Multi-country cluster factorial trial of a family intervention to improve adolescent mental health

Background

Adolescent mental health problems pose a significant global challenge, particularly in low-resource family contexts such as North Macedonia and Moldova. Early parenting interventions have demonstrated efficacy in preventing mental health problems across diverse cultural, clinical, and socio-economic settings. Phase 2 of the FLOURISH project, aligned with the MOST framework, aimed to optimize the Parenting for Lifelong Health (PLH) for Parents and Teens program and identify the most cost-effective and scalable intervention package.

Methods

A multi-country randomized factorial trial evaluated the effectiveness of three add-on components to the PLH program: (1) adolescent mental health tools, (2) adolescent peer support, and (3) an engagement booster. A total of 654 adolescent-caregiver dyads were enrolled across 64 clusters. Primary outcomes were adolescent internalizing problems, social support, family functioning, and program attendance. Secondary outcomes included broader adolescent and caregiver mental health, implementation processes, and costs. A dyadic data framework will be used to examine parenting practices and adolescent mental health.

Results

Adjusted regression analyses indicated reduced adolescent internalizing behaviors (d=-.652) and improved family functioning (d=-.223) reported by caregivers. Secondary outcomes showed enhanced parenting, family communication, and adolescent and caregiver well-being. The adapted PLH program without additional components was deemed the most cost-effective and feasible intervention.

Discussion

Phase 2 of FLOURISH provides critical insights into family-focused interventions to prevent adolescent internalizing problems and promote family well-being. The optimized program is currently being evaluated in a multi-country randomized waitlist-controlled trial to assess its implementation, scalability, and cost-effectiveness.

Key messages

• Family-focused interventions show promise for improving adolescent mental health and family well-being in low-resource settings.

• These findings support adaptation and scale-up of open-source, evidence-informed family interventions for adolescents and caregivers, potentially reducing mental health risks in Eastern Europe.