Objective: To estimate the prevalence rate of major depression among people with diabetes. Research Design and Methods: Data from the 2006 Behavioral Risk Factor Surveillance System, a standardized telephone survey among U.S. adults aged >/= 18 years, were analyzed (N=18,814). The Patient Health Questionnaire diagnostic algorithm was used to identify major depression. Results: The age-adjusted prevalence rate of major depression was 8.3% (95% confidence interval, 7.3% to 9.3%), ranging from a low of 2.0% in Connecticut to a high of 28.8% in Alaska. There were 25-fold differences in the rate among racial/ethnic subgroups (lowest, 1.1% among Asians; highest, 27.8% among American Indians/Alaska Natives). People with type 2 diabetes who were currently using insulin had a higher rate than people with type 1 diabetes (P = 0.0009) or type 2 diabetes who were currently not using insulin (P = 0.01). Conclusions: Major depression was highly prevalent among people with diabetes.