In Part I, the authors described the relationship between somatization and depression and the extent and rate of misdiagnosis of the problem of depression in primary care. A conceptual model was developed to explain the patient's selective perception and focus on the somatic manifestation of depression and the resulting misdiagnosis. In the first section, the sociocultural and childhood experience were reviewed as two major factors influencing the ability of the patient to perceive affective changes. In this second part, the authors review the influence of the developmental stage of the patient's cognitive mechanisms and the effect of the environmental systems in which the patient dwells, i.e., medical care, family and social network, work/disability and the sociopolitical institutions, on the recognition of affective, cognitive and somatic symptoms.