One means of comparison is to focus on screening for suicidal ideation among patients in primary care, because we know that suicidal symptoms are related to depression but are less frequently endorsed than other symptoms of depression. Using a universal screening approach, Bryan and colleagues (2) found that 2.1% of adult patients who had been referred to a behavioral health consultant endorsed current suicidal ideation. When screening was specific, indicated, and conducted by the behavioral health consultant, the rate was 12.4%. Different outcomes of screening based on the approach used have also been found for adolescents. Universal screening of an adolescent population found that 3.6% of the sample endorsed suicidal ideation (3). In contrast, a psychosocial screening project in primary care providers' offices in which providers used the same screening questions and criteria as in the universal screening study above but instead employed an indicated-screening approach found that the suicide risk among adolescents was 17.2%. The results of these studies indicate that when screening is universal, positive endorsement is about five times lower. Given these findings, we may hypothesize that primary care providers who use indicated screening are likely to identify a higher percentage of depressed patients and spend more time with those patients during their visits. In fact, it may not be that the screening process actually added significant time, but rather that the follow-up interview extended the length of the office visit. Thus providers who choose specific patients to screen and complete that process themselves may spend more time with these patients because they are good at identifying patients at risk—perhaps as much as five times greater than if all patients were screened.