Is it Depression - or Loss?
A study published a few weeks ago in the Archives of General Psychiatry suggests that approximately one in four people who are diagnosed with depression are in fact reacting with normal sadness to a loss in their life.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the mental health bible for medical professionals, provides an exclusion for bereavement-related sadness (also referred to in the study as uncomplicated depression) in its criteria for major depression, but does not provide an exclusion for other types of loss, such as job loss, divorce or the loss of an investment.
So in other words, if I go to see my doctor with symptoms of depression after my spouse has died, he is not going to diagnose me with depression. He's going to make an exception, since I'm bereaved.
But if I saw my doctor with the same depression-like symptoms after losing my job or getting a divorce, he would not exclude my loss if he was following the DSM-IV to the letter, and so would very possibly diagnose me with depression.
Of course, some doctors will not follow the DSM-IV slavishly, and take the initiative to exclude losses other than bereavement when diagnosing.
The researchers analyzed the data derived from the National Comorbidity Survey completed between 1990 and 1992 by over 8,000 Americans. A total of 157 participants had depression symptoms triggered by bereavement. An additional 710 participants had depression symptoms triggered by losses other than bereavement.
The frequency of depression symptoms between the two groups were almost identical. The only major difference was that people who were grieving a death were more likely to have thoughts of death and suicide than those who were dealing with another type of loss.
The study's authors advocate broadening the DSM-IV bereavement exclusion to include other types of loss, which would theoretically lead to 25 percent fewer depression diagnoses.
Their suggestion seems to make a lot of sense. Lives can be devastated, at least temporarily, by many circumstances. If your life savings are wiped out, it very well might affect you profoundly enough that you have depression symptoms. And in many situations, losing a spouse to divorce is as difficult as losing them to death (and the process of loss is usually more protracted).
One thing that does need to be emphasized is that you can't completely ignore depression symptoms triggered by any loss or emotional trauma. You should consult a doctor if the symptoms continue for more than a few weeks after the event. Not that you necessarily would have clinical depression in that case, but it's a good idea to talk to your doctor.
Published On: May 10, 2007