Cross-sectional analysis of 20,580 community-dwelling US adults aged ≥50 from the 2022–2023 National Survey on Drug Use and Health, examining past-year prevalence, demographic and substance use correlates of major depressive episode (MDE), mental health treatment utilization, and barriers to care among untreated individuals.
Past-year MDE prevalence was 4.6% (95% CI: 4.2–5.2%); 66.2% of those with MDE received any mental health treatment. Adults ≥65 were less likely to receive outpatient mental health services (38.7% vs. 50.1%, p=0.032) and less likely to report perceived unmet need (8.8% vs. 23.3%, p=0.019). Among untreated individuals with unmet need, barriers were predominantly attitudinal (86.2%), access-related (73.1%), and financial (48.6%).
Cross-sectional design prevents causal inference; the survey excludes institutionalized adults, likely underrepresenting those with severe depression; MDE and treatment data rely on self-report, which may introduce recall or social desirability bias.
Nearly 1 in 3 older adults with MDE goes untreated, and adults ≥65 are especially unlikely to seek or report unmet care — clinicians should proactively screen and address attitudinal and access barriers in this age group. Co-occurring alcohol use disorder, cannabis use, and prescription opioid or sedative misuse are each independently linked to higher odds of MDE and should prompt depression screening.
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