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Response to an unsolicited intervention offer to persons aged ≥ 75 years after screening positive for depressive symptoms: a qualitative study

Published online by Cambridge University Press:  16 August 2011

Gerda M. van der Weele
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Margot W. M. de Waal*
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Philip Spinhoven
Institute of Psychology, Leiden University, Leiden, The Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
Herman A. H. Rooze
Rivierduinen, Mental Health Institution, Leiden, The Netherlands
Ria Reis
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Willem J. J. Assendelft
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Jacobijn Gussekloo
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Roos C. van der Mast
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
Correspondence should be addressed to: Margot W. M. de Waal, Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Phone: +31 715268444; Fax: +31 715268259. Email:


Background: Screening can increase detection of clinically relevant depressive symptoms, but screen-positive persons are not necessarily willing to accept a subsequent unsolicited treatment offer. Our objective was to explore limiting and motivating factors in accepting an offer to join a “coping with depression” course, and perceived needs among persons aged ≥75 years who screened positive for depressive symptoms in general practice.

Methods: In a randomized controlled trial, in which 101 persons who had screened positive for depressive symptoms were offered a “coping with depression” course, a sample of 23 persons were interviewed, of whom five (22%) accepted the treatment offer. Interview transcripts were coded independently by two researchers.

Results: All five individuals who accepted a place on the course felt depressed and/or lonely and had positive expectations about the course. The main reasons for declining to join the course were: not feeling depressed, or having negative thoughts about the course effect, concerns about group participation, or about being too old to change and learn new things. Although perceived needs to relieve depressive symptoms largely matched the elements of the course, most of those who had been screened were not (yet) prepared to accept an intervention offer. Many expressed the need to discuss this treatment decision with their general practitioner.

Conclusions: Although the unsolicited treatment offer closely matched the perceived needs of people screening positive for depressive symptoms, only those who combined feelings of being depressed or lonely with positive expectations about the offered course accepted it. Treatment should perhaps be more individually tailored to the patient's motivational stage towards change, a process in which general practitioners can play an important role.

Research Article
Copyright © International Psychogeriatric Association 2011

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