OBJECTIVES:  To evaluate the impact of comorbid depression in patients with T2DM on work productivity and activity impairment in France, Germany Italy, Spain and the United Kingdom.   METHODS: Data were from the 2008 U.S. National Health and Wellness Survey (NHWS), an annual cross-sectional survey of self-reported healthcare behaviors, disease states, and outcomes of adults aged 18+, translated for each country.   A cohort of patients with T2DM without comorbid depression was compared to a cohort of T2DM with comorbid depression. Depression was defined as affirmative responses in the past month to: bothered by feeling down, depressed or hopeless; and bothered by having little interest or pleasure in doing things.  The Work Productivity and Activity Impairment (WPAI) questionnaire measured productivity;  regression models adjusted for gender, age, country, marital status, education and an adjusted Charlson Comorbidity Index score.    RESULTS: Among 2668 respondents diagnosed with T2DM, 828 (31%) were female and 750 (28%) experienced symptoms of depression. Of 873 employed patients, 275 had symptoms of depression. After controlling for our covariates, employed patients with comorbid depression had significantly worse levels of absenteeism [β=11.15, t=5.66; p<0.001] and impairment while at work (presenteeism) [β=20.96, t=11.72; p<0.001], and had significantly more overall work loss [β=25.58, t=11.59; p<0.001].  For all respondents activity impairment was also significantly higher for patients with comorbid depression [β=22.76, t=21.40; p<0.001]. Germany has a greater amount of presenteeism, and work productivity loss (p<0.05) than the other EU countries compared to the UK in this study; however, France, Germany, Italy and Spain patients experience significantly less activity impairment than UK patients (p<0.05). CONCLUSIONS:  Patients with T2DM and comorbid depression reported significantly more absenteeism and presenteeism overall. Treating both diseases effectively might lessen burden of disease and related indirect costs; further research is needed to clarify geographical and cultural influence associated with lost productivity.