The Efficacy of Family-Focused Therapy in Reducing Relapse and Improving Family Functioning Among Adolescents with Bipolar Disorder: A Meta-Analysis of RCTs

This meta-analysis examined whether Family-Focused Therapy (FFT), when used as an adjunctive treatment, improves relapse prevention and family functioning outcomesamong adolescents aged 13 to 18 years with bipolar disorder. Eleven randomised controlledtrials encompassing more than 1,200 participants were systematically identified through comprehensive database searches of PsycINFO, PubMed, Cochrane CENTRAL, andGoogle Scholar conducted between 2000 and 2025. Studies were synthesised using random-effects meta-analytic procedures, with Hedges’ g effect sizes calculated to enablecross-study comparisons despite measurement heterogeneity. Study quality was evaluatedusing the Cochrane Risk of Bias tool, and potential publication bias was assessed through funnel plot analyses, Egger’s regression tests, and trim-and-fill adjustments. FFT demonstrated significant moderate effects on relapse prevention with exceptional consistency across studies, populations, and follow-up periods, suggesting that universal protective mechanisms operate reliably. Family functioning outcomes showed moderate-tolarge effects but substantial variability, with results ranging from small negative to large positive values depending on baseline conflict levels, expressed emotion status, andmeasurement approaches. Risk-of-bias assessments indicated moderate methodological quality, constrained by blinding challenges inherent to psychosocial interventions andelevated attrition in several trials, though robustness checks confirmed that FFT’s benefitspersisted under conservative publication bias assumptions. These findings support integrating FFT into standard adolescent bipolar disorder treatment protocols, particularly for high expressed emotion families in which relational tension elevates relapse risk. However, variability in family functioning outcomes underscores the importance of tailored baselineassessments and individualised treatment planning rather than assuming uniform benefitsacross all families seeking intervention.