Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity?: evidence from the National Comorbidity Survey

J Nerv Ment Dis. 2011 Feb;199(2):66-73. doi: 10.1097/NMD.0b013e31820840c5.


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.

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents / administration & dosage
  • Bereavement*
  • Comorbidity
  • Depression / epidemiology
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / psychology
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Severity of Illness Index
  • Suicide, Attempted / statistics & numerical data
  • Surveys and Questionnaires
  • Time Factors
  • United States / epidemiology


  • Antidepressive Agents