Lifestyle interventions for depression in primary care: a qualitative study

BACKGROUND: In individuals with depression a vicious circle 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 circle entails a multicomponent lifestyle intervention (MLI).

AIM: Exploring the barriers and facilitators for an MLI in patients with depressive symptoms from the perspective of general practitioners (GP), chronic disease practice nurses (CD-PN), mental health nurses (MHN), lifestyle coaches (LC) and patients (PT).

DESIGN & SETTING: Qualitative study using semi-structured interviews in Dutch primary care. Methods We interviewed 5 GPs, 6 MHNs, 5 CD-PNs, 5 LCs and 7 PTs. Focus was on possible barriers and facilitators for an MLI. Data were analyzed using thematic analysis. A focus group was used as a member check.

RESULTS: Five themes were identified: 'expectations of effectiveness, 'motivation', 'stigma', 'logistics and organization' and 'communication by professionals'.

CONCLUSION: Ideas on effectiveness were crucial and could be either a facilitator or a barrier for a DT-MLI. Professionals often had high expectations, based on work experience, making this a facilitator. Other facilitators are motivating participants, good logistics and good communication by professionals, thus destigmatizing depression. Patients considered being motivated by the program 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.