Multi-country cluster factorial trial of a family intervention to improve adolescent mental health
Abstract
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.
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BibTeX
@article{mueller2026multicountry,
title = {{Multi-country cluster factorial trial of a family intervention to improve adolescent mental health}},
author = {J Mueller and M Radloff and A Piolanti and D Wienand and F Waller and J Simon and M Raleva and V Babii and Y Shenderovich and HM Foran},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.155},
url = {https://doi.org/10.1093/eurpub/ckag169.155},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Multi-country cluster factorial trial of a family intervention to improve adolescent mental health
AU - J Mueller
AU - M Radloff
AU - A Piolanti
AU - D Wienand
AU - F Waller
AU - J Simon
AU - M Raleva
AU - V Babii
AU - Y Shenderovich
AU - HM Foran
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.155
UR - https://doi.org/10.1093/eurpub/ckag169.155
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -