Table 2.

Studies of psychoeducational interventions (PIs) in adolescents at high-risk of depression, and families/carers.

Study, country	Details of Intervention (and control)	Study Design	Participant characteristics (n)	Assessment, follow-up	Findings
Family PI (parental depression)
Beardslee et al. [26], USA	Intervention:	Randomised controlled trial	37 families, each with an asymptomatic (non-depressed) 8–15 year old child (53 children in total, 21 females: 32 males), and at least one parent who had experienced a mood disorder (primarily depression) within 18 months	Semi-structured Interview about Disorder Impact and Intervention (parent) (SII) (family functioning; illness-related behaviour; benefits from intervention)	Intervention parents:
	Preventive group intervention facilitated by clinicians, with manual. 6–10 sessions (mean 7.7) attended mainly by parents; adolescents attended at least one clinician meeting and one family meeting.	(‘First-phase pilot study’)	(19:18)	Semi-structured Child Interview (SCI) (functioning; knowledge, feelings, experience of parent depression; coping style, perception of change)	-happier with factual information received than controls. -reported greater understanding of their feelings about mental illness and increased marital support.
	Main concepts: increased familial understanding of the disorder, appreciation of children’s experience of parental illness and potential effects.			Baseline, post-intervention (8.6 weeks on average)	Improved communication with children about their illness because of increased understanding in parent and child.
	Control:
	2 × 1-h lectures to small groups, attended by parents only − on depression, its effects and warning signs.
Beardslee et al. [27], USA	See details above	Randomised controlled trial (Efficacy study to establish sustained effects)	See details above	Semi-structure interviews as above Second follow-up, 1.5 years after enrolment	Intervention parents reported more positive changes than controls. Scores similar to those recorded post-intervention, which demonstrated sustained effects.
Beardslee et al. [28], USA	As above		First 12 families to complete intervention above	As above; clinical case discussions	Healing elements identified included:
	Authors explored ‘healing principles’ that contributed to positive changes in family behaviour and attitudes, which in turn enhanced resilience in children.			Follow-up (at least 3 years)	-demystification of illness, -modulation of shame and guilt, -increase in capacity for perspective taking, -development of hopeful perspective and belief in own competence.
					Families developed shared understanding of illness.
Beardslee et al. [29], USA	As above	Randomised controlled trial	93 families (121 children, 52 females: 69 males), same criteria as above	Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) & Streamlined Longitudinal Interval Continuation Evaluation (SLICE).	PI had long-term effects on how families address problems regarding parental mental illness. Parents found intervention more beneficial than lecture in changing child-related behaviour and attitudes.
	Telephone contacts/refresher meetings at 6–9 month intervals, with psychologists, social workers, nurses.	(‘Large-scale efficacy trial’)	(53:40)	Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidomologic Version Revised (Kiddie-SADS-E-R) & Kiddie-Streamlined Longitudinal Interval Continuation Evaluation (K-SLICE).	Children reported increased understanding of parental illness over lecture group (x21 = 8.2, p = 0.004).
	Educational material linked to family’s experience, reducing feelings of guilt/blame and helping children to build relationships within/outside of home.			Global Assessment Scale (GAS).	All children reported reduced depressive symptomatology over 2 years since intervention. (x21 = 7.3, p = 0.007), but no significant effect of group on this change (x21 = 0.2, p = 0.69).
				Youth Self-Report (YSR).
				SII & SCI (see previous Beardslee et al. studies)
				Baseline, post-intervention, 1 and 2 years after enrolment
Solantaus et al. [30], Finland	Intervention:	Randomised controlled trial	109 parents with a mood disorder (primarily depression) and their partners, who had at least one child aged 8–16 years (not treated for psychiatric disorder)	Beck Depression Inventory (BDI); Spielberger State Anxiety Inventory (STAI); Strengths and Difficulties Questionnaire (SDQ); Screen for Child Anxiety Related Emotional Disorders (SCARED).	In both groups:
	‘Family Talk Intervention (FTI)’ preventive programme, included psychoeducation. Minimum 6 sessions (more for families with >1 child), with manual. 2 parent-focussed sessions followed by session with each child − on depression, how to talk about it with family members, coping with family problems and answering children’s questions.	(‘Efficacy study’)	(53:56)	Baseline, 4, 10 and 18 months post-intervention.	-improvement seen in children’s prosocial behaviour -reduction in emotional symptoms and anxiety.
	Control:				Changes noted sooner with FTI (baseline-4 months) than LT (4–10 months). No group differences after 10–18 months follow-up.
	Let’s Talk about the Children (LT)’: brief, child-focussed, discussion with parents to assess child’s situation and support them. Duration: single 15-min session to 2 × 45-min sessions.				Marginal decrease in hyperactivity in both groups.
Family PI (psychososocial stress)
Jordans et al. [31], Burundi	Intervention:	Controlled trial	120 children aged 10–14 years with high levels of psychosocial stress on screening due to political violence (and their parents)	Primary outcomes: Depression self-rating scale (DSRS); Aggression Questionnaire.	Intervention parents saw improvement in child’s aggression, effect size d = 0.60 (p < 0.001), especially in boys.
	Group-based parenting programme, adapted from manual for parents about helping children cope with political violence.
	Facilitated by 2 community counsellors (attended by parents only). 2 sessions: First (2.5 h) on problems affecting children and communication, second (3 h) on how to manage difficulties.		(58 (32 females: 27 males): 62 (39 females: 23 males))	Secondary outcome: Family Social Support scale	No improvement in depressive symptoms or perceived family support.
	Part of larger mental health package for low and middle-income countries.			Baseline, 3-weeks post-intervention	Majority of parents satisfied with intervention, and learned to be ‘better parents’.
	Control: Waiting list.
Martinez-Pampliega et al. [32], Spain	Intervention:	Controlled trial	34 parents, total of 51 children (31 females: 25 males), aged 2–23 years (including 6 family controls).	Child Behavior Checklist (CBCL); Symptoms Checklist (parental) (SCL-90); O’Leary-Porter Scale of Marital Conflict (OPS); Family Communication Scale.	Differences, especially in follow-up, in perceived family conflict (d = 0.85, p = 0.01) and children’s mental health symptoms: anxiety/depression (d = 0.57, p < 0.001) and aggression (d = 0.65, p < 0.001).
	‘Egokitzen’: Post-divorce parent intervention. 11 weekly (1.5 h) sessions, with role-playing, debates, group activities - on divorce, interparental conflict, parenting styles and discipline.	(exploratory, ‘quasi-experimental’)		Baseline, post intervention, 6-months follow-up
	Control: Waiting-list
INDIVIDUAL PI
Barnet et al. [33], USA	Intervention:	Randomised controlled trial	84 pregnant adolescents aged 12–18 years (predominantly with low incomes and African-American), from urban prenatal care sites.	Adult-Adolescent Parenting Inventory (AAPI); Center for Epidemiologic Studies Depression (CES-D); School status − self-report.	Intervention improved parenting attitudes (by 5.5 points higher than controls (95% CI 0.5–10.4, p = 0.3)) and school continuation (3.5 times greater than control, 95% CI 1.1-11.8, p < 0.05).
	Community-based programme for adolescent mothers. Trained home visitors paired with mothers through child’s second birthday.		(44: 40)	Baseline, 1 and 2 years follow-up	Did not reduce odds of repeat pregnancy or depression, or achieve coordination with primary care.
	Parenting curriculum − encouraged contraceptive use, connected adolescent with primary care, promoted school continuation.
	Rationale: Adolescent mothers at risk for rapidly becoming pregnant again, depression, school dropout, and poor parenting.
	Control: Usual care.