OBJECTIVES: Public and private healthcare systems in Brazil differ in focus and regulations for disease management, especially mental health.  The aim of this study was to assess differences between privately and publicly insured patients in access to care, as well as differences in mental health, work productivity impairment, and healthcare resource utilization among patients diagnosed with depression. METHODS: The 2014 Brazil National Health and Wellness Survey (N=9,082), a self-reported, cross-sectional survey representative of the adult population, provided data.  Access outcomes included physician diagnosis of depression, visits to psychiatrists, and visits to psychologists in the past six months.  Other outcomes included work impairment due to health using the Work Productivity and Activity Impairment questionnaire and depression severity according to the Patient Health Questionnaire.  Patients with private insurance were compared to patients with only public insurance with chi-square tests; generalized linear models were used to adjust outcomes for covariates.  RESULTS: Overall, 11% (n=990) of the sample reported a depression diagnosis.  Diagnosis was more common among those with private than public insurance (12.5% vs. 9.3%, p<0.001), a pattern that remained after controlling for covariates (OR=1.4, p<0.001).  Visiting a psychiatrist (OR=1.7) or a psychologist (OR=1.8) was also more common with private insurance (both p<0.001).  Among those diagnosed with depression, severity was lower among those with private insurance (mean 10.8 vs. 11.9, p=0.026).  Employed patients with depression with private insurance missed more work due to health (14.3% vs. 8.0%, p<0.01), while the levels of health-related impairment while at work, overall work impairment, and activity impairment were not significantly different.  CONCLUSIONS: Private insurance appears to be associated with more access to depression care as well as less severe depression among depression patients. More work missed among privately insured patients warrants further study, and may be due to differences not included here, such as type of employment.