MedWire News: Bereavement-related depression is similar to that due to other stressful life events, say US researchers in findings that question the exclusion of bereavement from the diagnosis of major depression.
Of stressful life events that could contribute to the onset of major depression, only bereavement was assigned a special status in DSM-III and DSM-IV. Consequently, bereavement-related depression with clinical features indicative of normal grief is considered sufficiently different from other types of depressive episodes that it should not be diagnosed as major depression.
To determine the validity of this exclusion, Kenneth Kendler, from Virginia Commonwealth University Medical School in Richmond, and colleagues examined a large population-based sample of twins interviewed up to four times over a 10-year period.
The participants were administered the Structured Clinical Interview for DSM-III-R, and the team assessed whether individuals with bereavement-related depression who also meet the DSM-IV criteria for “normal grief” were qualitatively distinct from other cases of depression.
In all, 82 individuals met the definition for confirmed bereavement-related depression, while 224 had confirmed depression related to other stressful life events, including divorce/separation, illness, and job loss. Individuals with bereavement-related depression were significantly more likely to be older and female at their index episode than other patients, at 35.1 versus 33.0 years, and 72.0% versus 56.3%.
Of those with bereavement-related depression, 28% met the criteria for normal grief, compared with 25% of those with depression related to other stressful life events, which was a non-significant difference. There were also no significant differences in terms of age at onset, number of prior episodes, duration of index episode, number of endorsed major depression criteria, risk for future episodes, pattern of comorbidity, levels of extraversion, and risk for major depression in the co-twin.
However, patients with bereavement-related depression had lower levels of neuroticism, treatment seeking, and guilt than other patients, and higher levels of fatigue and loss of interest. Analysis revealed that there were no unique features of bereavement-related depression compared with depression due to other stressful life events.
The team concludes in the American Journal of Psychiatry: “The similarities of bereavement-related depression and depression related to other stressful life events far outweigh their differences.”
Free abstract
