OBJECTIVES: Patients with major depressive disorder (MDD) frequently report lower quality of life (QoL) and increased disability compared with the general population.  This post hoc analysis describes the association between QoL, painful physical symptoms (PPS), depressive symptoms and employment status in a Chinese MDD patient cohort. METHODS: Chinese MDD patients (299) from a prospective observational study of six East Asian countries/regions were compared at baseline and after 3 months of naturalistic treatment on QoL (EuroQoL Questionnaire-5 Dimensions [EQ-5D] utility score), PPS (Somatic Symptom Inventory [SSI]), depression (17-item Hamilton Depression Rating Scale [HAMD17]) and employment status measures.  Patients were classified as PPS positive or negative (PPS+, PPS-; SSI mean score ≥2 or<2 respectively).  Effect sizes (ES) were calculated using Cohen's d. RESULTS:  Patients who were employed at baseline reported higher QoL (EQ-5D: 0.60 vs. 0.42; ES 0.7) and were less severely ill (HAMD17 total score: 22.7 vs. 26.0; ES -0.7) than those who were unemployed.  Few transitions in employment status were observed during the study.  Self-reported QoL was low (EQ-5D: mean 0.52) at baseline and improved substantially after 3 months (EQ-5D: 0.89).  PPS+ patients were more severely ill (HAMD17: 25.4 vs. 23.3; ES 0.4) and had a lower QoL (EQ-5D: 0.41 vs. 0.58; ES -0.6) at baseline than PPS- patients.  The higher illness severity (HAMD17: 7.0 vs. 4.6; ES 0.4) and lower QoL (EQ-5D: 0.83 vs. 0.92; ES -0.6) of PPS+ patients persisted after 3 months. CONCLUSIONS: Employed patients reported a higher QoL and a lower symptomatic burden than unemployed patients.  Patients with a low QoL were more likely to be unemployed.  The QoL of Chinese MDD patients improved over 3 months of naturalistic treatment.  The presence of PPS was associated with higher illness severity and lower QoL at baseline and after 3 months.