Kendler Kenneth S, Myers John, Zisook Sidney
Departments of Psychiatry and Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298, USA.
Am J Psychiatry. 2008 Nov;165(11):1449-55. doi: 10.1176/appi.ajp.2008.07111757. Epub 2008 Aug 15.
Of the stressful life events influencing risk for major depression, DSM-III and DSM-IV assign a special status to bereavement. A depressive episode that is bereavement-related and has clinical features and course characteristic of normal grief is not diagnosed as major depression. This study evaluates the empirical validity of this exclusion criterion.
To determine the similarities of bereavement-related depression and depression related to other stressful life events, the authors identified and compared cases on a range of validators in a large-population-based sample of twins. The authors evaluated whether cases of bereavement-related depression that also met DSM criteria for "normal grief" were qualitatively distinct from other depressive cases.
Eighty-two individuals with confirmed bereavement-related depression and 224 with confirmed depression related to other stressful life events were identified. The two groups did not differ in age at onset of major depression, number of prior episodes, duration of index episode, number of endorsed "A criteria," risk for future episodes, pattern of comorbidity, levels of extraversion, risk for major depression in their co-twin, or the proportion meeting criteria for "normal grief." However, individuals with bereavement-related depression were slightly older, and more likely to be female, and had lower levels of neuroticism, treatment-seeking, and guilt and higher levels of fatigue and loss of interest. Interaction analyses failed to find unique features of people whose illness met criteria for both bereavement-related depression and normal grief compared to those whose illness was related to other life stressors.
The similarities between bereavement-related depression and depression related to other stressful life events substantially outweigh their differences. These results question the validity of the bereavement exclusion for the diagnosis of major depression.
在影响重度抑郁症风险的应激性生活事件中，《精神疾病诊断与统计手册》第三版（DSM - III）和第四版（DSM - IV）赋予了丧亲之痛特殊地位。与丧亲相关且具有正常悲伤的临床特征和病程特点的抑郁发作，不被诊断为重度抑郁症。本研究评估这一排除标准的实证效度。
为确定与丧亲相关的抑郁症和与其他应激性生活事件相关的抑郁症之间的相似性，作者在一个基于大样本人群的双胞胎样本中，在一系列验证指标上识别并比较了病例。作者评估了那些同时符合“正常悲伤”的DSM标准的与丧亲相关的抑郁症病例在性质上是否与其他抑郁病例不同。
确定了82例确诊的与丧亲相关的抑郁症患者和224例确诊的与其他应激性生活事件相关的抑郁症患者。两组在重度抑郁症发病年龄、既往发作次数、本次发作持续时间、认可的“A标准”数量、未来发作风险、共病模式、外向性水平、其双胞胎患重度抑郁症的风险或符合“正常悲伤”标准的比例方面并无差异。然而，与丧亲相关的抑郁症患者年龄稍大，更可能为女性，神经质水平、寻求治疗的意愿、内疚感较低，而疲劳感和兴趣丧失程度较高。交互分析未能发现其疾病既符合与丧亲相关的抑郁症标准又符合正常悲伤标准的人群与疾病与其他生活应激源相关的人群相比有独特特征。
与丧亲相关的抑郁症和与其他应激性生活事件相关的抑郁症之间的相似性大大超过它们之间的差异。这些结果质疑了丧亲排除标准在重度抑郁症诊断中的效度。
