Beyond Symptom Reduction: A Research Protocol for a Family Psychoeducational Intervention Focused on Personal Recovery and Empowerment in Major Depressive Disorder

Abstract Background Family psychoeducation shows promise in major depressive disorder (MDD), but evidence is limited and heterogeneous, and person-centred outcomes such as personal recovery and empowerment have rarely been examined. Objective To explore, in a pilot randomized controlled trial, the effects of a Falloon-based Family Psychoeducation Intervention (FPI), compared with an active family healthy-lifestyle program of equal intensity, on personal recovery, empowerment, expressed emotion, symptoms, functioning and quality of life. Methods Seventeen families of clinically stable outpatients with MDD (Foggia, Italy) were randomized to FPI (n = 8) or control (n = 9); both programs (12–14 sessions over about six months) were adjunct to usual care. Assessments took place pre-treatment (T0), post-intervention (T1) and at six-month follow-up (T2). Data were analyzed with nonparametric ANOVA-type statistics (nparLD) and Holm-adjusted post hoc tests. Results Significant group × time interactions emerged for the Recovery Assessment Scale total score (ATS = 9.28, p < .001; higher in FPI at T1 and T2, adjusted p = .010) and goal-orientation subscale (p = .039), and for family-reported expressed emotion (ATS = 3.22, p = .041), which decreased progressively in the FPI group. No significant interactions were found for depressive and anxiety symptoms, functioning, quality of life, medication adherence, internalized stigma or empowerment (whose scale showed poor internal consistency). Several outcomes improved over time in both arms. Conclusions In this small pilot, FPI appeared to influence personal recovery and family emotional climate rather than symptoms, whose improvement was shared by both conditions, consistent with non-specific factors. Findings are exploratory (no a priori power calculation or correction across outcomes) and need confirmation in adequately powered multicenter trials with longer follow-up.