Suicidal ideation (SI) affects ∼30-40% of those with major depressive disorder (MDD). While studies show that caring for a person with MDD confers substantial strain, little is known of the additional burden of caring for persons with MDD and suicidal ideation (SI). This study examined the excess burden of caring for people with depression and SI in five major European countries. A retrospective, cross-sectional analysis of the 2020 Europe National Health and Wellness Survey (NHWS; France, Germany, Italy, Spain, UK) was conducted. Caregivers for adults with unipolar depression and SI (CAUD-SI) were compared to caregivers for adults with unipolar depression without SI (CAUD-nSI) and non-caregivers. Outcomes including health status (EuroQol 5-dimension 5-level; EQ-5D-5L), health-related quality of life (HRQoL Medical Outcomes Study Short Form [SF-12v2]), Work Productivity and Activity Impairment (WPAI), and healthcare resource utilization (HRU) were assessed. Generalized linear models adjusted for covariates and presented as marginal means±standard error (SE). 554 CAUD-SI were compared to 837 CAUD-nSI and 49,662 non-caregivers. After adjusting for covariates, CAUD-SI had significantly lower health status, HRQoL and HRU compared to non-caregivers. Compared to CAUD-nSI, CAUD-SI had significantly lower EQ-5D-5L scores (0.58±0.02 vs 0.61±0.02; p<0.019) and physical component score (PCS; SF-12v2; 42.4±0.45 vs 43.7±0.39, p=0.015). A significant increased HRU was observed for CAUD-SI compared to CAUD-nSI: healthcare provider visits (10.8±1.2 vs 9.2±1.0, p=0.022), emergency room visits (1.4±0.3 vs 0.8±0.2, p=0.002), and hospitalizations (0.8±0.1 vs 0.5±0.1, p=0.001). No significant differences were observed for indicators of WPAI for all comparison groups. The present study shows that in these five European countries, caring for persons with depression and SI is associated with an increase in the humanistic (health status and physical functioning) and economic (HRU) burden compared to caring for persons with depression without SI. Management of patients with MDD and SI should consider the additional burden on caregivers.