Most people with clinical depression aren’t getting treatment. And most people who get treatment don’t actually have clinical depression.

That’s the conclusion of a straightforward but alarming study published in JAMA Internal Medicine this week, which we spotted after the psychologist Vaughan Bell flagged it.

The authors examined data from 46,417 adults who filled out government Medical Expenditure Panel Surveys between 2012 and 2013.

They found that among adults treated for depression, only 29.9% screened positive for depression and another 21.8% for serious psychological distress.

More alarming: Among the 8.4% of adults who screened positive for depression, only 28.7% received any depression treatment at all.

In other words, people who need treatment the most are probably not getting it, while many of the people receiving treatment probably don’t need it. That means that a dangerous mistake is being repeated over and over again, as the healthcare system continually fails to identify people who are depressed and push them toward treatment.

Depression is a relatively common illness with potentially severe mental and physical symptoms; it’s not just a particularly acute form of feeling sad. People who live with it may deal with fatigue, hopelessness, physical aches and pains, trouble sleeping, loss of appetite, and digestive problems — often over long time scales that can severely impact long-term health. Most worryingly, people with depression are at significantly heightened risk of suicide.

With appropriate treatment, the picture looks much more hopeful. Yet part of the problem is that people suffering from depression often struggle to seek help.

That’s why the researchers recommend a heightened effort among general practitioners to identify symptoms of depression in their patients and refer them to mental health care providers. That’s likely a critical step in beginning to rectify the imbalance identified by their study.

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