The concept of “meaning in life” is defined as both the motivation to seek meaning and the subjective perception that one’s life holds significance [1]. Individuals with a high sense of meaning in life tend to exhibit greater self-efficacy, which is the positive belief that they can make autonomous choices in their actions [2]. A strong sense of meaning in life provides individuals with confidence in their life direction, the foundation for their choices, and the courage to achieve their goals, ultimately enhancing their self-efficacy [3].

Middle-aged women experience various physical, psychological, and social changes as they transition through a critical phase of life [4]. During this period, they undergo physiological changes due to aging, including menopause, as well as shifts in family dynamics, such as children’s academic progression, career transitions, and marriage [4]. These changes often lead to a transformation in their roles within the family and society. Many middle-aged women are known to experience a loss of meaning in life due to a decline in self-esteem and self-efficacy throughout this transitional period [5]. The loss of meaning in life in middle-aged women has been identified as a psychosocial factor contributing to depression [6]. Previous studies have reported a significant negative correlation between meaning in life and depressive symptoms, indicating that individuals with higher levels of meaning in life tend to experience lower levels of depression [7,8].

One of the psychotherapeutic models for treating depression is logotherapy, which aims to reduce the loss of meaning in life and help individuals rediscover their sense of purpose. To date, logotherapy has been studied in various populations, including cancer patients, elderly individuals with depression, alcohol-dependent individuals, and Korean immigrants. Findings from these studies indicate that logotherapy enhances individuals’ sense of meaning in life, reduces physical pain, alleviates anxiety and depression, and promotes positive psychological states such as self-esteem, quality of life (QoL), selfefficacy, resilience, well-being, and hope. Furthermore, research comparing the effectiveness of cognitive-behavioral therapy (CBT) and logotherapy has demonstrated that logotherapy significantly improves depressive symptoms in the elderly. While prior studies have largely validated the efficacy of logotherapy, there is a paucity of studies specifically targeting middle-aged women with depression, who frequently experience a loss of meaning in life due to drastic role transition. In addition, many existing logotherapy interventions lack structured formats, making them challenging to apply effectively in clinical practice. To bridge this gap, we developed a structured, 8-session group logotherapy program called the life meaning promotion (LMP) program based on Stark’s Theory of Meaning, designed to help individuals rediscover meaning in life when faced with existential challenges [9]. The program incorporates three core dimensions of meaning: creative values, experiential values, and attitudinal values.

In this study, we implemented our previously developed LMP program for a 4-week intervention with middle-aged women diagnosed with depression, recruited from the community. The aim of this study was to investigate the effectiveness of this structured LMP program in alleviating depressive symptoms and enhancing psychological well-being in middle-aged women with mild-to-moderated depression.

This randomized, single-blind trial showed that the 4-week group-based, structured LMP program produced significant improvements in psychological and existential functioning among middle-aged women with depression in the community settings. Across three assessments (baseline, 4 weeks, 8 weeks), the LMP group demonstrated statistically significant improvement than controls in meaning in life, PIL, depressive symptoms (CES-D), self-efficacy, and QoL (WHOQOLBREF). Time by group interactions were significant for all outcomes, indicating divergent trajectories favoring the LMP program. Interaction effects were large, suggesting that the observed differences are not only statistically significant but also clinically meaningful over a 4-week trial.

Our findings for meaning in life was in line with the previous logotherapy and meaning-centered therapy studies, which posit that cultivating purpose, values-congruent action, and attitudinal freedom reduced distress and enhanced well-being in the middle-aged women with depression. Previous trials also reported that meaning-centered or logotherapy-based programs reliably increased meaning and related existential outcomes compared with controls [18-20]. The significant increase in the MLQ score in the present study was consistent with prior studies showing that therapies grounded in existential or positive psychology could enhance one’s sense of meaning. A prior study by Sun et al. [18] reported that a 12-week logotherapy-based intervention for depressed patients led to significantly higher meaning in life scores compared to controls. Similarly, group-based meaning-oriented therapies have demonstrated increased perceived life meaning in cancer survivors [19]. We showed that even a relatively brief (4-week) program might be able to yield similar therapeutic effects. A notable strength of our LMP program might be simultaneous targeting life meaning and purpose; this dual focus might be im-portant because PIL had an established inverse relationship with depression in midlife and older adults [21].

There was significant improvement in the PIL score after the 4-week LMP program. From the previous literature, purpose is known to be the goal-directed facet of meaning and inversely associated with depressive symptoms and impaired functioning [21]. In these regards, the structure of the LMP such as self-clarification, values articulation, and prosocial microactions might enhance goal re-engagement, translating existential gains into day-to-day direction in the study participants.

The CES-D reductions observed were consistent with evidence that meaning-focused interventions might be able to relieve depressed mood while enhancing existential resources [18-20]. In mechanistic terms, increases in meaning and purpose might counter hopelessness and passivity, facilitating adaptive reappraisal and behavioral activation. Prior studies showed that changes in personal meaning could mediate the antidepressant effects of life review or meaning-centered treatments [22], suggesting a plausible pathway also operating in the LMP group. The present results added that symptom relief co-occurred with rises in self-efficacy and QoL, indicating that benefits extended beyond mood control to perceived capability and holistic well-being.

After 4-week trial, self-efficacy showed a significant groupby-time interaction, indicating greater improvement in LMP group, a pattern that coheres with social-cognitive theory (mastery experiences, vicarious learning, and verbal persuasion) [23]. Although improving self-efficacy is not a primary aim of classic logotherapy, it appeared to be a beneficial byproduct of the LMP program. Group discussion, logodrama, and responsibility-focused problem solving might create repeated mastery “micro-wins,” bolstering confidence to handle stressors. Similar gains reported in strength- or meaning-based group programs that foreground personal resources and valuecongruent action [24]. Although self-efficacy is not always measured in meaning-centered trials, our results suggest that selfefficacy might be a sensitive and clinically relevant target when the intervention explicitly links purpose to feasible next steps.

QoL also improved significantly more in the LMP group than the control group. This result might be in line with prior meaning-centered psychotherapy trials in serious illness, where enhanced meaning translated into better global life appraisal [19,20]. The QoL scores shifted over a short interval implies that addressing existential needs may have rapid downstream effects on satisfaction, relationships, and role participation, complementing symptomatic improvement.

To date, previous studies did not report equally strong shifts in meaning, purpose, or mood symptoms. When compared with active psychotherapies (e.g., CBT), meaning-centered approaches typically match depression outcomes while surpassing comparators on meaning-specific endpoints [19]. Such patterns help contextualize our results: 1) participants had room to improve on existential and mood metrics, 2) the intervention devoted substantial time to directly building meaning, and 3) group delivery may have amplified effects via belonging and shared narrative reconstruction. Collectively, these factors might play a pivotal role in the robust interactions seen across MLQ, PIL, CES-D, self-efficacy, and QoL.

Despite its positive results, this study has several limitations. Firstly, relatively small sample size limits the generalizability of the findings. Further prospective study with larger sample would increase statistical power and confidence in the stability of the effect size estimates. Secondly, as study design was single-blinded, there was a risk of expectancy effects or pla-cebo influences. Although we attempted to blind the outcome assessors, the lack of a double-blind, placebo-controlled design could introduce some bias in self-reported outcomes. Thirdly, outcomes were only tracked up to 8 weeks. While we found that improvements persisted at 4 weeks after the program, it remains unknown whether these gains are maintained over longer periods such as 6 months or 1 year. Depression often has a recurrent course, and meaning in life can fluctuate with life events; thus, a longer-term follow-up is needed to determine if the LMP program confers enduring resilience or if booster sessions might be required. Lastly, all outcome measures (meaning, purpose, depression symptoms, self-efficacy, and QoL) were self-reported questionnaires. Self-report could be subject to biases like social desirability, especially since participants knew their progress was being monitored. Therefore, future research should incorporate more objective or clinician-rated measures to corroborate the self-reported data.

In conclusion, a short, structured LMP program produced convergent improvements across five core outcomes, higher meaning and purpose, lower depressive symptoms, greater self-efficacy, and better QoL—with large, practically relevant divergences from control over 8 weeks. Future work should consolidate these findings in larger, multi-site randomized trials with active controls and longer follow-up, and clarify underlying therapeutic mechanisms. Until then, the present study offers timely evidence that cultivating meaning might be a viable and scalable path to recovery for depressed midlife women in community settings.