DSM bereavement exclusion for major depression and objective cognitive impairment

Background: The bereavement exclusion criterion for DSM major depressive episodes (MDE) has been challenged regarding symptom severity. This study aimed at assessing objective cognitive impairment, reflecting hippocampal function, in patients excluded from the diagnosis of major depression because of the bereavement exclusion. We expected that the bereavement excluded (BE) individuals would have less objective cognitive impairment than matched MDE patients.

Methods: 1138 individuals seeking treatment and meeting all DSM MDE criteria except the bereavement exclusion criterion (BE group) were matched for age, gender, educational level and the number of past MDE with 1138 MDE patients (MDE group). They were compared for the delayed paragraph recall index from the Wechsler Memory Scale-Revised at baseline and 6-week follow-up.

Results: The BE and MDE groups were not different in terms of immediate and delayed recall at baseline and follow-up. In both groups, multiple regression analyses showed that the number of correct answers of delayed recall at follow-up was not correlated with the HAD depression score but was correlated with the number of past major depressive episodes.

Conclusions: Instead of identifying subjects with less cognitive impairment, the bereavement exclusion selected subjects with similar cognitive impairment than MDE patients and similar neurotoxic effect on the hippocampus. The DSM bereavement exclusion for MDE is inadequate according to objective cognitive impairment, at least in this sample of individuals seeking treatment for depressive symptoms. Bereavement, just as any stressful event, could be quoted, but without interfering in the definition of major depressive episodes.