Background Despite the burden of depression, there remain few data on its economic consequences in an international context.

Aims To explore the relationship between depression status (with and without medical comorbidity), work loss and health care costs, using cross-sectional data from a multi-national study of depression in primary care.

Method Primary care attendees were screened for depression. Those meeting eligibility criteria were categorised according to DSM–IV criteria for major depressive disorder and comorbid status. Unit costs were attached to self-reported days absent from work and uptake of health care services.

Results Medical comorbidity was associated with a 17–46% increase in health care costs in five of the six sites, but a clear positive association between costs and clinical depression status was identified in only one site.

Conclusions The economic consequences of depression are influenced to a greater (and considerable) extent by the presence of medical comorbidity than by symptom severity alone.

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