title: Response to an unsolicited intervention offer to persons aged ≥ 75 years after screening positive for depressive symptoms: a qualitative study.
abstract: 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.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gerda M
authors.initials: GM
authors.lastname: van der Weele
authors.forename: Roos
authors.initials: R
authors.lastname: de Jong
authors.forename: Margot W M
authors.initials: MW
authors.lastname: de Waal
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
authors.forename: Herman A H
authors.initials: HA
authors.lastname: Rooze
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data