A recent study suggests that about one in twenty middle-aged and older adults in the United States experienced a major depressive episode in the past year, yet many do not receive mental health care. The findings indicate that demographic factors, such as marital status and income, along with substance use, play roles in who experiences depression later in life. The research was published in The American Journal of Geriatric Psychiatry.
Major depressive disorder is a serious medical condition characterized by persistent feelings of sadness, loss of interest in activities, and a range of physical and emotional problems. Among older populations, untreated depression is linked to a decreased quality of life, physical decline, and an increased risk of suicide. Despite these well-known risks, depression in older adults often goes undetected or inadequately treated in medical settings.
Most previous large-scale surveys on this topic focused exclusively on adults aged 65 and older. This narrowed focus left a gap in knowledge regarding middle-aged adults between the ages of 50 and 64, who may face different stressors and hold different views on mental health treatment. In addition, changes in the legal status and cultural acceptance of substances like cannabis necessitated an updated look at how substance use relates to depression in older adults.
“Depression in older adults is often underdiagnosed and undertreated, yet most of the foundational data we have on its prevalence, correlates, and treatment come from surveys that are now decades old and predate major events like the COVID-19 pandemic and rise of telehealth,” said study author Kevin Yang, a psychiatrist and postdoctoral fellow in the National Clinician Scholars Program at UCLA.
“Additionally, most prior research has focused on adults aged 65 and older, leaving a gap in our understanding of adults in their 50s and early 60s, who may face a different mix of risk factors and treatment patterns,” Yang explained. “We wanted an updated, nationally representative picture that captured this broader middle-aged and older adult population and see what the prevalence, correlates, and treatment patterns are.”
To examine these patterns, scientists analyzed data from the 2022 and 2023 National Survey on Drug Use and Health. This is an annual, nationally representative survey that tracks health and behavior across the noninstitutionalized United States population. The sample for this specific analysis included 20,580 adults aged 50 and older. Participants completed comprehensive questionnaires that assessed their demographic information, substance use habits, mental health status, and utilization of medical treatments.
The researchers defined a past-year major depressive episode using standard psychiatric criteria. This required participants to report at least five out of nine specific depressive symptoms occurring during the same two-week period, with at least one symptom being a depressed mood or a loss of interest in life. The survey also asked participants with depression if they received mental health treatment in the past year, whether they felt they needed treatment but did not get it, and what barriers prevented them from accessing care.
The researchers found that an estimated 4.6 percent of community-dwelling adults aged 50 and older experienced a major depressive episode in the past year. When controlling for various demographic and substance use characteristics, the authors identified several recurring patterns. Females had more than twice the odds of experiencing a depressive episode compared to males. Marital status also played a role, with divorced or separated individuals showing higher odds than married participants.
Substance use showed strong associations with depression. The scientists found that a cannabis use disorder increased the odds of a major depressive episode by four and a half times compared to non-users. Interestingly, even cannabis use without a formal use disorder was associated with a 50 percent relative increase in the odds of depression. Alcohol use disorder, as well as the misuse of prescription opioids and sedatives, were also linked to higher odds of experiencing a depressive episode.
“We found that cannabis use, even without a use disorder, was associated with higher odds of depression,” Yang told PsyPost. “This is interesting given how quickly the legal and cultural landscape surrounding cannabis has shifted, with many older adults viewing it as low-risk and/or therapeutic.”
The researchers noted that adults aged 65 and older had lower odds of a past-year depressive episode compared to those aged 50 to 64. Higher household income, specifically earning $50,000 or more annually, tended to protect against depression. Holding a college or postgraduate degree, however, was associated with higher odds of depression compared to not having a high school diploma, which the authors suggest might reflect elevated career expectations, financial pressures, or work-related stress.
Among the participants who experienced a major depressive episode, 66.2 percent received some form of mental health treatment. Prescription medication was the most common intervention, utilized by 55.1 percent of this group. Outpatient therapy was used by 46.6 percent, and telehealth services were accessed by 39.0 percent. Only about 5.2 percent of individuals with depression received inpatient treatment at a hospital or specialized facility.
Age differences emerged in how people accessed care and perceived their own mental health needs. Adults aged 65 and older were less likely to receive outpatient treatment, with 38.7 percent accessing these services compared to 50.1 percent of adults aged 50 to 64. The older group was also much less likely to report an unmet need for treatment. Only 8.8 percent of adults 65 and older felt they needed care but did not receive it, compared to 23.3 percent in the 50 to 64 age bracket.
“Adults aged 65 and older were much less likely than those aged 50-64 to say they felt they needed treatment, even though depression was still fairly common in that group, pointing to potential gaps where older adults may not recognize or acknowledge their symptoms,” Yang observed.
For those who did not receive treatment despite feeling they needed it, the most common hurdles were attitudinal in nature. About 86.2 percent of this untreated group cited reasons such as believing they could handle the problem on their own or not feeling ready for treatment. Access-related issues, like trouble finding a provider or transportation difficulties, affected 73.1 percent of these individuals. Financial obstacles, such as an inability to afford care or lacking sufficient insurance coverage, impacted 48.6 percent.
“About 1 in 20 adults aged 50 and older experienced a major depressive episode in the past year, and one third of these individuals did not receive any form of mental health treatment in that time frame,” Yang said. “Some of the biggest barriers to treatment were attitudinal barriers such as thinking they could handle without treatment or that they weren’t ready to start, which suggests stigma and self-sufficiency beliefs remain major obstacles to care in this population.”
The cross-sectional design of this research means that it captures a single snapshot in time. This makes it impossible to determine the direction of cause and effect between variables like substance use and depression. For instance, the data indicates a relationship between cannabis use and major depressive episodes, but it does not establish whether cannabis use contributes to depression or if individuals experiencing depression use cannabis in an attempt to self-medicate.
“We can’t determine causality or directionality, particularly for the cannabis findings,” Yang explained. “It’s possible that cannabis might contribute to depressive symptoms, that people use cannabis to self-medicate existing depression, or that the two co-occur without a causal link between them. Depression was also assessed using a validated symptom checklist rather than a clinical diagnosis.”
The data relies entirely on self-reported surveys, which can sometimes be influenced by a participant’s ability to recall past events or their willingness to disclose sensitive information. The study only included individuals living in the community, meaning the findings do not apply to older adults residing in institutional settings like nursing homes. In such care facilities, depression rates often differ and require distinct assessment strategies.
Future longitudinal studies, which track individuals over extended periods, are needed to clarify how substance use directly influences depression in older age. Additional research could also explore ways to improve digital literacy among older adults to expand telehealth access. Such steps would help address the persistent barriers preventing many older adults from receiving necessary mental health care.
“We’re interested in longitudinal work that can better disentangle the direction of the relationship between substance use, particularly cannabis, and depression in this age group,” Yang said. “We’d also like to explore what specific interventions, such as psychoeducation, primary care screening, or telehealth outreach, might be effective at closing the attitudinal and treatment gaps we identified.”
“Depression in older adults is not as well-studied compared to other populations, and we hope this study reinforces the importance of proactive screening and treatment for this growing population, as the number of older adults in the US continues to rise,” Yang concluded.
The study, “Prevalence, Correlates, and Treatment of Major Depression Among Community-Dwelling Adults Aged ≥50 in the US,” was authored by Kevin H. Yang, Cooper Urban, Haley V. Solomon, and Joseph J. Palamar.
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