressive disorder (n = 446), and (4) those with nonbrief lifetime standard depressive disorder (n = 581). The recurrence rate in the excludable-depression group (3.7%) was not significantly different from the no-history group (1.7%) but was significantly and substantially lower than in the brief and nonbrief standard depression groups (14.4% and 16.2%, respectively). These findings confirm findings reported by Mojtabai (Arch Gen Psychiatry 68:920–928, 2011) using a different data set and time frame and thus substantially strengthen the support for the validity of bereavement exclusion and for its preservation in the DSM-5.

*Silver School of Social Work, New York University, New York, NY; †Department of Psychiatry, School of Medicine, New York University, New York, NY; ‡InSPIRES (Institute for Social and Psychiatric Initiatives–Research, Education and Services), New York University, New York, NY; §Division of Clinical Phenomenology, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY; and ∥School of Social Work, Temple University, Philadelphia, PA.

Send reprint requests to Jerome C. Wakefield, PhD, DSW, Silver School of Social, Work, New York University, 1 Washington Square North, New York, NY, 10003. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.