Family-based interventions for adolescent emotional disorders: a systematic review of effectiveness and mechanisms of change

Adolescent emotional disorders − particularly anxiety and depression − are highly prevalent worldwide and increasingly recognized as major public health concerns. Mental health practitioners are therefore seeking intervention models that address both individual symptoms and the relational contexts in which adolescents develop. Family‑based interventions (FBIs) offer a promising approach by engaging caregivers as active partners in treatment. This systematic review examines the effectiveness of FBIs for adolescents aged 10–19 with emotional disorders, the mechanisms through which these interventions exert change, and the ways they are currently implemented and studied. Following PRISMA guidelines, 18 studies published since 2014 were identified across major mental health databases. Findings show substantial variation in FBIs design, delivery format, theoretical orientation, and intensity. Evidence for effectiveness is mixed: several interventions demonstrated significant reductions in anxiety and depressive symptoms, while others showed limited or short‑term effects compared to treatment as usual. Across studies, three mechanisms of change emerged consistently: (1) improved family relational dynamics, particularly parent–adolescent communication and attachment; (2) enhanced parental competencies, including emotion regulation and supportive parenting practices; and (3) direct cognitive‑behavioral skill development for adolescents. Methodological diversity and inconsistent outcome measures limit comparability across studies. Overall, FBIs represent a flexible and context‑sensitive approach to adolescent mental health, but further research is needed to clarify which components are most effective for which populations and under what conditions.