Sociodemographic, clinical, and attitudinal characteristics of the untreated depressed in Ontario

Background: Epidemiologic surveys consistently document high rates of untre ated depression, yet why this unmet need exists is only partially understoo d. Methods: We compared untreated depressed, treated depressed and "healthy " subjects on sociodemographic characteristics, need for treatment, and hel p-seeking attitudes using household survey data from Ontario, Canada (n = 9 953). DSM-III R Major Depression was assessed by structured interview (UM-C IDI), and treatment was defined as seeking formal mental health care. Need for treatment was assessed using a broad array of clinical, disability, and risk measures. Results: Depressed (treated and untreated) and "healthy" re spondents differed significantly on nearly all comparative measures. Howeve r, the two depressed groups showed few sociodemographic or "need for treatm ent" differences. Notably, there were no significant clinical differences a lthough the untreated did report less physical comorbidity (33.9% vs 60.0% treated depressed). There were, however, several attitudinal differences. C ompared to the treated depressed, untreated respondents were less likely to feel they had a mental health problem (51.6% vs. 78.8%), to say they would seek help for a serious problem (36.6% vs 64.7%) or to feel comfortable co nsulting a professional (19.0% vs. 43.2%). Limitations: Because the data ar e cross-sectional, temporal relationships cannot be directly addressed. Con clusions : Despite appreciable morbidity, access to care by the untreated d epressed may be hindered by their self-perceptions and greater discomfort w ith help-seeking. Lower physical comorbidity may also contribute through de creased health care contact and thus fewer opportunities for disclosing or detecting their illness. (C) 1999 Elsevier Science B.V. All rights reserved .