Introduction Depression is strongly associated with use of health services and disability among older adults, however it is still poorly diagnosed and treated. It is still unclear how severity of depression is associated with health service use.

Methods The present study is part of the SPAH, a population-based study that investigated the epidemiology of mental disorders in 2072 community-dwelling elderly aged 65+ from economically disadvantaged areas of São Paulo, Brazil. ICD-10 depression and depressive symptoms (non ICD-10 depression) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. Information on health services use was collected with a standardised questionnaire.

Results 2024 SPAH participants were assessed for depression. Prevalence of depressive symptoms (23.1%) was approximately four times higher than ICD-10 depression (4.9%). Participants without depression used less health services than those with any severity of depression. The number of participants who used outpatient and inpatient services increased with severity of depression. Forty (41%) participants with depression and 144 (31%) with depressive symptoms had three or more out-patient consultations during the three months previous to the study assessment, and 15 (15%) participants with depression and 26 (5.6%) with depressive symptoms used inpatient services.

Conclusion From a population perspective, depressive symptoms have a higher impact than ICD-10 depression on health services use. Health services professionals, particularly those in primary care, must be aware of the increased likelihood of diagnosing depression or depressive symptoms in older adults who use health services more frequently. These individuals must be targeted by case-finding strategies.