Bereavement-Related Depressive Episodes Characteristics, 3-Year Course, and Implications for the DSM-5

Context: The DSM-IV criteria for major depressive episodes exclude brief episodes that are better accounted for by bereavement. However, a proposal has been made to remove this exclusion from the DSM-5. Objectives: To compare the demographic and psychiatric characteristics of participants with bereavement-related, single, brief (<2 months) depressive episodes and other types of depressive episodes and to compare the future risk of depression between these groups and participants without a history of depression at baseline. Design: A longitudinal, community-based, epidemiologic study conducted from August 1, 2001, through May 31, 2002 (wave 1), and from August 1, 2004, through September 30, 2005 (wave 2). Setting: The US general population, including residents of Hawaii and Alaska. Participants: Participants in the National Epidemiologic Survey on Alcohol and Related Conditions waves 1 (n=43 093) and 2 (n=34 653). Main Outcome Measures: Demographic characteristics, age at onset, history of depression in first-degree relatives, impairment in role functioning, psychiatric comorbidities, lifetime mental health service use, and new depressive episodes during the 3-year follow-up period. Results: Compared with participants with other types of depression, those with bereavement-related, single, brief depressive episodes were more likely to experience later onset and to be black but less likely to have had impairment in role functioning, comorbid anxiety disorders, or a treatment history at baseline. Participants with bereavement-related, single, brief episodes were less likely than those with bereavement-unrelated, single, brief episodes to experience fatigue, increased sleep, feelings of worthlessness, and suicidal ideations. The risk of new depressive episodes during the follow-up period among participants with bereavement-related, single, brief episodes was significantly lower than among participants with bereavement-unrelated, single, brief episodes and other types of depression but similar to the risk among the participants from the general population with no baseline history of depression. Conclusions: Bereavement-related, single, brief depressive episodes have distinct demographic and symptom profiles compared with other types of depressive episodes and are not associated with increased risk of future depression. The findings support preserving the DSM-IV bereavement exclusion criterion for major depressive episodes in the DSM-5.