High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

Internet-delivered cognitive and/or behavioural therapy (I-C/BT) for post-traumatic stress disorder (PTSD) addresses problems of access to evidence-based psychological treatments and is becoming more widespread. This commentary explores the effectiveness of I-C/BT for PTSD compared with waiting-list/treatment as usual controls as reported in Simon et al’s (2021) Cochrane Review and in subsequent studies. The results suggest that I-C/BT may reduce PTSD symptoms immediately post-treatment, without long-term effects. However, the very low certainty of evidence and inconsistent quality of I-C/BT interventions prohibits recommendations until further high-quality research becomes available.

Sleep disturbances are common in dementia and are associated with numerous problems. Medication is not clearly effective and is potentially problematic, giving a clear role for non-pharmacological measures. The Cochrane Review discussed here suggested that physical and social activities and carer interventions potentially improve sleep in dementia, although the evidence was not conclusive. The review was limited by the heterogeneity present and the low quality of evidence. The authors’ choice of primary outcomes leads to a wider discussion on the clinical relevance of available outcomes in evaluating sleep in dementia and the potential role for patients and carers in informing this.

The perinatal period is an important time for infant and parent. Vulnerable parents with pre-existing challenges, such as adverse experiences in their own childhood, might find the transition to parenthood particularly hard. The Cochrane Review considered here sought to assess the effectiveness of parenting interventions provided to parents with symptoms of complex post-traumatic stress disorder and/or a history of childhood maltreatment, with the aim of improving the parents’ well-being or parenting capacity. In this commentary we focus on how the limited evidence base, along with some key aspects of the review’s methodology, might have influenced its finding that such interventions showed little or no benefit.

Overweight and obesity are growing health concerns globally. Technological advances drive interest in smartphone applications as possible health behaviour interventions to promote lifestyle change in these conditions. This article critically appraises a Cochrane Review of 18 studies (2703 participants) of smartphone app interventions for overweight or obesity in adolescents and adults and considers its relevance to clinical practice and research. The review's results suggest that there may be minimal benefit to the use of smartphone apps, but the evidence is very uncertain, lacking high-quality, replicable studies.

This critical appraisal of a Cochrane Review assesses the efficacy of ketamine for treating unipolar major depressive disorder. The review included 31 randomised controlled trials involving ketamine. Results indicate that intravenous (i.v.) ketamine significantly improves antidepressant response compared with i.v. saline and, to a lesser extent, i.v. midazolam within 24–72 h. However, the evidence is constrained by performance bias owing to masking (‘blinding’) concerns and study heterogeneity, necessitating further robust research to confirm ketamine's clinical potential.

Music therapy attempts to facilitate communication and expression – core problems for autistic people – through the development of experiences and relationships mediated by music. This commentary assesses a Cochrane Review of the effects of music therapy, compared with placebo or standard care, for autistic people, and its conclusion that music therapy is probably associated with an increased chance of global improvement and perhaps a slight increase in quality of life and reduction in total autism symptom severity in the short to medium term. The review was not able to examine longer-term effects as the longest follow-up period was 12 months. The certainty of the evidence was graded from moderate to very low, and therefore the results need to be viewed with caution.

Diabetes and depression have a bidirectional relationship, but some antidepressants (such as the tricyclics) may have detrimental effects in diabetes that are exacerbated by behavioural changes associated with depression. This month's Cochrane Review evaluated the efficacy of psychological and pharmacological treatments of comorbid depression in diabetes and found that such interventions have a moderate and clinically significant effect on depression outcomes in people with diabetes. However, conclusions were limited by significant heterogeneity within examined populations and interventions, and significant risk of bias within trials. This commentary critically appraises the review and aims to contextualise its findings.

Antipsychotics are commonly prescribed to manage the behavioural and psychological symptoms of dementia (BPSD) despite their modest efficacy and significant adverse effects. Psychosocial interventions are recommended as the first-line approach in treating BPSD before considering pharmacological options. A Cochrane Review by Lühnen et al (2023) evaluated the effects of psychosocial interventions on reducing antipsychotic prescription in care homes, and found that no generalisable recommendations can be made based on the currently available evidence. This commentary attempts to critically appraise and add context to the review.

Multiple epidemiological studies have shown an increased prevalence of adverse mental health outcomes in refugee populations and have highlighted children and adolescents to be particularly at risk. This commentary considers a Cochrane Review examining the efficacy of community-based interventions at improving the mental health of refugee children and adolescents in high-income countries. The review concludes that community-based interventions are ineffective at improving mental health in such populations. Notably, the data are limited by significant risk of bias and a small sample size. This article aims to critically appraise this systematic review, extrapolate implications for current practice and identify avenues for further research.