title: Pulling out all the stops: what motivates 65+ year olds with depressive symptoms to participate in an outreaching preference-led intervention programme?
abstract: OBJECTIVE
  Many older adults have significant depressive symptoms but few people access care for these. This study explores which personal, clinical and need factors facilitate or hinder acceptance of a new outreaching preference-led intervention programme.
  
  
  METHODS
  From a sample of 9661 community-dwelling 65+ year olds, 244 persons with depressive symptoms according to the Patient Health Questionnaire-9 were included. Data on programme effectiveness in terms of care utilisation were collected. Associations between programme acceptance and personal, clinical and need factors were studied using quantitative (logistic regression analyses) and qualitative methods (semi-structured interviews with 26 subjects, who accepted (n = 20) or declined (n = 6) the programme).
  
  
  RESULTS
  Fifty-six per cent (n = 137) took part in the interventions. Quantitative logistic regression analyses showed that participants were more often female, suffered from more severe depressive symptoms and perceived more loneliness. Qualitative analyses revealed that people accepting the intervention programme felt that medical terms as having a depressed mood were applicable to their situation, more often perceived their symptoms as hindering, felt lonely and more often perceived a need for care. They were more often advised by their general practitioner to participate than individuals who refused the interventions. Many participating individuals did not see a match between the intervention programme and their needs, especially with respect to meeting new people.
  
  
  CONCLUSIONS
  Many older persons with depressive symptoms did not feel the need to take part in the programme. Providing support in alleviating loneliness and further adaptation to older adults' illness representations and perceptions when discussing depressive symptoms might enhance care utilisation.
authors.affiliation: a Department of Psychiatry , VU University Medical Center/GGZ in Geest and EMGO+ Institute for Health and Care Research , Amsterdam , The Netherlands.
authors.forename: Ilse M J
authors.initials: IM
authors.lastname: van Beljouw
authors.forename: Marjolijn
authors.initials: M
authors.lastname: Heerings
authors.forename: Tineke A
authors.initials: TA
authors.lastname: Abma
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
authors.forename: Petronella J Van't
authors.initials: PJ
authors.lastname: Veer-Tazelaar
authors.forename: Vivianne E
authors.initials: VE
authors.lastname: Baur
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.forename: Eric
authors.initials: E
authors.lastname: Van Exel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008132:Loneliness; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: aged; depression; mass screening; patient acceptance of health care; qualitative research