OBJECTIVES: The aim of the current study was to establish the burden of depression (diagnosed, self-reported, and at-risk) in both Europe and Japan.  METHODS: Data from the 2008 EU and 2008 Japan National Health and Wellness Survey (NHWS) were used.  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, 5,848 patients (10.9%) were diagnosed, 2,037 (3.8%) were self-reported, 13,168 (24.6%) were at-risk, and 32,471 (60.7%) were controls. In Japan, 884 (4.4%) were diagnosed, 162 (0.8%) were self-reported, 5,681 (28.4%) were at-risk, and 13,273 (66.4%) were controls. After controlling for demographics and patient characteristics, those with diagnosed depression (Adjusted Mean (Madj)=34.4), self-reported depression (M­­adj=35.5), and at-risk depression (M­­adj=41.0) reported significantly lower levels of MCS scores than controls ((M­­adj=51.10, p’s<0.0001) across all countries. The gap between controls and self-reported depression (b=3.18, p<.0001) and at-risk depression (b=0.63, p<.001) was significantly greater in Japan than in the EU.  Both those with diagnosed (Madj=46.2) and at-risk (M­­adj=49.4) depression reported significantly lower levels of PCS than controls (M­­adj=49.6, p’s<0.05).  Finally, those diagnosed with depression (M­­adj=39.2%), self-reported depression (M­­adj=30.9%), and at-risk for depression (M­­adj=23.3%) all reported significantly more overall work impairment than controls (M­­adj=12.8%).  There was also a significant interaction, such that the difference in impairment between patients diagnosed with depression and controls was significantly greater in Japan (p<.05).  CONCLUSIONS: Levels of diagnosed and self-reported depression were lower in Japan than in Europe, yet rates of at-risk depression were higher.  Although the burden of depression was substantial, the results suggest that the work impairment burden in Japan is significantly greater than in the EU.