Journal
JOURNAL OF CLINICAL PSYCHIATRY
Volume 73, Issue 2, Pages 208-215Publisher
PHYSICIANS POSTGRADUATE PRESS
DOI: 10.4088/JCP.10m06080
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Funding
- Abbott
- Alkermes
- Aspect Medical Systems
- AstraZeneca
- BioResearch
- BrainCells
- Bristol-Myers Squibb
- Cephalon
- CeNeRx BioPharma
- Clinical Trials Solutions
- Clintara
- Covidien
- Eli Lilly
- EnVivo
- Euthymics Bioscience
- Forest
- Ganeden Biotech
- GlaxoSmithKline
- Icon Clinical Research
- i3 Innovus/Ingenix
- Johnson & Johnson Pharmaceutical Research Development
- Lichtwer Pharma GmbH
- Lorex
- National Alliance for Research on Schizophrenia & Depression (NARSAD)
- National Center for Complementary and Alternative Medicine
- National Institute of Drug Abuse
- National Institute of Mental Health
- Novartis AG
- Organon
- PamLab
- Pfizer
- Pharmavite
- Photothera
- Roche
- RCT Logic
- Sanofi-Aventis
- Shire
- Solvay
- Synthelabo
- Wyeth-Ayerst
- Affectis AG
- Amarin Pharma
- Auspex
- Bayer AG
- Best Practice Project Management
- BioMarin
- Biovail
- CNS Response
- Compellis
- Cypress
- DiagnoSearch Life Sciences (P)
- Dainippon Sumitomo Pharma
- Dov
- Edgemont
- Eisai
- ePharmaSolutions
- EPIX
- Fabre-Kramer
- GenOmind
- Grunenthal GmbH
- i3 Innovus/Ingenis
- Janssen
- Jazz
- Knoll
- Labopharm
- Lundbeck
- MedAvante
- Merck
- MSI Methylation Sciences
- Naurex
- Neuronetics
- Next Wave
- Nutrition 21
- Orexigen Therapeutics
- Organon Otsuka
- PharmaStar
- PharmoRx Therapeutics
- Precision Human Biolaboratory
- Prexa Pharmaceuticals
- Puretech Ventures
- PsychoGenics
- Psylin Neurosciences
- Rexahn
- Ridge Diagnostics
- Sepracor
- Servier Laboratories
- Schering-Plough
- Somaxon
- Somerset
- Sunovion
- Supernus
- Takeda
- Tal Medical
- Tetragenex
- TransForm
- Transcept
- Vanda
- Adamed
- Advanced Meeting Partners
- American Psychiatric Association
- American Society of Clinical Psychopharmacology
- Belvoir Media Group
- Boehringer Ingelheim GmbH
- CME Institute/Physicians Postgraduate Press
- Imedex
- Massachusetts General Hospital (MGH) Psychiatry Academy/Primedia
- MGH Psychiatry Academy/Reed Elsevier
- United BioSource
- National Institutes of Health [MH087544, DA080887, MH66057]
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Objective: Bereavement-related depression is excluded from a diagnosis of major depressive episode (MDE) in DSM-IV, unless the syndrome is prolonged or complicated. The objective of this study is to assess the validity of the bereavement exclusion by comparing characteristics of bereavement-related episodes that are excluded from a diagnosis and bereavement-related episodes that qualify for a diagnosis (complicated bereavement) to MDE. Method: We used data from 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093) to compare bereavement-excluded depression and complicated bereavement to MDE with respect to indicators of preexisting risk for psychopathology (antecedent indicators) and indicators of disorder severity measured at baseline and at the study's 3-year follow-up interview (consequent indicators). The primary outcome measure was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. Results: Compared to individuals with MDE, individuals with bereavement-excluded depression had lower risks of preexisting psychiatric disorders (eg, 0.44 lower odds of social phobia, P = .006), fewer depressive episodes (recurrence rate 0.37 times lower, P < .001), less psychosocial impairment (P < .001), a 0.18 times lower odds of seeking treatment (P < .001), and a lower risk of psychiatric disorders during a 3-year follow-up period. Unexpectedly, this same pattern of differences was observed between individuals with complicated bereavement and MDE. Conclusions: Despite the presence of a clinically significant depressive episode, bereavement-excluded depression is in many ways less indicative of psychopathology than MDE. However, complicated bereavement was more similar to bereavement-excluded depression than to MDE. We therefore question whether the DSM-IV criteria validly distinguish between nondisordered loss reactions (bereavement-excluded depression), pathological loss reactions (complicated bereavement), and nonloss-related MDE. J Clin Psychiatry 2012;73(2):208-215 (C) Copyright 2011 Physicians Postgraduate Press, Inc.
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