A Chain Approach to Preventing Depression in Chronically Ill Patients

Almost 10 million Dutch people live with one or more chronic diseases. These diseases affect various aspects of their lives, such as work, family, nutrition, exercise, medication, (social) relationships and finances. This can cause a lot of stress mentally. People are more likely to feel lonely, anxious, insecure and have low self-esteem, which is sometimes exacerbated by medication. This puts this group at higher risk of depressive symptoms. The Trimbos Institute estimates that more than 700,000 chronically ill adults have depression.

To best support these people and prevent depressive symptoms where possible, good cooperation is needed between formal and informal support, professionals and organisations.


Commissioned by the Dutch Ministry of Health, Welfare and Sport, Ecorys and PROOF Advisors tested and further developed an approach for (improved) chain cooperation in three locations in the Netherlands. This chain approach should both improve cooperation between chain partners and optimise (mental) support for the chronically ill. In this project, three pilots were organised to inspire (possibilities for) chain cooperation and make concrete how cooperation between chain partners can be improved or expanded.

Key findings

During this project, Ecorys supported the development of the chain approach and the cooperation between chain partners by developing personas and chain analyses.

Personas are detailed descriptions of a fictional person with a chronic illness, which help bring knowledge about the target group ‘to life’. This gives different groups a name and a face. During the pilots, we developed personas for diabetes patients, chronically ill parents, chronically ill patients with a migration background and breast cancer patients. In the various pilot municipalities, the personas were received with enthusiasm. For organisations, the personas were a tool to have conversations about each other’s target group and working methods, and about the needs of chronically ill patients.

Knowing each other is an important prerequisite for a well-functioning chain. It is therefore important that chain parties know who they are and what they do. A chain analysis is a tool to map the current situation. It makes clear which chain parties are structurally involved in caring for the target group, which cooperation already exists and where cooperation can be strengthened. The graphic representation of the chain provides an overview, shows strengths and weaknesses and can be used to follow up on developments in the chain.

The practical experiences of the pilots, the underlying theoretical model and the personas can be found here (in Dutch).

7 June 2024

2 minute read