Psychotherapy for Depression Across Different Age Groups: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: It is not clear whether psychotherapies for depression have comparable effects across the life span. Finding out is important from a clinical and scientific perspective. Objective: To compare the effects of psychotherapies for depression between different age groups. Data Sources: Four major bibliographic databases (PubMed, PsychINFO, Embase, and Cochrane) were searched for trials comparing psychotherapy with control conditions up to January 2019. Study Selection: Randomized trials comparing psychotherapies for depression with control conditions in all age groups were included. Data Extraction and Synthesis: Effect sizes (Hedges g) were calculated for all comparisons and pooled with random-effects models. Differences in effects between age groups were examined with mixed-effects subgroup analyses and in meta-regression analyses. Main Outcomes and Measures: Depressive symptoms were the primary outcome. Results: After removing duplicates, 16 756 records were screened and 2608 full-text articles were screened. Of these, 366 trials (36 702 patients) with 453 comparisons between a therapy and a control condition were included in the qualitative analysis, including 13 (3.6%) in children (13 years and younger), 24 (6.6%) in adolescents (≥13 to 18 years), 19 (5.2%) in young adults (≥18 to 24 years), 242 (66.1%) in middle-aged adults (≥24 to 55 years), 58 (15.8%) in older adults (≥55 to 75 years), and 10 (2.7%) in older old adults (75 years and older). The overall effect size of all comparisons across all age groups was g = 0.75 (95% CI, 0.67-0.82), with very high heterogeneity (I2 = 80%; 95% CI: 78-82). Mean effect sizes for depressive symptoms in children (g = 0.35; 95% CI, 0.15-0.55) and adolescents (g = 0.55; 95% CI, 0.34-0.75) were significantly lower than those in middle-aged adults (g = 0.77; 95% CI, 0.67-0.87). The effect sizes in young adults (g = 0.98; 95% CI, 0.79-1.16) were significantly larger than those in middle-aged adults. No significant difference was found between older adults (g = 0.66; 95% CI, 0.51-0.82) and those in older old adults (g = 0.97; 95% CI, 0.42-1.52). The outcomes should be considered with caution because of the suboptimal quality of most of the studies and the high levels of heterogeneity. However, most primary findings proved robust across sensitivity analyses, addressing risk of bias, target populations included, type of therapy, diagnosis of mood disorder, and method of data analysis. Conclusions and Relevance: Trials included in this meta-analysis reported effect sizes of psychotherapies that were smaller in children than in adults, probably also smaller in adolescents, that the effects may be somewhat larger in young adults, and without meaningful differences between middle-aged adults, older adults, and older old adults.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An inverse association with age has also been found in studies on CBT-I with noncancer samples and in studies on psychotherapy for depression.
“This inverse association with age has also been found in studies on CBT-I with noncancer samples (113) and in studies on psychotherapy for depression (114).”
From Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis (2024) · cites this paper as [114]
The ‘Age as Predictor in Meta-regression Analyses’ section reports no significant association between mean age and psychotherapy effect size, contrary to the claimed inverse association. The age-group analyses also found smaller effects in youths than in adults and no clear difference between early-middle and late adults. The cited-paper passages provide no page numbers. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn older adults with depression, manual-based psychotherapeutic treatments do not show attenuated response.
“However, there is no evidence of an attenuated re sponse in older adults with depression re ceiv ing manual-based psychotherapeutic treatments 111”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [111]
The ‘Differences of Effects Across the 6 Specific Age Categories’ section reports no considerable difference in psychotherapy effect sizes between older and middle-aged adults. However, the ‘Identification and Selection of Studies’ section includes psychological treatments without requiring them to be manual-based, and the reported age comparison is not specific to manual-based treatments. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSeveral prior systematic reviews investigated the effects of psychotherapies across different age groups but did not focus exclusively on depression in older people.
“Several prior systematic reviews investigated the effects of psychotherapies across different age groups (Cuijpers 2020; Cuijpers 2023), but did not focus exclusively on depression in older people.”
From Psychotherapeutic treatments for depression in older adults (2024) · cites this paper as Cuijpers 2020
Structural brain changes are minimal during the first episode of depression, but become more evident with recurrence.
“Consistent with this, structural brain changes are minimal during the first episode of depression, but become more evident with recurrence. 489,490”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [489]
The effect of exercise is comparable to recent meta-analyses of psychotherapy (NNT 2.5 main, 3.5 low risk of bias) and medication (NNT 4.3).
“This effect is comparable to recent meta-analyses with psychotherapy revealing a NNT of 2.5 for the main analyses and 3.5 in the low risk of bias studies and for medication of 4.3.85 86”
From Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression (2023) · cites this paper as [85]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Wasserman, S. S., Hedges, L. V., & Olkin, I. (1988) · Journal of Educational Statistics · doi:10.2307/1164953 · Cited by 10,347 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
Statistical Methods for Meta-Analysis.
Freeman, P. R., Hedges, L. V., & Olkin, I. (1986) · Biometrics · doi:10.2307/2531069 · Cited by 4,832 · see citing works
Basics of meta‐analysis: <i>I</i> <sup>2</sup> is not an absolute measure of heterogeneity
Borenstein, M., Higgins, J. P. T., Hedges, L. V., & Rothstein, H. R. (2017) · Research Synthesis Methods · doi:10.1002/jrsm.1230 · Cited by 1,848 · see citing works
Effects of psychotherapy for depression in children and adolescents: A meta-analysis
Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.1.132 · Cited by 942 · see citing works
Self-citationWeisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., Jensen-Doss, A., Hawley, K. M., Krumholz Marchette, L. S., Chu, B. C., et al. (2017) · American Psychologist · doi:10.1037/a0040360 · Cited by 862 · see citing works
Self-citationCuijpers, P., Noma, H., Karyotaki, E., Cipriani, A., & Furukawa, T. A. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0268 · Cited by 539 · see citing works
Self-citationCuijpers, P., Li, J., Hofmann, S. G., & Andersson, G. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.06.001 · Cited by 383 · see citing works
Self-citationZhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., Cohen, D., Del Giovane, C., Liu, Y., Michael, K. D., et al. (2015) · World Psychiatry · doi:10.1002/wps.20217 · Cited by 322 · see citing works
Self-citationThe effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review
Cuijpers, P., Karyotaki, E., de Wit, L., & Ebert, D. D. (2020) · Psychotherapy Research · doi:10.1080/10503307.2019.1649732 · Cited by 276 · see citing works
Self-citationMeta-analysis: 13-year follow-up of psychotherapy effects on youth depression
Eckshtain, D., Kuppens, S., Ugueto, A., Ng, M. Y., Vaughn-Coaxum, R., Corteselli, K., & Weisz, J. R. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.04.002 · Cited by 224 · see citing works
Self-citationManaging depression in older age: psychological interventions
Cuijpers, P., Karyotaki, E., Pot, A. M., Park, M., & Reynolds, C. F. (2014) · Maturitas · doi:10.1016/j.maturitas.2014.05.027 · Cited by 192 · see citing works
Self-citationWeisz, J. R., Kuppens, S., Ng, M. Y., Vaughn-Coaxum, R. A., Ugueto, A. M., Eckshtain, D., & Corteselli, K. A. (2019) · Perspectives on Psychological Science · doi:10.1177/1745691618805436 · Cited by 180 · see citing works
Self-citationEuropean Psychiatric Association Guidance on psychotherapy in chronic depression across Europe
Jobst, A., Brakemeier, E., Buchheim, A., Caspar, F., Cuijpers, P., Ebmeier, K. P., Falkai, P., van der, G. R. J., Gaebel, W., Herpertz, S., et al. (2016) · European psychiatry · doi:10.1016/j.eurpsy.2015.12.003 · Cited by 143 · see citing works
Self-citationCuijpers, P. J., van Straten, A., Smit, F., & Andersson, G. (2008) · International Psychogeriatrics · doi:10.1017/s1041610208008089 · Cited by 141 · see citing works
Self-citationCuijpers, P., Cristea, I. A., Ebert, D. D., Koot, H. M., Auerbach, R. P., Bruffaerts, R., & Kessler, R. C. (2016) · Depression and Anxiety · doi:10.1002/da.22461 · Cited by 137 · see citing works
Kirkham, J. G., Choi, N., & Seitz, D. P. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4358 · Cited by 136 · see citing works
van Bronswijk, S., Moopen, N., Beijers, L., Ruhe, H. G., & Peeters, F. (2019) · Psychological Medicine · doi:10.1017/s003329171800199x · Cited by 128 · see citing works
Behavioural activation for depression in older people: systematic review and meta-analysis
Orgeta, V., Brede, J., & Livingston, G. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.117.205021 · Cited by 120 · see citing works
Pastor, D. A., & Lazowski, R. A. (2017) · Multivariate Behavioral Research · doi:10.1080/00273171.2017.1365684 · Cited by 117 · see citing works
Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence
Cuijpers, P., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1420098 · Cited by 115 · see citing works
Self-citationJonsson, U., Bertilsson, G., Allard, P., Gyllensvärd, H., Söderlund, A., Tham, A., & Andersson, G. (2016) · PLOS ONE · doi:10.1371/journal.pone.0160859 · Cited by 87 · see citing works
Zhang, A., Franklin, C., Jing, S., Bornheimer, L. A., Hai, A. H., Himle, J. A., Kong, D., & Ji, Q. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.12.008 · Cited by 83 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Self-citationMcIntyre, R. S., Alsuwaidan, M., Baune, B. T., Berk, M., Demyttenaere, K., Goldberg, J. F., Gorwood, P., Ho, R., Kasper, S., Kennedy, S. H., et al. (2023) · World Psychiatry · doi:10.1002/wps.21120 · Cited by 836 · see citing works
Li, H., Zhang, R., Lee, Y.-C., Kraut, R. E., & Mohr, D. C. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00979-5 · Cited by 598 · see citing works
“Future research is warranted, as a prior review suggests a curvilinear relationship between age and treatment effects 59 .”
Digital interventions for the treatment of depression: a meta-analytic review
Moshe, I., Terhorst, Y., Philippi, P., Domhardt, M., Cuijpers, P., Cristea, I., Pulkki-Råback, L., Baumeister, H., & Sander, L. B. (2021) · Psychological Bulletin · doi:10.1037/bul0000334 · Cited by 390 · see citing works
Self-citationHeissel, A., Heinen, D., Brokmeier, L. L., Skarabis, N., Kangas, M., Vancampfort, D., Stubbs, B., Firth, J., Ward, P. B., Rosenbaum, S., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106282 · Cited by 449 · see citing works
Psychological Treatment of Depression in Primary Care: Recent Developments
Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1117-x · Cited by 296 · see citing works
Self-citationRandomized Trial of a Generative AI Chatbot for Mental Health Treatment
Heinz, M. V., Mackin, D. M., Trudeau, B. M., Bhattacharya, S., Wang, Y., Banta, H. A., Jewett, A. D., Salzhauer, A. J., Griffin, T. Z., & Jacobson, N. C. (2025) · NEJM AI · doi:10.1056/aioa2400802 · Cited by 287 · see citing works
Zhang, R., Peng, X., Song, X., Long, J., Wang, C., Zhang, C., Huang, R., & Lee, T. M. C. (2023) · Psychological Medicine · doi:10.1017/s0033291722000241 · Cited by 174 · see citing works
Gadot, R., Najera, R., Hirani, S., Anand, A., Storch, E., Goodman, W. K., Shofty, B., & Sheth, S. A. (2022) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2021-328738 · Cited by 148 · see citing works
Cuijpers, P., Karyotaki, E., Ciharova, M., Miguel, C., Noma, H., Stikkelbroek, Y., Weisz, J. R., & Furukawa, T. A. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01884-6 · Cited by 118 · see citing works
Self-citationEgan, S. J., Rees, C. S., Delalande, J., Greene, D., Fitzallen, G., Brown, S., Webb, M., & Finlay-Jones, A. (2022) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01170-2 · Cited by 140 · see citing works
Domhardt, M., Steubl, L., Boettcher, J., Buntrock, C., Karyotaki, E., Ebert, D. D., Cuijpers, P., & Baumeister, H. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101953 · Cited by 106 · see citing works
Self-citationPsychological treatment of perinatal depression: a meta-analysis
Cuijpers, P., Franco, P., Ciharova, M., Miguel, C., Segre, L., Quero, S., & Karyotaki, E. (2023) · Psychological Medicine · doi:10.1017/s0033291721004529 · Cited by 103 · see citing works
Self-citationCuijpers, P., Pineda, B. S., Ng, M. Y., Weisz, J. R., Muñoz, R. F., Gentili, C., Quero, S., & Karyotaki, E. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.11.024 · Cited by 102 · see citing works
Self-citationDomhardt, M., Messner, E.-M., Eder, A.-S., Engler, S., Sander, L. B., Baumeister, H., & Terhorst, Y. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00401-6 · Cited by 43 · see citing works
Nissen, E. R., Neumann, H., Knutzen, S. M., Henriksen, E. N., Amidi, A., Johansen, C., von Heymann, A., Christiansen, P., & Zachariae, R. (2024) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkae041 · Cited by 46 · see citing works
“This inverse association with age has also been found in studies on CBT-I with noncancer samples (113) and in studies on psychotherapy for depression (114).”
ResultVollbehr, N. K., Hoenders, H. J. R., Bartels-Velthuis, A. A., Nauta, M. H., Castelein, S., Schroevers, M. J., Stant, A. D., Albers, C. J., de Jong, P. J., & Ostafin, B. D. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000777 · Cited by 26 · see citing works
Ng, M. Y., DiVasto, K. A., Cootner, S., Gonzalez, N.-A.-R., & Weisz, J. R. (2023) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12367 · Cited by 25 · see citing works
Self-citationRasing, S. P. A., Stikkelbroek, Y. A. J., den Hollander, W., Riper, H., Deković, M., Nauta, M. H., Creemers, D. H. M., Immink, M. C. P., Spuij, M., & Bodden, D. H. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063102 · Cited by 21 · see citing works
Ahmad Othman, A., Wan Jaafar, W. M., Zainudin, Z. N., & Yusop, Y. M. (2024) · Current Psychology · doi:10.1007/s12144-023-05064-4 · Cited by 4 · see citing works
McAlister, K. L., Baez, L., Newton, D., Seiniger, S., Pearlman, A., Woodhouse, A., & Huberty, J. (2025) · Journal of Medical Internet Research · doi:10.2196/75750 · Cited by 2 · see citing works
“Older adults may experience a slower response to psychotherapy due to factors such as longer illness duration, differences in cognitive flexibility, or variations in engagement with DMHIs [55].”
Psychotherapeutic treatments for depression in older adults
Ang, L., Lee, M. S., Song, E., Lee, H. W., Cao, L., Zhang, J., Wang, Q., Jung, J., Jang, S., Gastaldon, C., et al. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015976
Self-citation
- Authors
- Cuijpers, P., Karyotaki, E., Eckshtain, D., Ng, M. Y., Corteselli, K. A., Noma, H., Quero, S., & Weisz, J. R.
- Affiliations
- Amsterdam Public Health (NL)
- Harvard University (US)
- Florida International University (US)
- The Institute of Statistical Mathematics (JP)
- Universitat Jaume I (ES)
- Corresponding author
- Cuijpers, Pim
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2020-07-01
- Volume
- 77
- Issue
- 7
- Pages
- 694
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC7081149
- OpenAlex
- W3012444575
- Cited by
- 429
- References
- 27
- Citations by year
- 2026: 62 · 2025: 71 · 2024: 107 · 2023: 70 · 2022: 61 · 2021: 42 · 2020: 14 · 2019: 1 · 2012: 1
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, psychotherapy, age differences, lifespan, children, adolescents, young adults, middle-aged adults, older adults, depressive symptoms, treatment effect heterogeneity, subgroup analysis, meta-regression
- MeSH terms
- Adolescent, Adult, Aged, Child, Depression, Depressive Disorder, Humans, Middle Aged, Psychotherapy, Outcome Assessment, Health Care, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
