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 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复杂，涉及多个生物系统。稳态负荷（allostatic load, AL）模型通过评估反映不同生理系统活动状态的生物标志物，为捕捉此类多系统失调提供了分析框架。本系统综述旨在梳理当前关于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平台）、PsycINFO、Ovid Emcare、CINAHL、Cochrane图书馆及Scopus数据库，检索时限为建库至2025年7月。最终共有28项研究纳入本系统综述，其中16项符合荟萃分析的纳入标准。
研究结果显示，精神障碍患者的稳态负荷水平显著高于健康对照（healthy controls, HCs）。此外，组间荟萃分析的总体标准化均数差结果表明，精神分裂症及首发精神病患者的稳态负荷水平更高（标准化均数差SMD: 0.97；95%置信区间CI: 0.76, 1.18；p p = 0.67）。
综上，稳态负荷模型可为评估慢性应激对多生物系统的影响提供有价值的工具。该方法可应用于精神症状患者核心病理生理学的早期干预，以及该群体中常见的系统性共病的防治。