Validity of the bereavement exclusion to major depression: does the empirical evidence support the proposal to eliminate the exclusion in DSM-5?

摘要

The DSM-IV major depression “bereavement exclusion” (BE), whichrecognizes that depressive symptoms are sometimes normal in recently bereavedindividuals, is proposed for elimination in DSM-5. Evidence cited for theBE’s invalidity comes from two 2007 reviews purporting to show thatbereavement-related depression is similar to other depression across variousvalidators, and a 2010 review of subsequent research. We examined whetherthe 2007 and 2010 reviews and subsequent relevant literature support the BE’sinvalidity. Findings were: a) studies included in the 2007 reviews sampledbereavement-related depression groups most of whom were not BE-excluded, makingthem irrelevant for evaluating BE validity; b) three subsequent studies citedby the 2010 review as supporting BE elimination did examine BE-excluded casesbut were in fact inconclusive; and c) two more recent articles comparing recurrenceof BE-excluded and other major depressive disorder cases both support theBE’s validity. We conclude that the claimed evidence for the BE’sinvalidity does not exist. The evidence in fact supports the BE’s validityand its retention in DSM-5 to prevent false positive diagnoses. We suggestsome improvements to increase validity and mitigate risk of false negatives.