Uncomplicated Depression, Suicide Attempt, and the DSM-5 Bereavement Exclusion Debate: An Empirical Evaluation

Purpose: To evaluate the claim, made repeatedly during Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition debates over eliminating the bereavement exclusion (BE), that uncomplicated depressive reactions have elevated suicidality like other major depressive disorder (MDD), so exclusions risk missing suicidal cases. Method: We found no published evidence assessing suicide risk specifically in uncomplicated depression. Using data from four epidemiological surveys, we calculated suicide attempt rates both concurrently and predictively for those with histories of no MDD, uncomplicated MDD, and standard MDD. Results: Both concurrently and predictively, uncomplicated MDD suicide attempt rates were no greater than no-MDD history rates and less than standard MDD rates. Discussion: Excluding uncomplicated cases from MDD poses no risk of missing elevated suicidal rates typical of depression. The suicide argument used to support BE elimination was spurious.