Samenvatting

This thesis concerns the implementation and testing of a Behavioral Activation (BA) intervention in inpatients with a Late Life Depression (LLD). The primary aim of this thesis is the development and testing of easy manageable version of BA (i.e. the Systematic Activation Method) for inpatients with LLD when implemented by mental health nurses in routine daily care.

LLD is a heterogeneous disorder, which seriously impairs daily living (Lepine & Briley, 2011; Beekman, Penninx, Deeg et al. 2002). Patients who suffer from LLD are often trapped in a circle of anhedonia, inactivity, and beliefs that they are unable to change their situation. As a result, they tend to withdraw themselves from social activities and social participation. This phenomenon is described as the circle of depression (Lewinsohn, Hobermann, Teri & Hautzinger, 1985).

To break through this depression circle, treatment of LDD requires a multidisciplinary approach in which activation is a major focus. This is especially relevant for mental health nursing practice given their close contact with these patients during everyday care and treatment (Kok, 2008, Harvath & McKenzie, 2005). However, activation is a true challenge in patients with LLD. Given the nature of the depressive disorder, patients tend to reject participation in activation programs.

When I worked as a nurse, and later as a clinical nurse specialist in an inpatient setting for mental health care in old age psychiatry, LDD was the most frequent diagnosis. I personally experienced that it took a lot of effort to successfully activate these patients. It was striking that patients seemed to “forget” the misery of their depression during a television program. This showed the positive impact of a pleasant day-to-day activity on their mood and behavior. And this was my motivation to study activation as a purposefully and systematic intervention in the treatment of LLD as described in this thesis.