How Different Is Depression Following Bereavement?

Unlike other major adverse life events, recent bereavement is an exclusion criterion for the diagnosis of major depressive disorder in the DSM-IV. The rationale is that symptoms of major depression may be confused with symptoms of grief among newly bereaved individuals. These investigators used a large, population-based dataset to examine whether depression during bereavement differs from other stress-related depressions. They identified 82 individuals with major depression occurring in the same month as a relative’s or friend’s death (“bereavement-related depression”) and 224 individuals diagnosed with major depression related to other adverse life events (divorce/separation, 167; illness, 36; job loss, 21).

Twenty-three individuals with bereavement-related depression (28%) met the DSM-IV exclusion criteria for normal grief (i.e., no psychomotor retardation, episode length under 2 months, no work impairment, and no suicidal ideation), but so did 55 individuals with other stress-related depressions (25%). Of the remaining individuals with bereavement-related depression, 54% had psychomotor retardation, 46% had episode length longer than 2 months, 24% had severe work impairment, and 20% had suicidal ideation. This phenomenology was similar in most aspects to that of other stress-related depressions. However, those with bereavement-related depression were significantly older, more likely to be female, and less likely to seek treatment for the index episode; they also had significantly less neuroticism and guilt and more loss of interest and tiredness.