The association of mental health symptoms with cocaine use was studied among post partum women. Gestational cocaine use was determined by confidential interview or urine assay. A structured Psychiatric Symptom Index was used to measure mental health symptoms. Among 155 women, 24 (15%) used cocaine. Cocaine-using women had less education, higher parity, less weight gain during pregnancy, and used more cigarettes, marijuana, and opiates in pregnancy than nonusers. High frequency of symptoms (standardized Psychiatric Symptom Index score greater than or equal to 20) was found in 71% of women for the Total Index score, 81% on depression, 61% on anxiety, 36% on cognitive disturbance, and 75% on anger. No differences in Psychiatric Symptom Index Total or factor scores were associated with cocaine use.