The word depression is used to describe a vague swath of symptoms. But, clinically significant depression is different. It refers to symptoms that have reached a specific threshold that would qualify someone for an official diagnosis of depression.
In order to meet the criteria for clinically significant depression, an individual’s distress level must impair daily functioning. It’s not the same as being down or simply feeling sad.
When Is a Mood Disorder Clinically Significant?
The criteria for a mood disorder and its clinical significance is set by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Every few years, the DSM is updated and sometimes the criteria for clinically significant depression shifts slightly.
The DSM-III had a broad set of diagnostic criteria for mental illness. So, in 2000, the DSM-IV, added “clinically significant distress and impairment” to the diagnostic criteria for all mental disorders.
By adding “clinically significant distress and impairment,” the team of professionals who contribute to the DSM sought to narrow down the diagnosis of various mental disorders to people who are not just showing symptoms, but whose symptoms are creating a serious problem in their lives.
In the newest version of the DSM, the DSM-5 which was released in 2013, the standards for clinical significance carried over. The editors took the diagnostic criteria a step further by adding severity measures. Through adding severity measures, the editors of the DSM-5 fine-tuned the diagnostic criteria and linked it to treatment and outcomes.
Sadness vs. Clinically Significant Depression
Everyone feels down sometimes and periods of sadness can be normal. But, individuals with clinically significant depression experience sadness, markedly diminished interest in their activities, and several other symptoms to the extent that they struggle to function.
So someone who is sad yet continues to perform their work without an issue and who socializes without a problem likely won’t meet the threshold. But, an individual who misses college classes because he can’t get out of bed or one who is falling behind at work because he can’t concentrate, may have clinically significant depression.
The symptoms of clinically significant depression are persistent. An individual who feels down for an afternoon or a couple of days won’t meet the diagnostic criterion for clinically significant depression if the symptoms resolve. If, however, symptoms persist for two weeks or longer and they represent a significant change from previous functioning, a person may have clinically significant depression.
Distinguishing grief from major depression can be difficult at times. Although they are distinct from one another, they can coexist.
Following a major loss, it’s expected that an individual may experience overwhelming sadness and many of the symptoms of clinical depression. Over time, however, the symptoms should improve. If they do not improve, a grieving individual may be diagnosed with clinically significant depression.
An individual whose symptoms aren’t clinically significant may still experience distress. But they may not meet criteria for a depressive disorder.
Sadness may resolve on its own over time or with support from an individual’s friends and family. It may progress into clinically significant depression as well and it may require professional treatment.
Prevalence of Depression
Depression isn’t a sign of weakness. Anyone can experience clinically significant depression at any stage of life.
The World Health Organization estimates that 300 million people around the world have depression. An estimated 6.7 percent of adults in the United States have experienced a major depressive episode at some point in the past year.
It’s also estimated that 3.1 million children between the ages of 12 and 17 in the United States have experienced at least one major depressive episode in the past year. Many children with depression go untreated as the symptoms often go undetected in children.
Types of Clinically Significant Depression
There are different types of depression that may vary in duration, timing, presumed causes, or may involve different types of symptoms. The treatment for different types of depression varies too. Here are some of the most common types that are categorized in the DSM-5 as “depressive disorders.”
Disruptive mood dysregulation disorder is diagnosed in children and involves temper outbursts, anger, and irritability.
Major depressive disorder requires a two week period of intense sadness or loss of interest in almost all activities, in addition to several other symptoms of depression.
Persistent depressive disorder is chronic and can last for two or more years.
Premenstrual dysphoric disorder involves depressive symptoms that begin shortly before the onset of menses in the majority of menstrual cycles.
By Lauren DiMaria, Reviewed by Steven Gans, MD