A common physical sign associated with depression, Veraguth's eyelid folds, was found considerably more often in white than in African American patients with depressive illness. Moreover, the folds are more strongly correlated with severity of depression in patients of European descent when they occur. The reported high rate of misdiagnosis of depressive illness in Americans of African descent may thus be related in part to differences in the facial expression of affect. The implications of this finding are discussed in regard to the importance of careful gathering of history for diagnostic purposes.