Purpose <p>Cognitive-behavioural therapy (CBT) is the most widely used intervention to treat depression’s significant negative impacts on older adults. Although many studies have verified CBT’s effectiveness in treating late-life depression in China, none have identified the factors of its effectiveness in that context. To that end, we conducted a systematic review and meta-analysis.</p> Methods <p>We searched three Chinese-language databases and five English-language databases from their inception through April 2024 for randomised controlled trials that using CBT-related therapy for late-life depression. We used a random-effects model to calculate CBT’s overall effect size and a mixed-effects model to analyse subgroups.</p> Results <p>In the final sample of 40 studies (<i>N</i> = 4099 participants), heterogeneity was substantial (<i>I</i>² = 91.73%, <i>df</i> = 39, <i>Q</i> = 471.605, <i>p &lt;</i> .001), and CBT’s overall effect size of − 1.235 (95% confidence interval: −1.472, − 0.997) was significantly determined by treatment setting (<i>p</i> &lt; .001) and diagnosis tools of depression (<i>p =</i> .027). Although our results indicated no significant differences in the effectiveness of CBT across different approaches (<i>p =</i> .211), deliverers (<i>p =</i> .167) and session duration (<i>p =</i> .489), cognitive therapy, interventions delivered by nurses and sessions shorter than an hour nevertheless appeared to demonstrate better outcomes in alleviating geriatric depression among older adults in China.</p> Conclusions <p>Our results, based on an overview of CBT’s application in the mainland of China and the influence of various factors on CBT’s effects, offer several suggestions for further developing CBT for older adults with depression.</p>