Bereavement-related depression: Did the changes induced by DSM-V make a difference? Results from a large population-based survey of French residents

- We compared DSM-4 and DSM-5 criteria for bereavement-related depression.
- Overall depression prevalence is marginally increased with DSM-5 criteria.
- Prevalence of depression among the bereaved gains 10 points with DSM-5 implementation.
- Depression cases added by DSM-5 seem less severe than cases diagnosed with DSM-4.
- In France, mental healthcare use will probably not be modified by the new criteria.

BackgroundDSM-V has been criticized for excessively expanding criteria for bereavement-related depression. The aim of this study was to quantify a potential increase in depression prevalence due to changes in diagnostic criteria and to assess the severity, clinical profile and healthcare use of new cases.MethodsA cross-sectional telephone survey was performed in 2005-2006 in four French regions. Twelve-month prevalence of psychiatric disorders was measured by CIDI-SF. Bereavement was assessed in those who endorsed the gate question to the depression module. Persons with bereavement-related depression according to DSM-IV and DSM-V diagnosis criteria were compared.ResultsOf the 22,138 respondents, 692 were bereaved. The prevalence of depression among those bereaved was 54.2% (95% CI=50.5-57.9) according to DSM-IV and 64.3% (60.7-67.9) according to DSM-V. The overall prevalence of major depression increased from 9.5% (9.1-9.9) with DSM-IV to 9.8% (9.4-10.2) with DSM-V. Cases diagnosed using DSM-IV presented more symptoms than cases diagnosed using DSM-V but clinical features were similar except regarding criterion E׳s symptoms. Healthcare use was similar between the two groups regarding consultations and psychotropic drug prescription.LimitationsSome DSM-IV and DSM-V criteria were difficult to operationalize in the survey. The observed difference in prevalence according to DSM-IV and DSM-V may be reduced when clinical judgment is taken into account.ConclusionsThe overall prevalence of major depression is only marginally increased by the new criteria. However, diagnostic changes increase the prevalence by 10 points among those bereaved. Diagnostic changes do not appear to modify service use.