Allostatic load in psychiatry: a systematic review and meta-analysis

The pathophysiology of psychiatric disorders is complex and involves multiple biological systems. The allostatic load (AL) model offers a framework to capture this multisystem dysregulation by assessing biomarkers that reflect the activity of different physiological systems. This systematic review aimed to summarise current literature on the association between AL and psychiatric disorders. The databases Medline (Ovid), PsycINFO, Ovid Emcare, CINAHL, Cochrane, and Scopus were systematically searched from inception to July 2025. A total of twenty-eight studies were included in the systematic review, and sixteen were eligible for meta-analysis. We found that individuals with a psychiatric disorder demonstrated elevated AL compared to healthy controls (HCs). Furthermore, the meta-analyses revealed an overall standardised mean difference of the between-group meta-analysis, which demonstrated higher AL in individuals with schizophrenia and first-episode psychosis (SMD: 0.97; 95% CI: 0.76, 1.18; p < .0001) compared to HCs. In contrast, no significant difference in AL was observed for individuals with major depressive disorder (SMD: 0.07; 95% CI: −0.23; 0.37; p = 0.67). In conclusion, the AL model may offer a valuable tool for evaluating the impact of chronic stress across various biological systems. This approach can be applied to the early intervention of the core pathophysiology as well as systemic comorbidities that are common among those with psychiatric symptoms.

精神障碍的病理生理学机制极为复杂，涉及多个生物系统。内稳态负荷（allostatic load, AL）模型提供了研究框架，通过评估反映不同生理系统活动的生物标志物，来捕捉这种多系统失调状态。本系统综述旨在系统梳理当前关于内稳态负荷与精神障碍之间关联的研究文献。本研究系统检索了Medline (Ovid)、PsycINFO、Ovid Emcare、CINAHL、Cochrane及Scopus数据库，检索时限自建库起至2025年7月。本系统综述最终纳入28项研究，其中16项符合元分析（meta-analysis）纳入标准。研究发现，精神障碍患者的内稳态负荷水平显著高于健康对照（healthy controls, HCs）。此外，元分析结果显示，组间元分析的总体标准化均数差（standardised mean difference, SMD）表明，精神分裂症及首发精神病患者的内稳态负荷水平显著高于健康对照（SMD=0.97；95%置信区间：0.76~1.18；p<0.0001）。与之相反，重度抑郁症患者的内稳态负荷水平与健康对照无显著差异（SMD=0.07；95%置信区间：-0.23~0.37；p=0.67）。综上，内稳态负荷模型可为评估慢性应激对各生物系统的影响提供极具价值的研究工具。该方法可应用于精神症状患者核心病理生理学机制的早期干预，以及这类人群常见的系统性共病管理。