Is Anorexia Truly a Contemporary Disease?

BACKGROUND: Anorexia nervosa (AN) is reported to be on the rise. However, instances of fasting have been noted since antiquity. Can modern diagnoses be applied to circumstances very different from our own? Is there a continuum of symptoms whose meanings have evolved over centuries, or is AN a recent development? SUBJECTS AND METHODS: A literature review was conducted. Twelve articles were found to be pertinent to the study, including several by Jacques Maître, who also published a book on the subject that was utilized. RESULTS: Few instances of fasting and no deaths from AN are reported in Western antiquity. With the advent of Christianity, prolonged fasting appears in the West. From the 12thcentury onwards, food deprivation becomes significant in women's spiritual lives, reaching a peak in inedia until the Renaissance. In 1873, Lasègue and Gull published a medical description of AN. Thereafter, AN fluctuated between being a distinct pathology and a symptom of another syndrome. Long considered a hysterical symptom, Freud initiated a shift toward sexual causality. In 1914, hypophyseal atrophy was considered a cause but was later forgotten. World War II did not produce instances of AN; food refusal has meaning only when food is abundant. During times of imposed famine, women's roles in food management and corpulence are valorized. In the 1960s, attention shifted to body image and an inability to cope with pubertal changes. Today, Russell describes a change in patient profiles with increased fear of weight gain and reduced fear of sexualization. CONCLUSION: Two opposing theses emerge. On one hand, it is argued that mystical fasts and AN cannot be linked and that AN is a recent disorder. Modern society subjects us to greater social pressures, forcing women to deny their biological roles in pursuit of thinness. On the other hand, AN is considered the heir to mystical fasting, as part of women's attempts to escape societal roles. Hagiographic descriptions and psychoanalytic studies that highlight the unconscious dynamics between mother-daughter relationships and pubertal difficulties support this view.

Microbiota Diversity and Inflammation as a New Target to Improve Mood: Probiotic Use in Depressive Disorder.

BACKGROUND: There is a lot of evidence for a bidirectional communication between the gut and brain. Dysbiosis and increase intestinal permeability may lead to a systemic low-grade inflammatory response or various neuroactive bacterial metabolite may cross gut barrier. Pro-inflammatory cytokines or bacterial metabolites such as short-chain fatty acid (SCFA) are known to pass through blood brain barrier and altered neurotransmitter metabolism or increase production of neurotoxic pathways. In this review we hypothesized that restoring the gut microbiota ecosystem could improve mental disorders. We reviewed literature for human evidence proving clinical relevance of probiotics intake in mental disorders. SUBJECTS AND METHODS: We searched literature with keywords "depression" or "major depressive disorder" and "probiotic". We selected randomized control trial and we considered having both outcomes concerning impact on depressive symptoms but also on inflammation biomarkers, microbiota composition, cerebral nervous system or cognition. RESULTS: Seven out of fourteen randomized control trial reported significant improvement on depressive symptoms in patients taking probiotics. Besides improvement in depressive symptoms, we found decrease in inflammatory markers such as IL-6, decrease in serum kynurenine level, changes in microbiota diversity and abundance of species correlated to depressive disorder and higher cognitive performance. CONCLUSIONS: Probiotic seems to be secure and more effective on depression when used in supplement to usual antidepressant and in mild to moderate depression. We highlighted positive impact on vulnerability factors prevent further worsening. Probiotics could have anti-inflammatory effect acting on inflammatory markers well known to have a role on pathogenesis of depression. A strong correlation between neuroactive metabolites and a relative abundance of microbiota bacterial species underlined importance to consider the gut-brain axis in mental disorders.

Division of labor or mental illness?

BACKGROUND: The pathological entity to which the term "burnout" refers is not clear, although the phenomenon exists. This article aims to clarify the professional and social origins of burnout by confronting the philosophers who have analyzed the concept of work and the modern society to scientific literature. SUBJECT AND METHOD: The master thesis of Manguelinckx M. served as a starting point for the review of the scientific literature because it tends to understand the concept of burnout based on recent articles from Google Scholar, Discovery-libellule, Pubmed and Mediquality. The philsophers mobilized are: Karl Marx, Hannah Arendt and Bernard Stiegler. RESULTS: There is heterogeneity in the definition of burnout, its causes and its symptoms. The diagnosis is established in several ways but most of the time, the exhaustion component suffices for diagnosis. Karl Marx describes work as alienating when the person executes repetitively an elementary task imposed on him. Hannah Arendt shows that at work, modern human performs these tasks in a stereotypical way and rarely thinks about their ethical consequences. Modern society transforms humans into consumers and provokes their instrumentalization. Bernard Stiegler shows that at work, the digital dispossesses the human from his know-how. The spread of digitalisation in all fields of life is hampering human autonomy and singularity, the dialogue between generations, friendship and family relationships. CONCLUSION: The professional and social changes caused by modernity can explain the causes, risk factors and symptoms of burnout. They do not respect the authentically human fulfillment, and seem to "mistreat" humans. It is mandatory to study the links between these mutations and their psychological impact on human. For this, psychiatry must open up to other disciplines. A dialogue between psychiatrists and social and political actors is required.

Phenomenon of Nightclub Shots: Mass Psychogenic Disease?

BACKGROUND: This article examines the possibility that the "nightclub shots" epidemic is a "mass psychogenic disease" phenomenon, by comparing the various cases of "mass sociogenic diseases" reported in the literature. We carried out a literature review on PubMed. The keywords used were "mass hysteria", "mass sociogenic disease", "mass psychogenic disease" and "epidemic of multiple unexplained symptoms". RESULTS: Our review of the literature revealed several elements common to the various "mass hysterias" we identified. These phenomena generally appear in a climate of anxiety specific to the era in which they occur, in this case the fear of bioterrorism in the 21st century. Symptoms are generally benign and transient, appearing and resolving easily without the identification of an organic cause. They usually occur in a small group of individuals, and more frequently in young people and women. The media can exacerbate the phenomenon. CONCLUSION: The phenomenon of epidemics of nightclub shots seems to fit into the common framework of "mass psychogenic diseases" identified in the literature. This diagnosis could therefore be evoked, in the absence of any other objective somatic explanation.

Difficulties in Combining Somatic and Psychiatric Care in Psychogeriatry.

BACKGROUND: This article attempts to understand the difficulties encountered in the articulation of health care, particularly between the organic and psychiatric aspects. It also aims to provide solutions to these collaboration issues. METHODS: We realized a literature review based on articles dated from 2002 to 2021 and selected from following databases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "aging, multidisciplinarity, psychiatric stigma, impotence, efficiency". RESULTS: Medical staff may encounter different problems in terms of care, faced to psychogeriatricpatients.These are both related to the medical aspect, including the difficulty of establishing a clear diagnosis in the face of a complex medical situation,clinical unknownledge, multiplication of intervenants with loss of centralisation in terms of care, etc. Added to this, is the organization of health care, which is increasingly specialized and restrictive in terms of hospitalization criteria. Finally to this, is the relational experience of the caregiver, both in relation to the patient and his disorders, and to their colleagues. CONCLUSION: In the era of the advent of medicinal progress and the advance of diagnostic and therapeutic techniques, it seems mandatory to place the human being at the center of our care. Interhuman interactions constituting the basis of medical care especially in terms of transdisciplinary collaboration. This last point could lead to cost reduction, a more efficient diagnostic and therapeutic management. It seems to be mandatory to reinforce our health care politics in order to time and importance to these various essential and fundamental relational issues.

COVID, the Main Cause of Mysery of Teenager? Retrospective Study of Hospitalizations of 15-25 in Psychosomatics (2018-2022).

BACKGROUND: Since the outbreak of COVID-19, there has been an apparent increase in the utilization of mental health services and psychiatric disorders among youth. However, there is little data on youth mental health prior to the pandemic. Some authors suggest that the increase in the use of psychiatric care started before. Are we facing a recent phenomenon initiated by the pandemic that will disappear with it, or did it highlight an older issue? Have the profiles of the young people and the care provided changed since the pandemic? SUBJECTS AND METHODS: Retrospective study of the hospitalization records of patients aged 15 to 25. The inclusion period extends from January 1, 2018, to December 31, 2022. RESULTS: There was an increase in the number of young people hospitalized from September 2020 to February 2021, suggesting a delayed effect of Covid's impact. 44% of young people were hospitalized through emergency services, number that has increased. There has been an increase in prior psychiatric care and hospitalizations among patients hospitalized since the beginning of the pandemic. 49% attribute their condition to family issues. Upon discharge, many patients were on medication, but there has been no significant change in prescriptions since the pandemic began. The majority of patients were referred to their primary care physician, psychologist, and psychiatrist, which has not changed since the pandemic began. CONCLUSIONS: Apart from the increase in hospitalizations, the rest of the practices within the institution has remained unchanged, suggesting that there are few differences in issues brought by patients since the start of the pandemic. Difficulties related to the family environment remain the primary reason for hospitalization requests. We do not have clear evidence of a worsening situation, which tends to support the hypothesis that COVID-19 has been a catalyst for a pre-existing state.

How to Improve Collaboration Between General Practitioners and Clinical Psychologists for Their Patients' Common Mental Health Problems in Primary Care Context?

BACKGROUND: Mental health problems have become a major topic of public health these last years, particularly since the pandemic of COVID-19. Primary care givers are confronted with high rates of common mental health problems (CMHPs) in population. This questions healthcare organization and specifically collaboration between general practitioners (GPs) and clinical psychologists (CPs). In this paper we aim to review recent literature to identify factors that facilitate or hinder collaboration between GPs and CPs when caring for their patients' CMHPs. METHODS: A non-systematic qualitative literature review was performed, using the PRISMA method. We restricted the review to papers published between 2010 and 2023. RESULTS: We identified 52 papers and after filtering, only 6 were included in the synthesis. Six main themes were identified: barriers to interprofessional collaboration, lack of mutual trust, mutual dissatisfaction with information exchanged, the paradox of professional secrecy, the necessity of a paradigm shift, and conceptual frameworks of collaboration. These themes were discussed to improve collaboration between GPs and CPs. CONCLUSION: This work provides some recommendations to support the development of interprofessional collaboration between GPs and CPs in primary care.

Love and Sexual Relationships Between Patients in Short Term Psychiatric Units: the Caregivers' Opinion.

BACKGROUND: The management of romantic and sexual relationships between inpatients in short-term psychiatric units is a controversial subject among caregivers. Not all units have policies, and the content of said policies can be unclear or even incoherent. The lack of clear policy leaves the caregivers without guidelines and can lead to a diverging management depending on personal values. SUBJECTS AND METHODS: A survey based on the current literature distributed among 69 caregivers of 20 short-term psychiatric units in French-Speaking Belgium. The survey included socio-demographic characteristics, questions about the existence, knowledge, and content of policy. RESULTS: Policies about romantic relationships exist for 51.5% of caregivers and 75% about sexual intercourse. The main content of policies is a ban on relations. Surprisingly, the study highlights the absence of staff consensus for most units on the existence and content of policies. Furthermore, while most caregivers consistently adhere to policies, 31% of caregivers for romantic relationships and 14% for sexual intercourse, never apply the rules in any situation. CONCLUSIONS: There's a lack of policy, knowledge of policy and application. Discussion about the creation of policy could be implemented during team meetings to allow the caregivers to develop new protocols about romantic or sexual relationships, more aligned to their moral compass and personal beliefs.

Depression during COVID-19 Pandemic: is There an Emergency?

BACKGROUND: As attention is currently focused on the urgent need to address the impacts of the social isolation measures imposed during the COVID-19 pandemic on adolescent mental health, this study aims to determine whether the reported malaise and depression among this population is directly related to the pandemic. SUBJECTS AND METHODS: We conducted an analysis of the review of the literature based on content in the leading medical databases, and reviewed empirical data regarding the number of psychiatric consultations, and markers of anxiety and depression in adolescents. RESULTS: Social isolation has clearly had a negative impact on adolescent mental health. However, while adolescent psychiatric consultations, and markers of anxiety and depression have increased, this increase has been present for many years. It is therefore difficult to establish a causal link between the two. CONCLUSION: Our results suggest that adolescent mental health is an important problem that needs to be addressed as a priority, while care needs to continue even after social isolation measures have been lifted.

Towards a Vulnerability Model for Major Depressive Episodes.

BACKGROUND: While many studies have investigated depression risk factors, few attempts have been made to weight, and compare them. Therefore, we conducted a prospective comparison of a sample of subjects suffering from major depressive disorder and a group of healthy subjects. We compared classic risk factors with internal elements such as personality, family dynamics and health locus of control. We also looked for prognostic factors. METHODS: Forty people with major depressive disorder (the MDD group) were randomly assigned to different treatment groups and followed for two years. In parallel, we followed a group of 21 healthy subjects (healthy group). At the beginning of the study, sociodemographic data were recorded and all subjects were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study, subjects were regularly assessed using the Hamilton Depression Scale (HDS) and the Short Form Health Survey (SF-12). RESULTS: Of the 23 explanatory variables, 13 were statistically different (p≤0.05): age, gender, number of people living together, income, extravert personality and neuroticism, Internal HLC, Powerful others HLC, Adaptability of the current couple and the family of origin, and Cohesion of the ideal and nuclear family and family of origin. The accumulation of risk factors doubles the chances of suffering from MDD (odds ratio 1.905**). Independent of treatment, among the 13 variables, the first nine explain 34.1% of change in depression measured on the HDS scale (p<0.001). CONCLUSION: While the size of our sample limits the robustness of our results, our study suggests that some risk factors are also prognostic. The respective weights of these factors vary as a function of age group. Finally, some, such as health locus of control, family dynamics or extraversion, can be modified as an adjunct to pharmacological treatment.

Can We Compare the Behaviour of the Zazous in the 1940s and Adolescents during the COVID-19 Crisis?

BACKGROUND: This article provides an insight into the behaviour of adolescents during the COVID-19 crisis through a comparison with the life of young people living in France under German occupation during the Second World War. METHOD: We conducted a literature review of articles in the CAIRN, SCOPUS and PsycINFO databases using the keywords zazou, adolescent and COVID-19. RESULTS: The zazou movement was a manifestation of young people's denial of the war through derision. Initially discredited, it was subsequently violently repressed by collaborationists and supporters of Marshal Pétain, as it was interpreted as an enemy of politics. In particular, it ran contrary to the Vichy regime's desire that young French men should spearhead the national revolution. The reaction among young people was to feel that they were being used by ageing politicians, who they considered were out of touch with reality. With respect to adolescents during the COVID-19 crisis, our review found that the French government has pressurised them to make sacrifices for the rest of the population, and has ignored their greater need for social links with peers. Many adolescents feel that they have been forgotten, in the midst of measures that have been imposed upon them with no explanation. This may have led, as in the 1940s, to a feeling of being instrumentalised and demonised by politicians. CONCLUSION: We argue that, in both cases, the dominant oppressive atmosphere has fostered similar behaviours and mental mechanisms. We therefore recommend that, rather than demonising young people, efforts should be made to include them in decision-making processes, in order to improve their understanding of the situation and encourage them to feel included.

Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department.

OBJECTIVE: During the deconfinement period after the coronavirus disease-2019 (COVID-19) pandemic, the number and characteristics of psychiatric visits changed in our emergency department (ED). We aimed to assess changes in the number of visits and characterize the profiles of these patients. METHODS: In this retrospective observational study, we examined the number of psychiatric ED visits and their proportion among the total number of ED visits. We also evaluated psychiatric visits characteristics during a one-month period after the declaration of deconfinement, and we compared those characteristics to characteristics observed during the same month over the previous 4 years. RESULTS: The number of psychiatric visits to our emergency department during deconfinement was similar to the number observed in the same month of previous years. However, the proportion of psychiatric visits to our emergency department among all visits to the ED rose during deconfinement to a level never before observed. The mean proportion of psychiatric admissions to all ED admissions rose from 3.5% in past years to 5.3% during deconfinement (p = 0.013). Moreover, during deconfinement, more visits (80%) were without an acute intoxication compared to past years (58.5%; p = 0.031). Also, in the deconfinement period, more visits lacked a follow-up consultation organized at discharge (40%) compared to the historical period (25%, p = 0.036). CONCLUSIONS: The deconfinement period after the first wave COVID-19 changed the number and type of psychiatric emergency medicine consultations at our hospital, suggesting a psychiatric impact of confinement during this pandemic. These findings will be of interest to practitioners and politicians in the coming months.

Multidisciplinary Management of Chronic Tinnitus in Audiophonology Centre: Survey of Psychiatric Comorbidities and Psychotropic Medications Use Over 10 Years of Activity.

BACKGROUND: The multidisciplinary management of disabling chronic tinnitus in the audiophonology centre demonstrates its relevance. The detection and treatment of overlapping psychiatric pathologies is a crucial issue in the work of liaison psychiatry. SUBJECTS AND METHODS: A 10-year retrospective review of the activities of a university audiophonology centre with 166 patients who consulted for disabling chronic tinnitus and who underwent a Mini International Neuropsychiatric Interview. The diagnostic criteria used were those of the DSM IV. RESULTS: Our sample shows that major depressive disorders, somatoform disorders and sleep disorders were the most frequently encountered. Alcohol misuse was also seen as the most common substance-related disorder. Thirty (30%) had prior psychiatric or psychological monitoring, and 60% were previously treated with at least one psychotropic drug. CONCLUSION: The systematic approach of liaison psychiatry appears to be essential in the treatment of disabling chronic tinnitus, given the associated psychiatric comorbidity. Beyond the detection of unrecognized or untreated disorders, patient education to attentional mechanisms and hypervigilance, which reinforce an unpleasant perception of tinnitus, as well as the management of stress and somatizations and sleep hygiene, is recommended.

Screen Time and (Belgian) Teenagers.

BACKGROUND: Parental anxiety about young people's use of media has increased with the advent of Generation Alpha. Excessive consumption is assumed to lead to a sedentary lifestyle, psychiatric disorders, overconsumption of sexual content and suicidal behaviour. But are these assumptions valid? METHODS: We supplemented data from the 2014 Health Behaviour in School-aged Children Study for Belgium with a bibliographical search of online databases (Medline, Scopus, PsycArticles, PsycInfo, PubMed) with the keywords 'adolescent' - 'internet' and 'sedentarity' or 'suicide' or 'family' or 'sex*' or 'porno*' for articles published between 2014 and 2019. We selected 27 original research articles and/ or quantitative or qualitative meta-analyses. RESULTS: Total consumption of different media (television, video games, internet) remained stable until 2010, and significantly increased in 2014. No parallel increase in sedentarity was reported. Controversy continues to surround the quantification of overconsumption, and the definition of 'problematic use'. Nevertheless, it appears that 5% of young people have unusual internet use, and 97.5% of these meet the criteria for a mental disorder. The risk of overconsumption is related to four factors: familial, personality, peer influence and supply. These general factors are supplemented by specific factors related to the abuse of sexual content and suicidal behaviour. For the latter, specific risk factors are the same as for suicidal young people who are not influenced by social media. CONCLUSION: Even if screen time is higher for Generation Alpha, these young people are no more at risk unless they accumulate risk factors. They are also exposed to challenges that researchers have not yet studied in any depth. One question relates to how they can manage their privacy if their parents published, without their consent, photographs of them as children? Another issue is their relationship to knowledge, given that everything they need to know can easily be found online.

Alcohol Use Disorder in Primary Cares: How to Integrate Brief Interventions and Continuous Care?

BACKGROUND: In Belgium, 82% of the population consumes alcohol occasionally while 10% consume in a way that can be seen as problematic. On a European level, only 8% of the people who can be characterized as having Alcohol Use Disorder (AUD) would have consulted professional assistance in the past year. In this context, the KCE (Belgian Health Care Knowledge Centre) has addressed multiple recommendations to health professionals to reduce the "treatment gap" concerning the patients' care: (1) encourage screening and preventative interventions, (2) promote the acquirement of communicational and relational competences (3) develop collaborations between professionals. The objective of this article is to better understand their functioning. METHOD: We format a non-systematic literature review concerning these recommendations. RESULTS: The implementation of these Brief Interventions programs in primary care is relevant due to the moderately positive impact on the frequency and quantity of alcohol consumption but both the quality of the therapeutic relationship and collaboration with the care network would optimize Brief Interventions. The quality of the therapeutic relationship alone appears to have an impact on therapeutic outcome. CONCLUSION: Training concerning patient-professional relationship is necessary to maximize the effectiveness of BIs.

Improving Transition from Child and Adolescent Mental Health Services to Adult Mental Health Services for Adolescents in Transition to Young Adulthood: A Literature Review.

BACKGROUND: These last years adolescents in transition to young adulthood (ATYA) have become a new matter of research. This population encounter specific issues and challenges regarding their mental health particularly when they have attained age boundaries and deal with the issue of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Many key questions regarding how to sustain continuity of mental health care for ATYA during transition remain. The aim of this paper is to review recent literature in the domain to identify dimensions that should be considered to improve ATYA transition from CAMHS to AMHS. SUBJECTS AND METHODS: A qualitative literature review was performed in Scopus-Elsevier database using the PRISMA method as reporting guidelines. Only papers discussing dimensions involved in the transition process from CAMHS to AMHS were considered. We restricted the review to researches published between 2010 and 2020. RESULTS: We identified 85 potential researches, after filtering; only 10 articles were finally included in the qualitative synthesis of the literature. Five main dimensions were identified: patient, professional, organization, policy, and ethic related. Those dimensions should be considered in order to improve ATYA transition process out of CAMHS to AMHS. CONCLUSION: This work contributes to identify principal dimensions that should be considered by mental health professionals and organizations in order to improve ATYA transition from CAMHS to AMHS.

From Family Surroundings to Intestinal Flora, A Literature Review Concerning Epigenetic Processes in Psychiatric Disorders.

BACKGROUND: Some behaviors or psychiatric conditions seem to be inherited from parents or explain by family environment. We hypothesized interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics. SUBJECTS AND METHODS: We searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota. We searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships. RESULTS: Some gene polymorphisms interact with negative environment and lead to psychiatric disorders. Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic. Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics. CONCLUSIONS: Our findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders. Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic. These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations.

Real or Virtual Relationships: Does It Matter to Teens?

BACKGROUND: Social networks are taking over teenagers' lives and altering the way they relate to others. They are creating their own and changing culture. Which is a cause for concern for adults, who do not understand it. Moreover, usage peaks at a pivotal time in life: adolescence. Therefore it seems important to understand these new habits, and the reasons why social networks are such an important part of the life of adolescents. Furthermore, we looked into the question if virtual relationships have an impact on real-life relationships, and vice versa. SUBJECTS AND METHODS: This literature review examined studies published between 2008 and September 2019. Twenty-five articles were selected from PubMed, Scopus, PsychINFO and Cochrane databases. RESULTS: Above all, teenagers are motivated to use social networks because they can develop an identity based on an idealized profile. This profile must be at least as good as those of their peers, in order to obtain the latter's approval. This is notably the case in a context where changes to the family structure give a greater weight to the opinion of peers. Young people are driven to seek refuge on the Internet by a lack of family support, and parents who are less emotionally present. This effect could be limited by encouraging communication between teenagers and their parents. Finally, romantic relationships are impacted by the availability of pornography. Viewing pornography is increasingly seen as a normal stage of development and is linked to poorer attachment to peers and family. CONCLUSIONS: The Internet seems to support a gradual detachment from family life and a move towards greater inclusion in the peer group. This is all the more evident in a context where family structures are changing.

Family relationships and health locus of control as covariables in the evolution of major depressive disorder.

BACKGROUND: In a two-year study, we compared the efficacy of noradrenergic and serotonergic antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from major depressive disorder (MDD). In this article we examine the influence of the health locus of control, family relationships and personality traits on the progress of MDD. SUBJECTS AND METHODS: 40 people with MDD (MDD group) were randomly assigned to the different treatment groups. They were followed in parallel with a group of 20 'healthy' subjects (HG). At the beginning of the study, sociodemographic data were collected, and patients were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study subjects were regularly assessed using the Hamilton Depression Scale (HDS), the Short Form Health Survey (SF-12) and the Clinical Global Impression scale (CGI). RESULTS: Regardless of the type of treatment, physical health is the best predictor of variation at two years in the MDD group; 45% of variance is explained by a linear regression model that includes three variables from the MHLC, FACES III and NEO-FFI scales. Similarly, 40% of CGI and 24% of HDS variance is predicted. These explanatory variables are statistically less powerful in the MDD group than the HG group. CONCLUSION: While drug treatment is a determinant in changes on the HDS, CGI and SF12 scales, factors such as family relationships, MHLC or personality are important covariates of these changes. The question remains whether we can influence these covariates to improve the response to antidepressants.