Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2002). Multi-family psychoeducation groups (MFPG) for families of children with bipolar disorder. Bipolar Disorders, 4(4), 254–262. https://doi.org/10.1034/j.1399-5618.2002.09073.x

Type of Study: Randomized controlled trial
Number of Participants: 35 children

Population:

• Age — 8–11 years
• Race/Ethnicity — 88% Caucasian, 3% African American, 3% Asian, 3% Biracial, and 3% Native American
• Gender — 77% Male
• Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of Multi-Family Psychoeducational Psychotherapy (MF-PEP) in a sample of families with children with mood disorders. Participants were randomly assigned to a MF-PEP plus treatment as usual (TAU) intervention group or to a waitlist control plus TAU control group. Measures utilized include the Children's Interview for Psychiatric Syndromes – Child and Parent Forms (ChIPS/P–ChIPS), Children's Depression Rating Scale-Revised (CDRS-R), Mania Rating Scale (MRS), Children's Global Assessment Scale (C-GAS), Expressed Emotion Adjective Checklist (EEAC), Social Support Scale, and the Child and Adolescent Services Assessment (CASA). Results indicate that at 4-month follow-up, families described having gained knowledge, skills, support, and positive attitudes during treatment. Limitations include audiotaped sessions that were not systematically coded, small sample size, and length of follow-up.

Length of controlled postintervention follow-up: 4 months.

Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2003). Multi-family psychoeducation groups in the treatment of children with mood disorders. Journal of Marital and Family Therapy, 29(4), 491–504. https://doi.org/10.1111/j.1752-0606.2003.tb01691.x

Type of Study: Randomized controlled trial
Number of Participants: 35

Population:

• Age — 8–11 years
• Race/Ethnicity — 88% Caucasian, 3% African American, 3% Asian, 3% Biracial, and 3% Native American
• Gender — 77% Male
• Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fristad et al. (2002). The purpose of the study was to examine the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on parental knowledge of mood disorders, family interaction patterns, perceived social support, and subsequent utilization of clinical services. Participants were randomly assigned to a MF-PEP plus treatment as usual (TAU) intervention or to a waitlist control plus TAU. Measures utilized include the Children's Interview for Psychiatric Syndromes – Child and Parent Forms (ChIPS/P–ChIPS), Children's Depression Rating Scale-Revised (CRS-R), Mania Rating Scale (MRS), Children's Global Assessment Scale (C-GAS), Expressed Emotion Adjective Checklist (EEAC), Social Support Scale, and the Child and Adolescent Services Assessment (CASA). Results indicate that at the 4-month follow-up, intervention group families reported increased parental knowledge about childhood mood symptoms, increased positive family interactions as reported by the parent, increased perceptions of parental support as reported by children, and increased utilization of appropriate services by families. Limitations include small sample size, concerns about generalizability due to the sample consisting largely of white males, and length of follow-up.

Length of controlled postintervention follow-up: 4 months.

Fristad, M. A., Verducci, J. S., Walters, K. & Young, M. E. (2009). Impact of Multifamily Psychoeducational Psychotherapy in treating children aged 8 to 12 years with mood disorders. Archives of General Psychiatry, 66(9), 1013–1021. https://doi.org/10.1001/archgenpsychiatry.2009.112

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8– 11 years
• Race/Ethnicity — Immediate Treatment Group: 94% White; Waitlist Control Group: 89% White
• Gender — Immediate Treatment Group: 76% Male; Waitlist Control Group: 71% Male
• Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of Multi-Family Psychoeducational Psychotherapy (MF-PEP) in a sample of families with children with major mood disorders. Participants were randomly assigned to an MF-PEP plus treatment as usual (TAU) intervention or to a waitlist control plus TAU. After one year of treatment, participants in the control group were assigned to the MF-PEP intervention. Measures utilized include the Children's Interview for Psychiatric Syndromes, Children's Interview for Psychiatric Syndromes – Parent Version, Children's Depression Rating Scale – Revised (CDRS-R), Mania Rating Scale (MRS), and the Mood Severity Index (MSI). Results indicate that participants in the MF-PEP immediate treatment group reported improvement in mood symptom severity compared with the control group. Improvements were observed at the 18-month follow-up. When control group participants received MF-PEP treatment after 12 months, they showed a similar pattern of improved mood symptoms. Limitations include include lack of generalizability due to the sample consisting primarily of white males, use of a wait-list control group, and a substantial minority (38%) of the participants were self-referred.

Length of controlled postintervention follow-up: 1 year.

Mendenhall, A. N., Fristad, M. A. & Early, T. (2009). Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of Multi-Family Psychoeducation Groups (MFPG). Journal of Consulting and Clinical Psychology, 77(3), 463-473. https://doi.org/10.1037/a0014527

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8-11 years
• Race/Ethnicity — 90% White/Non-Hispanic, 7% Black/Non-Hispanic, 2% Mixed, and 1% Hispanic
• Gender — 73% Male
• Status — Participants were children with depressive and bipolar disorders who were recruited from clinical and community settings.

Location/Institution: Ohio State University

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fristad et al. (2009). The purpose of the study was to investigate the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on service utilization and mood symptom severity in children with mood disorders. Parents’ knowledge of mood disorders, beliefs about treatment, and perceptions of children’s need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Participants were randomly assigned to an MF-PEP plus treatment as usual (TAU) intervention or to a waitlist control plus TAU. After one year of treatment, participants in the control group were assigned to the MF-PEP intervention. Measures utilized include the Mental Health Services Grid Interview, the Children's Interview for Psychiatric Syndromes (ChIPS), the Children's Interview for Psychiatric Syndromes, Parent Version (P–ChIPS), the Understanding Mood Disorders Questionnaire (UMDQ), the Treatment Beliefs Questionnaire – Parent Form (TBQ–P), and the Caregiver Concordance Interview (CCI). Results indicate that participation in MF-PEP significantly improved quality of services utilized, mediated by parents' beliefs about treatment. Participation in MF-PEP also significantly improved severity of child's mood symptoms, mediated by quality of services utilized. Limitations include the reliance on secondary data analysis, parent-rated effectiveness of services was problematic, the lack of a long-term follow-up for control group, and length of follow-up.

Length of controlled postintervention follow-up: 6 months.

Nadkarni, R. B., & Fristad, M. A. (2010). Clinical course of children with a depressive spectrum disorder and transient manic symptoms. Bipolar Disorders, 12(5), 494–503. https://doi.org/10.1111/j.1399-5618.2010.00847.x

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8–11 years (Mean=9.9 years)
• Race/Ethnicity — DSD+TMS Group: 89% White and 11% Non-White; DSD Only Group: 92% White and 8% Non-White; BPSD Group: 91% White and 9% Non-White
• Gender — 121 Male
• Status — Participants were children with mood disorders.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fristad et al. (2009). The purpose of the study was to examine rates of conversion to bipolar spectrum disorder (BPSD) and risk factors associated with conversion in children with depressive spectrum disorders (DSD) and transient manic symptoms (TMS) over 18 months. Participants were randomly assigned to receive immediate Multi-Family Psychoeducational Therapy (MF-PEP) plus treatment as usual; the remaining participants were in a one-year wait-list control condition and received this combination of treatment after their Time 3 assessment. Measures utilized include the Children's Interview for Psychiatric Syndromes' Child (ChIPS), the Children's Interview for Psychiatric Syndromes' Parent (P-ChIPS), the Mania Rating Scale (MRS), the Children's Depression Rating Scale – Revised (CDRS-R), The Coddington Life Events Scale for Children (LES), the Expressed Emotion Adjective Checklist (EEAC), the Hamilton Rating Scale for Depression (HAM-D), and the Kaufman Brief Intelligence Test, 2nd Edition. Results indicate that the scores did not differ significantly between the DSD+TMS, DSD, and BPSD groups. Conversion rates to BPSD were significantly higher for the DSD+TMS group compared to the DSD group. Conversion was significantly more frequent for participants in the one-year wait-list control group compared to the immediate treatment group. Participation in MF-PEP was associated with a four-fold reduction in risk for conversion at the Time 3 assessment when compared to the wait-list control group. Clinical presentation, family environment, and family history did not differ significantly between the small subset of DSD+TMS participants who did convert to BPSD at follow-up and those who did not convert. Baseline functional impairment was greater for the converted group than the nonconverted group. Limitations include small sample size, high attrition rate at follow-up, and limited generalizability due to racial and gender composition.

Length of controlled postintervention follow-up: Varied depending on randomization group.

Cummings , C. M., & Fristad, M. A. (2012). Anxiety in children with mood disorders: a treatment help or hindrance?. Journal of Abnormal Child Psychology, 40(3), 339–351. https://doi.org/10.1007/s10802-011-9568-5

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8–11 years
• Race/Ethnicity — 91% White Non-Hispanic, 7% African American, 2% Mixed Race, and 1% White Hispanic
• Gender — 73% Male
• Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fristad et al. (2009). The purpose of the study was to examine the role of comorbid anxiety in treatment outcome for children with mood disorders participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Participants were randomized into immediate treatment (MF-PEP) or to waitlist control group condition. All participants also received treatment as usual (TAU) throughout the study. Measures utilized include the Children’s Interview for Psychiatric Syndromes–Child Form (ChIPS), the Parent Form (P-ChIPS), the Children’s Depression Rating Scale–Revised (CDRS-R), the Mania Rating Scale, the Mood Severity Index, and the Children’s Global Assessment Scale (C-GAS). Results indicate that participation in MF-PEP did not significantly reduce anxiety symptoms. However, presence of comorbid anxiety did not impede reduction in depressive or manic symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores posttreatment. Limitations include the limited number of anxiety measures used, lack of generalizability due to gender and racial composition, and randomization was stratified to ensure relatively equal therapy group composition.

Length of controlled postintervention follow-up: 6, 12, and 18 months.

Boylan, K., MacPherson, H. A., & Fristad, M. A. (2013). Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), 699–708. https://doi.org/10.1016/j.jaac.2013.04.014.

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8–11 years
• Race/Ethnicity — 91% White Non-Hispanic, 7% African American, 2% Mixed Race, and 1% White Hispanic
• Gender — 73% Male
• Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Fristad et al. (2009). The purpose of the study was to examine the associations between disruptive behavior disorder (DBD) symptoms and impairment, the impact of Multi-Family Psychoeducational Psychotherapy (MF-PEP) on the severity of DBD symptoms, and whether DBDs affected the response of mood symptoms to MF-PEP. Participants were randomized into immediate treatment (MF-PEP) + TAU or to waitlist control group condition (WLC +TAU). All participants also received treatment as usual (TAU) throughout the study. Measures utilized include the Children’s Interview for Psychiatric Syndromes–Child Form (ChIPS), the Parent Form (P-ChIPS), the Children’s Depression Rating Scale–Revised (CDRS-R), the Mania Rating Scale, the Mood Severity Index, and the Children’s Global Assessment Scale. Results indicate that greater degree of disruptive behaviors was associated with worse mood symptoms and impairment. Analyses examining outcome of disruptive behaviors were nonsignificant. Results also suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder, oppositional defiant disorder, and overall disruptive behavior symptoms, but not conduct disorder symptoms. Severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP. Limitations include the sample lacked diversity and therefore may not be representative of the broader population of children with mood disorders and DBDs, and reliance on parent-reported outcome measures.

Length of controlled postintervention follow-up: 12 months.

MacPherson , H. A., Algorta, G. P., Mendenhall, A. N., Fields, B. W., & Fristad, M. A. (2014). Predictors and moderators in the randomized trial of Multi-Family Psychoeducational Psychotherapy for childhood mood disorders. Journal of Clinical Child and Adolescent Psychology, 43(3), 459–472. https://doi.org/10.1080/15374416.2013.807735

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 8–11 years
• Race/Ethnicity — 91% White Non-Hispanic, 7% African American, 2% Mixed Race, and 1% White Hispanic
• Gender — 73% Male
• Status — Participants were children with mood disorders and their families.

Location/Institution: Midwest

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as the Fristad et al. (2009) study. The purpose of the studywas to investigate predictors and moderators of mood symptoms in the randomized controlled trial of Multi-Family Psychoeducational Psychotherapy (MF-PEP) for childhood mood disorders. Participants were randomized into immediate treatment (MF-PEP) + TAU or to waitlist control group condition (WLC +TAU). All participants also received treatment as usual (TAU) throughout the study. Measures utilized include the Children's Global Assessment Scale (CGAS), the Expressed Emotion Adjective Checklist, the Coddington Life Events Scale for Children, the Children's Interview for Psychiatric Syndromes' Child Form (ChIPS) and Parent Form (P-ChIPS), the Psychiatric Diagnostic Interview – Revised, the Structured Clinical Interview for DSM–IV Axis II Personality Disorders – Patient Questionnaire (SCID-IIPQ), and the Hamilton Rating Scale for Depression. Results indicate that treatment nonresponse was significantly associated with higher baseline levels of global functioning (i.e., less impairment) and lower levels of stress, trauma history in children and Cluster B personality disorder symptoms in parents. Children with moderately impaired functioning who received MF-PEP had significantly decreased mood symptoms compared with the waitlist control group. MF-PEP had the strongest effect on severely impaired children. Limitations include concerns regarding generalizability due to lack of diversity within the sample, the attrition rate at the follow-up timepoints, and the reliance on parent-reported measures.

Length of controlled postintervention follow-up: 6, 12, and 18 months.