When is depression not depression?

No one can dispute that depression is now a major public health issue, with incidences skyrocketing all over the Western world.

A new piece of research by Fried et al., published in the Journal of Abnormal Psychology, seems to offer a glimmer of hope by suggesting that depression is being over-diagnosed among the bereaved.

In the study, entitled 'From loss to loneliness: the relationship between bereavement and depressive symptoms', the researchers followed 515 married men and women over the age of 65, who lost a spouse during the observation period. They compared the depression symptoms of those who had lost a spouse with an equally large (n=241) still-married control group.

Lead author, Dr Eiko Fried, identifies the two key findings:

"First, we found that spousal loss causes a very small number of specific depression symptoms, the most important of which is loneliness. Second, we observed that these few initial depression symptoms, in turn, trigger a specific network of subsequent depression symptoms."

The implications are significant, Fried notes, because it opens the door to targeting symptoms, such as loneliness, to prevent the activation of further symptoms and possibly full-fledged depression.

One of the concerns raised by the team is the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its latest edition (the DSM-5 published in 2013), actively removed the distinction between depression and natural bereavement. This has been highly controversial, since pathologising normal sadness increases the risk of labelling and medicalising those who are simply passing through the normal stages of grief.

This is not the first time the DSM-5 has been called into question. In 2013, another notable change to the text designated paedophilia a 'sexual orientation' rather than its former description as a 'disorder'. This is a radical shift, indicating as it does, that the desire for sex with children is just one other variant in the normal spectrum of sexual behaviours.

In the case of blurring the lines between bereavement and depression, it would appear that the DSM-5 has introduced the potential to put people at risk of misdiagnosis and unnecessary medicalisation; but in the case of reclassifying paedophilia as a lifestyle choice, it has potentially entered another realm.

We need more research like this to promote common-sense findings, which can make a real difference in peoples' lives and ensure they get the help they need, rather than suffer unnecessary harm. The authors are also to be applauded for shining a light on this subtle, but highly significant, edit to the DSM-5.

Do you have any thoughts on this topic? If so, we'd love to hear from you. Please comment.


Written by Jacqui Hogan