Effectiveness of multi-family group therapy for school refusal in adolescents with depressive disorders: study protocol for a randomized controlled trial

This study aims to develop a manualized multi-family group therapy (MFGT) program for adolescents with depressive school refusal and to evaluate its effectiveness through a randomized controlled trial. By comparing MFGT with group cognitive behavioral therapy (GCBT), the study seeks to examine the relative efficacy of MFGT in improving school refusal behaviors and depressive symptoms, to assess the stability of treatment effects during follow-up, and to explore potential mechanisms underlying behavioral change. This study is designed as a single-center, single-blind, randomized controlled non-inferiority trial. A total of 138 adolescents aged 12-19 years who meet DSM-5 criteria for depressive disorders and Berg’s criteria for school refusal will be randomly assigned in a 1:1 ratio to either the MFGT plus treatment-as-usual (TAU) group or the GCBT plus TAU group. Both interventions consist of eight group sessions delivered over four weeks. Primary outcomes include school attendance rate and clinician-rated depressive symptoms assessed using the Hamilton Depression Rating Scale. Secondary and intermediate outcomes include self-reported depressive and anxiety symptoms, school refusal maintaining factors, school-related self-efficacy, family functioning, and parent–adolescent communication. Assessments will be conducted at baseline, post-treatment, and at 1- and 3-month follow-up. This study will be the first randomized controlled trial to evaluate a standardized and manualized MFGT protocol specifically developed for adolescents with depressive school refusal. By adopting a family-based and scalable intervention model, the study is expected to provide evidence for an effective and resource-efficient treatment approach that addresses both individual psychopathology and family dynamics. The findings may contribute to improving school attendance and mental health outcomes in adolescents and inform clinical practice and public mental health strategies in settings with limited mental health resources. Chinese Clinical Trial Registry (ChiCTR2500100225). Registered, 2025.