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Objectives: To examine the prevalence and treatment of diagnosed depression among elderly nursing home residents and determine the resident and facility characteristics associated with diagnosis and treatment. Design, Setting, and Participants: Documented depression, pharmacotherapy, psychotherapy, sociodemographics, and medical characteristics were obtained from Ohio’s Minimum Data Set for 76 735 residents in 921 nursing homes. The data were merged with Online Survey Certification and Reporting System data to study the impact of facility characteristics. Chi-squared statistics were used to test group differences in depression diagnosis and treatment. Multiple logistic regressions were used to examine the prevalence of diagnosed depression, and among those diagnosed, of receiving any treatment. Results: There were 48% of residents who had an active depression diagnosis; among those diagnosed, 23% received no treatment; 74% received antidepressants; 0.5% received psychotherapy; and 2% received both. African Americans, the severely cognitively impaired, and those in government facilities were less likely to be diagnosed. Residents aged 85 and older, African Americans, individuals with severe mental illness, those with severe ADL or cognitive impairment, and individuals living in a facility with 4 or more deficiencies were less likely to receive treatment. Conclusion: Significant disparities exist both in diagnosis and treatment of depression among elderly residents. Disadvantaged groups such as African Americans and residents with physical and cognitive impairments are less likely to be diagnosed and treated. Our results indicate that work needs to be done in the nursing home environment to improve the quality of depression care for all residents. [Copyright &y& Elsevier]