OBJECTIVE: This study examined the magnitude of association between alcohol misuse and recent depressive symptoms. METHODS: We conducted a cross-sectional study of 412 randomly selected patients at least 18 years old and seeking emergency department (ED) care. RESULTS: Of the patients, 51.0% reported depressive symptoms. At-risk drinking was reported by 26.0%, and 28.2% scored positive on the Rapid Alcohol Problems Screen 4. Alcohol abuse and binge drinking were reported by 25.1% and 28%, respectively, of the patients. According to our results, at-risk drinking (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.47-4.20, P < or = .001), problem drinking (OR = 2.11, 95% CI = 1.27-3.51, P < or = .004), drinking abuse (OR = 2.58, 95% CI = 1.51-4.40, P < .001), and binge drinking (OR = 1.89, 95% CI = 1.13-3.15, P < .001) were all related to the manifestation of depressive symptoms. CONCLUSIONS: The findings of this study yield information that could be used by ED health care practitioners and health educators to educate ED patients at risk for alcohol misuse and depression.