No Perceived Need Despite Higher-Severity Indicators among Untreated Young Adults with Major Depressive Episode

Young adults with untreated major depressive episode (MDE) occupy different positions before care, but planning based on expressed need may overlook those who do not perceive a need for treatment. This cross-sectional analysis used public use data from a 2024 nationally representative survey of respondents aged 18-25 years and was conducted in 2025-2026. Survey-weighted estimates and descriptive logistic models accounted for the complex design. Among 886 untreated young adults, 56.3% reported no perceived need, 34.5% endorsed need without seeking treatment, and 9.2% had sought treatment without receiving it. No perceived need remained common among those with severe MDE-related role impairment (48.7%) or serious suicidal thoughts (40.5%). Severe role impairment was associated with a 22.3-percentage-point lower adjusted probability of no perceived need. The persistence of no perceived need at higher severity supports planning for three entry positions rather than expressed need alone.