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Editor's Correspondence |

Grief in Health Care Professionals: When Screening for Major Depression Is Needed—Reply

Leeat Granek, PhD
Arch Intern Med. 2012;172(22):1768-1769. doi:10.1001/jamainternmed.2013.2096.
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In reply

In response to our study,1 Corruble et al note that grief should not be confused with major depressive episode (MDE) and that health care professionals whose grief lasts longer than 2 weeks should be screened for MDE. I thank the authors for their letter; however, I am concerned about these conclusions for the following reasons:

  1. Two weeks is not enough time to allow for oncologists' grief. The literature on grief supports the fact that mourning lasts longer than 2 weeks. In an informal survey of nearly 8000 bereaved people, one-fourth reported feeling normal “one to two years” after the loss and 30% reported feeling “normal” or symptom-free again within 6 months after a loss.2 The majority of mourners grieve for longer than 2 weeks, and this is likely true for physicians as well.

  2. Symptoms of grief and symptoms of depression may overlap, but this does not necessarily indicate a pathologic condition or merit an MDE diagnosis even if MDE criteria are met. One study that looked at a national survey of 8098 people found that 90% of those diagnosed and treated for major depressive disorder attributed their depression to a bereavement-related loss or another loss.3 Grieving is context specific and is a natural reaction to loss that does not require intervention in most cases.

  3. Oncologists' grief may be different from the grief of the general population; thus, different criteria to assess distress are needed. The authors suggest that there are features that are unique to grief vs MDE. For example, “feelings of worthlessness and self-loathing are present (in grief alone, self-esteem is usually preserved).” For oncologists, grief included feelings of responsibility toward their patients. Guilt, worthlessness, and negative affect were key features of their phenomenological experiences of grief.1 While these particular distinctions between grief and depression may be relevant to a general population, they may not be applicable to oncologists.

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December 10, 2012
Emmanuelle Corruble, MD, PhD; Ronald Pies, MD; Sidney Zisook, MD, PhD
Arch Intern Med. 2012;172(22):1768-1769. doi:10.1001/2013.jamainternmed.90.
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