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People with low socioeconomic status (SES) more often suffer from chronic stress, anxiety and depression (21%) than other people(9%). Underlying causes are often related to social problems such as financial debts or lack of participation. Low SES patients have limited health literacy and chronic stress deteriorates problem solving skills. Existing mental health treatments however, often do not pay attention to health literacy or underlying social problems and therefore are not applicable in this group of low SES patients.



Together with low SES patients and professionals in primary healthcare and social work we will implement and evaluate existing effective mental health interventions tailored to the needs and skills of low SES patients, combining them with actions targeting underlying social causes. Thus, we will elicit knowledge on conditions and characteristics of effective person-centred care for low SES patients with chronic stress, anxiety or depression.



1. Which adjustments are necessary to tailor existing mental health interventions for chronic stress, anxiety or depression to the needs and skills of low SES patients ?

2. What conditions facilitate or hinder a person-centred integrated approach for early recognition and treatment of chronic stress, depression and anxiety in low SES patients with underlying social problems in deprived neighbourhoods?

3. What is the effect of this approach on perceived mental health, change in depressive symptoms, level of distress and self-efficacy, of patients involved and on workload and satisfaction of professionals involved?



- Existing mental health interventions are tailored to the needs and skills of low SES patients living in deprived neigbourhoods.

- Knowledge is provided on the conditions for (and perceived effects) of effective implementation of an integrated approach in which adjusted mental health interventions are combined with actions targeting underlying social causes at individual as well as community level.

- A guidance and training modules for a person-centred integrated approach for early recognition and treatment of chronic stress, anxiety and depression that addresses underlying social causes is available for (education of) community healthcare teams, social workers, primary - and mental healthcare professionals.



Low SES patients living in deprived neighbourhoods with mental health issues: chronic stress, depression, anxiety, treatable in primary care, in combination with social or financial problems.



Participatory community oriented action research design using Normalization Process Theory (NPT) and Participatory Learning Action (PLA) as research methods. This enables all stakeholders, including lowly educated patient representatives to engage in all phases of the study. A patient expert panel will test and adjust the materials of (2-4) effective mental health interventions on applicability in low SES patients with limited (health) literacy skills. Mental health nurses working in General Practice (POH-GGZ) will be trained in applying the specific mental health interventions. Healthcare and social work professionals will be trained in communication skills and skills to elicit and address the social needs and problems of patients. The local stakeholder groups will additionally identify neighbourhood support and activities to address these needs. Besides qualitative evaluation the following primary outcome measures will be assessed in patients: perceived mental health, level of distress, change in depressive symptoms and level of self-efficacy.



Patient participation is guaranteed through the patient expert panel that will be recruited with support from Panel Meetellen Utrecht and stichting Al Amal, as well as through the participation of patient representatives in the local stakeholders groups.



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