期刊
JOURNAL OF NERVOUS AND MENTAL DISEASE
卷 199, 期 2, 页码 66-73出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/NMD.0b013e31820840c5
关键词
Depression; diagnosis; bereavement; grief; DSM; validity; harmful dysfunction
The DSM's major-depression bereavement exclusion eliminates bereavement-related depressive episodes (BRDs) from diagnosis unless they are complicated by prolonged duration or certain severe symptoms. The exclusion was substantially narrowed in DSM-IV to decrease false-negative diagnoses, but the impact of this change remains unknown. We divided BRDs in the National Comorbidity Survey into uncomplicated versus complicated categories using broader DSM-III-R and narrower DSM-IV exclusion criteria. Using 6 pathology validators (symptom number, melancholic depression, suicide attempt, interference with life, medication for depression, and hospitalization for depression), we compared the validity of the 2 exclusion criteria sets using 2 tests: (1) which criteria set yielded less pathological uncomplicated cases or more pathological complicated cases; (2) which yielded the largest separation between uncomplicated and complicated pathology levels. Results of both tests indicated that the narrower DSM-IV criteria substantially decreased the exclusion's validity. These results suggest caution regarding the current proposal to eliminate the bereavement exclusion in DSM-5.
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