Table 1.
Studies of psychoeducational interventions (PIs) for adolescents with depression, and families/carers.
| Study, country | Details of Intervention (and control) | Study Design | Participant characteristics (n) | Assessment, follow-up | Findings |
|---|---|---|---|---|---|
| Family PI | |||||
| Sanford et al. [17], Canada | Intervention: | Randomised controlled trial | 31 adolescents aged 13–18 years (20 females: 11 males), meeting DSM-IV criteria for MDD, and their families. | Primary outcomes: | Intervention improved RADS, SSAI, ACL post-treatment and follow-up, compared to usual treatment: effect size >0.5 for all. |
| Adjunctive PI: group sessions with all family members at home, PLUS usual treatment. | (feasibility, effectiveness) | (16:15) | Reynolds Adolescent Depression Scale (RADS); Structured Social Adjustment Interview (SSAI) (adolescent social functioning); Family Assessment Device (FAD) (family functioning); Adjective Checklist (ACL) (adolescent-parent relationship) | Effect size for RADS on follow-up: 0.64. | |
| Twelve structured interactive 90-min sessions, with manual. Aims: increase family knowledge about depression, appreciate effects on family, improve communication between adolescent and family and coping strategies. | Secondary outcomes: | Greater satisfaction reported with intervention. | |||
| Control: | Children’s Global Assessment Scale (CGAS) (adolescent); Client Satisfaction Questionnaire (CSQ) (parent satisfaction with services) | ||||
| Usual treatment: individual/group counselling. | Baseline (plus retest at 2 weeks), 3 months (mid-treatment), 6 months (post-treatment), 9 months (follow-up) | ||||
| Lopez et al. [18], USA | ‘Children’s Medication Algorithm Project (CMAP)’: | Feasibility trial with 2 arms | 90 children aged 6–17 years (26 females: 64 males) with diagnosis of depressive disorder, ADHD or both, being treated with medication in 4 community clinics. | Parent Satisfaction Questionnaire; Child/Adolescent Satisfaction Questionnaire; CMAP Education Log | Majority of caregivers (63%) and children (60%) happy with amount of information and found this helpful. 20% of parents and 14% of children/adolescents received much more information than they wanted. 90–100% of children and parents found written materials helpful. |
| Group intervention facilitated by clinicians/assistants, with manual, on medication, self-monitoring, lifestyle, coping strategies. | Baseline, then 4-month intervals | Programme successfully implemented, but follow-up data not analysed (confirmed from personal communication with authors). | |||
| Programme structured but could be tailored to families’ needs. Several available formats. No fixed number of sessions (median:6). | |||||
| Aims: improve compliance with medication and coping strategies. | |||||
| Brent et al. [19], USA | 2-h session with manual, for parents on diagnosis, course, treatment, methods of coping with family member. Depression described as a chronic, recurrent illness. | Trial of acceptability, feasibility, efficacy | 62 parents of 34 adolescents (22 females: 12 males) with mood disorder (primarily depressive disorder). | Questionnaire on attitude and knowledge about depression, and views of the programme Baseline, post-intervention |
Improvement in knowledge, modification of dysfunctional beliefs about depression and treatment. |
| ‘Significant improvement’ on 8/21 questionnaire items, decline in one item. | |||||
| Useful, interesting for almost all (97%) participants. | |||||
| INDIVIDUAL PI | |||||
| Parker et al. [20], Australia | Simple low-intensity interventions. | Factorial (2 × 2) randomised controlled trial | 176 help-seeking 15–25 year olds (mean age 17.6 years) with sub-threshold or mild-moderate depression/anxiety. | Primary outcomes: | Reduction in depression symptoms in BAPA and PI groups, greater reduction with BAPA, but not anxiety symptoms. Effect size post-intervention: BDI-II: d = 0.41 (95% CI 0.07–0.76); MADRS: d = 0.48 (95% CI 0.13–0.82). |
| Up to 6 manualised weekly sessions. | (acceptability, effectiveness) | Lifestyle PI:86 (53 females:33 males), BAPA:88 (53 females:35 males) | Beck Depression Inventory-II (BDI-II); Montgomery-Asberg Depression Rating Scales (MADRS); Beck Anxiety Inventory (BAI) | Lifestyle PI: | |
| Exercise: Behavioural activation physical activity (BAPA) v Lifestyle psychoeducation (e.g. physical activity, sleep, substance use) | Secondary outcomes: | BDI-II (mean): Baseline: 22.23, Post-intervention 14.09; | |||
| Psychological: Problem Solving Therapy v Supportive Counselling. | Clinical caseness; Substance (use) and Choices Scale; Social and Occupational Functional Scale; Active Australia (physical activity) Survey; Questionnaire on other interventions received | MADRS (mean): Baseline: 20.44, Post-intervention 12.87; | |||
| Baseline, post-intervention | BAI (mean): Baseline: 15.56, Post-intervention 7.88. | ||||
| Problem solving therapy not superior to supportive counselling. No interactions between interventions. | |||||
| COMPUTERISED/ONLINE PI | |||||
| Stasiak et al.[21], New Zealand | Intervention: | Randomised controlled trial | 34 adolescents (13–18 years) with low mood (14 females: 20 males), self-referred to school counsellors across 8 urban schools. | Primary outcome: Child Depression Rating Scale Revised (CDRS-R); | Reductions in depression scores in both groups, greater reduction with cCBT. |
| ‘The Journey’, computerised CBT programme (cCBT) at school, with guidebook. No school counsellor support unless requested. | (feasibility, acceptability, effectiveness). | (17:17) | Secondary outcomes: RADS-2; Pediatric Quality of Life Inventory (PedsQL); Adolescent Coping Scale (ACS) | CDRS-R mean change: | |
| 7 × 25–30 min multimedia modules (‘fantasy game-like environment’), on problem solving, conflict resolution, identifying and challenging unhelpful thoughts, relaxation techniques. | Acceptability: Brief satisfaction questionnaire | cCBT = 17.6 (CI = 14.13–21.00); CPE = 6.1 (CI = 2.01-10.02); p < 0.001. Effect size between groups: 1.7. | |||
| Control: | Baseline, post-intervention, 1-month follow-up | CPE had been helpful, positive feedback on computer-based format. Some felt it was more suited to younger ages. | |||
| Psychoeducation computer programme (CPE). Same structure as above but different content − on depression, ‘mental health hygiene’, stress reduction. CPE more ‘instructional’ than ‘therapeutic’. | |||||
| Demaso et al. [22], USA | ‘Depression Experience Journal (EJ)’: website for children/adolescents, families and healthcare professionals to share personal experiences of living/working with mental illness (to ‘facilitate healthy coping’). Used individually or with others. | Development trial − feasibility, safety | 38 primary caregivers, each with a child aged 8–19 years (26 females: 12 males) with depression, during a psychiatric hospital admission. | 2 semi-structured interviews: | Parents satisfied overall with EJ and presentation of stories and facts. Personal stories most helpful. |
| First assessed families’ experiences of child’s depression and management; | They suggested greater number and wider variety of narratives, and more interactivity. | ||||
| Second on views of intervention: using satisfaction & safety, concerns/areas for improvement, specific impacts, coping response & attitude change scales. | |||||
| Baseline, 2–4 weeks after use | |||||
| Stjernswärd & Hansson [23], Sweden | Web-based support for relatives of individuals with depression − psychoeducation module, diary, forum. | Explorative open trial | 25 relatives of individuals (including adolescents) with depression. | System usability scale (questionnaire); Content analysis of forum |
Generally well-received. |
| Intervention could help e.g. with feelings of isolation. | |||||