Several not so surprising difficulties were encountered: specifically, process issues, low English literacy, and uncertain follow through by physicians. Nonetheless, Goldwasser and Badger were able to demonstrate that such screening is feasible for a significant portion of the patient population and that a substantial number of those completing the screener, in this case, the General Health Questionnaire, reported symptomatology that warranted further inquiry by a health professional. Evidence is mounting that large percentages of medical patients suffer from mental health problems that are often undetected by providers. Consequently, the management of psychiatric illness in primary care settings has captured the attention of the broader scientific community. Witness, for example, the recent National Institute of Mental Health "Depression Awareness, Recognition, and Treatment" (DART) initiative. Given the stigma that continues to plague Indian/Native mental health programs, efforts to detect serious psychological dysfunction among Indian and Native medical patients and to treat them appropriately in the clinics where they are first seen hold considerable promise for success.In course of that epidemic. It also summarizes a comprehensive approach to suicide prevention that proceeds in several phases and that may be adapted to other community settings.The fourth and last article in this issue, "An Investigation of Health Decision-Making Skills Among American Indian Adolescents", by Okwumabua, Okwumabua, and Duryea, speaks to a very specific and poorly understood mechanism that underpins many of the preventive interventions being promoted for Indian/Native adolescents at high risk of alcohol, drug abuse, or mental health problems. Working with a small sample of seventh graders, the authors examined their decision-making skills in regard to a series of health and social matters. The students proved to be equally efficacious in their ability to make decisions across both types of situations. However, some intriguing differences arose in the nature of the decisionmaking errors committed, largely with respect to the steps taken in analyzing and implementing responses to problematic social situations. Further work along these lines may prove useful in adapting various intervention strategies to this special population. Abstract: This study presents a trial in which the General Health Questionnaire (GHQ) was introduced among general medicine clinic patients on a Navajo Indian reservation in Chinle, Arizona, to test its utility in enhancing recognition of significant psychiatric problems. It was found useful in alerting physicians to suicidal patients, and in identifying risk factors such as household size and number of children for symptoms of anxiety and depression. The few problems encountered in administration of the screening tool could easity be overcome.As a fourth-year medical student, one of the authors (H.G.) completed a five-week family and community medicine rotation in Chinle, Arizona. While there, he examined...