Skip to main content Accessibility help

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

  • Gerda M. van der Weele (a1), Roos de Jong, Margot W. M. de Waal (a1), Philip Spinhoven (a2) (a3), Herman A. H. Rooze (a4), Ria Reis (a1), Willem J. J. Assendelft (a1), Jacobijn Gussekloo (a1) and Roos C. van der Mast (a3)...


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.


Corresponding author

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:


Hide All
Arean, P. A., Alvidrez, J., Barrera, A., Robinson, G. S. and Hicks, S. (2002). Would older medical patients use psychological services? Gerontologist, 42, 392398.
Baas, K. D. et al. , (2009). Screening for depression in high-risk groups: prospective cohort study in general practice. British Journal of Psychiatry, 194, 399403.
Becker, M. H. and Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Care, 13, 1024.
Brody, D. S., Khaliq, A. A. and Thompson, T. L. (1997). Patients' perspectives on the management of emotional distress in primary care settings. Journal of General Internal Medicine, 12, 403406.
Burroughs, H., Lovell, K., Morley, M., Baldwin, R., Burns, A. and Chew-Graham, C. (2006). ‘Justifiable depression’: how primary care professionals and patients view late-life depression? A qualitative study. Family Practice, 23, 369377.
Chapman, D. P. and Perry, G. S. (2008). Depression as a major component of public health for older adults. Preventing Chronic Disease, 5, A22.
Chavannes, N. H. et al. (2007). NHG-Standaard Stoppen met roken. Huisarts en Wetenschap, 50, 306314.
Cooper-Patrick, L., Powe, N. R., Jenckes, M. W., Gonzales, J. J., Levine, D. M. and Ford, D. E. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine, 12, 431438.
Cuijpers, P., van Straten, A., van Schaik, A. and Andersson, G. (2009). Psychological treatment of depression in primary care: a meta-analysis. Britisch Journal of General Practice, 59, e51e60.
de Craen, A. J., Gussekloo, J., Blauw, G. J., Willems, C. G. and Westendorp, R. G. (2006). Randomised controlled trial of unsolicited occupational therapy in community-dwelling elderly people: the LOTIS trial. Public Library of Science Clinical Trials, 1, e2.
Glaser, B. and Strauss, A. (1979). The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Aldine Publishing Company.
Green, J. and Thorogood, N. (2004). Qualitative Methods for Health Research. Thousand Oaks, CA: Sage.
Gussekloo, J. et al. (2003). Auditory rehabilitation of older people from the general population: the Leiden 85-plus study. British Journal ofGeneral Practice, 53, 536540.
Haringsma, R., Engels, G. I., Cuijpers, P. and Spinhoven, P. (2006). Effectiveness of the Coping With Depression (CWD) course for older adults provided by the community-based mental health care system in the Netherlands: a randomized controlled field trial. International Psychogeriatrics, 18, 307325.
Jacobson, M. and O'Connor, A. (2006). Population Needs Assessment: A Workbook for Assessing Patients' and Practitioners' Decision Making Needs. Univerisity of Ottawa. Available at:
Joling, K. J. et al. (2011). How effective is bibliotherapy for very old adults with subthreshold depression? Randomized controlled trial. American Journal of Geriatric Psychiatry, 19, 256265.
Lang, A. J. (2005). Mental health treatment preferences of primary care patients. Journal of Behavioural Medicine, 28, 581586.
Lewin, S., Glenton, C. and Oxman, A. D. (2009). Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ, 339, b3496.
Montano, C. B. (1999). Primary care issues related to the treatment of depression in elderly patients. Journal of Clinical Psychiatry, 60 (Suppl. 20), 4551.
Moore, S. L., Metcalf, B. and Schow, E. (2006). The quest for meaning in aging. Geriatric Nursing, 27, 293299.
Murray, J., Banerjee, S., Byng, R., Tylee, A., Bhugra, D. and Macdonald, A. (2006). Primary care professionals' perceptions of depression in older people: a qualitative study. Social Science and Medicine, 63, 13631373.
Norcross, J. C. and Prochaska, J. O. (2002). Using the stages of change. Harvard Mental Health Letter, 18, 57.
Prochaska, J. O., DiClemente, C. C. and Norcross, J. C. (1992). In search of how people change: applications to addictive behaviors. American Psychologist, 47, 11021114.
Simon, D., Loh, A., Wills, C. E. and Harter, M. (2007). Depressed patients' perceptions of depression treatment decision-making. Health Expectations, 10, 6274.
van der Weele, G. M. et al. (2011). Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice. International Journal of Geriatric Psychiatry, 26, 229238. doi: 10.1002/gps.2518.
Wetherell, J. L., Kaplan, R. M., Kallenberg, G., Dresselhaus, T. R., Sieber, W. J. and Lang, A. J. (2004). Mental health treatment preferences of older and younger primary care patients. International Journal of Psychiatry in Medicine, 34, 219233.
Wittkampf, K. A., van Zwieten, M., Smits, F. T., Schene, A. H., Huyser, J. and van Weert, H. C. (2008). Patients' view on screening for depression in general practice. Family Practice, 25, 438444.


Related content

Powered by UNSILO

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

  • Gerda M. van der Weele (a1), Roos de Jong, Margot W. M. de Waal (a1), Philip Spinhoven (a2) (a3), Herman A. H. Rooze (a4), Ria Reis (a1), Willem J. J. Assendelft (a1), Jacobijn Gussekloo (a1) and Roos C. van der Mast (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.