There has been a growing concern over the impact of mental health on patient outcomes in the field of orthopaedic surgery. However, it is uniquely difficult to investigate the impact of depression on surgical outcomes for several reasons: (1) Patients who do not formally seek help for mental health issues often go undiagnosed. (2) Prospectively administered depression screening forms provide limited data. (3) Debilitating pain and function may be the cause-not effect-of mental health issues. The recent literature on patients undergoing arthroscopic rotator cuff repair suggests an association between depression and increased utilization of health care resources. There is also evidence that patients with a recent acute depressive episode shortly before surgery are more likely to require more opioids, sedatives, and antidepressants after surgery. Consideration of surgical patients' mental health status can result in timely intervention to improve outcomes.