To study reasons for not receiving treatment, and examine characteristics and one-year outcome of untreated anxiety and depression.

Data were used of 743 primary care patients with a six-month anxiety or depressive disorder in the Netherlands Study of Anxiety and Depression (NESDA). Diagnoses were confirmed by the Composite Interview Diagnostic Instrument (CIDI). Patients’ perceived need for care, service utilisation, and reasons for no treatment were assessed by the Perceived Need for Care Questionnaire (PNCQ).

43% of the respondents received no treatment. Of these untreated patients, 25% did not perceive a mental problem; 26% perceived no need for care; and 49% expressed a need for care which was not met. Untreated patients with a treatment need showed the same symptom severity and disability as treated patients, and reported even more loneliness. Compared to other untreated patients, they were more handicapped regarding clinical and psychosocial functioning.

After one year, treated and untreated patients with a treatment need showed a poorer outcome than untreated patients without a self-perceived mental problem or need for care.

Many patients with anxiety or depression do not seek treatment. Half of them are probably right: they do not perceive a mental problem or treatment need, suffer from relatively mild symptoms, and show a favourable one-year course. Untreated patients with a perceived treatment need, however, suffer from severer symptoms, and show a poorer outcome than other untreated patients. Therefore, care providers should pay considerable attention to this worrisome group.