A Scoping Review of Family-Based Prevention Strategies in Adolescent Mental Health

Abstract

Adolescence is a critical developmental stage with increased risk for mental health problems, where family dynamics and parental involvement play key protective roles. Family-based prevention emerges as a key approach to addressing adolescent needs by preventing the onset and escalation of mental health difficulties, particularly in at-risk but often non-clinical populations. This scoping review systematically synthesizes evidence to examine the roles, characteristics, and reported outcomes of family-based prevention interventions for adolescent mental health across different prevention levels. A comprehensive search was undertaken in multiple scholarly databases, including PubMed, ScienceDirect, Scopus, EBSCOhost, SAGE Journals, Wiley Online Library, and Taylor & Francis Online, and 16 studies were included in the review. The included studies spanned universal, selective, and indicated prevention, as well as programmes framed as primary, secondary, and tertiary prevention. The review identified four primary themes characterizing the interventions of family-based prevention, including parenting skill training programs, family therapy and communication enhancement interventions, risk-specific targeted interventions, and socioeconomic and self-directed family interventions. These thematic strategies highlight different pathways to impact, from strengthening parenting practices and family communication to addressing risk-specific vulnerabilities and socioeconomic stressors. Most studies reported improvements in at least one adolescent mental health or behavioural outcome, although effect sizes and study quality varied and were not formally appraised. The findings reinforce that families remain a powerful context for preventive interventions. Family-based strategies show promise in enhancing adolescent mental health outcomes in various worldwide contexts. Future research should integrate approaches, such as combining parenting skills with economic support or family therapy with digital resources, and address carer well-being to conceptualise the family as a unit of care. In practice, these findings may inform stakeholders seeking to prioritise and refine family-based prevention strategis for adolescent mental health.

Introduction

Adolescence is a critical developmental stage characterised by an increased susceptibility to the emergence of mental health issues. Globally, it is estimated that 14% of individuals aged 10 to 19 experience mental health disorders, although the majority remain unrecognised and unmanaged.^1,2 The global prevalence of common mental disorders, including depression and anxiety disorders, among teenagers ranges from 25% to 31%.³ These disorders represent approximately 16% of the worldwide disease burden in adolescents.^4,5 Unaddressed teenage mental health disorders can lead to enduring adverse consequences, such as diminished academic performance, interpersonal challenges, and reduced well-being in adulthood.^6,7

Families play a pivotal role in adolescents’ lives, serving as a primary context for socialization, support, and early intervention. A strong family environment is associated with better youth mental health outcomes, whereas family dysfunction or lack of support can exacerbate risks. Studies indicate that strong parental support can enhance resilience and reduce the incidence of mental health disorders.^8–10

Parents and carers are indispensable contributors to mental health prevention. Parental support has been shown to yield positive outcomes in adolescent mental health.^11,12 Parents who engage actively and sustain open communication with their children can foster resilience and enhance mental health during adolescence.^13,14 Therefore, involving parents and carers in mental health programs is a crucial component in establishing effective approaches to prevent mental health problems among adolescents.

Family-based prevention approaches have gained attention as strategies to promote adolescent mental health and prevent problems before they escalate. In this review, family-based prevention is conceptualised as an approach that targets the prevention of the onset or escalation of mental health difficulties among adolescents, rather than the treatment of established psychiatric disorders. Family-based prevention therefore focuses on providing information to families, improving the quality of family relationships, and educating families about family management skills. This approach aims to improve parenting, monitoring, and family relationships so that conflicts are better resolved, the affective environment is improved, risk factors are reduced, and family functions are strengthened.¹⁵

Existing family-based programmes have demonstrated benefits for adolescent mental health in a variety of settings, yet important challenges remain. Current family-based adolescent mental health programs face a variety of challenges, despite the potential for positive results. Programs frequently neglect to address the full range of adolescent requirements, particularly those of vulnerable groups.¹⁶ Despite the fact that effective interventions should incorporate these elements, many programs disregard their integral role in family dynamics and support systems.^16,17

Cultural context has a substantial impact on the efficacy and design of family-based interventions. Interventions that are culturally appropriate have been demonstrated to improve the relevance and effectiveness of programs such as the Strengthening Families Program.¹⁸ Designing interventions that address the specific contexts of families, such as those of runaway adolescents, highlights the importance of considering cultural narratives and family structures in program design.¹⁹ Culturally sensitive interventions that align with familial contexts are essential to optimize preventive measures and enhance their acceptance and efficacy.²⁰

Prior reviews have predominantly focused on specific parenting interventions or particular diagnostic outcomes. For instance, several studies examined parenting programs targeting adolescent depression or substance use, while others emphasized help-seeking or parenting support strategies for parents of adolescents.^21–23 However, these reviews do not provide a comprehensive synthesis of the full range of family-based preventive strategies across diverse mental health outcomes and prevention levels in adolescence.

Considering the fragmented evidence and varied contexts in implementing family-based interventions, including programmes spanning universal, selective, and indicated prevention as well as primary, secondary, and tertiary prevention perspectives, there is a need to map and understand the landscape of family-based preventive interventions targeting adolescent mental health. A scoping review is an appropriate method because it enables a broad mapping of the range, nature, and key characteristics of heterogeneous interventions and outcomes. This review therefore seeks to identify the predominant thematic approaches to family-based prevention strategies for adolescent mental health, describe their key characteristics and targeted outcomes, and clarify how families are engaged and positioned within these interventions spanning different prevention levels.

Methods

We performed a scoping review study following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).²⁴ A scoping review was chosen because it enables a systematic mapping of the breadth, nature, and key characteristics of heterogeneous family-based prevention interventions, rather than evaluating pooled effectiveness as in a traditional systematic review or meta-analysis. This scoping review included a careful and systematic investigation of relevant academic publications about the family-based prevention approaches and their impact on adolescent mental health.

Research Question

The review aimed to: (1) map and describe the predominant thematic approaches used in family-based prevention strategies for adolescent mental health, and (2) summarize their key characteristics and targeted outcomes. The research question formulated was, “What are the main thematic approaches to family-based prevention strategies for adolescent mental health, and what are their key characteristics and outcomes?”

Eligibility Criteria

We adopted the WHO definition of adolescence (10–19 years) to ensure a comprehensive and internationally comparable scope. Studies were required to include family-based preventive interventions (involving at least one family member/primary caregiver) with an outcome measure of adolescent mental health. We restricted the review to English-language and full-text articles due to resource constraints and database availability. Open-access status was applied as part of the eligibility to ensure full methodological assessment. Only original research articles were included in the search, with no restriction on the publication year. All years up to 2024 were considered.

Search Strategy

The PICO framework was operationalized through defined criteria for Population, Intervention, and Outcome. The population is adolescent, explored with the words adolescence, teenager, teenage, teen, youth, young people. The intervention is limited to family-based prevention, with additional terms family-based preventive. The Outcome was focused on mental health.

The search strategy encompassed the following terms: (((((((((adolescent) OR (adolescence)) OR (teenager)) OR (teenage)) OR (teen)) OR (youth)) OR (young people)) AND (family-based prevention)) OR (family-based preventive)) AND (mental health) These terms were adjusted as needed for each database (using MeSH terms and Boolean operators) to ensure a sensitive search capturing all relevant publications.

Selection Process

The selection process involved multiple stages illustrated in the PRISMA flow diagram (Figure 1). A comprehensive search was undertaken in various scholarly databases, including PubMed (n=250), ScienceDirect (n=179), Scopus (n=170), EBSCOhost (n=54), SAGE Journals (n=157), Wiley Online Library (n=322), and Taylor & Francis Online (n=204). The search was done in September 2024.

Figure 1.

PRISMA Flowchart of articles selection.

First, 1336 records were identified through database searches. An automated screening using built-in database filters combined with keyword-based exclusion algorithms was applied to eliminate clearly ineligible records. This automation step removed 992 records that did not meet basic criteria (eg, non-original articles, wrong age group, non-English language, or not available in full text). To ensure accuracy, a random 10% sample of excluded records was manually checked by two reviewers, confirming correct exclusion. Next, 63 duplicate records were identified and removed (n = 1,055 total removed). This left 281 unique records, which proceeded to the screening phase. Two reviewers independently screened titles and abstracts of these 281 records against the inclusion criteria, discrepancies were resolved through discussion. At this stage, 231 records were excluded for clearly not meeting criteria (for example, studies focusing on unrelated topics or lacking any family intervention component). The remaining 50 articles were retrieved in full text for detailed review. Each full-text article was assessed for eligibility. Full-text screening was conducted independently by two reviewers using predefined eligibility criteria. During full-text eligibility checking, we excluded 34 articles due to various reasons: 13 had ineligible populations (eg the sample was outside the adolescent age range or did not involve families as intended), 13 had wrong outcomes (no relevant mental health outcomes), 6 had inappropriate study designs (eg reviews or study protocols without data), and two did not contain the intended preventive information (eg interventions that were purely treatment or not preventive in nature). After these exclusions, 16 studies met all criteria and were included in the final scoping review. The articles included in the review were analyzed to obtain the necessary data synthesis.

Data Extraction and Charting

We extracted key data from each of the 16 included studies using a standardized charting form completed independently by two reviewers. For each study, we extracted information on the authors and year of publication, country of research, intervention setting, prevention level, participant characteristics, study design, intervention program, and primary outcomes related to adolescent mental health. To strengthen the analytical rigor of this review, the level of prevention was classified using two complementary frameworks: the Universal-Selective-Indicated (USE) model and the Primary-Secondary-Tertiary (PST) model. The USE framework enabled risk-based categorization, whereas the PST framework positioned interventions along the clinical trajectory of mental health.²⁵ The use of both frameworks aligns with current recommendations for comprehensive prevention mapping in mental health research.

Thematic synthesis followed Braun and Clarke’s approach to thematic analysis, comprising initial coding, development of focused codes, and generation of overarching themes.²⁶ Discrepancies in coding or theme assignment were resolved through consensus discussions. This analytic approach aimed to capture the range and mechanisms of family-based preventive efforts across diverse contexts.

Results

The results reported findings from studies that examined the extent and nature of family-based prevention strategies aimed at adolescent mental health. The analysis focused on study characteristics, prevention levels as defined in the included studies, and thematic patterns reflecting the core mechanisms and approaches used across interventions.

The Study Profile Counts

We successfully gathered 1,336 articles from multiple databases. Following the elimination of duplicates and automation of exclusions (n = 1,055 total removed), 281 records were screened by title/abstract, 50 full-text articles were assessed for eligibility, and 16 studies were ultimately included in the review. We identified the characteristics based on the authors’ names and publication years, the country of research, intervention setting, prevention level, participant details, study design, intervention program, and key outcomes related to adolescent mental health. The study profiles featured in this scoping review are presented in Table 1.

Table 1.

Included Studies for the Analysis (n=16)

Author(s) Publication (Year)	Country	Settings	Level of Prevention		Participants and Sample Size	Study Design	Intervention Programs	Key Outcomes
			USE Framework	PST Framework
Dumka et al (2007)27	Mexico	School setting	Selective prevention	Primary prevention	516 Mexican-origin 7th-grade students and families	RCT	The Puentes program (“Bridges to High School Program”)	Prevent school disengagement and mental health problems
Cervantes et al (2011)28	USA	School setting	Indicated prevention	Secondary prevention	153 Latino youth aged 11–14 years with behavioral or school problems, and 149 parents	One-group pretest-posttest	Familia adelante (The Hispanic Family Intervention Program)	Enhanced family and peer communication, prevent substance abuse, increase knowledge and improve school bonding
Hughes et al (2013)29	USA	Emergency Department, Hospital	Indicated prevention	Secondary&tertiary prevention	181 youth aged 10–18 presenting to the emergency department (ED) with suicidal ideation or a suicide attempt, and their parents	RCT	FISP (Family Intervention for Suicide Prevention)	Increased outpatient treatment participation after ED discharge
Bhana et al (2014)30	South Africa	Hospital	Indicated prevention	Tertiary prevention	65 youth aged 10–13 with HIV-positive and their families	RCT	The VUKA program	Improved mental health, behavior, knowledge, stigma, communication and adherence to medication
Lynn et al (2014)31	USA	Family homeless shelters	Selective prevention	Secondary prevention	28 homeless youth aged 11–14 and their family residing within family shelters	Quasi-experimental study	HOPE Family Program	Reduction of suicidal ideation
Esposito-Smythers et al (2017)32	USA	Mental health care in community	Selective &indicated prevention	Secondary prevention	81 adolescents (ages 13–17) in mental healthcare and their parents	RCT	ASH-P (Alcohol, Self-Harm and HIV Prevention)	Mitigated alcohol use, HIV transmission, and Deliberate Self-Harm (DSH)
Bröning et al (2017)33	Germany	Community counseling centers	Selective&indicated prevention	Primary prevention	292 children aged 10–14 years and their families	RCT	Familien Stärken (the German adaptation of the Strengthening Families Program 10–14)	Reduction in behavioral problems and substance use indicators.
Thurman et al (2018)34	South Africa	Community-based organizations	Selective prevention/	Primary& secondary prevention	105 adolescents (ages 13–17) and 95 caregivers	One-group pretest-posttest	‘Let’s Talk’ Program	Support caregiver’s mental health and parenting skill for orphaned and vulnerable adolescents.
Henderson et al (2019)35	Canada	School, clinics, youth service agencies	Universal, selective, indicated prevention	Primary, secondary and tertiary prevention	87 youth (ages 14–17) and 95 families.	Mixed-methods study	Research and Action for Teens (RAFT)	Provided valuable insight into system-level changes and youth needs in addressing concurrent mental health.
You et al (2020)36	Taiwan	Hospital	Indicated prevention	Tertiary prevention	103 youths aged 12–18 with substance use and their caregivers	Longitudinal cohort study	Family-oriented therapy program	Reduction in behavioral problems during treatment to prevent substance use relapse
Cluver et al (2020)37	South Africa	Community setting	Selective prevention	Primary prevention	552 families (adolescents aged 10–18 and primary caregivers)	RCT	Parenting for Lifelong Health for Teens	Mitigated violence against children, improved parenting and family economic strengthening
Ng et al (2020)38	USA	Juvenile Drug Court	Indicated prevention	Secondary prevention	47 justice-involved adolescents and their parents.	RCT	FAMI (Family-based Affect Management Intervention)	Mitigated substance use and HIV by enhancing parental skills to support adolescents.
Donenberg et al (2021)39	South Africa	Community setting	Selective prevention/	Primary&Secondary prevention	60 Adolescent girls and young women (AGYW) aged 15–19 years and their female caregivers	RCT	IMARA-SA (Informed, Motivated, Aware, and Responsible Adults and Adolescents-South Africa)	Reduction of anxiety symptoms, depression and trauma
Cavazos-Rehg et al (2021)40	Uganda.	Health clinics	Indicated prevention	Secondary prevention	702 adolescents living with HIV aged 10–16	RCT	Suubi + Adherence	Improved hopelessness, depression and poor self-concept
Haggerty et al (2023)41	USA	Families fostering youth	Selective prevention	Primary prevention	220 families with youth aged 11–15	RCT	Connecting Program	Improved family bonding, family climate, risk behavior attitude, mental health and placement stability
Berkel et al (2024)42	USA	Community setting	Universal&Selective prevention	Primary prevention	667 African American youth and families	RCT	Strong African American Families (SAAF)	Decreased psychological distress and risk behaviours associated with racial discrimination.

Characteristics of the Studies

The 16 studies identified in this review used heterogeneous prevention classifications. Applying both frameworks enabled a clearer distinction between interventions aimed at population-level risk reduction (USE framework) and those positioned within the clinical progression of mental health problems (PST framework). This dual classification improved the interpretability of findings and provided greater practical relevance for prevention planning and implementation.

Across the 16 studies included in the scoping review, distinct patterns were observed when applying the two prevention frameworks. Using the USE framework, the majority of interventions were categorized as Selective (37.5%)^{27,31,34,37,39,41} and Indicated (37.5%),^{28–30,36,38,40} while fewer studies fell into Selective & Indicated (12.5%),^32,33 Universal & Selective (6.25%),⁴² and Universal-Selective-Indicated (6.25%).³⁵ Using the PST framework, a similar distribution emerged, with Primary (31.25%)^{27,33,37,41,42} and Secondary (31.25%)^{28,31,32,38,40} prevention being most common, followed by Tertiary (12.5%),^30,36 Primary & Secondary (12.5%),^34,39 Secondary & Tertiary (6.25%),²⁹ and Primary-Secondary-Tertiary (6.25%).³⁵ These findings indicate that family-based interventions for adolescent mental health predominantly operate at targeted or early-stage levels rather than universal or purely rehabilitative approaches. A summary of these findings is provided in Table 2.

Table 2.

Characteristics of Included Studies by Prevention Levels (n=16)

Level of Prevention		n	%	References
USE Framework	Selective	6	37.50	Dumka et al (2007)27 Lynn et al (2014)31 Thurman et al (2018)34 Cluver et al (2020)37 Donenberg et al (2021)39 Haggerty et al (2023)41
	Indicated	6	37.50	Cervantes et al (2011)28 Hughes et al (2013)29 Bhana et al (2014)30 You et al (2020)36 Ng et al (2020)38 Cavazos-Rehg et al (2021)40
	Selective & Indicated	2	12.50	Esposito-Smythers et al (2017)32 Bröning et al (2017)33
	Universal & Selective	1	6.25	Berkel et al (2024)42
	Universal-Selective-Indicated	1	6.25	Henderson et al (2019)35
PST Framework	Primary	5	31.25	Dumka et al (2007)27 Bröning et al (2017)33 Cluver et al (2020)37 Haggerty et al (2023)41 Berkel et al (2024)42
	Secondary	5	31.25	Cervantes et al (2011)28 Lynn et al (2014)31 Esposito-Smythers et al (2017)32 Ng et al (2020)38 Cavazos-Rehg et al (2021)40
	Tertiary	2	12.50	Bhana et al (2014)30 You et al (2020)36
	Primary & Secondary	2	12.50	Thurman et al (2018)34 Donenberg et al (2021)39
	Secondary & Tertiary	1	6.25	Hughes et al (2013)29
	Primary-Secondary-Tertiary	1	6.25	Henderson et al (2019)35

Several interventions were classified into two categories because they operated across multiple levels of prevention. Rather than being confined to a single stage, these programs targeted both at-risk populations and adolescents who already exhibited early symptoms, thereby functioning as both selective and indicated prevention. Similarly, some interventions addressed both early detection and relapse prevention, hence falling into both secondary and tertiary prevention categories.

The majority of study designs (68.75%, n=11) were randomized controlled trials (RCTs), reflecting a high proportion of rigorous experimental designs.²⁷,²⁹,³⁰,³²,³³,³⁷,³⁸,^40–42 The remaining studies comprised two one-group pretest-posttest studies (12.5%),^28,34 one quasi-experimental study (6.25%),³¹ one longitudinal cohort study (6.25%),³⁶ and one mixed-method study (6.25%).³⁵ The distribution of study designs indicates that while rigorous trials dominated the evidence base, several interventions were evaluated through observational or pilot designs, reflecting the developmental stage of many family-based prevention programs.

The studies were conducted in diverse geographic locations, highlighting the global interest in family-based prevention. Seven studies were conducted in the United States,^{28,29,31,32,38,41,42} four in South Africa,^30,34,37,39 and one each in Germany,³³ Canada,³⁵ Taiwan,³⁶ Uganda,⁴⁰ and Mexico.²⁷ The intervention settings were varied: six studies were delivered in community settings,^{32–34,37,39,42} two in school settings,^27,28 four in healthcare settings (such as hospitals or clinics),^29,30,36,40 and one study in multiple settings³⁵ (a Multi-method study with various settings, such as community, school, and clinics). The remaining studies were situated in special contexts, including homeless shelters,³¹ the foster care system,⁴¹ and the juvenile justice system.³⁸ This variation in settings demonstrates the adaptability of family-based strategies across structurally and culturally diverse contexts.

Synthesis of the Results

Table 3 presents the synthesis result of the selected studies. To synthesize the findings of the 16 included studies, we developed four thematic categories that reflect shared mechanisms of change and the primary focus of each intervention type. These themes helped organize a diverse literature base and highlight how different family-based strategies operate across prevention contexts. Each theme represents a distinct approach to family-based prevention for adolescent mental health, although some programs span multiple themes. The theme synthesis sought to encompass the wide range of preventive efforts families engage in, in collaboration with program providers, to promote adolescent mental health.

Table 3.

Themes of Selected Studies

Themes	n	%	References
Parenting skill training programs	3	18.75	Dumka et al (2007)27 Bröning et al (2017)33 Berkel et al (2024)42
Family therapy and communication enhancement interventions	4	25.00	Hughes et al (2013)29 Cervantes et al (2011)28 You et al (2020)36 Ng et al (2020)38
Risk-specific family-based interventions	6	37.50	Bhana et al (2014)30 Lynn et al (2014)31 Esposito-Smythers et al (2017)32 Thurman et al (2018)34 Donenberg et al (2021)35 Henderson et al (2019)39
Socioeconomic and self-directed family interventions	3	18.75	Cluver et al (2020)37 Cavazos-Rehg et al (2021)40 Haggerty et al (2023)41
Total	16	100

Interventions identified across the 16 analyzed studies in this scoping review were broadly categorized into four themes: parenting skill training programs, family therapy and communication enhancement interventions, risk-specific family-based interventions, and socioeconomic and self-directed family interventions. These themes represent distinct pathways through which family-based prevention may influence adolescent mental health, whether by improving parenting practices, strengthening relational functioning, addressing targeted behavioural or psychosocial risks, or reducing socioeconomic stressors that shape family well-being. Some interventions employed multi-component strategies bridging themes, underscoring the interconnected nature of family processes.

Discussion

Mental health, as conceptualized by the World Health Organization (WHO), refers to a state of well-being that enables people to cope with the stresses of life, understand their potential, learn and work proficiently, and contribute actively to their society.⁴³ For adolescents, positive mental health is manifested through emotional, psychological, and social well-being, alongside the capacity to regulate affect, appropriately respond to life events, and demonstrate resilience in the face of challenges.⁴⁴ Among the various determinants of adolescent mental health, family structure and dynamics play a crucial role. Family involvement acts as a protective factor in preventing adolescent mental health problems.^45,46 A high level of parental involvement is significantly linked to a lower incidence of psychological distress among adolescents.⁴⁷

Family-based prevention serves as a prevalent approach in addressing adolescent needs, including the prevention of mental health problems. This approach refers to interventions that actively involve at least one parent, caregiver, or family member in efforts to improve adolescents’ health outcomes. Based on the thematic synthesis, four predominant intervention approaches were identified: (1) Parenting Skill Training, (2) Family Therapy and Communication Enhancement Interventions, (3) Risk-Specific Targeted Interventions, and (4) Socioeconomic and Self-Directed Family Interventions. These themes reflect different mechanisms by which families contribute to prevention, aligning with theoretical perspectives such as family systems theory and ecological models of development.

Parenting Skill Training Programs

One major category of family-based prevention focuses on improving parenting skills as a means to foster healthier adolescent development. Parenting skill training programs serve as a fundamental element of family-oriented preventative methods designed to improve adolescent mental health. These interventions consistently demonstrate that strengthening parental competencies produces measurable improvements in both parent and adolescent outcomes. Across studies, such programs operated primarily through mechanisms of enhanced parental monitoring, increased warmth, consistent discipline, and improved family management, mechanisms well-documented as protective factors in adolescent development. The interventions identified in this theme are The Puentes Program, The Strengthening Families Program (SFP 10–14), and the Strong African American Families (SAAF) program.^27,33,42

The Puentes program was implemented in a community of Mexican-origin families through a partnership with local schools. This program combined group-based parent training, parallel youth sessions, and joint family activities over nine weeks, with additional home visits and a school liaison component. The results highlighted multiple benefits: parents became more involved in their children’s education and reported improved communication with their 7th-grade children, which corresponded with adolescents showing better coping in school and fewer behavioral problems.²⁷

The Strengthening Families Program (SFP 10–14), originally a United States-developed intervention, was adapted in Germany with Familien Stärken. SFP is a classic parent and youth skill-building intervention designed to prevent substance misuse and behavioral problems. The intervention consisted of seven weekly sessions and follow-up boosters, emphasizing positive parenting, effective discipline, and family cohesion activities. These findings suggest that parenting skill programs may have the most impact on youths who begin with multiple risk factors, likely because the intervention addresses deficits in parenting or family management that are contributing to those youths’ difficulties.³³

The Strong African American Families (SAAF) program integrates standard parenting skill training with content on racial socialization to help Black parents prepare their children for potential discrimination. SAAF’s core parenting components (consistent discipline, monitoring, warmth, and involvement) are common to many parent training programs, but its unique addition is guiding parents to communicate messages of cultural pride and adaptive coping in the face of racial bias. Adolescents showed enhanced ethnic identity or Black pride, which was linked to improved psychological functioning and indirectly to lower engagement in risk behaviors by mid-adolescence. On the other hand, exposure to racial discrimination still had a significant detrimental effect on adolescents, and SAAF did not completely eliminate this effect. This finding is important for contextualizing expectations of parenting interventions: they can strengthen family and youth capacities, but external stressors may continue to pose challenges.⁴²

Parenting skills training programs significantly influence adolescent mental health outcomes by enhancing parental competence, fostering emotional support, and reducing behavioral issues in adolescents. Research indicates that participants in parenting interventions often report improved parental competencies, which correlate with higher parental warmth and involvement, and lower adolescent depressive symptoms.^48,49 Meta-analyses show that these interventions can enhance both parental mental health and child behavioral outcomes, creating a positive feedback loop that benefits adolescents.^50,51 For instance, online interventions have been found to improve parenting practices and reduce adolescent behavior problems effectively, indicating that these programs empower parents while mitigating potential behavioral challenges faced by adolescents.^51,52 Such evidence underscores the critical nature of these programs in supporting both parental and adolescent mental health.

Interventions designed to prevent adolescent mental health problems often target specific parenting behaviors associated with various styles. The authoritative parenting style, characterized by warmth, responsiveness, and appropriate expectations, is frequently emphasized due to its positive correlation with lower levels of anxiety, depression, and behavioral issues in adolescents.^53,54 These interventions aim to cultivate parental emotional competence, encouraging parents to develop skills that enhance their involvement and responsiveness, thereby reducing the risk of future mental health complications in their children.^55,56 Negative parenting behaviors, such as harsh discipline and overprotection, are also addressed. Programs typically teach parents to recognize and mitigate these detrimental styles, as such behaviors can exacerbate issues like sadness or aggression in adolescents.^57,58 Furthermore, the modulation of parental stress and rejection is a focal point, interventions propose that reducing these factors can significantly improve adolescent well-being.⁵⁹ Studies indicate that increasing parental efficacy and ensuring consistent affectionate responses can foster resilience in adolescents, further solidifying the role of parenting interventions in mental health promotion.⁶⁰

Implementing effective parenting skills training interventions across varied groups requires addressing numerous obstacles and enablers. Significant obstacles encompass cultural disparities that may influence communication and the acceptance of parenting standards. The absence of sign language proficiency among deaf parents impedes their participation in programs, highlighting the necessity of inclusive communication initiatives, including the provision of sign language interpretation services.⁶¹ Cultural taboos and apprehensions regarding the discourse on sensitive subjects, such as sexual health, can obstruct transparent communication between parents and teenagers, as evidenced by research that underscores how sociocultural norms limit parental dialogue.⁶² Facilitators encompass the modification of programs to align with local contexts. Culturally customised treatments can markedly improve parental engagement and contentment. Adaptations implemented for Filipino parents in a particular program demonstrated effective participation and enhanced parent-child connections.⁶³ Furthermore, peer support mechanisms can serve as a critical facilitator in these interventions by enhancing parental confidence and coping strategies. In communities that are experiencing economic hardships or social stigmas, parents require essential resources such as a support network among peers and a familiarity with parental issues.^64,65

Family Therapy and Communication Enhancement Interventions

The second theme includes interventions that explicitly seek to enhance family communication and functioning as a means of achieving better adolescent outcomes, or that adopt a family therapy approach. Structured therapeutic sessions with the family (or parts of the family) are frequently a component of these programs, which may be administered by trained health professionals in clinical or crisis environments. Family therapy interventions have a substantial impact on the mental health and risk behaviours of adolescents by promoting effective communication and supportive family dynamics. Positive family relationships are associated with decreased symptoms of depression and lower risk behaviours among adolescents, according to a multitude of studies.^9,10,66 Across the included studies, these interventions operated through mechanisms such as strengthening emotional availability, increasing shared problem-solving, and improving communication clarity mechanisms consistent with family systems and ecological models. Program interventions on this theme include The Family Intervention for Suicide Prevention (FISP), The Familia Adelante program, Family-based Affect Management Intervention (FAMI), and the Family-oriented therapy program.^28,29,36,38

The Family Intervention for Suicide Prevention (FISP) exemplifies the potential of brief therapeutic interventions administered in critical care environments. The FISP program is intended for emergency departments (ED) and consists of a single therapeutic session with the youth and their parent or guardian during an emergency room visit for suicidal ideation or attempts, accompanied by several follow-up phone check-ins. The intervention aimed to enhance the family communication regarding the problem and to establish a safety plan for implementation post-discharge. The research has shown that augmenting parent-child cooperation during crises enhances access to follow-up care, a crucial measure for suicidal teenagers.²⁹

The FISP model has demonstrated effectiveness through brief crisis therapy sessions within the ED, improving follow-up engagement and decreasing subsequent suicide attempts among participants.^67,68 By ensuring that emergency department personnel communicate treatment processes and long-term care plans in a timely and clear manner, they can reduce parental anxiety and increase the likelihood of follow-up adherence, thereby providing the best possible support to families.^69,70 Integrating family-focused interventions into crisis management clearly improves individual adolescent outcomes and boosts the overall efficacy of mental health services in acute contexts.^69,71

Family-based interventions targeting adolescents at risk of suicide have shown effectiveness by emphasizing family support as a central protective factor. Research indicates that interventions that improve the functionality of families are essential, as they can mitigate suicidal ideation among adolescents through the facilitation of positive family dynamics and emotional availability from parents.^72,73 A systematic review found that perceived family support is linked to reduced suicidal behaviors in adolescents, underscoring the significance of positive family relationships.⁷⁴ Research also indicates that fostering communication and trust within the family can mitigate feelings of loneliness, a primary contributor to suicidal ideation.⁷⁵ Therefore, integrating family-based strategies into suicide prevention efforts is essential for effectively addressing adolescent mental health needs and reducing suicide risk.

The Familia Adelante program was explicitly designed to improve family and peer communication as a means to reduce problems. Over 12 weekly sessions, facilitators worked with Latino adolescents and their parents on sharing feelings, discussing stressful experiences (including those related to immigration and discrimination), and practicing constructive communication and parenting styles. By helping families talk about sensitive topics (substance abuse, HIV risks, discrimination), the program likely reduced secrecy and conflict, thereby indirectly improving behavioral outcomes. The outcomes demonstrate that this communication enhancement focus proved effective; youths reported significantly increased comfort in talking with their parents and better communication with peers post-intervention. They also felt more attached to their family. These changes coincided with a host of positive outcomes in knowledge, attitude, and behaviours and decreases in substance use.²⁸

The importance of family communication quality is further illustrated in a more nuanced way. In this pilot study, it was found that among justice-involved youth, the effectiveness of Family-based Affect Management Intervention (FAMI) versus an adolescent-only health program (HPI) depended on parental distress levels. FAMI implemented a 4-week family therapy program with 2-hour sessions each week, teaching both youth and parents emotion regulation, interpersonal skills, and strategies to reduce substance use and sexual risk. When parents had high psychological distress, FAMI led to better teen substance use outcomes by equipping parents with coping and parenting tools. Conversely, when parents had low distress, HPI slightly outperformed FAMI in reducing alcohol use. The study underscores that family interventions are most effective when addressing existing dysfunction, supports tailoring approaches to family needs, and highlights the value of addressing parent mental health alongside youth behavior.³⁸

Family communication explains a significant part of the variance in adolescents’ mental health.⁷⁶ Effective family communication strategies are essential in preventing mental health issues among adolescents. Conflict within family settings negatively impacts adolescent mood and self-esteem, suggesting that minimizing family discord through effective communication can be protective against mental health problems.^76,77 Importantly, these communication processes form part of broader relational mechanisms such as trust-building, emotional regulation support, and shared meaning-making that help explain why family-based interventions exert preventive effects. This holistic approach underscores that strengthening the home environment can enhance mental health literacy and ultimately improve adolescents’ mental health trajectories over time.^78,79

A family-oriented therapy program is an example of a clinical family therapy plus parent training blend for substance abuse in a Taiwanese hospital setting. The youth attended therapy sessions targeting their motivation and emotion management around drug use, while parents received parallel training on how to communicate and set limits constructively. The study’s key finding was that changes achieved during the intervention had long-lasting significance. Adolescents who showed improvement in behavioral problems by the end of the 10-week program were significantly less likely to relapse into drug use over a 5-year follow-up period.³⁶

The effectiveness of family therapy interventions for adolescents with mental health issues is moderated and mediated by several factors. High family cohesion and effective communication significantly enhance treatment outcomes, as evidenced by studies indicating that family support strengthens the impact of therapeutic interventions.^78,80 The psychological state of parents, including their mental health literacy, can influence adolescent therapy outcomes; parents with better mental health knowledge tend to foster supportive environments that are conducive to positive mental health outcomes in their children.^78,81 The socio-economic status of families impacts the effectiveness of interventions, with lower socioeconomic backgrounds often correlating with poorer mental health outcomes in adolescents.^82,83 Individual factors (eg, gender, physical health, and past traumatic experiences), family factors (eg, parental criticism and family support), and school/community factors (eg, academic pressure and safety) were associated with mental health outcomes.⁸¹ Various parental engagement strategies, like cooperative participation in therapy, have been shown to mediate the impacts of familial dynamics on treatment success.⁹ Study indicates that involving families in therapeutic processes not only targets individual symptoms but also enhances overall family functioning, leading to improved mental health outcomes for adolescents.⁸⁴

Family functioning plays a pivotal role, as environments characterized by support and understanding contribute to enhanced mental well-being.^10,85,86 Family therapy interventions are crucial in promoting better mental health outcomes and reducing risky behaviors among adolescents. Engaging families in therapeutic processes not only supports mental health directly but also mitigates risks associated with mental health issues.⁸⁰ Interventions targeting parent-child relationships can particularly benefit adolescents dealing with issues like depression or anxiety, facilitating healthier coping strategies and resilience.^80,87 Additionally, family-based therapeutic models, such as structural-strategic therapy, have been shown to improve overall mental health outcomes by addressing familial patterns that contribute to adolescent distress.^84,87

Risk-Specific Family-Based Interventions

The third theme comprises family-based interventions that are tailored to address specific risk factors or high-risk populations. In contrast to general parenting or therapy programs, these interventions are purposefully tailored to specific outcomes, including the prevention of substance use, reduction of sexual risk behaviors (such as HIV transmission), and mitigation of suicide risk, particularly among youth with elevated risk profiles. In this theme, the interventions found are The VUKA Family Program, The HOPE Family Program, The ASH-P (Alcohol, Self-harm, HIV-Prevention) program, Let us Talk Program, IMARA-SA, and The Research and Action for Teens (RAFT).^{30–32,34,35,39} Collectively, these interventions illustrate how family-based prevention can be embedded within risk-specific contexts (eg, HIV, homelessness, justice involvement) and operate through mechanisms such as stigma reduction, improved adherence, and strengthened coping around clearly defined threats.

The VUKA Family Program for HIV-positive pre-adolescents in South Africa was innovative in using culturally relevant storytelling (cartoons featuring characters living with HIV) as a way to engage children and caregivers in discussions about sensitive topics like stigma, bereavement, and disclosure. Caregivers and HIV-positive youth attended joint sessions to practice health and feelings-related communication, leading to improvements in all measured psychosocial outcomes compared to controls. Caregivers felt more comfortable discussing puberty and HIV, and youth showed significantly better ART adherence. Qualitative feedback indicated enhanced self-concept, resilience, and hope.³⁰ The program therefore exemplifies how culturally resonant, family-based content can address both the psychosocial sequelae of HIV and concrete health behaviours such as treatment adherence.

Family interventions aimed at HIV prevention among adolescents significantly influence mental health and behavioral outcomes by fostering resilience, enhancing psychosocial support, and improving knowledge about HIV. Programs such as the Collaborative HIV Prevention and Adolescent Mental Health Program have shown that integrating family dynamics helps adolescents cope with internalized stigma associated with HIV, leading to positive behavioral changes.^88,89 These findings suggest that family-based HIV-related interventions may act through overlapping mechanisms of stigma reduction, enhanced communication about sexual health, and strengthened caregiver-youth connectedness.

Moreover, improved family functioning correlates with enhanced resilience among adolescents, reinforcing positive health behaviors such as adherence to antiretroviral treatment.⁹⁰ This support from family members not only bolsters mental health outcomes but also strengthens the adolescents’ capacity to engage in health-promoting behaviors.⁹¹

The HOPE Family Programs are enhanced family-strengthening interventions designed for adolescents residing in homeless shelters. Though originally designed for HIV/STI prevention, the family-focused approach yielded striking mental health benefits among youth with baseline suicidal ideation. Participants were 13 times more likely to no longer report such thoughts at follow-up, with 64% achieving remission versus far fewer in the control group. Benefits were greatest for non-substance-using youth, as substance use strongly predicted persistent suicidality, highlighting the need for integrated substance use and family interventions. The study demonstrates that even in unstable environments, investing in parent–child relationship building can significantly improve adolescent mental health, though scaling remains challenging due to attendance barriers.³¹ This pattern also illustrates that risk-specific programs may yield differential benefits across subgroups, reinforcing the importance of considering comorbid risks such as substance use when designing and targeting family-based interventions.

The ASH-P (Alcohol, Self-harm, HIV-Prevention) program for teens in outpatient mental health care with co-occurring risk behaviors combines brief, intensive joint youth-parent workshops grounded in cognitive-behavioral and social learning principles. Compared to controls, ASH-P families reported more open communication on taboo topics, and adolescents perceived stronger parental disapproval of risky behavior changes linked to deterrence. By 12 months, ASH-P youths had significantly lower odds of self-harm and were more likely to refuse unprotected sex, though no differences emerged for alcohol/marijuana use or suicidal ideation. These mixed results suggest that targeted family boosters can selectively improve certain outcomes, with communication gains appearing early and behavior changes emerging later, highlighting the need for sustained follow-up and possibly additional supports for entrenched behaviors like substance use.³² Such mixed patterns underscore that even within risk-specific designs, different outcomes may respond to distinct “active ingredients” (eg, communication vs skills training), which future studies should unpack more explicitly.

Let us Talk Program is a South African program for orphans and vulnerable adolescents and their caregivers, aiming to improve mental health, parenting skills, adolescent life skills, and sexual health communication. Without a control group, significant pre–post gains included more sexual health discussions, stronger caregiver-youth connectedness, and reduced depression/anxiety for both generations. Youth also showed greater HIV knowledge and condom self-efficacy. By engaging influential caregivers and addressing both emotional well-being and knowledge deficits, the program demonstrated a holistic, risk-specific approach that tackles psychosocial drivers of HIV risk alongside prevention knowledge, aligning with best practice in youth HIV prevention.³⁴ However, the absence of a comparison group limits causal inference, highlighting a broader limitation among some risk-specific interventions in this review.

IMARA-SA is a family-based HIV prevention program for South African adolescent girls and young women focusing on mental health outcomes. Compared to a health promotion control, intervention participants reported significantly fewer anxiety symptoms and were less likely to have even mild depression, though PTSD symptoms showed no group differences. These benefits, likely aided by caregiver involvement and culturally relevant content, are meaningful given the link between mental health problems and HIV risk. The findings underscore that targeted prevention programs can also address co-occurring mental health needs in high-risk youth.³⁹

The Research and Action for Teens (RAFT) is an initiative study designed to strengthen the evidence base for prevention, screening, treatment, and service delivery for youth with concurrent mental health and substance use concerns. RAFT included four sub-studies including a longitudinal study tracking the emergence of mental health and substance use, validation of screening tools using a diagnostic interview, evaluation of the feasibility and effectiveness of dialectical behavior therapy (DBT) skills training for youth and family members, and implementation of cross-sectoral collaborative networks of youth-serving agencies using a common screening tool. RAFT provided valuable insight into system-level changes and youth needs in addressing concurrent disorders.³⁵ In contrast to the more program-specific interventions above, RAFT illustrates a systems-oriented approach, emphasizing how family components can be embedded within broader service and screening infrastructures.

Family-centered interventions targeting substance use among adolescents have demonstrated significant positive outcomes. Such interventions enhance family engagement and focus on improving familial relationships, which are crucial for mitigating substance use issues. Studies have shown that higher family connectedness correlates with lower rates of substance use, as it promotes resilience among youths.⁹² Family-based treatments, including Multidimensional Family Therapy and Functional Family Therapy, are recognized as particularly effective, significantly reducing drug use and delinquent behavior among adolescents.^93,94 These findings are consistent with the risk-specific programs in this review, which similarly leverage family processes to influence high-risk behaviours, although the included studies often had shorter follow-up periods and more heterogeneous designs.

Moreover, the quality of family dynamics impacts adolescent substance initiation, with supportive family structures serving as protective factors against early substance use.^95,96 Parental involvement has also been linked to better treatment retention and satisfaction in interventions aimed at adolescents using illicit substances.⁹⁷ Neglectful or hostile family environments have been associated with an increased risk of substance abuse, emphasizing the need for interventions that address familial support systems.⁹⁸ Effective family-centered strategies leverage familial relationships to cultivate healthier behaviors in adolescents, thereby underscoring the critical role of supportive home environments in substance use prevention.

Family-based interventions designed for adolescent mental health can enhance effectiveness through several key intervention characteristics. First, fostering strong family communication and involvement is critical; positive family dynamics have been associated with improved mental health outcomes, as effective communication helps adolescents express their feelings and cope with stressors.⁶⁶ Furthermore, interventions that incorporate psychoeducation for parents enhance their understanding of mental health issues, which subsequently improves parenting practices and support systems for adolescents.⁸¹ The risk-specific programmes in this review generally integrated these features within a targeted risk frame (eg, HIV, self-harm, substance use), suggesting that generic family processes and risk-specific content work in tandem.

Additionally, a focus on resilience-building strategies within the family context has shown promise. Research indicates that supportive family relationships can cultivate resilience, enabling adolescents to better manage challenges and prevent mental health issues.^9,12 Practical components, such as skill-building techniques that empower families to navigate stressors effectively, also contribute to positive outcomes.^99,100 Tailoring interventions to meet the specific needs of families facing unique socio-cultural challenges ensures greater relevance and engagement, which can enhance adherence to interventions and lead to sustained mental health improvements.¹⁰¹ Nonetheless, many of the risk-specific interventions reviewed were small-scale or context-bound, indicating a need for future research to test the transferability of these tailored models, identify their most active components, and explore how digital or hybrid delivery could extend their reach. Thus, these dimensions are fundamental in optimizing the impact of family-based mental health programs for adolescents.

Socioeconomic and Self-Directed Family Interventions

The fourth theme groups together interventions that extend beyond traditional workshop or therapy formats by addressing socioeconomic factors or utilizing self-directed delivery methods to empower families. These programs recognize that factors such as poverty, financial stress, and limited access to services can underlie adolescent mental health risks. The programs in this theme are Parenting for Lifelong Health for Teens, Suubi+Adherence, and Connecting Program.^37,40,41 These interventions illustrate how economic strengthening, financial literacy, and low-cost delivery formats operate as structural supports that complement family processes and reduce contextual vulnerabilities linked to mental health risk.

Parenting for Lifelong Health for Teens is a South African parenting program enhanced with economic strengthening to reduce violence against adolescents. Delivered by community members, the program combined positive parenting skills with budgeting and saving strategies. Mediation analysis showed that improved family economic welfare, along with reduced caregiver depression and substance use, were key pathways to reduced violence, highlighting the link between financial stability, caregiver well-being, and safer home environments. Direct parenting improvements also mediated effects, while changes in child behavior did not. The findings suggest that empowering caregivers through both skills and socioeconomic support is an effective, scalable approach in impoverished contexts.³⁷

Suubi+Adherence is a Ugandan family-level economic empowerment program for adolescents with HIV, combining financial literacy training and matched savings accounts to improve treatment adherence and mental health. During the 2-year intervention, participants showed significant reductions in hopelessness and depression, likely due to increased financial security and future-oriented goals. However, by the 4-year follow-up, these mental health gains had faded, suggesting the need for ongoing support to sustain benefits. The study highlights that strengthening a family’s socioeconomic foundation can yield substantial, though potentially short-term, psychological improvements for high-risk youth.⁴⁰ The short-lived nature of gains also underscores a broader challenge in economic interventions, namely the difficulty of maintaining psychological effects once financial inputs cease.

The Connecting Program was designed to strengthen family management and bonding to reduce delinquency and substance risk. In the RCT, no overall effects emerged compared to usual services, likely due to variable engagement or the limited relevance of one-size-fits-all content. However, older teens (16–17) showed improved caregiver bonding and less favorable attitudes toward early sex and substance use. Engagement remained the main challenge, suggesting future adaptations could combine low-cost self-directed delivery with interactive technology or limited live support to boost participation and impact.⁴¹ This finding reflects a common limitation across self-directed programs, high variability in uptake, which suggests the need for hybrid models that retain affordability while improving adherence.

Family socioeconomic status positively influences adolescent mental health, with varying effects depending on residence type and participation in health courses.¹⁰² Stress within the family proved to be significant in explaining adolescents’ mental health, especially due to financial issues.⁷⁶

The socioeconomic empowerment of families plays a pivotal role in shaping adolescent mental health outcomes through various mechanisms. Research indicates that family economic empowerment interventions, such as cash transfers and economic strengthening programs, can significantly alleviate financial stress, which is a known risk factor for mental health issues among adolescents. These interventions often lead to improved family functioning, enhanced parental support, and decreased rates of anxiety and depression in adolescents.^103,104 Economic empowerment initiatives in Uganda demonstrated that families experiencing financial stability reported better mental health outcomes for adolescents, including reductions in feelings of hopelessness and depression.^104,105

Empowering families economically can provide adolescents with resources to engage in productive activities and promote resilience against socio-economic adversities. Programs that focus on skill development and financial literacy have been linked to better psychological well-being in youth, further enhancing their coping mechanisms.^105,106 Studies also show that better economic conditions lead to improved educational and health outcomes, which can foster a supportive environment conducive to mental health.^106,107 Therefore, socioeconomic empowerment serves as a foundational element in promoting adolescent mental health by reducing stressors associated with poverty and enhancing familial support systems.

Economic strengthening interventions have been consistently shown to reduce mental health problems among adolescents, primarily by alleviating poverty-related stressors and enhancing family stability. As an illustration, poverty-targeted unconditional cash transfer programs can improve adolescent mental health by providing financial relief to families, which in turn enhances household dynamics and caregiving practices.¹⁰⁸

The “Suubi4StrongerFamilies” intervention in Uganda, which aims to strengthen family financial stability alongside parenting support, indicates significant reductions in depression and hopelessness among youths benefiting from this economic empowerment initiative.¹⁰⁴ Savings-led family-based economic empowerment interventions positively affected the mental health and self-efficacy of adolescents, suggesting that economic resilience fosters psychological well-being.¹⁰⁵ Poverty has been linked to adverse mental health effects. Economic strengthening could mediate mental health improvements through enhanced family resources and reduced stressors associated with poverty.¹⁰⁹ Therefore, economic empowerment not only facilitates immediate financial relief but also contributes fundamentally to better mental health trajectories for adolescents.

Self-directed or low-cost family interventions have shown positive effects on improving mental health outcomes among adolescents, demonstrating their potential as cost-effective solutions in various settings. Evidence indicates that these interventions promote mental well-being through enhanced family engagement and supportive communication. Evidence indicates that family-based interventions contribute to improved mental health outcomes in adolescents, highlighting the significance of family dynamics.¹¹⁰ However, as seen in the Connecting Program, engagement remains a critical limiting factor for self-directed approaches, reinforcing concerns about the need for clearer articulation of mechanisms, adherence supports, and contextual moderators.

Bhana et al conducted a systematic review that underscored the importance of family support in mental health interventions for adolescents living with HIV. They found that interventions focusing on strengthening family relationships were associated with reduced symptoms of depression and improved self-esteem among adolescents.¹¹¹

Family engagement and sustained outcomes in socioeconomic and self-directed adolescent mental health interventions are influenced by several interrelated factors. Parental involvement is crucial, who found that effective engagement strategies, including motivational interviewing and coping enhancement, significantly improve family participation in mental health programs.¹¹² Socioeconomic status plays a pivotal role, with families from higher socioeconomic backgrounds typically demonstrating greater involvement and engagement in interventions. The relationship between family socioeconomic status and engagement in mental health interventions is supported by evidence that indicates economic resources can affect participation rates.¹¹³

Cultural relevance is essential for the effectiveness of interventions. Culturally adapted interventions are more likely to resonate with families, facilitating increased engagement and improving mental health outcomes.²⁰ Flexibility in scheduling and community involvement in the design and implementation of interventions also supports sustained engagement by making programs more accessible and tailored to families’ needs.¹¹⁴ The perceived meaningfulness of the intervention suggests that when families see tangible benefits and experience interventions as relevant to their lives, they are more likely to commit to and sustain engagement over time. Thus, the interplay of these factors is critical for promoting effective family engagement in socioeconomic and self-directed mental health interventions for adolescents.

Taken together, the four thematic domains demonstrate how family-based prevention operates through distinct but complementary mechanisms, namely skills strengthening, relational repair, risk-targeted support, and socioeconomic empowerment. Synthesizing these patterns shows that most interventions function by enhancing family communication, caregiver efficacy, and emotional availability, while targeted programs address specific vulnerabilities such as HIV risk or suicidality. However, notable gaps remain. Universal prevention approaches were underrepresented across the evidence base, suggesting insufficient investment in population-wide, early-stage prevention. Similarly, digital, hybrid, or low-intensity technology-supported formats were rarely evaluated despite their potential to expand reach and overcome engagement barriers. The evidence also indicates the need to identify the active ingredients of multi-component interventions and to strengthen implementation strategies that improve caregiver engagement in self-directed or low-intensity programs. These observations underscore the need for future research to clarify mechanisms of change across intervention types and to develop scalable, culturally adaptable models that combine multiple pathways of family support.

Strength and Limitation

This scoping review offers a concise yet comprehensive map of family-based prevention strategies for adolescent mental health, synthesizing four major thematic approaches, namely parenting skill training, family therapy and communication enhancement, risk-specific interventions, and socioeconomic and self-directed family interventions. A key strength of this review is its broad coverage across diverse cultural and contextual settings, enabling a clearer understanding of the mechanisms through which families contribute to adolescent mental health prevention. However, several limitations should be acknowledged. The restriction to full-text English-language and open-access studies may have excluded relevant evidence from non-English or region-specific sources. The absence of a formal quality appraisal, consistent with scoping review methodology, limits conclusions regarding the strength or effectiveness of included interventions.

Conclusion

The reviewed interventions underscore the crucial role of family-based preventive approaches in supporting adolescent well-being and preventing a spectrum of mental health and behavioral problems. Four thematic approaches highlight different pathways to impact. Parenting Skill Training programs strengthen parenting and family management, proving especially effective for high-risk youth by preventing problem escalation and fostering broad benefits such as improved communication and monitoring. Family Therapy and Communication Enhancement interventions address relational issues as they emerge, showing that even brief efforts to improve family interactions can enhance cohesion, support, and goal alignment, thereby reducing adolescent mental health risks. Risk-Specific Targeted Interventions integrate family involvement into strategies for vulnerable youth, showing that tailoring to specific risks while engaging caregivers can yield strong outcomes. Socioeconomic and Self-Directed Interventions broaden prevention by addressing family financial stability and offering flexible delivery, showing that reducing structural stressors and offering low-cost delivery models can strengthen the preventive impact of family-based programs.

This scoping review highlights that the family is a powerful agent of prevention for adolescent mental health. However, variability in study quality, prevention classifications, and contextual factors limits the strength of inferences, indicating a need for more rigorous designs, clearer operationalization of prevention levels, and consistent reporting of mechanisms of change. Future research should integrate approaches, such as combining parenting skills with economic support or family therapy with digital tools, and address caregiver well-being to treat the family as a unit of care. In practice, A clearer focus on engagement strategies, scalability, and cultural adaptation will also strengthen future implementation efforts. In practice, the findings may inform stakeholders in their efforts to prioritise and enhance family-based strategies for adolescent mental health. Additionally, they provide researchers and practitioners with a clear thematic framework to conceptualise the current range of family based interventions and to inform the design and refinement of future programs.

Funding Statement

The Academic Grant from Universitas Padjadjaran, Indonesia, funded the APC.

Ethical Approval

This review is part of the broader study, which received ethical approval from the Ethics Committee of the Faculty of Medicine, Universitas Padjadjaran, Indonesia, with reference number 1031/UN6.KEP/EC/2024.

Disclosure

The authors declare that there are no conflicts of interest in the writing or publishing of this article.