The Bereavement Exclusion and DSM-5

Zisook, Sidney; Duan, Naihua; Iglewicz, Alana; Karam, Elie G.; Lanouette, Nicole M.; Lebowitz, Barry D.; Pies, Ronald W.; Reynolds, Charles F.; Seay, Kathryn; Shear, Matthew; Simon, Naomi M.; Young, Ilanit Tal

doi:10.1002/da.21972

Cited by 19 publications

(23 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the DSM no longer considering bereavement as an exclusion factor for depression, it is recognized that major depression can occur during a period of mourning. 40 We must also take account of the increasingly differentiated diagnosis of prolonged grief disorder (also referred to as complicated bereavement) which is a distinct entity from both depression and PTSD, provisionally referred in the DSM V as persistent, complex bereavement disorder. [41][42][43] We need to be especially mindful that this first report assessed responses an average of 9 months after loss, before the 12-month minimum for symptoms to qualify for prolonged grief disorder.…”

Section: Main Findingsmentioning

confidence: 99%

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample

Gold

Leon

Boggs

et al. 2016

Journal of Women's Health

102

View full text Add to dashboard Cite

Introduction: Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. Methods: We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. Results: Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. Conclusion: This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.

show abstract

Section: Main Findingsmentioning

confidence: 99%

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample

Gold

Leon

Boggs

et al. 2016

Journal of Women's Health

102

View full text Add to dashboard Cite

show abstract

“…And yet, based on the best available, albeit imperfect, data, the patient who meets MDD criteria in the context of recent bereavement is probably not experiencing a "normal" and "adaptive" response. 3 Withholding a diagnosis of MDD seems an odd way of "respecting" a patient who may be at risk for further decompensation or suicide; indeed, in my view, doing so would be unethical.…”

Section: Toward Development Of a Screening Toolmentioning

confidence: 92%

“…On the contrary, the preponderance of clinical data strongly suggest that BRD does not differ in any clinically important respects from non-BRD that meets DSM-IV symptom and duration criteria for a major depressive episode. 2,3 As to the claim that Mr. Smith is merely showing "normal, non-disordered sadness," this, too, requires a demonstration that individuals like Mr. Smith show no greater morbidity or mortality than the average "sad" or grieving person who does not meet DSM-IV symptom and duration criteria for MDD, but, to my knowledge, no empirical studies have demonstrated this.…”

Section: From Context To Phenomenology In Grief Versus Major Depressionmentioning

confidence: 99%

From Context to Phenomenology in Grief Versus Major Depression

Pies¹

2013

Psychiatric Annals

Self Cite

View full text Add to dashboard Cite

“…Those in favor of retaining the exclusion argue that there are fundamental differences between those depressive syndromes that are targeted by the bereavement exclusion (BE) and other, nonbereavement-related instances of MDD, 2 whereas proponents in favor of removing the BE argue that data support the similarity of bereavement-related depression and MDD, regardless of the context. 3 It is worth noting that no rigorous prospective study has been done to specifically answer the question of whether there are important, clinically significant differences between MDD after bereavement compared with MDD that occurs in other contexts. Therefore, the authors of DSM-5 needed to make their best judgment about this challenging issue.…”

Section: Diagnostic Boundarymentioning

confidence: 99%

“…5 Similarly, most of the available evidence shows that MDD occurring soon after bereavement is clinically meaningful, not unlike MDD occurring in other contexts. 3 In both cases, following general medical illness or after bereavement, diagnosing MDD can be challenging but may be a vital step towards healing and well-being.…”

Section: Diagnostic Boundarymentioning

confidence: 99%