Is the diagnosis of depression too broad?

[Halo]

Depression Diagnosis Is To Broad
by: John M. Grohol, Psy.D.
Tuesday, Apr, 3, 2007

Depression may not be as commonplace as researchers thought. A new study published today suggests that about one in four people who were diagnosed with depression may instead be struggling with normal and expected emotions associated with an important loss or event in the person?s life. For instance, it is not uncommon for someone who has lost their job, marriage, or a loved one, to feel deep, depressive feelings. But researchers now suggest that such feelings, when associated with such a traumatic event, should not usually be diagnosed as depression.

The study appeared in today?s The Archives of General Psychiatry. It was based on a survey administered to 8,098 Americans from 1990 to 1992. The questions were based on diagnostic criteria for mood problems and asked people who reported a period of sadness if they remembered any event that might have caused it, like the death of a loved one or a divorce. Researchers estimated that approximately one in six people suffer from depression at some point in their lives.

Researchers of the study found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness. They also found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said.

?Larger and larger numbers of people are reporting symptoms on [depression] checklists, and there?s no way to know whether we?re finding normal sadness responses or real depression,? said Jerome C. Wakefield, a professor of social work at New York University and the study?s lead author.

To avoid unnecessary diagnosis and stigma, the standard definition of depression should be redrawn to specifically exclude cases where a person is experiencing a normal grief reaction to a loss, rather than full-blown depression, the researchers argue.

The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful ? but normal ? responses to life?s stresses. Supportive psychotherapy, on the other hand, may be useful ? and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression.

 

[David Baxter PhD]

Re: Depression Diagnosis Is Too Broad

I read this opinion piece by John Grohol earlier and frankly I think the basic thesis is a crock.

“Larger and larger numbers of people are reporting symptoms on [depression] checklists, and there’s no way to know whether we’re finding normal sadness responses or real depression,” said Jerome C. Wakefield, a professor of social work at New York University and the study’s lead author.

Most "checklists" are painfully transparent and have little or no validity. If your clinician has to depend on such instruments to diagnose depression, i would suggest that you find another therapist.

To avoid unnecessary diagnosis and stigma, the standard definition of depression should be redrawn to specifically exclude cases where a person is experiencing a normal grief reaction to a loss, rather than full-blown depression, the researchers argue.

The problem that I have with this statement is that the two - a "normal gried reaction" (whatever that is) and depression - cannot coexist.

They can and frequently do.

 

[David Baxter PhD]

Checklists Often Fail to Address Important Aspects of Depression Diagnosis

Checklists Often Fail to Address Important Aspects of Depression Diagnosis

Sometimes it can be difficult to distinguish bereavement from depression, especially in the moment immediately following a profound loss. That is one of the many roles of doctors and therapists who work with those who have experienced the damaging effects of persistent and deep sadness.

As it stands right now, the diagnosis for major depression specifically carves out exemptions for those who experience a major loss, like the death of a loved one, preceding their current demonstration of symptoms. New research that is drawn from NCS data shows just how important a complete picture can be when diagnosing depression and why some believe that the diagnosis might benefit from an expansion of the definition of the role of context to include losses or changes beyond those included in the bereavement exemption.

The new study, conducted by representatives from four northeastern universities, found that when depression is measured by a checklist, as it was with the NCS, respondents whose symptoms can be attributed to a death were not statistically different from those who had other contextual reasons for their symptoms. While the New York Times reported this new information under the headline, "Many Diagnoses of Depression May Be Misguided, Study Says," that declaration is in fact misleading. The team's work shows that checklist type survey's that rely on only a few broad questions to assess the possibility of a depression diagnosis are flawed because they do not take into account the life events that may have led to the symptoms.

While the study does highlight some important points--primarily that there is a difference between bereavement and depression and that our environments can have an important effect on our mental health--to say that the diagnosis for depression needs to be reworked might be a stretch. What this research clearly shows is that simple surveys are not ideal tools for diagnosing depression. It is virtually impossible to assess someone's mental health in a mere six or ten questions. That is why doctors and therapists often use thorough intake questionnaires and interviews that flesh out a full picture of the patient and their history. Only with this information in hand can an accurate and actionable diagnosis truly be provided.

In the data set that they were working with, the original National Comorbidity Survey, the team's conclusions may have been accurate, but in terms of drawing broader points, that is more difficult. A more thorough and in-depth survey, which may be a nuisance to randomly selected test subjects, could serve as a powerful clinical tool in other settings. Only through assessing a more thorough picture, including a medical and personal history, can a therapist or a doctor help guide the client through the best possible course of action.