The objective of the study was to determine the prevalence of depressive symptoms in African American medical clinic patients age 50 and older and to describe the presentation of depressive symptoms in this sample. Consecutive, consenting, African American patients age 50 and older in active treatment at a University Hospital medical clinic were screened for the presence of depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Thirty-two per cent of the 66 patients comprising the sample had scores of 16 or higher on the CES-D. Based upon a clinical interview using the DSM-111-R checklist, 11% (seven patients) had affective disorders and were referred for psychiatric evaluation. Although 33% ( N = 22) of the sample reported that they had 8 years or less of formal education, 62% (N=41) were found to have a current reading level of seventh grade or less. These data demonstrate that the levels of depressive symptoms among medically ill, African American medical clinic patients with two or more medical illnesses are higher than reported for medical clinic samples composed of white Americans or of mixed racial subjects. Unless current reading levels are assessed, functional illiteracy and the patient's inability to provide informed consent based upon reading material may be missed.