NEW YORK -- About 1 in 4 people who appear to be depressed are in fact struggling with the normal mental fallout from a recent emotional blow, like a ruptured marriage, the loss of a job, or the collapse of an investment, a new study suggests. To avoid unnecessary diagnoses and stigma, the standard definition of depression should be redrawn to specifically exclude such cases, the authors argue.
The study, appearing today in The Archives of General Psychiatry, is based on survey data from more than 8,000 Americans; it did not analyze the number of people who had been misdiagnosed.
Psychiatrists and other doctors who take careful medical histories do so to rule out such life blows, as well as the effects of physical illnesses, before making a diagnosis of depression.
But the American Psychiatric Association's diagnostic manual does not specifically exclude people experiencing deep but normal feelings of sadness, unless they are grieving the death of a loved one. And an increasing number of school districts and health clinics use simple depression checklists, which do not take context into account, the authors said.
"Larger and larger numbers of people are reporting symptoms on these 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.
His co authors were Mark F. Schmitz of Temple University, Allan V. Horwitz of Rutgers University, and Dr. Michael B. First, a Columbia psychiatrist who edited the current version of the psychiatric association's diagnostic manual.
The study's findings suggest that previous estimates of the number of Americans who have depression at least once during their lives -- more than 30 million -- are about 25 percent too high.
Dr. Darrel Regier, director of research for the American Psychiatric Association, said, "I think the concern this study raises is real, and that we do need to be very careful not to overdiagnose a normal, homeostatic response to loss and call it a disorder."
The researchers analyzed responses from 8,098 adults to survey questions posed between 1990 and 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.