What are the causes of low participation rates in preventive interventions for depression?

Although effective interventions are available to prevent the onset or delay of
depressive disorders (Cuijpers et al., 2008), only
few people who could benefit from the interventions actually participate in
this. This is especially true for indicated prevention
aimed at people with subthreshold depressive symptoms. Epidemiological research
has shown that about 7.5% of the population in the Netherlands (750.000 people
between 18 and 65) suffer from subthreshold depression (Cuijpers et al., 2004).
Data from the Netherlands Institute for Mental Health and Addiction (Trimbos
Institute) have show, however, that in 2007 only
8.273 people (about 1%) participated in a preventive intervention (Ruiter & de
Jonge, 2008).
It is not clear why participation rates in these interventions is so low. There
is no scientific research available examining the
reasons for this. In an earlier paper, we distinguished three categories of
reasons for this (Cuijpers et al., 2009): (1) people with
subthreshold depression are not willing to participate in preventive
interventions (for example because they do not consider
themselves to be subclinically depressed; they are not willing because of the
stigma associated with treatment for mental health
problems; they think preventive interventions are not effective); (2) the
organisation of preventive interventions is not optimal
(for example, these interventions are now organised by specialized mental
health services, while they may be better positioned
in primay care; and general practitioners and other health care professionals
in primary care should refer better to these
interventions); and (3) the information about the interventions does not reach
the target group sufficiently.
It is not known currently which of these three groups of reasons are the most
important ones. Knowledge about this is very
important for the development of measures to improve the participation rates in
preventive interventions. The current project is
aimed at examining the reasons for not participating in preventive services
systematically, and to make an overview of possible
solutions.
Both people who will be taking part in the preventive interventions and those
who do not will be invited to answer questions regarding (non-) participation
and other related variables. We will make an overview of reasons why people do
or do not participate. Help seeking in people with depression has not been
systematically researched either. Therefore, we will investigate reasons for
(not) participating by people with depression as well. One year later we will
interview them once more to examine whether they have developed a depressive
disorder and thus did not participate *correctly* or *not correctly* in a
preventive intervention. Before the start of the study, study procedures and
materials will be tested in a pilot study and qualitative interviews will be
held with 20 participants.

The current project is aimed at examining the reasons for not participating in
preventive services systematically and to make an overview of possible
solutions. A second goal is to make an overview of reasons for (not)
participating in interventions by people who have a depressive disorder. We are
interested in investigating their help-seeking behaviors.

The basic idea is that we will organize preventive interventions in several
communities in the Netherlands. These communities will be selected by using
zip-codes. We then will draw a random sample from the adult population in these
communities and select the potential participants (those with a subthreshold
depression) . We will ask both people who take part in preventive interventions
and people who do not take part about their reasons for (non) participation.
We will also examine variables that are expected to be related to help-seeking
behavior, to get a clearer picture of whom participates seek help and what
kind of help they seek. Finally, we will examine whether these (non)
participants have developed a (more severe) depressive disorder one year later
and, therefore, have *(in)correctly* not participated. We will also investigate
work absenteeism and costs being made by (non) participants.

This study contains an epidemiological population screening and a prospective
cohort study of people taking part in preventive interventions for depression.

Screener, either filled out at the institution during intake or during the
Gezondheidsmonitor. Diagnostic interview and Quesntionnaire. After one year
there will be a follow up which will consist of the CIDI and the Questionnaire.

Where possible we will use the Health monitor (GZM) conducted by the GGD. The
participants in the communities in Amsterdam will be selected through the GZM.
After receiving data from the GZM we will conduct a CIDI over the thelephone.
Depending on the score on the CIDI we will send people questionnaires. Filling
in the questionnaires will take about 30 to 45 minutes.


The participants in the intervention group are all people who sought help on
their own. They will also be taking a CIDI and afterwards the questionnaires.
Which will be the same questionnaires the "non-participants" are taking.