Do Clinical Psychologists Extend the Bereavement Exclusion for Major Depression to Other Stressful Life Events?

Abstract

Background. In assessing potential cases of major depressive disorder (MDD), to what extent do clinicians interpret symptoms within the explanatory context of major life stressors? Past research suggests that when clinicians know a plausible life event cause for a person’s disordered symptoms, they generally judge that person to be less abnormal than if the cause was unknown. However, the current, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders specifies that only bereavement-related life events exclude a client from a diagnosis of MDD, and the upcoming fifth edition of the manual (DSM-V) is currently slated to eliminate this bereavement clause altogether. Objective. To systematically examine whether clinicians’ judgments reflect agreement with either of these formal DSM specifications. Method. In a controlled experiment, 72 practicing, licensed clinical psychologists made judgments about realistic MDD vignettes that included a bereavement event, stressful non-bereavement event, neutral event, or no event. Results. Bonferroni-corrected paired comparisons revealed that both bereavement and non-bereavement life events led MDD symptoms to be rated as significantly less indicative of a depression diagnosis, less abnormal, less rare, and less culturally unacceptable (all P ≤ 0.001) relative to control conditions. Limitations. Clinicians made judgments of realistic, controlled vignettes rather than patients. Conclusions. The results suggest that practicing clinical psychologists assess symptoms within the explanatory context of bereavement and non-bereavement life stressors, indicating a departure from the DSM’s recommendations, both current and proposed. Implications for diagnostic decision making and the clinical utility of the DSM’s recommendations are discussed.