Persistent Racial and Ethnic Disparities in Untreated Adolescent Depression in the United States, 2021-2024.

BACKGROUND: Adolescents with depression continue to face substantial barriers to treatment, which may be unevenly distributed across racial and ethnic groups. We examined recent trends in adolescent major depressive episode (MDE) and disparities in untreated MDE in the United States. METHODS: We analyzed 2021-2024 National Survey on Drug Use and Health public-use data for adolescents aged 12-17 years. Outcomes were past-year MDE, depression-related treatment receipt, untreated MDE, and untreated MDE with severe role impairment. Survey-weighted logistic regression accounted for the complex survey design and adjusted for sociodemographic, clinical, substance-use, insurance, and county-type characteristics. Adjusted probabilities and absolute differences versus non-Hispanic White adolescents were estimated using marginal standardization. RESULTS: Among 43,828 adolescents, weighted past-year MDE prevalence declined from 20.5% in 2021 to 14.8% in 2024. Among adolescents with MDE, treatment receipt increased from 41.8% to 52.2%, while untreated MDE decreased from 58.2% to 47.8%. In the fully adjusted model (n = 8,066), adjusted untreated probabilities were higher among non-Hispanic Black (61.1%), American Indian or Alaska Native (63.6%), Asian (59.8%), multiracial (59.2%), and Hispanic adolescents (57.7%) than among non-Hispanic White adolescents (46.3%), corresponding to absolute differences of 11.4-17.3% points. Uninsured adolescents and those living in nonmetropolitan counties also had higher odds of untreated MDE. CONCLUSIONS: Adolescent MDE declined and treatment receipt improved, but substantial inequities in treatment connection remained. Surveillance should track equity-focused treatment metrics alongside symptom prevalence.