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Affiliation
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Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island. |
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Abstract
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BACKGROUND: Despite the removal of the bereavement exclusion from DSM-5, clinicians may feel uncertain on how to proceed when caring for a patient who presents with depressive symptoms following the death of someone close. The ability to better distinguish, on a symptom and functional level, between patients who experience depression in the context of bereavement and those with nonbereavement-related depression, could help guide clinical decision making.
METHOD: Individual and clustered depressive symptom and impairment measures were used for modeling bereavement status within a nationally representative longitudinal cohort. Deviance, linear shrinkage factor, and bias-corrected c-statistic were used for identifying a well-calibrated and discriminating final model.
RESULTS: Of the 450 (1.2%) respondents with a single brief major depressive episode, 162 (38.4%) reported the episode as bereavement-related. The bereaved were less likely to endorse worthlessness (P <.001), social conflict (P <.001), distress (P <.001), thoughts of suicide (P =.001), wanting to die (P =.01), self-medicating (P =.01), and being withdrawn (P =.04). In a multivariate model, the bereaved were more likely to have thoughts of their own death (P =.003), guilt coupled with weight or appetite loss (P =.013), and were less likely to report social conflict (P <.001), worthlessness coupled with difficulty making decisions (P <.001), thoughts of suicide (P =.006), distress coupled with weight or appetite gain (P =.022), and self-medicating (P =.045).
CONCLUSIONS: Traits and trait combinations differentiate individuals who experience brief depressive episodes following the death of a loved one from other brief episodes. These differences can help guide clinical care of patients who present with depressive symptoms shortly after a loved one's death.
Language: en |