This systematic review examined how adverse social determinants of health (SDOHs) — including early life adversity, social disconnection, racism/discrimination, poverty, and food insecurity — are associated with neurobiological changes (brain structure, function, neurochemistry, neuroplasticity) across the schizophrenia spectrum, from high schizotypy to chronic schizophrenia. A search of three databases from inception to January 2026 identified 114 eligible studies covering 10,921 participants.
Across 114 studies, greater exposure to adverse SDOHs was consistently linked to cortical thinning, regional brain volume reduction, decreased structural connectivity, reduced functional activation, and abnormal neurochemical levels. Early life adversity dominated the evidence base (95/114 studies); racism/discrimination (n=4), poverty (n=2), and food insecurity (n=1) were severely underrepresented. No studies reported on neuroplasticity outcomes.
- Evidence is heavily skewed toward early life adversity; racism/discrimination, poverty, and food insecurity are nearly absent from the literature, limiting conclusions about those SDOHs. - No studies measured neuroplasticity, leaving a major biological mechanism unexamined. - As a systematic review of observational studies, causal inference is not possible; directionality and confounding remain unresolved.
Clinicians managing schizophrenia-spectrum conditions should routinely screen for adverse SDOHs — especially early life adversity and social disconnection — as these exposures appear to be biologically embedded and linked to worse brain outcomes. Integrating social history into neurobiological risk assessment may help target prevention and tailor treatment for the most disadvantaged patients.
