Background Schizophrenia is a longstanding condition and most patients experience multiple relapse in the course of the condition. High expressed emotion (HEE) has been found to be a predictor of relapse. This meta-analysis and meta-regression examined the association of global EE and relapse specifically focusing on timing of relapse and EE domains. Methods Random-effects model was used to pool the effect estimates. Multiple random-effects meta-regression was used to compute the moderator analysis. Putative effect moderators including culture, EE measurements, age, length of condition and study quality were included. Results Thirty-three prospective cohort studies comprising 2284 patients were included in the descriptive review and 30 studies were included for meta-analysis and meta-regression. Findings revealed that global HEE significantly predicted more on early relapse (⩽12 months) [OR 4.87 (95% CI 3.22–7.36)] than that on late relapse (>12 months) [OR 2.13 (95% CI 1.36–3.35)]. Higher level of critical comments (CC) significantly predicted relapse [OR 2.22 (95% CI 1.16–4.26)], whereas higher level of warmth significantly protected patients from relapse [OR 0.35 (95% CI 0.15–0.85)]. None of the moderators included significantly change the results. Conclusions These findings indicate that there is a dynamic interaction between EE-relapse association with time, and CC and warmth are the two important EE domains to influence relapse among patients with schizophrenia. Results also confirmed the foci of family interventions on reducing CC and improving warmth in relationship.

This review provides evidence that family intervention is effective for caregivers of recent-onset psychosis, especially for care burden where the positive effects are enhanced over time.

Accessible Summary What is known on the subject? Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence‐based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta‐analysis have been conducted. What the paper adds to existing knowledge CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. What are the implications for practice? The results of this review suggest that the brief CBFI is an effective family‐inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. AbstractIntroductionCognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI.AimThis review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families.MethodEligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random‐effects models.ResultsFour studies consisting of 524 participants were included. The risk of bias was low–unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post‐treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal.DiscussionThe findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention.Implications for PracticeMental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse‐led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.