Lifestyle interventions for depression in primary care: a qualitative study

Abstract

Background: In individuals with depression a vicious cycle tends to occur in which depressive symptoms cause an unhealthy lifestyle, which reversibly causes an increase in depressive symptoms; both of which are associated with a decreased life expectancy. A potential way to break this cycle entails a multicomponent lifestyle intervention (MLI). Aim: To explore the barriers and facilitators for an MLI in patients with depressive symptoms from the perspective of GPs, chronic disease practice nurses (CD-PNs), mental health nurses (MHNs), lifestyle coaches (LC), and patients. Design & setting: Qualitative study using semi-structured interviews in Dutch primary care. Method: We interviewed five GPs, six MHNs, five CD-PNs, five LCs, and seven patients. Focus was on possible barriers and facilitators for an MLI. Data were analysed using thematic analysis. A focus group was used as a member check. Results: The following five themes were identified: expectations of effectiveness; motivation; stigma; logistics and organisation; and communication by professionals. Conclusion: Ideas on effectiveness were crucial and could be either a facilitator or a barrier for a depression-tailored MLI (DT-MLI). Professionals often had high expectations, based on work experience, making this a facilitator. Other facilitators were motivating participants, good logistics and good communication by professionals, thus destigmatising depression. Patients considered being motivated by the programme as a reason for participating, as they did not expect a DT-MLI would give them new information. Support from others was considered a motivator to participate.