Table 2 Overview of themes, questions and results

Illness perception (identity)

Patient

• How would you describe your mental state before starting Step-Dep?

• If not depressed: please tell more about it?

• If depressed: please tell more about it? Did it influence your life?

PN

• How did you view their mental state/ depressive symptoms?

• Did patients recognize themselves in the depressed profile?

• Patients’ and PNs’ perceptions of depressive symptom severity varied from not to severely depressed and were not always congruent with PHQ-9 scores at inclusion

• Almost all patients considered themselves at least mildly to moderately depressed

• PNs frequently perceived their patients as ‘not depressed’

• Patients sometimes needed time to talk about and reflect on their mood

• Work experience perhaps influenced PNs’ perceptions of patients’ depressive symptoms

• Many patients did not initially realize that the mental state they were in was a level of depression

• Patients preferred using their own words to describe their mental state, some terms were not connected to mood.

• Sleeping was frequently pointed out as the most burdensome symptom

Need for care (cure/control)

Patient

• Were you in need of care/ a preventive program to improve depressive symptoms?

• How would it have been, if you had not received an invitation for Step-Dep?

• What were your expectations/ hopes from the program?

• What would your care of choice have been like? And to improve depressive symptoms?

PN

• Were the patients in need for care for depression? Other need for care? Why? Why not?

• Most interviewed patients experienced a need for care and preferred psycho-educational advice and talking therapy

• PNs frequently said that patients had minimal need for specific care and mostly needed attention

• In patients, perceived symptom severity corresponded with perceived need for care, but did not necessarily match help-seeking behaviour

• Barriers to seek care:

○ Not realizing that mental state is a level of depression

○ Experienced stigma of depression

○ Unfamiliarity with mental health care

○ Experienced barriers discussing mental problems with GP

Depression causes (cause)

Patient

• Is there a relationship with your chronic disease? How?

• What do you think caused your depressive symptoms?

• How is your mental state now? If improved: what are the reasons for that?

PN

• How do you view the relationship with the chronic disease? What coping strategies do patients have with a chronic disease?

• What are causes of depressive symptoms?

• If the depressive symptoms improved in your patients; what was the reason?

• Most patients and PNs appointed a mix of causes of depression

• Most were related to negative life events and circumstances

• Many PNs and patients perceived indirect links with long-term conditions via:

○ physical limitation

○ changed future perspectives

○ difficulties with acceptance of diagnosis of a long-term condition