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

Background: Epidemiologic surveys consistently document high rates of untreated depression, yet why this unmet need exists is only partially understood. Methods: We compared untreated depressed, treated depressed and "healthy" subjects on sociodemographic characteristics, need for treatment, and help-seeking attitudes using household survey data from Ontario, Canada (n = 9953). DSM-III R Major Depression was assessed by structured interview (UM-CIDI), 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" respondents differed significantly on nearly all comparative measures. However, the two depressed groups showed few sociodemographic or "need for treatment" differences. Notably, there were no significant clinical differences although the untreated did report less physical comorbidity (33.9% vs 60.0% treated depressed). There were, however, several attitudinal differences. Compared 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 consulting a professional (19.0% vs. 43.2%). Limitations: Because the data are cross-sectional, temporal relationships cannot be directly addressed. Conclusions : Despite appreciable morbidity, access to care by the untreated depressed may be hindered by their self-perceptions and greater discomfort with help-seeking. Lower physical comorbidity may also contribute through decreased health care contact and thus fewer opportunities for disclosing or detecting their illness. (C) 1999 Elsevier Science B.V. All rights reserved.