Depression and cannabis use intersect in many older Americans

To estimate past-year prevalence and correlates of major depressive episode (MDE), characterize mental health treatment utilization, and identify barriers to care among community-dwelling US adults aged ≥50. Cross-sectional analysis of a nationally representative survey. Noninstitutionalized US population. 20,580 respondents aged ≥50 from 2022 to 2023 National Survey on Drug Use and Health. We estimated past-year MDE prevalence and delineated demographic and past-year substance use correlates; examined mental health treatment utilization among individuals with MDE; and identified barriers to care among untreated individuals. An estimated 4.6% (95% confidence interval: 4.2-5.2) of adults aged ≥50 experienced past-year MDE. In multivariable analyses, higher odds were estimated among females, divorced/separated or widowed individuals, college-educated individuals, and those with alcohol use disorder, cannabis use (with or without use disorder), and prescription opioid or tranquilizer/sedative misuse. Lower odds were estimated among adults aged ≥65, Non-Hispanic Black individuals, and those with income ≥$50,000. Among those with MDE, 66.2% received any mental health treatment. In bivariable comparisons, adults aged ≥65 were less likely than those aged 50-64 to receive outpatient mental health services (38.7% versus 50.1%, p = 0.032) and to report perceived unmet need for treatment (8.8% versus 23.3%, p = 0.019). Among untreated individuals with perceived unmet need, barriers to treatment were attitudinal (86.2%; e.g., thought could handle without treatment), access-related (73.1%), and financial (48.6%). MDE is prevalent among older adults with heterogeneity across demographic and substance use factors. Treatment disparities and high barrier rates highlight the need for targeted interventions in this population.