OBJECTIVE: The objective of this study is to examine the religious characteristics of older medical inpatients with major and minor depression, compare them with religious characteristics of nondepressed patients, and examine their relationship to severity and type of depression. METHODS: Medical inpatients over age 50 at Duke University Medical Center (DUMC) and three community hospitals were identified with depressive disorder using a structured psychiatric interview. Detailed information was obtained on their psychiatric, medical, and religious characteristics. Religious characteristics of these patients were then compared with those of nondepressed patients in a concurrent study at DUMC controlling for demographic, health, and social factors. Among depressed patients, relationships to severity and type of depression were also examined. RESULTS: Religious involvement among 411 patients with major and 585 with minor depression was widespread, although not as frequent as in 428 nondepressed patients. After controlling for demographic and physical health factors, depressed patients were more likely to indicate no religious affiliation, less likely to affiliate with neofundamentalist denominations, more likely to indicate "spiritual but not religious," less likely to pray or read scripture, and scored lower on intrinsic religiosity. Among depressed patients, there was no relationship between religion and depression type, but depression severity was associated with a lower religious attendance, prayer, scripture reading, and lower intrinsic religiosity. Social factors only partially explained these relationships. CONCLUSION: Older medically ill hospitalized patients with depression are less religiously involved than nondepressed patients or those with less severe depression. Implications for clinicians are discussed.