Using a standardized measure of health beliefs, this study sought to disentangle factors that contribute to increased medical service use in a sample of 64 high-utilizing elderly patients. In adjusted models, people with depressive symptoms were more likely than those without depression to believe that they were susceptible to chronic medical conditions, and that these conditions were severe. However, they did not appear to have a distorted view of the potential benefits and risks of seeking health care. The results of this study suggest that the association between depressive symptoms and medical service use may be more closely related to how patients view their medical illnesses than with how they perceive their need for health care.