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'Sawa Aqwa' (Stronger Together): A multi-site randomized controlled trial of a brief family systemic intervention for adolescent mental health in Lebanon.

Tania Bosqui·Felicity L Brown·Sally Farah·Joseph Elias·Maliki E Ghossainy·Anas Mayya·Diana Abo Nakkoul·Bryony Walsh·Sarah Chreif·Ahmad Einein·Bassel Meksassi·Roula Abi Saad·Hady Naal·Michael Donnelly·Theresa S Betancourt·Alan Carr·Eve S Puffer·Estefania Hanna·Hasan Mansour·Farah Semaan·Rabih El Chammay·Mark J D Jordans
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Abstract

BACKGROUND: There are no evaluated family-based mental health and psychosocial support (MHPSS) interventions for adolescents in Southwest Asia (known as the Middle East), and few whole-family interventions in low- and middle-income countries, despite consistent evidence for the impact of family support on mental health and well-being. This study aims to evaluate the effectiveness of a brief family systemic mental health intervention, deliverable by non-specialists in mental health. METHODS: We conducted an assessor-blind type I hybrid effectiveness-implementation multi-site randomized controlled trial comparing the locally developed family intervention to a waitlist control group for randomly allocated families residing in North Lebanon and Beqa'a governorates. Eligible families presented with medium-to-high risk for child protection concerns (abuse, neglect, child labor, early marriage) and had at least one adolescent aged 12-17 who demonstrated psychological distress. Outcomes at the family, caregiver, and adolescent level were measured pre- and post-intervention, and at 3-month follow-up. RESULTS: Intent-to-treat analyses found a significant between-group effect of the intervention on adolescent-reported family functioning, caregiver mental health, and parenting. No change was found for adolescent psychological distress. Further analyses found effects on adolescent well-being for those who completed the intervention, and that father attendance was associated with better outcomes for adolescent well-being in the intervention group. No other significant moderators were found. At the 3-month follow-up for the intervention condition, family functioning and caregiver well-being significantly dropped from endline. CONCLUSIONS: The study demonstrates mixed results for a non-specialist-delivered family-systemic intervention developed in the context of humanitarian crises in Lebanon. While the intervention did not result in benefits in adolescent-reported symptoms of psychological distress, the intervention group did show greater improvements than the control group on a number of other outcomes, showing the potential impact of working with the wider family system to support adolescents in humanitarian settings.

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HumansLebanonAdolescentMaleFamily TherapyFemaleChildFamily SupportOutcome Assessment, Health CareHumanitarianadolescentsarmed conflictfamilylow‐ and middle‐income (LMIC) countriesmental health and psychosocial supportrandomized controlled trialrefugeesJournal ArticleRandomized Controlled TrialMulticenter Study

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Tania Bosqui, Felicity L Brown, Sally Farah, Joseph Elias, Maliki E Ghossainy, Anas Mayya, Diana Abo Nakkoul, Bryony Walsh, Sarah Chreif, Ahmad Einein, Bassel Meksassi, Roula Abi Saad, Hady Naal, Michael Donnelly, Theresa S Betancourt, Alan Carr, Eve S Puffer, Estefania Hanna, Hasan Mansour, Farah Semaan, Rabih El Chammay, Mark J D Jordans. 2026-06-04. 'Sawa Aqwa' (Stronger Together): A multi-site randomized controlled trial of a brief family systemic intervention for adolescent mental health in Lebanon.. https://doi.org/10.1111/jcpp.70174

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