What Helps and Hinders Recovery from Depression? A Systematic Review and Qualitative Evidence Synthesis of Patient-Identified Recovery Factors

Abstract

Introduction

Depression is a common mental disorder with often persistent consequences. Even after adequate treatment, recovery may be far from optimal. To enhance outcomes, we aimed to identify and synthesize factors that depressed adults themselves perceived as facilitating or hindering recovery.

Methods

We searched PubMed, PsycINFO, and SocINDEX (last search: February 2, 2025), screened reference lists, and consulted experts. Eligible studies used a qualitative design, published in English or Dutch since 1980, and explored recovery factors in adults (≥18 years) with depression.

Results

From 4,872 records, 3,394 were screened on title and abstract, and 122 on full text. Twenty-seven articles were eligible and included in the qualitative evidence synthesis. These articles described the experiences with recovery from depression of 939 individuals. Most studies were conducted in Europe (N = 11), followed by North America (N = 7), Asia (N = 6), Australia (N = 5), and South America (N = 2). Eight overarching themes emerged: (1) social connections, (2) reconstructing the self, (3) autonomy, (4) professional support, (5) self-management strategies, (6) physical health, (7) instrumental facilitators/barriers, and (8) temporal dimensions. We present an overview of the relative importance of factors and propose a conceptual model illustrating the interconnectedness of themes.

Conclusion

Recovery from depression involves a diverse range of interconnected factors. While professional treatment is considered valuable, various other factors also influence individuals’ recovery. Our findings underscore the need for an integrated and person-centred approach that combines therapeutic support with personal capacities, self-management strategies, and contextual aspects, emphasizing relational quality, self-reflection, and open dialogue, to optimize subjectively experienced recovery.

Plain Language Summary

Depression is a common mental health condition that can have long-lasting effects. Even after receiving treatment, many people do not feel fully recovered. This literature review looked at studies that explored what individuals themselves said helped or hindered their recovery from depression. Because recovery can mean more than just reducing symptoms, we focused on what individuals personally experienced as recovery. We included studies that did not use predefined clinical measures but instead asked individuals to describe what they found important in their recovery. We found 27 articles, reporting on 939 adults from different parts of the world who had experienced partial or full recovery from depression. Across the described studies, 134 different recovery factors were mentioned, highlighting diverse influences on individuals’ recovery processes. Our analysis revealed eight main themes of factors: (1) social connections (support from family, friends, and others), (2) reconstructing the self (how people see and value themselves), (3) autonomy (feeling in control of one’s life), (4) professional support (help from doctors, therapists, or other professionals), (5) self-management strategies (personal ways of coping, such as exercise or journaling), (6) physical health (the impact of physical well-being on mental health), (7) instrumental factors (practical issues like housing or money), and (8) temporal dimensions (time and course of depression). The identified recovery factors are often interconnected and vary in importance for each person. This review highlights the need for a person-centred approach that combines therapeutic support with personal capacities, self-management strategies, and life context to foster subjectively experienced recovery.

Introduction

Depression affects over 280 million people worldwide, a number expected to rise in the coming years [1]. Between 1990 and 2021, the number of healthy life years lost due to depression rose by 28.3%, making it the second most burdensome disease globally today [2]. Depression causes a wide range of disabling consequences, including emotional, cognitive, and physical symptoms, as well as difficulties in daily life, social interactions, and work functioning [3]. Contributing further to its burden is the association between depression and (severe) physical diseases [4, 5]. While treatment often alleviates symptoms, its impact on overall functioning seems limited [6, 7], with many individuals experiencing persistent functional impairments or a rapid decline in functioning after treatment [8]. Furthermore, the recurrent nature of depression [9] contributes to its lasting impact, profoundly affecting individuals’ quality of life [10]. Therefore, gaining a deeper understanding of the factors that facilitate or hinder recovery is essential.

A key challenge in studying recovery is its definition. Traditionally, it is defined as the phase when symptom severity gets below a predefined numeric threshold [11], commonly referred to as “clinical recovery.” Although this remains an important outcome in clinical research and practice, studies have shown that individuals and clinicians differ in the outcomes they prioritize. For example, clinicians tend to emphasize symptom reduction, while individuals with depression often value broader aspects such as regaining meaningful roles in life, restoring relationships, improving physical health, and the ability to manage day-to-day challenges [12–15]. These differing perspectives add complexity to the concept of recovery and underscore the need for approaches that better reflect what individuals themselves consider important. Following the growing recognition that the concept of recovery extends beyond symptom reduction and varies between individuals [16, 17], increased emphasis is given to a broader definition of recovery, known as “personal recovery.” This is described by Anthony (1993) as a complex, personal journey toward a fulfilling life despite ongoing difficulties [18]. Key elements to facilitate personal recovery are described by Leamy et al. [19] in their widely cited CHIME framework. According to this conceptual framework, for individuals to recover, they need connectedness, hope, identity, meaning, and empowerment. Although this framework offers a valuable foundation for understanding personal recovery, further insight is needed into the specific concrete factors that individuals, who experienced recovery, identify as important in their recovery process.

Given the subjective nature of recovery, the perspectives of individuals with lived experience are crucial to identify what has helped or hindered their recovery [3, 20]. However, research on depression recovery has largely relied on quantitative symptom measures [7], mostly assessing treatment effects based on predefined criteria [21]. While treatment clearly plays a very important role, a narrow focus only looking at therapy and its ingredients neglects other potentially influential factors. The importance of incorporating individuals’ perspectives is also emphasized in previous qualitative syntheses, which have highlighted that recovery requires individuals to be actively involved in defining their goals, with personal context shaping both the meaning and process of recovery [22, 23]. However, no prior synthesis has focused specifically on self-reported facilitating and hindering factors described by individuals who have recovered from depression.

To address this knowledge gap, this review aimed to systematically identify and synthesize the factors that individuals, who have experienced depression themselves identified as influencing their recovery, without using predefined recovery definitions or measures. To capture these deeply personal experiences, we focused specifically on qualitative studies, as they are best suited to explore such subjective experiences [24]. Drawing on existing literature about mental health recovery, we hypothesized that facilitators of recovery would include factors related to social support, gaining a sense of control, developing a new identity, and receiving specific treatments. Conversely, we expected that barriers would include the absence of these facilitators, as well as experiences of stigma, self-blame, and comorbid physical illnesses. Based on the findings of this review, we aimed to gain insights that can inform more person-centred approaches to mental health care and research.

Methods

Search Strategy and Selection Criteria

This systematic review was conducted in accordance with PRISMA guidelines [25], using a registered protocol (PROSPERO: CRD42024595180). The completed PRISMA checklist is provided in the online supplementary Table A.1, A.2 (for all online suppl. material, see https://doi.org/10.1159/000548808). All procedures followed the registered protocol without deviations. We included articles describing qualitative studies that focused on first-person perspectives of factors perceived as either facilitating or hindering recovery from depression. Articles were identified through systematic searches of PubMed, PsycINFO, and SocINDEX, as well as reference list screening and expert consultation. Articles were eligible if published after 1980, focused on depression as the primary area if concern, and included participants aged 18 years or older. Articles describing studies on bipolar disorder, specific subtypes of depression (e.g., seasonal or postpartum), or cases where depression was secondary to another condition (e.g., cardiac disease) were excluded. Online supplementary Section B (pp. 6–9) provides a detailed description of the search strategy and selection criteria, and online supplementary Table C.1 (pp. 10–16) lists the full-text articles excluded after screening, along with reasons for exclusion.

Data Analysis

Risk of bias was assessed using an optimized version of the Critical Appraisal Skills Programme (CASP) qualitative checklist [26]. As proposed by Boeije et al. [27], we applied a three-point scale (0: no, 1: somewhat, 2: yes) across the checklist items. Two reviewers (D.W. and J.H.M.H.-H.) independently scored each of the checklist’s ten items: a score of 2 was assigned when an item was fully addressed, 1 when partially addressed, and 0 when not addressed. After independent scoring, the reviewers compared their assessments and resolved any discrepancies through discussion until consensus was reached. Based on the item scores, each article received an overall quality score ranging from 0 to 20, with scores categorized as follows: good quality (15–20), fair quality (8–14), and poor quality (<8). Online supplementary Section D (pp. 17–19) provides a detailed description of the CASP checklist, along with the assigned scores to each included article (online suppl. Table D.1).

Data synthesis followed an inductive approach, using thematic synthesis as described by Thomas and Harden [28]. This involved three stages: (1) line-by-line coding of key findings in an iterative process, allowing for recoding as new codes emerged; (2) grouping codes into descriptive themes; and (3) developing overarching analytical themes. Two reviewers (D.W. and J.H.M.H.-H.) independently categorized themes, compared interpretations, and reached consensus through discussion. The results sections of the included articles were imported into ATLAS.ti (v25) for coding, using the codes developed in the second stage. This facilitated the examination of the relative importance of each code (based on frequency of mention), refinement of analytic themes, and exploration of interconnections between themes.

Results

The selection process is outlined in Figure 1. After screening 4,872 records, 27 reports were included, describing in depth research into the recovery experiences of 939 individuals with a depressive disorder (Table 1). An overview of participants’ characteristics is provided in the online supplementary Table E.1 (p. 20).

Fig. 1.

PRISMA flow diagram of article selection.

Table 1.

Characteristics of included articles

Author(s)	Aim of study	Sample	Identified helping and hindering factors (as described in the results)	Study qualitya
Amini et al. [29] (2019)	To explore the process of recovery from MDD within an Iranian sociocultural context	20 patients from a psychiatric hospital, private clinic and a psychiatric clinic in the Zanjan province in Iran, who experienced their first episode of MDD and had partially or fully recovered	Helping strategies: consciously deciding to fight depression, reconnecting with god and spirituality, seeking help from others, psychiatric referral, attempting to adopt a realistic and positive attitude, closely adhering to medical prescription, making use of nursing therapy and support, communicating with other patients, using complementary therapies, employing strategies for coping with multiple coincident stressors, and attending educational and skill development programs Counterproductive strategies: can be passive (e.g., doing nothing, and excessive sleeping) or active (e.g., self-stigmatization and self-blaming, excessive crying, projection, and changing the physician) Contextual factors (hindering): poverty, lack of access to or inefficient health-care systems, perceived support, feelings of failure, and social stigma	14, fair
		N male: 7 (35%)
		Mean age 37.1 (range 18–70)
Badger and Nolan [30] (2005)	To establish what participants believed helped them during their depression, to identify the factors to which they attributed their recovery, and to explore their reflections on the experience of depression	60 patients from four GP practices in the West Midlands (UK), who received a prescribed antidepressant for a new episode of unipolar depression in the preceding 12 months and had been cared for in primary care	Personal factors: support from family and friends, self-determination, willpower, and personal strengths Employment and leisure: gaining or leaving employment, sport, and voluntary work or study Information: about depression, the commonness of it and that recovery is expected Health service practitioners and treatment: medication, practitioners who acknowledged and encouraged people’s roles in recovery, and supported multifaceted care Self-chosen treatments: over the counter treatments, complementary or alternative therapies Time: passage of time, timeliness of interventions, and setting realistic time-limited personal targets Turning points: receiving a diagnosis, and understanding health professionals Multifactorial nature of recovery: sufficient degree of choice during the course of treatment Taking stock: reflection on the experience of depression, accepting necessary life changes, and shifting ones view on the depression	17, good
		N male: 23 (38.3%)
		Mean age 46.7 (range 24–68)
Brijnath [31] (2015)	To examine how two culturally diverse groups, based in the community conceptualize recovery from depression	58 MDD patients from community and primary care settings in Melbourne (Australia), of which 30 were Anglo-Australians and 28 Indian-Australians	Connectedness: connection to oneself and feeling part of the world were supported by leisure activities, hobbies, and social or community engagement. Stigma was a hindering factor Hope: positive thinking, belief in the possibility of recovery, hope-inspiring relationships and having dreams Identity: medication can change the way someone sees himself, both positively (e.g., by improving ones mood) and negatively (e.g., by making one feel not as his self or making one feel dependent of medicines) Meaning: spiritual or religious activities, a diagnostic label, and discovering inner strength Empowerment: taking control and being personally accountable, and being socio-economically stable	11, fair
		N male: 23 (39.7%)
		Mean age 39.6 (SD 15.8)
Cartwright et al. [32] (2018)	To understand how the experiences of antidepressant use and other practices promote or diminish women’s sense of agency in regard to their recovery from depression	50 women, recruited from a large anonymous online survey about antidepressant use in Australia, who had experiences with antidepressants	The main focus in this article is on the use of antidepressants. Results show that these can both promote agency (by alleviating symptoms) and diminish agency (caused by side effects, sense of dependency and beliefs about ones own abnormality) Personal activities and practices that participants believed to promote recovery were: exercise or other physical activities, having a healthy diet, social support from family, friends or partner, engaging in yoga, meditation or mindfulness and engaging in therapy	12, fair
		Mean age: 44.5 (range 27–63)
Chambers et al. [33] (2015)	To understand how people with longer term depression manage the condition, how services can best support self-management and whether the recovery approach is a useful concept	21 patients from primary, secondary, and voluntary services in South Yorkshire (UK), with longer term depression	Experience of depression: (differences in) the course of depression, episodic or chronic nature The self: hope, confidence and motivation are key. Social connections and meaningful activities foster hope. Long-term depression reduces confidence; rebuilding it involves social engagement and confidence. Motivation is driven by rewards. Positive self-identity aids coping Wider environment: empathetic professionals build trust, while rigid services reduce effectiveness. Stigma impedes service use. Peer-shared, timely information is beneficial Self-management strategies: holistic, individualized approaches matter. Choice, control, and routine support self-management. Activities like exercise, nature engagement, socializing, and interacting with animals are helpful	20, good
		N male: 6 (28.6%)
		Mean age: not specified (range 18–75+)
Chan et al. [34] (2020)	To explore Malaysian young adults’ perceptions of personal healing factors that were contributing to their recovery from MDD.	9 young adults from public hospitals in Perak and Kuala Lumpur (Malaysia), who had recovered from MDD within the past year	Supportive relationships: supportive significant other, family support, and social support Medication: regular use of antidepressants Counselling: learning self-care strategies, expressing problems, emotions and struggles, and active participation Religion and spirituality: believing in god, religious guidance, and prayer and meditation Caring for others: helping others, doing charity, and experiencing mutual support Employment: progression in career, achieving milestones, and having financial security	16, fair
		N male: 1 (11.1%)
		Mean age: 29.1 (range 24–37)
Chuick et al. [35] (2009)	To explore men’s experiences of depression	15 males from the community of Iowa (USA), who had been diagnosed with and treated for depression within the prior 5 years	Maladaptive coping: substance abuse, infidelity, isolation, denial, avoidance, focusing excessively on work Adaptive coping: key factor for more sustained recovery was taking responsibility for resolving ones issues, which can be increased by sufficient access to treatment and recognition in others with similar struggles Helpful treatment includes psychotropic medications, individual therapy, couple’s therapy, group therapy, and religious counselling	15, fair
		Mean age: 44.6 (range 24–75)
Doherty et al. [36] (2016)	To explore elite male athlete’s experiences of depression during their sporting careers	8 male elite athletes from North America, Australia/Oceania, Ireland, and the UK, who had previously publicly self-disclosed as having had depression	Maladaptive responses and barriers to recovery: isolating self from social support, using alcohol, lack of available psychological support or understanding of depression from others, not being listened to and the lack of collaboration in first experience of treatment, dealing with publicity and the continued expectations from elite sport and overtraining Adaptive processes and turning points in recovery: separate from elite sport environment, taking personal responsibility by using ones sporting characteristics (e.g., focus and motivation) to commit to recovery, experiencing acceptance and expressing real self in therapeutic relationship, and support from significant others The process of recovery and transitions within the self: being less defined by sport, broadening identity, and adopting self-care, developing intrinsic motivation an internal locus of evaluation and falling in love with sport again, coming out and gaining self-acceptance in sport and society	14, fair
		Mean age: 40.4 (range 22–65)
Fernández et al. [37] (2023)	To characterize the subjective experience of recovery from depression based on the perspective of those who suffer from it	40 patients from mental health institutions, university-based centres, and private practice psychologists in Chile and Colombia, who had been or were currently being treated for depression	Personal: an attitude of involvement and commitment towards treatment and participants’ positive expectations of recovery are facilitating factors. In contrast, a lack of commitment and consistency regarding treatment, not following indications, self-managing medications, without the supervision of the treating clinician, and negative expectations are hindering factors Contextual: helping factors are family and friends with supportive attitudes and supportive employers. Hindering factors are family and partners with an indifferent attitude or expressing their opposition to treatment, workplaces that give little credence to psychiatric leave, and economic difficulties	16, good
		N male: 9 (22.5%)
		Mean age: 39 (range 22–63)
Glas et al. [38] (2021)	To explore the experiences of older adults themselves to identify factors contributing to resilience after depression	25 older adults recruited from in- and outpatients clinics from mental health-care facilities and general practitioners in five regions across the Netherlands, who successfully recovered from MDD	Taking agency: realizing you have to do it yourself, finding a balance between rest, safety and activity, and understanding which factors make you emotionally vulnerable Social support and engaging in social activities: receiving social-emotional support, being around people and building relationships Doing activities individually and managing thought processes: taking part in physical exercise and engaging in meaningful activities Managing thought processes: leaving negative thoughts behind and going on with daily life, and taking lessons forward to life after depression	16, good
		N male: 9 (36%)
		Mean age: 77.9 (range 73–85)
Grove [39] (2012)	To explore midlife depression and counselling	6 midlife men from counselling centres in West Canada, who had completed counselling for depression	Helping: self-awareness (e.g., of personal needs, depression triggers, and lifestyle preferences) is key and is fostered by a combination of individual counselling, group therapy, personal development workshops, self-reflection, journal writing, support groups, and videos. For professional therapy to be effective, concordance between the therapist and patient is important Hindering: stress, low self-awareness, lack of strategies, and regrets	15, good
		Mean age: not specified (range 35–55)
Hajela [40] (2013)	To understand the lived experience of depression and self-recovery from it using narratives of participants who had recently suffered and recovered from depression	25 patients, recruited via general physicians and psychiatrists from different cities in India, who had a first episode of mild depression in the past 18–24 months, dropped out of treatment and had self-recovered	Dealing with negative emotions: helping factors are talking with family or friends, writing down feelings, comparing oneself selectively with others worse off, relying on faith, focusing on the positives of the situation, and taking prescribed medication temporarily Cultivating positive emotions and attitudes: practicing self-praise and pride, engaging in meaningful work, prioritizing happiness, finding meaning in the depressive experience, involvement in meaningful tasks beyond personal interests, lowering expectations and embracing acceptance, and reassessing ones situation positively	10, fair
		N male: 7 (28%)
		Mean age: not specified (range 24–35)
Hansson et al. [41] (2012)b	To explore patients’ explanation for the improvement of their depression	184 depressed primary care patients from 46 separate primary health-care centres in Sweden, who participated in an earlier study evaluating the Contactus programme and who considered themselves improved	External factors: work-related factors (e.g., improved work situation, relocation at work, new employment or less stress at work), reduction of non-specified stress, social support, and positive life events Self-management: personal development, rest/relaxation, and alternative methods (e.g., meditation, physical exercise, or improved eating habits) Passing spontaneously: time, seasonal change, and improving somatically Professional help: the Contactus programme, antidepressants, supportive counselling, and psychotherapy	9, fair
		N male: 52 (28.3%)
		Mean age: 44 (range 18–69)
Idris et al. [42] (2023)	To explore the women MDD survivors’ experience throughout their journey to recovery	Four women under 55, recruited via a hospital and a patient Facebook page in Malaysia, were previously diagnosed with depression and had experienced remission	Connectedness – social support: good care by the caregiver, support from other family members, and indirect assistance from others (e.g., support groups or counselling) Hope: positive expectations of oneself, one’s family, the community, and of health-care workers and service providers Identity – survivor efforts: getting help from health services, completing one task at a time, and taking care of the food intakes, sleep and emotions Meaning: having good coping skills (e.g., writing down feelings, sharing ones experiences, relaxing activities) Empowerment – challenges: acceptance by family members, social stigma, struggle against self-stigma, challenges of starting a new life	14, fair
		Mean age: 29.8 (range 17–41)
Li and Xu [43] (2023)	To explore the coping strategies of depression sufferers that have worked for them	120 stories from an online depression community in China in which community members talked about how they tried to cope with depression	Self-reconciliation: perceiving/accepting feelings, accepting the present self, and holding hope for the future Action: recreational activities, physical exercise, and engaging in volunteer work Addressing stressors and symptoms: staying away from stressors, and seeing the doctor Seeking interpersonal support: getting support from family, friends, and peers online	15, good
		N men: not specified
		Mean age: not specified
Löwe et al. [44] (2006)c	To investigate treatment preferences for emotional problems and factors affecting emotional well-being among depressed and non-depressed medical outpatients	87 depressed patients and 91 non-depressed patients from 7 outpatient clinics and 12 family practices in Heidelberg (Germany)	Impairing: interpersonal problems, work-related problems, health problems, psychological problems, non-satisfactory medical care, excessive demands, dealing with significant others’ problems, housing conditions, death of family member/close friend, and financial situation Improving: psychotherapy, partner, family, talking with close friends, activity/exercise, relaxation/rest, medication, actively addressing problems, medical care/improvement of physical illness, success in one’s career, suppressing problems, and positive thinking Self-management strategies: exercise, relaxation, actively addressing problems, activity, talking with close friends, living healthier, suppressing problems, positive thinking, and finding a better job	11, fair
		N men (in the depressed subsample): 30 (34%)
		Mean age (of the depressed subsample): 41 (SD 13.6)
Peden [45] (1994)	To describe treatment strategies, interventions, and skills used by women to recover from depression	7 women, recruited via psychiatric nurses and word of mouth with friends in Kentucky (USA), who had been hospitalized for depression and who now considered themselves to be recovering	Cognitive strategies: improving problem-solving skills, practicing positive thinking, memorizing affirmations, challenging negative statements with positive ones, resisting negative influences from others, employing positive self-talk, and recognizing negative triggers while developing healthier responses Active-behavioural strategies: writing in a journal, exercising, planning activities, meditating daily, using relaxation techniques (self-hypnosis/imagery), and making lists Information-seeking: reading about depression and its treatment, reading popular psychology and ‘self-help’ books, attending classes on topics related to mental health, and receiving and using printed information on mental health	10, fair
		Mean age: 39 (range 29–53)
Polacsek et al. [46] (2020)	To identify the barriers and facilitators to self-management of depression in older adults	32 older adults, recruited via senior citizens’ groups, community centres and social clubs in Victoria (Australia), who had a diagnosis of moderate depression for which treatment and/or support was being received	Perspectives on age and depression: a negative view on ageing can lead to a sense of futility, which hinders day-to-day management of one’s health and delays help seeking. Other hindering factors are patronizing GPs and (self-)stigma Ability to access the health-care system: level of mental health literacy of the patient, informal support provided by significant others, guidance by a health professional, instrumental barriers (e.g., a lack of appropriate services, financial costs, problems with transport, long waiting lists), and the quality of the patient-doctor relationship Individual capacity for self-management: enhanced by a proactive attitude towards age and depression, the establishment of short- and long-term strategies, remaining socially engaged, maintaining physical health, and self-education. Ability to use these resources depended on patients level of mental health literacy	15, good
		N men: 13 (40.6%)
		Mean age: 71.3 (range 65–82)
Skärsäter et al. [47] (2003)	To describe, women’s conceptions of coping with major depression in daily life with the help of professional and lay support	13 women from two psychiatric departments in the southwest of Sweden, who were previously hospitalized for major depression	Self-healing: gaining space for oneself (time for reflection), being confirmed (receiving confirmation of one’s disease), and being seen (as an individual and not just as a case) Managing: having personal strategies (e.g., exercise, massage, positive affirmation, hypnosis, music, reading, painting, vitamins and minerals, and conversations with both friends and health-care professionals), undergoing a process of transition (changing one’s view of themselves), and becoming empowered (taking responsibility for one’s own recovery) Receiving social support: can help with regaining command over the everyday structure, being together with other people can help restore health, and receiving information to find structure and hope Finding meaning: reflecting on one’s life can lead to personal growth and believing in the future	17, good
		Mean age: 42 (range 28–63)
Skärsäter et al. [48] (2003)	To describe how men with major depression cope with daily life with the help of professional and lay support	12 men from two psychiatric clinics in the southwest of Sweden, who were previously hospitalized for major depression	Being unburdened: being admitted, receiving information about the disease, its symptoms and consequences, and interacting with family and friends Restoring one’s health: developing a new perception about oneself and one’s surrounding world, using one’s own resources (e.g., physical exercise, spending time outdoors, listening to music, and meditating), and trying another road (e.g., active, conscious choices to change one’s working life or private life) Feeling involved: being part of society (being listened to and feeling needed), being confirmed (by professionals and friends), and therapeutic alliance Finding meaning: reflection, accepting one’s situation, and living in the present	17, good
		Mean age: 48 (range 28–65)
Tanaka [49] (2018)	To clarify strengths for promoting the recovery process among older adults with depression in Japan	12 older adults from a psychiatric hospital ward in Japan, who experienced depression and were receiving treatment after having been admitted to the psychiatric hospital ward	Sense of emotional connection: trusting caregivers and family members, genuine kindness, and tenderness of others and receiving emotional support from others in the community Dialogue with life: feelings of accomplishment in life, facing mortality, seeing oneself as being part of a generational continuity, affirmation in life, understanding illness in the context of life, ability to discover ways to live in old age, and an optimistic attitude towards life in the face of hardship Discovery: finding a “natural self” and heightened spirituality	18, good
		N male: 5 (41.7%)
		Mean age: 71.5 (range 62–82)
van Grieken et al. [50] (2013)	To explore the patients’ perspectives towards self-management in their recovery from depression	20 adults from different mental health-care organizations in the Netherlands, who had experience with professional treatment for depression and a depressive disorder in remission	Proactive attitude towards depression and treatment: 11 strategies such as acknowledging that depression is a disease and completing treatment Daily life strategies and rules: 7 strategies such as setting realistic short-term goals and healthy eating Explanation of the disease to others: 9 strategies such as explaining depression to one’s partner, family, or friends and including partner or family in treatment Remaining socially engaged: 2 strategies such as meeting up with friends regularly Engaging in activities: 9 strategies such as leaving the house regularly and exploring new hobbies Structured attention to oneself: 8 strategies such as a good day/night rhythm and keeping a diary Contact with fellow sufferers: 1 strategy Other: 3 strategies such as asking for support at work and searching out your family background	12, fair
		N men: 9 (45%).
		Mean age: 42.6 (range 25–57)
van Grieken et al. [51] (2014)	To explore what patients believe they can do themselves to cope with enduring MDD besides professional treatment, and which self-management strategies patients perceive as most helpful to cope with their MDD.	25 adults recruited via MDD patient websites and an Academic Medical Center in the Netherlands, who had a current major depressive episode and received at least two different treatments with a poor or unsatisfactory response	A focus on the depression: being aware that depression needs active coping (7 strategies; e.g., taking signals seriously, engaging in structured form of meditation) and active coping with professional treatment (8 strategies; e.g., maintaining long-term professional support, finding information) An active lifestyle: active self-care, structure, and planning (13 strategies; e.g., setting realistic short-term goals, keeping a diary) and free time activities (5 strategies; e.g., sports, hobbies) Participation in everyday social life: social engagement (11 strategies; e.g., informing family/friends, seeking contact with fellow sufferers) and work-related activities (6 strategies; e.g., explaining depression to manager/colleges, providing backup from colleges)	15, good
		N men: 10 (40%)
		Mean age: 49 (28–67)
Vidler [52] (2005)	To understand the essential experience of depression from a female perspective	22 women from the inner urban region of Melbourne (Australia), of whom 11 had a current diagnosis of depression and 11 were recovered	Recovered women: breaking isolation through paid work, education, relocation near supportive family and friends, engaging in self-care through personal time, self-reflection, counselling, using resources like self-help books or natural remedies (e.g., St. John’s Wort), antidepressants, balancing self-care with care for others, and setting boundaries by avoiding responsibility for others’ issues Non-recovered: involvement in sport, music, or singing lessons, recovering from a long-standing physical illness, eating healthy food, doing physical exercise and losing weight, and obtaining paid work outside of the home	12, fair
		Mean age: 41.3 (range 22–75)
Villagi et al. [53] (2015)	To explore strategies used by people recovering from depressive, anxiety, and bipolar disorder	50 adults from community organizations, health and social services centres, and hospitals in Montreal region (Canada), who recovered or were in recovery from a depressive, anxiety, or bipolar disorder	Social recovery: surrounding oneself with people who make them feel better (4 strategies) and taking care of others (5 strategies) Existential recovery: having a positive outlook (10 strategies), developing a balanced sense of self (5 strategies), finding meaning (2 strategies), and empowering oneself (3 strategies) Functional recovery: creating a routine (2 strategies) and taking action (5 strategies) Physical recovery: maintaining a healthy lifestyle (6 strategies) and managing one’s energy levels (3 strategies) Clinical recovery: seeking formal professional help (5 strategies), developing a better understanding of your illness (4 strategies), managing daily symptoms (4 strategies), and preventing relapse (2 strategies)	15, good
		N men: 24 (48%)
		Mean age: 47.3 (SD 10.5)
Ward et al. [54] (2014)	To examine older African American women’s lived experience with depression and their coping behaviours in response to depression	13 older African American females from a local community in the Midwest of the USA, who had a diagnosis of depression	Religious coping: belief in God, prayer, bible reading, consulting with clergy and involvement in church activities (e.g., bible study, attending church services and singing in the choir) Being resilient: staying strong in the context of hardship, live in the moment, and maintain a positive attitude Other strategies: volunteering, social support from friends, staying busy, and keeping their mind occupied	19, good
		Mean age: 71 (range 60–78)
Wendt and Gone [55] (2016)	To explore the significance of traditional healing for individuals who live away from reservation-based kin and culture	1 former male college student from an urban metropolitan area in the Midwest (USA), who was diagnosed and treated for depression	A case study of an American Indian college student is presented in which four healing approaches are described. The first is medication, which the student found not helpful as he experienced this to be emotional blunting without further changes. Psychological counselling (psychotherapy) was experienced as a safe space where he felt free to “discuss anything” and from which he began to notice behavioural and relationship patterns. However, it was limited in its ability to address the students’ cultural and spiritual needs. Bonding with (mostly male) relatives, friends, and deceased and nonhuman persons was instrumental in facilitating healing. Finally, spiritual practices (through drumming and singing) allowed for a level of spiritual healing and cultural renewal that could not be obtained through the other healing approaches	18, good
		Age: between 20 and 30

Data on the methods used and definitions of recovery are not presented in the table as the methods were largely similar across studies (semi-structured interviews and thematic analyses) and definitions of recovery were not explicitly stated in most articles.

^aNumbers indicate the score on the Critical Appraisal Skills Programme (CASP) qualitative checklist (classification cut-offs: “good quality”: 15–20, “fair quality”: 8–14, “poor quality”: <8).

^bParticipants in this study were restricted in their answer to the open-ended question by a maximum of 57 words.

^cFor this review, the results from the depressed subsample are used.

Thematic Synthesis

For each included article, factors reported as helping or hindering recovery are summarized in Table 1. Thematic analysis identified 134 factors that influenced recovery, with 89 described as helpful and 46 as hindering (Table 2; complete list available in online supplementary material pp. 21–25). One factor (medication) was reported as both helpful and hindering, resulting in a combined total of 135 mentions. Eight overarching themes, each with two to four subthemes, emerged (see Fig. 2): (1) social connections, (2) reconstructing the self, (3) autonomy, (4) professional support, (5) self-management strategies, (6) physical health, (7) instrumental facilitators and barriers, and (8) temporal dimensions. The themes and subthemes, along with the number of helpful and hindering factors identified per subtheme, are described in more detail below. Notably, a strict categorization with each factor being assigned to a single subtheme was not feasible. Given the complexity of the recovery process and the interconnected nature of its different aspects, we chose to assign some factors (n = 10) to multiple subthemes.

Table 2.

Factors mentioned in eight or more included articles

Factor	Related to theme	Articles mentioned as helping, n	Articles mentioned as hindering, n
Support from partner/family/friends	Social connections	19	​
Therapy	Professional support	17	​
Performing meaningful tasks	Reconstructing the self	13	​
	Social connections
Relaxing activities	Self-management strategies	12	​
Exercise or other physical activities	Self-management strategies	12	​
	Physical health
Medication	Professional support	11	8
Implementing healthy habits	Self-management strategies	11	​
	Physical health
Contact with peers	Social connections	10	​
	Reconstructing the self
Stigma	Social connections	​	10
	Instrumental facilitators/barriers
Positive thinking	Self-management strategies	10	​
Having a proactive attitude	Self-management strategies	9	​
Reflection/reassessing ones situation	Reconstructing the self	9	​
Accepting the present self	Reconstructing the self	8	​
Social/community engagement	Social connections	8	​

Fig. 2.

Overview of superordinate themes and descriptive subthemes. Black lines indicate factors participants mentioned as helpful in their recovery, while red lines indicate factors mentioned as hindering recovery. The width of the lines corresponds to the frequency of these factors being reported in the included articles. The background colour indicates groupings of interconnected themes, which are further illustrated in Fig. 3.

Social Connections

Almost all articles (n = 25, 93%) reported that social connections played a crucial role in recovery. Three interrelated subthemes emerged: social support, the attitude of others, and social activities.

Social Support (6 Helpful Factors, 1 Hindering Factor). Twenty-two articles (81%) highlighted social support as essential, particularly from partners, family, and friends (n = 19, 70%). Participants in the reviewed articles mentioned how social support helped them maintain structure, foster hope, stay engaged, and feel safe and understood. Peer support was described in ten articles (37%) as being beneficial in several ways, including enhancing feelings of hope, fostering a sense of normalcy, and feeling understood/validated. Additionally, five articles (19%) noted that participants mentioned that broader societal support also played a role in their recovery. One article (4%) described how participants mentioned interpersonal problems as a barrier to their recovery, as this impaired their emotional well-being.

Attitude of Others (6 Helpful Factors, 3 Hindering Factors). Thirteen articles (48%) emphasized that social support was not always experienced as helpful and that this depended on the attitude of others. For example, supportive family, friends, and employers who provided nonjudgmental encouragement facilitated recovery. However, social stigma was described as a barrier to recovery in 10 articles (37%), as this discouraged participants to seek help or openly discuss their depression. Other factors related to the attitude of others that hindered participants’ recovery included a lack of acceptance (n = 4, 15%) and trivialization of depression by others (n = 2, 7%).

Social Activities (2 Helpful Factors, 1 Hindering Factor). Sixteen articles (59%) reported that participants considered social activities important for their recovery. Engagement in meaningful tasks (n = 13, 48%) and community involvement (n = 8, 30%) were considered as beneficial because this provided confidence, structure, and hope. One article (4%) explicitly noted that a lack of social contact hindered recovery.

Reconstructing the Self

Almost all articles (n = 25, 93%) described factors related to the impact of depression on participants’ identity. Participants needed to reassess who they were in light of this new reality, to achieve a sense of balance and come to terms with it. We identified two interrelated subthemes within this process: self-awareness and personal growth.

Self-Awareness (11 Helpful Factors, 3 Hindering Factors). Many articles (n = 23, 85%) reported how participants stressed the importance of self-awareness, which encompasses participants’ efforts to understand and accept their current selves, distinguish their identity from the illness, and gain perspective, in their recovery. In addition to providing social support, both engaging in meaningful tasks, which enhanced confidence, provided a sense of purpose, and fostered feelings of being valued, and contact with peers, which helped individuals feel normal, find hope, and gain perspective by comparing with those worse off, were also linked by participants to increased self-awareness. Furthermore, we identified four overlapping factors related to self-awareness: finding a new perception of oneself (n = 5, 19%), accepting ones present self (n = 8, 30%), receiving a diagnosis (n = 5, 19%), and distinguishing the illness from ones personality (n = 2, 7%). A common thread across these factors was their helpfulness in developing a self-image that better aligned with participants’ current reality, aiding in self-acceptance and, in turn, recovery. Nine articles (33%) described how participants used reflection to facilitate this process. Conversely, self-stigma was identified in four articles (15%) as hindering recovery, as it led participants to perceive themselves as weak or incapable of managing their struggles. Other factors hindering recovery by negatively influencing participants’ self-awareness included feelings of failure (n = 1, 4%), which were perceived to be associated with a loss of integrity of the self, and negative views on ageing (n = 1, 4%), which contributed to a sense of futility.

Personal Growth (3 Helpful Factors, 0 Hindering Factors). Eleven articles (41%) reported that participants viewed their experience with depression as a learning process that ultimately made them stronger, as it fostered resilience, new coping strategies, assertiveness, and goal achievement. The articles described how moving beyond depression was a process of discarding old attitudes and roles in order to develop new approaches to daily life. For example, completing tasks, reaching career goals, and everyday accomplishments (even small ones) were emphasized as crucial for recovery.

Autonomy

This theme emphasized the importance of choice and control in recovery. Twenty-three articles (85%) described factors related to this theme, which we assigned to two subthemes: agency and personal strengths.

Agency (9 Helpful Factors, 3 Hindering Factors). The majority of articles (n = 22, 81%) described how participants mentioned a need to feel in control, which was linked to various aspects of recovery, including changes in their identity. Interestingly, some articles described agency as a prerequisite for developing a new identity (e.g., Fernández et al. [37], Idris et al. [42]), while others suggested that agency emerged as a result of self-acceptance and increased self-knowledge (e.g., Tanaka [49], Hajela [40]). One of the key factors related to agency, described in eight articles (30%) as supporting recovery, was accepting one’s situation. Other factors included the realization that one is accountable for one’s own recovery and taking responsibility (n = 7, 26%), receiving a formal diagnosis accompanied with the message that depression is common and that recovery is expected (n = 5, 19%), and the level of influence offered in choosing treatment options (n = 2, 7%). Self-management strategies, described as aiding agency and, in turn, recovery, included seeking information and complementary therapies (n = 7, 26%) and setting realistic, time-limited goals (n = 7, 26%). Conversely, hindering factors related to agency were described in four articles (15%) and included an avoidant coping style, experiencing excessive demands, and a sense of futility or hopelessness.

Personal Strengths (7 Helpful Factors, 0 Hindering Factors). Five articles (19%) emphasized how participants used personal strengths, which were described as internal qualities that participants used to achieve what was important to them, to aid their recovery. These included self-determination, patience, confidence, willpower, self-discipline, and resilience. Of note, some articles highlighted that these strengths may have developed as a result of experiencing depression (e.g., Glas et al. [38], Tanaka [49]), in line with what we described under the subtheme of personal growth.

Professional Support

Almost all articles (n = 26, 96%) noted that participants mentioned how professional support played an important role in their recovery. We assigned identified factors in this theme to two subthemes: the treatment itself and the attitude of the professional.

Treatment (4 Helpful Factors, 4 Hindering Factors). Participants in most articles (n = 23, 85%) mentioned treatment as helpful, aiding their self-understanding and coping, and resolving constraining issues. Barriers to treatment, which hindered recovery, were described in four articles (15%) and included rigid services and lack of commitment. One of the most controversial forms of treatment seemed to be medication, which was the only factor viewed as both helpful (n = 11, 41%; e.g., by alleviating symptoms and making the situation manageable) and hindering (n = 8, 30%; e.g., by blunting people’s feelings or making them feel dependent). Additionally, most articles that described positive effects of medication emphasized that its benefits were strongest in the early stages of recovery and were influenced by other aspects of participants’ lives (e.g., personal circumstances, social support, other treatment elements).

Attitude of Professionals (4 Helpful Factors, 2 Hindering Factors). Twelve articles (44%) stressed how participants found the helpfulness of treatment to be dependent on the attitude of the professional. Experiences with professionals ranged from being very helpful to not helpful at all. Helpfulness was often linked to an understanding and empathetic attitude, a strong therapeutic alliance, and feeling treated as an individual rather than a case. In contrast, unhelpful experiences were mostly attributed to a patronizing attitude or a perceived lack of emphatic engagement.

Self-Management Strategies

All articles reported self-management strategies that participants used to cope with their depression. Six articles (22%) focused specifically on the self-management of depression. We identified a long list of self-management strategies, which we categorized into active coping strategies, mental coping strategies, developing skills, and religious/spiritual activities.

Active Coping (14 Helpful Factors, 11 Hindering Factors). Almost all articles (n = 26, 96%) described the deliberate actions that participants used to manage their depression. We identified 14 helpful active coping strategies, including relaxing activities, implementing healthy habits, adopting a proactive attitude, setting realistic time-limited goals, writing down feelings, and creating day-to-day structure. In contrast, 11 strategies were described as counterproductive, such as avoidance, focusing excessively on work, lack of commitment, and denial, which were perceived as hindering recovery.

Mental Coping (11 Helpful Factors, 1 Hindering Factor). Seventeen articles (63%) emphasized how participants used mental strategies that helped them recover, such as positive thinking, accepting one’s situation, lowering expectations, and selective comparison. Having regrets was described in one article (4%) as hindering recovery, as it enhanced feelings of failure and diminished feelings of hope.

Religious/Spiritual Activities (5 Helpful Factors, 0 Hindering Factors). Eight articles (30%) reported how participants found religious or spiritual activities helpful in their recovery. These ranged from reconnecting to god, to religious guidance, and spiritual activities (e.g., connecting with nature, meditation, singing hymns).

Developing Skills (4 Helpful Factors, 0 Hindering Factors). Three articles (11%) described how participants took deliberate action to acquire skills that supported their recovery, such as identifying triggers and practicing healthy responses, attending educational programs, and practicing self-praise.

Physical Health

Many articles (n = 18, 67%) highlighted participants’ perceived connection between physical and mental health, indicating that improvements in physical well-being were often perceived as essential to achieving recovery.

Healthy Activities (4 Helpful Factors, 2 Hindering Factors). Eighteen articles (67%) described how participants experienced that engagement in activities related to their physical health supported their recovery. These included relaxation, exercise, and implementing healthy habits. By promoting their own physical health, participants felt better able to cope with their depression and regain a sense of well-being. On the other hand, smoking and the consumption of alcohol/drugs were mentioned in one article (4%) as hindering recovery.

Health-Related Factors (1 Helpful Factor, 1 Hindering Factor). Three articles (11%) noted poor physical health as a barrier (e.g., by reducing resilience), while improvements in health were experienced as facilitating recovery.

Instrumental Facilitators and Barriers

Sixteen articles (59%) identified external factors affecting recovery, mostly as barriers. We assigned these factors to three subthemes: socioeconomic circumstances, access to services, and life events.

Access to Services (3 Helpful Factors, 7 Hindering Factors). Eleven articles (41%) described how participants experienced several barriers to accessing mental health services. The most mentioned barrier was stigma (n = 10, 37%). Other described barriers included inflexible services, long waiting lists, and a lack of available information. Conversely, when services were accessible and interventions were provided in a timely manner, articles (n = 5, 19%) described these factors as beneficial to participants’ recovery.

Socioeconomic Circumstances (2 Helpful Factors, 3 Hindering Factors). Six articles (22%) described the importance of participants’ socioeconomic situation in recovery. Among these, 2 (7%) highlighted the need for financial security, while 4 (15%) emphasized the role of gaining and maintaining employment, as well as opportunities for career development. On the other hand, nine articles (33%) described financial difficulties/poverty, work-related problems, and housing instability as barriers for recovery. One article (4%) described how participants mentioned that financial stability was a prerequisite for agency and in turn recovery.

Life Events (1 Helpful Factor, 3 Hindering Factors). Two articles (7%) noted how participants experienced life events as turning points, which either facilitated (e.g., birth of a [grand] child) or hindered (e.g., death of a loved one) recovery.

Temporal Dimensions

Although supported by fewer articles (n = 3, 11%), this specific theme captures how participants mentioned that factors related to time (e.g., the mere passage of time, seasonal variations) and the course of depression (e.g., fluctuating vs. persistent) shaped their recovery process. While not a dominant theme, these unique reflections offer insight into the broader context in which recovery unfolds and highlight how time-related experiences may influence both the recovery process itself and the impact of other factors.

Time. Two articles (7%) reported that some participants attributed recovery to the mere passage of time, and one article (4%) noted seasonal changes as beneficial.

Course of Depression. One article (4%) described how fluctuating or persistent depression shaped coping strategies and overall recovery. Participants with a persistent course of depression emphasized the need for ongoing self-management strategies, while those with a more episodic, cyclic pattern of depression had diverse experiences in what helped their recovery.

Interconnectedness of Themes

During synthesis, various overarching patterns and connections between themes emerged. First, personal capacities, such as the ability to reconstruct one’s identity, regaining control, and maintaining social connections, were described as central to recovery. Second, participants engaged in diverse strategies and treatments to manage their depression. The way individuals used these was shaped by their personal capacities. In turn, these activities and interventions influenced their personal capacities, which helped them to manage their depression. Third, many articles highlighted contextual factors as critical conditions shaping participants’ recovery process. These factors could either facilitate or hinder the use of strategies and interventions and the development of personal capacities, ultimately affecting individuals’ recovery process. Figure 3 presents a conceptual model illustrating these interconnections.

Fig. 3.

Conceptual model of recovery factors. Orange circles represent factors related to personal characteristics and capacities, which both influence and are influenced by the use of self-management strategies and professional treatment (shown in blue circles). The larger yellow circle represents contextual factors that influence both personal characteristics and the use of self-management strategies and treatment.

Relative Importance of Factors

Some factors appeared in more articles than others, indicating a possible difference in their relative importance. Table 2 lists the 14 most frequently mentioned factors, appearing in at least eight of the included articles. Keeping in mind that recovery is a highly individual and personal experience, this summary does provide some insight into the most common themes: five factors relate to social connections, five to self-management strategies, four to reconstructing the self, two to professional support, two to physical health, and one to instrumental facilitators and barriers. Notably, most frequently mentioned factors were described as helpful, except for medication, which was mentioned as both helpful and hindering, and stigma, which was consistently described as a barrier to recovery.

Discussion

This review aimed to deepen our understanding of recovery from depression by exploring the full spectrum of factors that individuals themselves identified as influential, with the goal of informing more person-centred approaches to mental health care and research. By synthesizing findings from 27 articles, we identified 134 unique factors, grouped into 20 descriptive categories and 8 overarching themes: (1) social connections, (2) reconstructing the self, (3) autonomy, (4) professional support, (5) self-management strategies, (6) physical health, (7) instrumental facilitators/barriers, and (8) temporal dimensions.

The range of recovery factors identified in our review was broad, though some were reported more frequently, indicating that some factors may hold greater relative importance than others. Social support and therapy were among the most commonly described factors. This aligns with previous research, which has established social support as a facilitator of depression recovery and linked it to lower symptom severity as well as reduced relapse rates [56, 57]. However, prior work has predominantly focused on quantitative indicators of social support, such as frequency of contact or network size. Our findings add depth by emphasizing the perceived quality of these relationships, particularly the presence of a genuinely supportive and emotionally attuned attitude. This nuance highlights the importance of not only increasing access to social support but also fostering affirming and empathetic interactions. The relational dimension also emerged as a key factor in participants’ perceptions of therapy effectiveness. Many included articles reported that participants emphasized the therapeutic relationship as central to the perceived effectiveness of therapy, which is consistent with existing literature [23]. Another noteworthy finding concerns participants’ experiences with antidepressant medication, which was frequently mentioned but elicited mixed views. While some individuals considered medication as essential to their recovery, others perceived it as a hindrance. This latter perspective appears to be underrepresented in existing literature. Prior research has indicated that antidepressants may be ineffective for a substantial proportion of individuals [58], tend to offer only short-term benefits, are frequently associated with adverse side effects and low long-term acceptability [59, 60], and may lead to severe withdrawal symptoms upon discontinuation [61]. However, few studies have explicitly reported that individuals themselves view medication as barrier to their recovery. Finally, many self-management strategies were mentioned as helpful for recovery, including engaging in meaningful tasks, practicing relaxation, setting realistic short-term goals, and maintaining a positive outlook. These findings underscore the critical role of individuals’ own efforts and capacities in the recovery process from depression, alongside the use of professional support. This is further reflected in the prominence of factors related to agency and self-awareness identified in our review.

While the abovementioned factors were among the most frequently described, less frequently mentioned factors may be equally or more important for specific individuals. The highly individual nature of recovery is evident in the wide range of identified factors, reflecting how many different aspects of a person’s life can shape their recovery. The reviewed articles consistently emphasized marked interpersonal differences in what individuals experienced as helpful or hindering, which aligned with prior research on the uniqueness of recovery pathways [62, 63]. Accordingly, no single factor seems to determine successful recovery. Rather, our findings reflect the complex and multifactorial nature of depression recovery, consistent with earlier work [64].

From our analysis, a conceptual model emerged, illustrating how different factors interact across three broad areas: (1) personal capacities (reconstructing the self, autonomy, and social connections), (2) activities and interventions (therapy and self-management strategies), and (3) contextual conditions (physical health, instrumental facilitators/barriers, and temporal dimensions). This aligns with previous frameworks. For example, Dell and colleagues [22] also emphasized the importance of gaining insight into oneself and accepting the illness as part of one’s life, as key factors in recovery, alongside the influence of social and environmental context, and autonomy. However, unlike their review, we did not identify “sense of belonging” as a primary theme. In our review, social support and meaningful activities were more often linked to self-awareness. Similarly, Salzmann-Erikson [64] identified self-acceptance, personal responsibility, social contributions, and meaningful activities, which relate to our themes of social contacts and reconstructing the self, although autonomy was less emphasized. The CHIME framework, however, underscores the importance of autonomy, identifying empowerment alongside social connections, hope, identity, and meaning as central to recovery [19]. Our model builds upon these existing frameworks by illustrating how changes in personal capacities are interconnected with the use of self-management strategies, professional support, and contextual conditions, highlighting the multifaceted nature of recovery.

The complexity of recovery is further underscored by the interplay between different dimensions of recovery. A narrow focus on specific aspects of recovery (e.g., symptomatic vs personal) can obscure how intertwined they are. For example, symptom improvement may facilitate reengagement in meaningful activities and reconnecting socially, which in turn supports functional and personal recovery. Conversely, limitations in one domain can impede progress in others. This mutual influence, also found in our review, supports the idea of recovery as a dynamic and interdependent process, as proposed by Whitley and Drake [65], and emphasizes the need to consider subjective experiences alongside clinical outcomes.

This review contributes to the field by synthesizing qualitative research without predefined recovery concepts, capturing a broad spectrum of personal experiences. This approach yielded findings, which offer several actionable insights for clinical practice. First, the emphasis on relational quality, both in therapy and informal support, underscores the importance of cultivating emotionally attuned, autonomy-supportive environments. This emphasize aligns closely with the foundational principles of person-centred care and is central to third-wave therapies such as acceptance and commitment therapy and mindfulness-based cognitive therapy. Clinicians may consider incorporating practices that clarify personal values and cultivate relational mindfulness, thereby strengthening therapeutic alliances and helping individuals reconnect with others in ways that support meaningful relationships. Second, the frequent mention of self-management strategies, along with factors related to agency and self-awareness, suggests that therapy should actively support clients to develop personalized coping tools, set realistic goals, and foster psychological flexibility. Encouraging self-reflection and ownership of the recovery process may enhance therapeutic engagement and contribute to more sustainable long-term outcomes. Finally, the mixed views on medication underscore the need for clinicians to have an open dialogue with clients about their subjective experiences with pharmacological treatment. This includes validating ambivalence, discussing alternatives, and integrating medication decisions into a broader, person-centred recovery plan.

Our used approach also introduces limitations. First, most included articles did not sufficiently address researcher-participant relationships, an important aspect in qualitative research, where the use of un/semi-structured ways of questioning can cause bias. Nonetheless, overall methodological quality was fair (n = 11) to good (n = 16), supporting confidence in the findings. Second, our inclusion of articles focused on self-management strategies (n = 6, 22%) may have led to their overrepresentation, while the exclusion of articles centred on specific interventions may have underrepresented therapy-related insights. Nonetheless, therapy was still frequently mentioned as an important factor, underscoring its relevance within the broader spectrum of helping factors. Future reviews could build on these findings by synthesizing qualitative data from intervention-specific studies to explore how individuals experience recovery within the context of different treatment modalities. Third, while our review included studies from multiple continents, the majority originated from Europe (40.7%) and North America (25.9%), with fewer from Asia (22.2%), Australia (18.5%), and South America (7.4%), and none from Africa. This geographic distribution reflects a predominance of Western perspectives and may limit the cultural diversity of recovery narratives. Future research should aim to incorporate non-Western and cross-cultural perspectives to obtain a better understanding of how sociocultural factors shape recovery processes. Fourth, individuals with lived experience of depression were not directly involved in the design, analysis, or interpretation of this review. While the synthesis is based on qualitative results, their perspective could have further enriched the analyses and interpretation of the results. Fifth, most of the included articles were retrospective in nature, relying on participants’ recollections rather than tracking recovery over time. While this limits the ability to observe recovery as it unfolds, it allowed for rich, reflective insights into different phases of the recovery journey. Importantly, the studies included a diverse range of participants: e.g., those who had fully or partially recovered, individuals with a first episode or multiple episodes of depression, and people across different age groups. Although these studies were not longitudinal, they captured varied recovery experiences across time and context. Future research could build on this foundation by employing longitudinal qualitative methods to explore how recovery develops in real time and how individuals’ needs and perspectives evolve throughout different stages of the process. Finally, given the complexity of recovery, alternative models may also be valid. However, our conceptual model was developed through an iterative, inductive process and independently reviewed by different researchers, supporting its credibility.

A valuable next step is to explore how significant others and professionals perceive recovery factors. Although these groups can provide essential perspectives, their views remain understudied. This is particularly relevant given our finding that the attitudes of significant others and professionals influence how their support is experienced. Additionally, culture-specific recovery factors warrant further study, as several articles suggest meaningful cultural differences in how depression and recovery are perceived [39, 50, 55]. More broadly, the wide range of factors identified in this review, combined with the complex and individual nature of recovery, highlights the need to rethink outcome measures in recovery research. Using symptom reduction as the (only) outcome measure for recovery might overlook areas in life that truly matter to individuals. Future studies should consider incorporating person-centred measures that reflect the diverse ways individuals define and experience recovery.

Conclusion

Our review underscores that recovery is not solely defined by symptom remission but also by individuals’ ability to connect to others, reconstruct their identity, and be autonomous. Supporting individuals with depression likely requires a broad approach that integrates multiple interconnected factors. While treatment is valuable, many other factors can also play a crucial role in individuals’ recovery and can influence the ultimate effects of treatment. Given the variety of available treatment programs, self-management strategies, and contextual influences, a personalized approach that incorporates all of these aspects may best support subjectively experienced recovery.

Statement of Ethics

An ethics statement is not applicable because this study is based exclusively on published literature. Also, written informed consent was not required as this study is based exclusively on published literature.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

This review is part of the PhD project of David Wedema, which is funded by the Netherlands Organization for Scientific Research (NWO), award number: 023.016.008. The funder had no role in the design, data collection, data analysis, interpretation, or writing of this manuscript. The authors retained full independence in the conception, planning, and decision to publish this work.

Author Contributions

D.W., E.L.K., K.J.W., and R.A.S. conceived the first concept of the study and formulation of the study design. D.W. and J.H.M.H.-H. developed the search strategy, which was crosschecked by E.L.K., K.J.W., and R.A.S. D.W. performed the literature searches and organized retrieval of articles. D.W. and J.H.M.H.-H. screened retrieved articles against eligibility criteria, assessed quality, and analysed the data, and E.L.K., K.J.W., and R.A.S. consulted on the selection of the reports, the data analysis, and the interpretation of the data. D.W. wrote the first draft of the manuscript. All authors contributed to the critical revision of the manuscript, had full access to all the data in the study, revised the manuscript, and had final responsibility for the decision to submit for publication.

Funding Statement

This review is part of the PhD project of David Wedema, which is funded by the Netherlands Organization for Scientific Research (NWO), award number: 023.016.008. The funder had no role in the design, data collection, data analysis, interpretation, or writing of this manuscript. The authors retained full independence in the conception, planning, and decision to publish this work.

Data Availability Statement

No original data were collected for this study. All data analysed in this systematic review were extracted from previously published articles, which are publicly available.