Is DSM-IV Bereavement Exclusion for Major Depressive Episode Relevant to Severity and Pattern of Symptoms? A Case-Control, Cross-Sectional Study

Objective: To assess the DSM-IV major depressive episode (MDE) bereavement exclusion criterion by comparing severity and pattern of symptoms in bereavement-excluded individuals satisfying all other DSM-IV MDE criteria to these same variables in MDE controls.

Method: A case-control, cross-sectional study of self-referred individuals seeking treatment for depressive symptoms was conducted. A total of 17,988 subjects met DSM-IV MDE symptom criteria. Of these, 1,521 individuals (8.5%) met all MDE criteria except the bereavement exclusion. They were matched by age, gender, marital status, and educational level with 1,521 MDE controls. Among the MDE controls, 292 had a recent bereavement and 1,229 did not. Severity of depression was measured by the number of MDE symptoms and the Montgomery-Asberg Depression Rating Scale (MADRS) score. Symptom cues of the bereavement-exclusion criterion were analyzed. The study was conducted between September 2003 and May 2004.

Results: Bereavement-excluded subjects were more severely depressed than MDE controls without bereavement and similar to MDE controls with bereavement. Two symptom cues, suicidal ideation and worthlessness, and the majority of other depressive symptoms were more pronounced in bereavement-excluded individuals than in MDE controls.

Conclusions: Symptom cues of the DSM-IV MDE bereavement exclusion criterion should be modified since they could result in patients failing to be correctly diagnosed and treated.

Submitted: June 17, 2008; accepted September 2, 2008.

Online ahead of print: June 30, 2009.

Corresponding author: Emmanuelle Corruble, MD, PhD, Department of Psychiatry, Bicêtre University Hospital, 78 rue du General Leclerc, 94275 Le Kremlin Bicêtre, France (emmanuelle.corruble@bct.aphp.fr).