[Severe depression : cultural and social factors]

After first providing a theoretical framework including the contributions of social constructivist and biological approaches to the comprehension of mental diseases in general and depression in particular, the authors stress the small number of publications mentioning a direct link between sociocultural factors and the severity of depression. However, there are indirect arguments that are classified into two groups : modifications based on the cultures of clinical expression (somatisation, delirious ideas) on one hand and the weight of social and individual views of depression and of its consequences in terms of stigmatisation on the other. These transcultural variations modify the process of seeking care and, thus, the progression of the disease towards increased severity. The authors point out, in conclusion, that the initial proposition could be reversed as some have postulated that the central role occupied by the diagnosis of depression is a phenomenon of civilisation or even the symptom of the severity of the uneasiness of western society.