Social Determinants of Health and Neurobiology Across the Schizophrenia Course: A Systematic Review.
Jessica P Y Hua, Kaitlyn Dal Bon
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In 30 seconds
This systematic review examined associations between adverse social determinants of health and brain measures in people across the schizophrenia spectrum, including those at elevated risk. Searches identified 114 eligible studies involving 10 921 participants. Most studies assessed early life adversity (n = 95); structural measures were most common (83 articles), and none examined neuroplasticity. The review found strong evidence that greater social adversity may be associated with neurobiological abnormalities, including cortical thinning, regional volume reduction, decreased structural connectivity and functional activation, and abnormal neurochemical levels.
Key findings
- The 114 included studies recruited 10 921 participants across high schizotypy, familial and clinical risk, first-episode, recent-onset, and chronic schizophrenia groups.
- Early life adversity was examined in 95 articles; social disconnection in 13, racism or discrimination in 4, poverty in 2, and food insecurity in 1.
- Across studies, greater adverse social exposure was associated with cortical thinning, regional brain volume reduction, decreased structural connectivity and functional activation, and abnormal neurochemical levels.
- Structural measures appeared in 83 articles, functional measures in 23, neurochemical measures in 10, and neuroplasticity in none.
Why it matters
The review links social adversity with brain differences across the schizophrenia spectrum, supporting a possible biological pathway between structural disadvantage and clinical outcomes. This perspective may help integrate social epidemiology and neuroscience when investigating psychosis risk and health inequities, while highlighting that evidence is concentrated on early life adversity and structural brain measures.
What to keep in mind
The evidence base was uneven: most studies examined early life adversity, few addressed other social determinants, and none assessed neuroplasticity.