Who Benefits from Family Psychoeducation for Relatives of Adults with Major Depressive Disorder? Findings from a Randomized Controlled Trial

Background: Major depressive disorder (MDD) affects not only patients but also their relatives, who often carry substantial emotional and practical responsibilities. Family psychoeducation has shown benefits in several psychiatric conditions, yet its effects on relatives of adults with MDD remain insufficiently documented. Aim: We aimed to examine whether a brief group-based family psychoeducation program improves relatives’ well-being and perceived family functioning compared with an active social-support control condition and to explore whether intervention response varies across caregiver subgroups. Methods: Relatives of patients with MDD were enrolled in a two-center randomized controlled trial and allocated to either a four-week psychoeducation program or a structurally matched social-support group. Outcomes were assessed at baseline, post-intervention, and 9-month follow-up using the WHO-5 Well-Being Index (WHO-5), the Family Attitude Scale (FAS), and the Family Assessment Device (FAD). Repeated-measures ANCOVA models tested time × group interactions, with and without adjustment for age and gender. Results: Eighty-nine relatives were included (n = 43 intervention; n = 46 control). No significant intervention effects were observed on well-being (WHO-5) or family attitudes (FAS). A significant time × group interaction was found only for the FAD affective involvement subscale, with short-term improvement in the intervention group compared with deterioration in the control group. Subgroup analyses suggested a heterogeneous pattern of response, with more consistent patterns of improvement among older relatives (≥50 years), non-partner relatives, and those with a history of psychiatric treatment, while effects appeared more limited among partners and younger participants. Women showed worsening communication in the intervention group, whereas men demonstrated improvements in selected well-being and general functioning outcomes. Conclusions: The intervention showed limited effects at the whole-sample level, but exploratory subgroup analyses suggested that responsiveness to brief family psychoeducation may vary according to caregiver characteristics. These findings support further investigation of more targeted psychoeducational approaches for relatives of adults with MDD.