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Objectives: Data were collected on postpartum depression from 151 women, ages 16-40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic makeup of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other., Methods: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women., Results: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression., Conclusions: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.