The ecosystem in the Northeast Forest Belt (NFB) can provide various ecosystem services, such as soil conservation, habitat provision, water conservation, and so on. It is essential for maintaining the ecological environment in Northeast China and the entire country. In the face of increasingly severe environmental problems, the comprehensive and accurate evaluation of ecosystem conditions and their changes is significant for scientific and reasonable recovery and protection measures. In this study, the NFB was taken as the research area. The spatio-temporal changes in ecological quality from 2005 to 2015 and the main driving factors behind them were analyzed by constructing the comprehensive ecosystem evaluation index. The results showed that: The landscape types of the NFB were mainly forest, cropland, and grassland. And the better ecological environment of the NFB was mainly distributed in the south of Changbai Mountains (CBM), the middle of Lesser Khingan Mountains (LKM), and the northwest of Greater Khingan Mountains (GKM). In contrast, the northeast of CBM, the southwest of LKM, and the edge of southern GKM were relatively poor. During 2005–2015, the ecosystem in the NFB was in a relatively good state as a whole, showing a steady-to-good development trend. However, more attention needed to be paid to some areas where degradation still existed. Land use/cover, climate (annual average rainfall, etc.), and human disturbance were potential factors affecting ecosystem evolution in the NFB. This study aims to provide an effective scientific basis and policy reference for the environmental protection and construction of the NFB.