It remains difficult to determine in what measure improvements observed in clinical trials of anti-depressants may be attributable to the psychological predispositions of the subjects. The present article focuses on the effect of a psychological variable, the Health Locus of Control, which measures the extent of a subject's belief that he is in control over his own health. The hypothesis is that depressed subjects whose locus of control is internal, i.e. who perceive themselves to be in control, rather than external, i.e. control perceived as being in others or just chance, will improve more markedly and consistently on the Hamilton Depression Rating Scale, across a number of clinical trials. Forty-nine depressive patients undergoing treatment with four different compounds were included, after a week's placebo run-in period, in a classical 42-day follow-up study comprising visits on days -7, 0, 10, 21; and 42. Interactions between the type of locus of control and the clinical course were investigated by MANOVA. Results show that with a classical design of clinical trials of antidepressants, locus of control plays a significant role if it is internal (P< 0.001) in consolidating the improvement process, and that this is true irrespective of type of antidepressant. The relationship between the concept of locus of control and placebo effect is discussed.

Decreased immunity in depressive as compared with control subjects has been well documented, although some depressed patients have severe alterations whereas others have milder ones or not at all. Since for equal severities of depression, there may be individual differences in the degree of perceived control over one's condition, we investigated the interaction of perceived control with immunological variations. Immune function (T and B lymphocytes, lymphocyte proliferation and natural killer cell activity (NKCA)) were evaluated in 34 adult major depressives and in 18 healthy controls. Lymphocyte proliferation did not differ between the two groups, but NKCA was significantly lower in the depressed patient group. Among the depressed subjects, those who experienced less subjective control also showed significantly lower NKCA. An internal locus of control appears to act as a buffer against the decrease in cellular immunity observed in major depression. Further studies should focus on methods of coping and on degree of perceived control rather than on diagnostic and nosographic variables alone.

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ObjectiveTo evaluate the long-term outcome of a multidisciplinary rehabilitation program for patients with chronic fatigue syndrome.Method98 patients fulfilling chronic fatigue syndrome criteria (Fukuda) participated at a six-month CBT associated with GET based on adaptive pacing strategy in a group therapy and were included in a prospective outcome study at the university outpatient Chronic Fatigue Reference Center.MeasuresMultidimensional assessments at baseline, after treatment and at 6 and 12 months follow-up : Checklist Individual Strength; Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index; HADS; Symptom Checklist; Short Form General Health Survey ands Self Efficacy Scale.ResultsAfter the revalidation program, subjective outcome parameters as fatigue severity, concentration troubles, somatic complaints, sleep disturbances and behavioral consequences of fatigue as activity reduction improve significantly (p< 0,001). The QoL related to health perception, measured in items as vitality, role-physical limitations and social functioning, also improve significantly (p< 0,001). Treatment doesn’t change HADS-scales but the scores don’t differ significantly from a healthy population at baseline. At 6 and 12 months follow-up, we didn’t notice significant decreases in outcome results. Significant improvements correlate significantly with an increase of sense of control of the symptoms (Self Efficacy Scale).ConclusionsSymptoms, health-related QoL and psychosocial functioning in patients with chronic fatigue syndrome improve after a six-month multidisciplinary rehabilitation program. The one-year follow-up study without any therapeutic intervention proves that outcome can be maintained. The correlation between the persisting outcome results and the increase of Self Efficacy will be discussed.

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