Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study

Abstract

Background Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs. International Registered Report Identifier (IRRID) RR2-10.1186/s12888-019-2034-6

Usage Intensity of a Relapse Prevention Program and Its Relation to Symptom Severity in Remitted Patients With Anxiety and Depression: Pre-Post Study

“…Potentially, patients with fewer symptoms may not need to engage with the entire program to feel well again and cease using the program after obtaining the benefits [ 35 , 36 ]. At the same time, a qualitative study on the GET READY program indicated that increased symptom levels might also limit patients from further using the program [ 37 ]. An increase in depressive or anxiety symptoms may result in avoidance behavior, which may also lead to avoiding actively working on the web-based modules.…”

“…This underlines the importance of the proactive role to be played by MHPs in terms of stimulating patients who are vulnerable to relapsing to continue using the program. Another important way of keeping patients engaged might be the further personalization of the intervention content, for example, by increasing the depth of tailored feedback, providing real-time feedback, and customizing the content based on current symptoms [ 9 , 37 ].…”