OBJECTIVES: The objective of this project was to assess the burden of depression in terms of quality of life and work impairment in the EU and China.  METHODS: Data were obtained from the 2008 EU and 2009 China National Health and Wellness Survey (NHWS).  Patients were categorized into four groups: diagnosed depression, self-reported depression, at-risk for depression, and controls.  Differences among these groups were examined on quality of life (mental (MCS) and physical component summary (PCS) scores of the SF-12v2), as well as overall work impairment, controlling for demographics and patient characteristics.  RESULTS: In the EU, 5848 patients (10.9%) were diagnosed, 2037 (3.8%) were self-reported, 13168 (24.6%) were at-risk, and 32471 (60.7%) were controls. In China, 339 (2.5%) were diagnosed, 348 (2.6%) were self-reported, 3883 (29.2%) were at-risk, and 8752 (65.7%) were controls. Adjusting for demographics and comorbidities, those with diagnosed (b=-16.00, p<0.0001) and self-reported (b=-14.42, p<0.0001) depression, and those at-risk for depression (b=-9.22, p<0.0001) reported significantly lower MCS than controls. Those diagnosed (b=-3.62, p<0.0001) and at-risk (b=-0.47, p=0.0022) for depression reported significantly lower PCS than controls. In addition, the MCS difference between those with diagnosed, self-reported, or at-risk depression relative to controls was significantly greater in Europe than in China (b=5.88, p<0.0001; b=5.60, p<0.0001; b=3.49, p<0.0001, respectively). However, the PCS gap between patients at-risk for depression and controls was significantly greater in China than in Europe (b=-0.99, p<0.0001).  Finally, the work impairment gap between patients with diagnosed, self-reported, or at-risk depression and controls was significantly greater in Europe than in China (b=-0.35, p=.0002; b=-0.40, p<0.0001; b=-0.08, p=0.0455, respectively).  CONCLUSIONS: Depression was associated with a substantial burden on patients.  The impact of depression on mental quality of life and work impairment was greatest in Europe while the impact of depression on physical quality of life was greatest in China.