Cited by 153Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

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Effect of psychotherapy for depression on quality of life: meta-analysis

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Kolovos, Spyros, Kleiboer, Annet, Cuijpers, Pim·2016·British Journal of Psychiatry

DOI 10.1192/bjp.bp.115.175059

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Abstract

Background: Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown. Aims: To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL. Method: We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment. Results: We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24–0.42) for global QoL, a moderate effect size for the mental health component ( g = 0.42, 95% CI 0.33–0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component ( g = 0.16, 95% CI 0.05–0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component. Conclusions: Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.

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Morton, E. E., Michalak, E. E., LEVITT, A. J., Levitan, R. D., Cheung, A., Morehouse, R. L., Ramasubbu, R., Yatham, L. N., Tam, E. M., & Lam, R. W. M. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720936470 · Cited by 11
“Further, a meta-analysis of the impact of psychotherapy showing that across studies, improvements in QoL were not fully explained by reduction in depressive symptom severity.(34) It is therefore important for trials of light therapy in nonseasonal MDD to explore additional predictors of change in QoL to better target…”
Background
Determinants of quality of life improvements in anxiety and depressive disorders—A longitudinal study of inpatient psychotherapy
Freidl, M., Wegerer, M., Litvan, Z., König, D., Alexandrowicz, R. W., Millinger, F. P., & Gruber, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.937194 · Cited by 10
Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes.
McPherson, S., & Senra, H. (2022) · Psychotherapy · doi:10.1037/pst0000448 · Cited by 10
“A previous meta-analysis of 44 trials of psychotherapy for depression reporting quality-of-life data included waitlist or placebo control studies of psychotherapy but excluded studies likely to fall into the category of persistent depression (Kolovos et al., 2016).”
BackgroundMethod
Long-term effectiveness of two models of brief psychotherapy for depression: A three-year follow-up randomized clinical trial
dos Santos, É. N., Molina, M. L., Mondin, T. C., Cardoso, T. D. A., da Silva, R. A., Souza, L. D. D. M., & Jansen, K. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112804 · Cited by 9
Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study
Machado, R. D. S., Vieira, I. S., Scaini, C. R., Molina, M. L., Barbosa, L. P., da Silva, G. D. G., Ores, L. D. C., Souza, L. D. D. M., Jansen, K., & da Silva, R. A. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.141 · Cited by 9
What does “Staying well” After depression mean? Chronic low grade symptomatology after treatment for depression is common
Strege, M. V., Richey, J. A., & Siegle, G. J. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.075 · Cited by 8
The Long-Term and Mediating Effects of Mindfulness Integrated with Body-Mind-Spirit Group Therapy on Depressive Symptoms and Quality of Life Among Non-small Cell Lung Cancer Patients
Hsiao, F., Lin, Z., Huang, F., Lai, Y., Chen, Y., Shih, J.-Y., Ho, C., Yu, C., & Hsieh, C. (2021) · Mindfulness · doi:10.1007/s12671-021-01793-4 · Cited by 8
“A meta-analysis demonstrated psychotherapy for depression is related to further QOL improvements (Kolovos et al., 2016).”
Background
Efficacy of internet-based cognitive behavioral and interpersonal treatment for depression in Arabic speaking countries: A randomized controlled trial
El‐Haj‐Mohamad, R., Stein, J., Stammel, N., Nesterko, Y., Wagner, B., Böttche, M., & Knaevelsrud, C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.080 · Cited by 9
Discrepancies between self- and observer-rated depression severities in patients with major depressive disorder associated with frequent emotion-oriented coping responses and hopelessness
Tsujimoto, E., Tsujii, N., Mikawa, W., Ono, H., & Shirakawa, O. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s175973 · Cited by 11
“37,38 Our results also confirmed that patients with MDD rarely use task-oriented coping and emphasized the frequent use of emotion-oriented coping, at least in patients with a rating discrepancy.”
A network approach to investigating the inter-relationship between health-related quality of life dimensions and depression in 1735 Chinese patients with heterogeneous cancers
Muhetaer, S., Mijiti, P., Aierken, K., Ziyin, H., Talapuhan, W., Tuoheti, K., Lixia, Y., Qi, S., & Jingjing, W. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1325986 · Cited by 7
“Furthermore, our study showed that the severity of depression was associated with almost all dimensions (symptoms/functions) of HRQOL in cancer patients except diarrhea; this was similar to results in previous studies (9, 40, 41).”
Result
MENTAL DISORDERS AND CARDIOVASCULAR DISEASES: GUIDELINES OF THE BAIKAL PSYCHOSOMATIC ASSOCIATION AND THE SIBERIAN PSYCHOSOMATIC ASSOCIATION
Fi, B., Sumin, A. N., Garganeeva, N. P., Ларева, Н. В., Петрова, М. М., Петрунько, О. В., Попонина, Т. М., Repin, A. N., & Собенников, В. С. (2024) · Complex Issues of Cardiovascular Diseases · doi:10.17802/2306-1278-2024-13-3s-222-253 · Cited by 8
Change in symptomatic burden and life satisfaction during short‐term psychotherapy: Focusing on the role of family income
Behn, A. J., Errázuriz, P., Cottin, M., & Fischer, C. (2017) · Counselling and Psychotherapy Research · doi:10.1002/capr.12158 · Cited by 7
First epileptic seizure and quality of life – A prospective study
Linka, L., Nephuth, S., Gorny, I., Krause, K., Mross, P. M., Tsalouchidou, P., Zahnert, F., Fuest, S., Menzler, K., Knake, S., et al. (2024) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2024.109704 · Cited by 6
“Apart from ASM and seizure frequency [1], depression appears to be one specific major predictor of QoL perception, not only in various population studies[11,12], but also in PWE.”
Background
Psychological factors and obesity, not thyroid biomarkers, predict thyroid-dependent quality of life in treated hypothyroidism: a cross-sectional study
Bakos, B., Solymosi, T., Szili, B., Vincze, Á., Mészáros, S., Stempler, M., Armos, R., Kiss, A., Bakos, A., Szücs, N., et al. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-025-01962-9 · Cited by 8
“Depression and negative affective state are well recognized contributors of decreased quality of life, and treatment of depressive disorders has been shown to carry some benefits in terms of QoL [51].”
The Mindful Compassion Program Integrated with Body-Mind-Spirit Empowerment for Reducing Depression in Lung Cancer Patient-Caregiver Dyads
Hsiao, F., Ho, C., Yu, C., Shih, J.-Y., Lin, Z., Huang, F., Chen, Y., & Hsieh, C. (2025) · Psychosocial Intervention · doi:10.5093/pi2025a1 · Cited by 5
Antidepressant activity of Riparin A in murine model
da Silva, C. P., Oliveira, D. D., Benincasa, B. I., Barbar, B., Facchin, A. L., & Beleboni, R. O. (2021) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000654 · Cited by 5
“Pathological anxiety is frequently associated as a comorbidity with depression, causing additional negative impacts on the already compromised quality of life of depressed patients (Kolovos et al., 2016; Heeren et al., 2018).”
Background
Effects of Psychotherapy on Quality of Life in End-stage Renal Disease Patients: A Systematic Review with Meta-analysis
Phang, K., Latif, A. A. L. A., Lee, K. W., Ching, S. M., & Ooi, P. B. (2021) · Oman Medical Journal · doi:10.5001/omj.2021.88 · Cited by 5
Storytelling and training to advance individual recovery skills (STAIRS). A feasibility study of a blended program to support personal recovery among patients with a major depressive disorder in remission
Wedema, D., Siero, J., Korevaar, E. L., Wardenaar, K. J., Alma, M., & Schoevers, R. A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.984104 · Cited by 5
Exploring Novel Therapeutic Approaches for Depressive Disorders: The Role of Allopregnanolone Agonists
Bhatti, N. A., Jobilal, A., Asif, K., Villegas, M. J., Pandey, P., Tahir, A. N., Balla, N. V. D. B., Camargo, M. P. A., Ahmad, S., Kataria, J., et al. (2023) · Cureus · doi:10.7759/cureus.44038 · Cited by 6
Depression mediates the relationship between social capital and health‐related quality of life among Chinese older adults in the context of the COVID‐19 pandemic: A cross‐sectional study
Ping, Z., Liu, X., Zhang, R., & Xia, N. (2023) · Nursing Open · doi:10.1002/nop2.1904 · Cited by 4
National Survey of US HIV Clinicians: Knowledge and Attitudes About the Affordable Care Act and Opinions of its Impact on Quality of Care and Barriers to Care
McManus, K. A., Ferey, J. C. M., Farrell, E. A., & Dillingham, R. (2020) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaa225 · Cited by 5
Emotion-Based Interventions for Clinicians
Stevens, F. L. (2022) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-022-09546-7 · Cited by 4
“While both psychodynamic and CBT have been found to be effective treatments, the effect size of these treatment approaches is still relatively low (Cuijpers et al., 2010; Renner et al., 2014; Kolovos et al., 2016).”
Background
A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China
Sit, H. F., Li, G., Chen, W. L., Sou, E. K. L., Wong, M., Burchert, S., Hong, I. W., Sit, H. Y., Lam, A. I. F., & Hall, B. J. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100579 · Cited by 4
Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial
Davis, C. H., Donahue, M. L., Gaudiano, B. A., Uebelacker, L. A., Twohig, M. P., & Levin, M. E. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2265560 · Cited by 7
“This result adds to a growing body of evidence that psychosocial treatments for depression can produce meaningful improvements in patient quality of life (Kolovos et al., 2016) when antidepressants alone cannot.”
Result
The effects of mindfulness-focused internet-based cognitive behavioral therapy on elevated levels of stress and symptoms of exhaustion disorder: A randomized controlled trial
Vernmark, K., Hursti, T. J., Blom, V., Asplund, R. P., Nathanson, E., Engelro, L., Radvogin, E., & Andersson, G. (2024) · Clinical Psychology in Europe · doi:10.32872/cpe.12899 · Cited by 4
“The significant small to moderate effect on quality of life is in line with the effects usually obtained in CBT-studies on this measure ( Kolovos et al., 2016).”
Probiotics in Depression Management: Efficacy, Mechanisms and Future Directions
Lee, L. (2025) · Progress In Microbes & Molecular Biology · doi:10.36877/pmmb.a0000459 · Cited by 4
Quality of Life Outcomes in Internet-Delivered (Space from Depression) Treatment for Depression
Enrique, Á., Burke, J., Richards, D., & Timulák, L. (2018) · Applied Research in Quality of Life · doi:10.1007/s11482-018-9654-8 · Cited by 4
Terapia cognitivo-conductual transdiagnóstica en Atención Primaria: un contexto ideal
González‐Blanch, C., Ruiz-Torres, M., Cordero‐Andrés, P., Umaran‐Alfageme, O., Hernández-Abellán, A., Muñoz‐Navarro, R., & Vindel, A. C. (2018) · Revista de Psicoterapia · doi:10.33898/rdp.v29i110.243 · Cited by 5
Quality-of-life measurement in depression trials: A consumerist relic
McPherson, S., Oute, J., & Speed, E. (2022) · Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine · doi:10.1177/13634593221074887 · Cited by 4
“The results indicate that QoL and depressive symptoms are two different constructs, and thus QoL could be assessed as an additional treatment outcome (Kolovos et al., 2016: 466).”
Background
A Retrospective Case–Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication
Ikawa, H., Takeda, Y., Osawa, R., Sato, A., Mizuno, H., & Noda, Y. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13020399 · Cited by 4
“…in addition to antidepressant treatment, psychotherapy, including cognitive behavioral therapy (CBT), is regarded as an effective treatment for MDD [33,34], and it has been reported that a combination of antidepressants and psychotherapy is clinically the most effective treatment for patients with…”
BackgroundMethodInfluential
Impacts on Quality of Life with Escitalopram Monotherapy and Aripiprazole Augmentation in Patients with Major Depressive Disorder: A CAN-BIND Report
Morton, E. E., Bhat, V., Giacobbe, P., Lou, W. Y. W., Michalak, E. E., Chakrabarty, T., Frey, B. N., Milev, R. V., Müller, D. J., Parikh, S. V., et al. (2021) · Pharmacopsychiatry · doi:10.1055/a-1385-0263 · Cited by 4
“Taken together, these findings add to a growing body of evidence supporting that changes to depressive symptoms under treatment (whether psychotherapy or pharmacotherapy) do not fully explain QoL outcomes [3, 13, 45, 46].”
Background
Health-related quality of life of people with depression: pre-post intervention compared with age-matched general population in Vietnam
Hoa, T. T. M., Ngan, T. T., Mai, V. Q., Minh, H. V., Thu, N. K., & Tran, N. K. (2024) · BMC Psychology · doi:10.1186/s40359-024-02067-z · Cited by 3
“A meta-analysis exploring the effect of psychotherapy for depression showed that psychotherapy for depression has a positive impact on HRQoL with a small to moderate effect size (Hedges’ g = 0.33) [25].”
Influential
Quality of Life in Mental Disorders
Enea, V., & Diaconu‐Gherasim, L. R. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_2 · Cited by 3
The Influence of Acceptance and Commitment Therapy on Depression and Quality of Life among Emerging Adults in Malaysia
Othman, A. A., Jaafar, W. M. W., Zainudin, Z. N., & Yusop, Y. M. (2024) · International Journal of Academic Research in Business and Social Sciences · doi:10.6007/ijarbss/v14-i3/21035 · Cited by 3
“Kolovos et al. (2016) suggested that since depression and quality of life are two different constructs, the absence or reduction in depression does not always reflect an improvement in quality of life, or vice versa.”
Background
Presence of Persistent Parent Reported Emotional and Behavioral-Related Concussion Symptoms Is Associated with Lower Health-Related Quality of Life in Adolescent Athletes
Callahan, C. E., Bloom, J., Fonseca, J. C., Ramsey, K., Maio, V. J. D., Deichmeister, M., & Register‐Mihalik, J. K. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2021.0398 · Cited by 4
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Depressive Symptoms and Their Association With Quality of Life in Older Adults With Cataracts: A National Survey in China
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“Previous research has found that effective interventions for depression are associated with an improvement in QoL [12], which not only reflects the relationship between depression and QoL, but also indicate that adequate management of depression can enhance life satisfaction and overall well-being…”
Discriminant analysis of occupational performance characteristics in patients with major depressive disorders and healthy individuals
Hayasaka, T., Nagashima, I., Hoshino, M., Teruya, K., Matumoto, Y., Murao, M., Maruki, T., Watanabe, M., Katagiri, T., Imamura, Y., et al. (2024) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70038 · Cited by 2
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Balancing Access to Medications and Psychosocial Treatments
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Efficacy of a Functional Therapy Program for Depression and C-Reactive Protein: A Pilot Study.
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“…efficacy of a three months structured program of FT for depression and its psychological correlates, therefore confirming the role of psychotherapy for improving mood (Cuijpers et al., 2020; Carletto et al., 2017) as well as self‐esteem (Ko & Hyun, 2016) and quality of life (Kolovos et al., 2016).”
Background
Antidepressants after stroke and patient centered care: An oxymoron
Braillon, A. (2019) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2019.04.050 · Cited by 2
Comment on: "Should Antidepressants be Avoided in Pregnancy?"
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Modifiable risk factors for comorbid complications in male patients of a therapeutic clinic
Валерьевна, Я. С., Shamsutdinova, Z. A., & Selyatitskaya, V. G. (2021) · Russian Journal of Preventive Medicine · doi:10.17116/profmed20212408149 · Cited by 1

Authors: Kolovos, S., Kleiboer, A., & Cuijpers, P.
Affiliations: Leuphana University of Lüneburg (DE)
Utrecht University (NL)
Corresponding author: Kolovos, Spyros
ORCID: Kolovos, Spyros
Kleiboer, Annet
Cuijpers, Pim
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2016-12
Volume: 209
Issue: 6
Pages: 460-468
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.115.175059
OpenAlex: W2510438371
Cited by: 153
References: 85
Citations by year: 2026: 9 · 2025: 21 · 2024: 19 · 2023: 25 · 2022: 19 · 2021: 15 · 2020: 12 · 2019: 11 · 2018: 10 · 2017: 10 · 2016: 2
FWCI: 1.63
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 397 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Multilingual Matters (Channel View Publications) (submittedVersion, other-oa)
VU Research Portal (submittedVersion, 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
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: psychotherapy, depression, quality of life, mental health, physical health, depression severity, treatment effectiveness
MeSH terms: Depression, Depressive Disorder, Humans, Psychotherapy, Quality of Life, Outcome Assessment, Health Care

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Effect of psychotherapy for depression on quality of life: meta-analysis

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