Depression Screening Positivity, Treatment-Seeking Intention, and Willingness to Take Antidepressants in a Self-Selected Online Sample of Korean Adults: Cross-Sectional Questionnaire Study

Abstract Background Depression is a prevalent psychiatric condition with functional and socioeconomic consequences. Understanding the barriers to professional help-seeking and treatment acceptance among individuals with depressive symptoms is important. Objective This study aimed to quantify depression screening positivity and examine treatment-seeking intention, willingness to use antidepressants, and perceived barriers among Korean adults, with attention to prior depression-related health care experiences. Methods A cross-sectional online survey was conducted in South Korea (March 16-April 5, 2024) via paid social media advertising and messaging app invitations. A total of 1053 adults aged 20 years and older participated in this study. Depression screening was conducted using 2 Primary Care Evaluation of Mental Disorders–derived items, with the endorsement of either item defining a positive screen. History of depression diagnosis or treatment, intentions toward professional treatment, antidepressant use, and perceived barriers were assessed. Results Overall, 65% (684/1053) of the participants had a positive depression screen. A positive depression screen was not associated with the intention to seek professional treatment for depression (adjusted odds ratio [aOR] 1.04, 95% CI 0.77‐1.41). Participants with a positive depression screen had lower odds of being willing to take antidepressants than those with a negative screen (aOR 0.73, 95% CI 0.54‐0.99). A within-participant analysis showed that the association of depression screening status differed between treatment-seeking intention and willingness to take antidepressants (ratio of odds ratios 0.70, 95% CI 0.53‐0.94; interaction P =.02). The joint response of intending to seek treatment while being unwilling to take antidepressants was more common among participants with a positive than a negative depression screen (75/384, 11% vs 23/369, 6.2%; aOR 1.70, 95% CI 1.04‐2.77). A history of depression diagnosis or treatment was positively associated with treatment-seeking intention and willingness to use antidepressants. Among screen-positive adults, those without such a history more often reported that they would not seek treatment if diagnosed with depression (129/505, 25.5% vs 26/179, 14.5%; P =.002) or would be unwilling to take antidepressants if recommended (154/505, 30.5% vs 29/179, 16.2%; P <.001). Barrier profiles to treatment seeking differed by history of depression diagnosis or treatment (interaction P <.001), whereas the patterns of reasons for unwillingness to take antidepressants did not differ according to history (interaction P =.08). Conclusions In this online survey sample, a positive depression screen was associated with a lower willingness to use antidepressants but not with treatment-seeking intention. Among screen-positive participants, those without prior depression-related health care experience had lower help-seeking intention and willingness to take antidepressants than those with prior contact, suggesting the need to reduce barriers to care and support earlier treatment initiation.