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A systematic review of specialized psychosocial and complex psychosocial interventions for early psychosis; early depression; early bipolar disorder; and early borderline personality disorder
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DOI：10.1192/j.eurpsy.2026.10158.png)
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Abstract
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BackgroundThis systematic review evaluates specialized psychosocial and complex interventions for early bipolar disorder (BD); early borderline personality disorder (BPD); early depression; early psychosis; and first-episode mental illness in general (FEMI).MethodsWe included systematic reviews and randomized controlled trials (RCTs) of interventions with psychosocial components; excluding trials that focused on pharmacological-only interventions and stand-alone psychotherapies. Searches were conducted in January 2023 across five databases. Review quality was assessed using AMSTAR-2 and risk of bias for RCTs using the Cochrane tool.ResultsTen studies met the inclusion criteria: seven reviews and three RCTs. High-to moderate-quality evidence supports complex psychosocial interventions combined with pharmacotherapy for early psychosis. The most robust effects were reductions in relapse and improvements in psychosocial functioning; additional benefits were observed for symptom burden; remission; treatment discontinuation; and hospital admissions. Benefits were most sustained in longer-duration; community-based programs. For early BD; limited evidence suggests that combining pharmacotherapy with family-focused therapy or structured psychoeducation may improve the course of illness and treatment satisfaction. One RCT in early BPD reported improved engagement with a developmentally tailored program. Two FEMI RCTs found that nurse-led psychoeducation and psychosocial programs improved in-patient duration; symptoms; insight; self-efficacy; quality of life; and engagement. No eligible studies addressed early-stage depression; indicating a notable evidence gap for multimodal psychosocial interventions.ConclusionsComplex psychosocial interventions are strongly supported for early psychosis. Preliminary data in BD; BPD; and FEMI suggest consistent benefits for engagement; but further rigorous trials – especially in early depression – focusing on different outcomes – are required.
Keywords:
complex interventions
early intervention
early severe mental disorders
psychosocial interventions
systematic review
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