Presentation (CTI)

OBJECTIVES: Depression remains substantially underdiagnosed in community settings. While prior research has identified socioeconomic and demographic barriers to diagnosis, less is known about how depressive symptom severity relates to diagnosis status — particularly among men, who face distinct help-seeking barriers. This study examined factors associated with undiagnosed depression among Korean men with PHQ-9-defined depressive symptoms.
METHODS: Data were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES). Men aged 19 years or older with PHQ-9 scores ≥10 were included (n=355). Undiagnosed depression was defined as PHQ-9 ≥10 without a physician diagnosis of depression. Multivariable logistic regression was conducted to identify factors independently associated with undiagnosed status. Covariates included sociodemographic characteristics, health behaviors, chronic conditions, and depressive symptom severity (moderate: 10-14; moderately severe: 15-19; severe: ≥20).
RESULTS: Among men with PHQ-9-defined depressive symptoms, 84.0% were undiagnosed. Higher household income was consistently associated with increased odds of remaining undiagnosed (3rd-4th quartile vs. lowest: aOR 4.92, 95% CI 1.45-16.74). A nonlinear association was observed for depressive symptom severity: men with moderately severe symptoms had substantially higher odds of being undiagnosed compared to those with moderate symptoms (aOR 3.45, 95% CI 1.17-10.21), whereas men with severe symptoms had markedly lower odds (aOR 0.21, 95% CI 0.07-0.66). Regular alcohol consumption (1 time/month-3 times/week) was also independently associated with undiagnosed status (aOR 2.42, 95% CI 1.02-5.70).
CONCLUSIONS: Among Korean men with depressive symptoms, the moderately severe range represents a critical diagnostic blind spot — sufficiently distressing to cause significant burden yet not severe enough to trigger help-seeking or clinical detection. Socioeconomic factors and drinking patterns further compound this gap. Targeted screening strategies addressing men in this symptom range may reduce the male depression diagnosis gap in Korea.