{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:14:22Z","timestamp":1772118862978,"version":"3.50.1"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,3,7]],"date-time":"2013-03-07T00:00:00Z","timestamp":1362614400000},"content-version":"vor","delay-in-days":34,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:p>High community prevalence estimates of DSM\u2010defined major depressive disorder (MDD) have led to proposals to raise MDD's diagnostic threshold to more validly distinguish pathology from normal\u2010range distress. However, such proposals lack empirical validation. We used MDD recurrence rates in the longitudinal 2\u2010wave Epidemiologic Catchment Area Study to test the predictive validity of three proposals to narrow MDD diagnosis: a) excluding \u201cuncomplicated\u201d episodes (i.e., episodes that last no longer than 2 months and do not include suicidal ideation, psychotic ideation, psychomotor retardation, or feelings of worthlessness); b) excluding mild episodes (i.e., episodes with only five to six symptoms); and c) excluding nonmelancholic episodes. For each proposal, we used lifetime MDD diagnoses at wave 1 to distinguish the group proposed for exclusion, other MDD, and those with no MDD history. We then compared these groups\u2019 1\u2010year MDD rates at wave 2. A proposal was considered strongly supported if at wave 2 the excluded group's MDD rate was not only significantly lower than the rate for other MDD but also not significantly greater than the no\u2010MDD\u2010history group. Results indicated that all three excluded groups had significantly lower recurrence rates than other MDD (uncomplicated vs. complicated, 3.4% vs. 14.6%; mild vs. severe, 9.6% vs. 20.7%; nonmelancholic vs. melancholic, 10.6% vs. 19.2%, respectively). However, only uncomplicated MDD's recurrence rate was also not significantly greater than the MDD occurrence rate for the no\u2010MDD\u2010history group (3.4% vs. 1.7%, respectively). This low recurrence rate resulted from an interaction between uncomplicated duration and symptom criteria. Multiple\u2010episode uncomplicated MDD did not entail significantly elevated recurrence over single\u2010episode cases (3.7% vs. 3.0%, respectively). Uncomplicated MDD's general\u2010distress symptoms, transient duration, and lack of elevated recurrence suggest it may generally represent nonpathologic intense sadness that should be addressed in treatment guidelines and considered for exclusion from MDD diagnosis to increase the validity of the MDD\/normal sadness boundary.<\/jats:p>","DOI":"10.1002\/wps.20015","type":"journal-article","created":{"date-parts":[[2013,4,8]],"date-time":"2013-04-08T09:27:29Z","timestamp":1365413249000},"page":"44-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["When does depression become a disorder? Using recurrence rates to evaluate the validity of proposed changes in major depression diagnostic thresholds"],"prefix":"10.1002","volume":"12","author":[{"given":"Jerome C.","family":"Wakefield","sequence":"first","affiliation":[{"name":"Silver School of Social Work New York University 1 Washington Square North New York NY"},{"name":"Department of Psychiatry School of Medicine New York University New York NY"},{"name":"InSPIRES (Institute for Social and Psychiatric Initiatives\u2013Research, Education and Services) New York University New York NY"},{"name":"Division of Clinical Phenomenology Department of Psychiatry Columbia University College of Physicians and Surgeons New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark F.","family":"Schmitz","sequence":"additional","affiliation":[{"name":"InSPIRES (Institute for Social and Psychiatric Initiatives\u2013Research, Education and Services) New York University New York NY"},{"name":"School of Social Work 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