Psychosocial Interventions Impact on Cardiometabolic, Neurobiological, Behavioral, and Immune Outcomes in People With a Serious Mental Illness: A Systematic Review

Julia Hill; Crystal M. Noller; Paul E. Holtzheimer; Krista D. DiSano; Ella Klinsky; Mona Pudasaini; Hannah Crowe‐Cumella; Karen L. Fortuna

doi:10.1002/hsr2.70954

July 1, 2025Health Science ReportsOpen Access

Psychosocial Interventions Impact on Cardiometabolic, Neurobiological, Behavioral, and Immune Outcomes in People With a Serious Mental Illness: A Systematic Review

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Why the study?

Psychosocial interventions may represent a strategy to increase the lifespan of people with serious mental illness, but the literature is limited.

Do psychosocial interventions improve cardiometabolic, neurobiological, behavioral, and immune mind-body outcomes associated with accelerated aging in adults with a serious mental illness compared to control conditions?

Structured PICO

Do psychosocial interventions improve cardiometabolic, neurobiological, behavioral, and immune mind-body outcomes associated with accelerated aging in adults with a serious mental illness compared to control conditions?

P

Population

32 RCTs pooling 4,571 adults (≥18 years) with a serious mental illness (SMI), defined as schizophrenia (assessed in 29 studies), schizoaffective disorder (15 studies), bipolar disorder (11 studies), or treatment-refractory major depressive disorder (4 studies). Mean age 40.78 years (range of study averages 24 to 55 years across 28 reporting studies), 62.2% male, 87.9% on psychotic medications (average 2.93 medications). Race/ethnicity across 24 reporting studies: 60.82% White, 26.68% Black, 7% Australian, 2.54% Asian, 2.0% Hispanic, 0.21% Aboriginal or Torres Strait Islander, 0.03% Native Hawaiian, and 5.44% other.

I

Intervention

Psychosocial interventions (nonpharmacological treatments incorporating social and psychological factors), including cognitive behavioral therapy (8 studies), cognitive remediation therapy (4 studies), weight management (4 studies), lifestyle coaching (3 studies), social skills training (2 studies), rehabilitation programs (2 studies), cardiovascular disease prevention (2 studies), care coordination (2 studies), motivational interviewing (2 studies), animal-assisted therapy (1 study), targeted cognitive training (1 study), yoga therapy (1 study), psychoeducation (1 study), auditory training (1 study), tai chi (1 study), nicotine replacement therapy (1 study), contingency management (1 study), and long-term multimodal psychosocial treatment (1 study).

C

Comparator

No psychosocial intervention / control conditions, including treatment as usual (TAU), standard care, waitlist controls, noncontingency groups, mindfulness, telephone-based intervention, standard nutrition and physical-activity information with health classes unrelated to weight, nutrition counseling, standard support groups, or group therapy/psychoeducation.

O

Outcome

41 mind-body outcomes associated with accelerated aging across four categories: (1) cardiometabolic outcomes (BMI, waist circumference, weight, cholesterol, blood glucose, blood pressure, triglycerides, HbA1c, cardiovascular risk factors, insulin, resting heart rate, forced expiratory volume, salivary amylase), (2) neurobiological outcomes (BDNF, fMRI, pituitary volume, mismatch negativity pMMN, electrophysiology, neuropeptide S), (3) immune outcomes (cortisol, GM-CSF, IL-5, IL-12, IL-6, TNF-alpha, sTNF-R2, MMP-9, C-reactive protein), and (4) behavioral outcomes (physical activity, Framingham risk assessment, energy intake, sedentary time, digit span, perseverative error, category achievement, ethyl glucuronide, other substance use, pupillometry, facial affect matching task, cardiorespiratory fitness).surrogate

This systematic review of 32 RCTs demonstrates that psychosocial interventions can significantly modify behavioral, neurobiological, and immune biomarkers of accelerated aging in adults with serious mental illness, though effects on cardiometabolic parameters remain inconsistent.

Limitations

Literature is limited regarding psychosocial interventions modifying mind-body outcomes associated with accelerated aging
Lack of collaterals across all included studies (N = 32, 100%)
Follow-up assessments in included studies were largely non-blind or unspecified (N = 28, 88.24%)
Large sample sizes and longer follow-up periods generally led to greater attrition rates and low methodological rigor

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Implication

Psychosocial interventions may extend lifespan in SMI; extends limited mind-body evidence but requires confirmatory trials.

Abstract

Background and Aims: Five and a half percent of the population of the United States has a serious mental illness (SMI). Mind-body outcomes represent a direct and operationalizable measurement associated with accelerated aging. These findings may suggest that psychosocial interventions represent the first-ever strategy to increase the lifespan of people with SMI; however, the literature is limited. Methods: The patient/population, intervention, comparison, and outcomes (PICO) criteria were used to assess study eligibility in partnership with a master's-level librarian. Studies focused on (1) the general population, which later became a population with SMI, (2) psychosocial intervention vs. no psychosocial intervention, and (3) cardiometabolic, neurobiological, behavioral, and immune outcomes. We searched the following databases from 1946 to January 2024: Medline, PsycINFO, Cochrane Central Register of Controlled Trials, Scopus, and PubMed. Thirty-two RCTs fit the criteria. The Methodological Quality Rating Scale assessed the methodological quality of the included studies. Studies assessed four outcome categories: (1) neurobiological, (2) behavioral, (3) immune, and (4) cardiometabolic. Results: Immune outcomes were the least recorded but significantly differed between the psychosocial intervention treatment group and controls. Behavioral and neurobiological outcomes significantly differed between the treatment group and controls. Cardiometabolic outcomes were the most studied, with inconsistencies in significant vs. nonsignificant differences between intervention and control. Conclusion: Evidence is growing that psychosocial interventions can improve the lives of people with SMI and potentially reduce accelerated aging. We suggest that psychosocial intervention randomized control trials with mind-body outcomes may represent a viable strategy for reducing disease burden and improving human health. Additional research is needed to examine the correlation between psychosocial interventions and the effects on mind-body outcomes of accelerated aging and SMI. The present systematic review extends this study by identifying the outcomes associated with accelerated aging significantly modified by psychosocial intervention.

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Cite This Study

Hill et al. (2025) studied this question.

synapsesocial.com/papers/6a70d06887f921057127e834 https://doi.org/10.1002/hsr2.70954

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Psychosocial Interventions Impact on Cardiometabolic, Neurobiological, Behavioral, and Immune Outcomes in People With a Serious Mental Illness: A Systematic Review

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Structured PICO

Limitations

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Implication

Abstract

Discussion

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Psychosocial Interventions Impact on Cardiometabolic, Neurobiological, Behavioral, and Immune Outcomes in People With a Serious Mental Illness: A Systematic Review

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Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

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