Recent advances in psychiatry: a systematic review of biopsychosocial approaches in the treatment of common mental disorders

Recent advances in psychiatry: a systematic review of biopsychosocial approaches in the treatment of common mental disorders | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Recent advances in psychiatry: a systematic review of biopsychosocial approaches in the treatment of common mental disorders Fernando Filipe Paulos Vieira This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7576884/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Common mental disorders (CMDs), including depression, anxiety, and post-traumatic stress disorder, remain leading causes of global disability. Over the past decades, a more integrated view of psychiatric treatment has been promoted. Objective: To analyze recent advances in psychiatry, with special emphasis on the biopsychosocial model applied to the treatment of CMDs. Method: A systematic literature review was conducted using peer-reviewed articles published between 2015 and 2024 in PubMed, Scopus, and SciELO. Studies in English, Spanish, and Portuguese were included. Results: Significant advances were identified in second- and third-generation pharmacotherapy, third-wave psychotherapies (e.g., ACT and mindfulness), and the increasing use of digital tools in mental health care. Collaborative care models have proven effective in improving treatment adherence and clinical outcomes in primary care settings. Discussion: The findings highlight the relevance of adopting a biopsychosocial framework that transcends the traditional biomedical paradigm. Advances in pharmacological and psychotherapeutic approaches demonstrate the need for tailored interventions, while the integration of digital health tools and collaborative care underscores the importance of accessibility, continuity, and equity in treatment. Nonetheless, challenges persist, including disparities in resource distribution, cultural adaptability of interventions, and the risk of over-reliance on technology without sufficient human support. Future research should focus on refining integrative models that ensure scalability and sustainability across diverse health systems. Conclusions : Contemporary psychiatry is evolving toward interdisciplinary, patient-centered, evidence-based practice, integrating biological, psychological, and social components. Psychiatry Psychiatry mental health biopsychosocial model common mental disorders integrated therapies Figures Figure 1 INTRODUCTION Mental health has emerged as one of the foremost public health challenges of the 21st century. According to the World Health Organization (WHO), more than one in eight individuals worldwide experiences some form of mental disorder, representing approximately 13% of the global population (World Health Organization [WHO], 2022). Among the most prevalent common mental disorders (CMDs) are depression, anxiety disorders, and post-traumatic stress disorder (PTSD), all of which contribute significantly to the global burden of disability. Indeed, depression alone is estimated to be the leading cause of years lived with disability (YLD) worldwide (GBD 2019 Mental Disorders Collaborators, 2022 ). Despite advances in neuroscience and psychopharmacology, rates of timely diagnosis, adequate treatment, and functional recovery remain unsatisfactory in many regions of the world, particularly in low- and middle-income countries, where resources are limited and structural barriers to mental health care persist (Patel et al., 2018 ). The treatment gap—the disparity between those who require care and those who actually receive it—remains alarming: in certain areas, up to 85% of individuals with CMDs do not receive specialized care (WHO, 2021). Historically, psychiatry has been dominated by a biomedical approach focused on the neurobiological underpinnings of mental disorders. This model has enabled significant advances in the development of psychotropic medications, functional neuroimaging, and psychiatric genetics (Insel & Quirion, 2005 ). However, it has been widely criticized for its reductionism, as it focuses almost exclusively on the biological correlates of psychological suffering, without adequately integrating the psychological and social factors that also affect mental health (Bracken et al., 2012 ). In response to these limitations, the biopsychosocial model, proposed by George Engel in 1977, has gained prominence as a more integrative paradigm. This model posits that health and illness processes cannot be understood solely through biology; instead, they must also take into account the personal, relational, and social contexts of the patient (Engel, 1977 ). The biopsychosocial model aligns with a more humanistic and holistic vision of mental health care, recognizing the subjectivity of suffering and the need for multimodal therapeutic approaches. In recent decades, both clinical and social contexts have changed substantially. New forms of psychological distress have emerged, associated with phenomena such as job insecurity, structural unemployment, urban social isolation, and digital hyperconnectivity—all of which can exacerbate stress, anxiety, and depression (Crisp et al., 2016 ; Twenge, 2019 ). Furthermore, patients’ expectations have evolved towards more person-centered, participatory, and culturally sensitive forms of care. The COVID-19 pandemic further intensified many of these trends, leading to an unprecedented increase in the prevalence of affective and anxiety disorders, particularly among young people, women, and vulnerable populations (Moreno et al., 2020 ). Simultaneously, the health crisis accelerated the adoption of digital technologies in mental health care, highlighting the potential of telepsychiatry, mobile self-help applications, and online therapy programs as tools to expand access and reduce treatment gaps (Torous et al., 2020 ). This scenario underscores the urgent need to reassess and update the therapeutic approaches employed in psychiatry. Interventions focused exclusively on pharmacological prescription have proven insufficient to address the complexity of contemporary psychological suffering. Therefore, it is essential to incorporate evidence-based psychotherapeutic strategies—such as cognitive-behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions—while also strengthening community mental health programs and integrating psychiatric care into primary health care services (Kazdin & Rabbitt, 2013 ; WHO, 2021). Moreover, particular emphasis must be placed on the active consideration of the social determinants of mental health, such as poverty, violence, discrimination, structural racism, and gender inequalities, as key factors in the etiology and persistence of common mental disorders (Lund et al., 2018 ). The integration of a human rights and social justice perspective into psychiatric practice thus becomes essential. This article aims to provide a narrative review of the most relevant advances in contemporary psychiatry, with a particular focus on the biopsychosocial model and its application to the management of common mental disorders. Recent developments in psychopharmacology, psychotherapy, and digital interventions will be explored, alongside successful experiences in collaborative, community-based, and integrated care. Through this review, the article seeks to offer a critical, contextualized, and constructive perspective on the future direction of psychiatry within both the Latin American and global contexts. METHOD Study Design This study employed a systematic literature review design to identify and synthesize evidence on psychiatric interventions for common mental disorders. The review followed a structured and reproducible methodology, including a comprehensive search of electronic databases, predefined inclusion and exclusion criteria, and a standardized data extraction process. The study design was guided by the PRISMA 2020 statement to ensure transparency and methodological rigor. Search Strategy A comprehensive search of the literature was performed in three electronic databases: PubMed, Scopus, and SciELO, covering the period from January 2015 to December 2024. The search combined keywords and MeSH terms related to common mental disorders, psychiatric interventions, biopsychosocial models, pharmacological treatments, psychotherapy, and integrative approaches. Boolean operators (AND, OR) were applied to refine the search and ensure the retrieval of relevant studies. Inclusion Criteria The inclusion criteria were designed to ensure that the review focused on high-quality and relevant studies. Therefore, only original investigations or systematic reviews with solid methodological foundations were considered. The time frame (2015–2024) was selected to capture the most up-to-date scientific contributions. In addition, linguistic inclusion (English, Spanish, and Portuguese) allowed for a broader and more representative sample of the literature. Finally, the studies needed to specifically examine psychiatric interventions or the use of biopsychosocial models in the treatment of CMDs, guaranteeing thematic coherence with the objectives of the review. Exclusion criteria: To maintain methodological rigor, studies with evident design flaws, insufficient clarity in their procedures, or those that failed to meet peer-review standards were excluded. Duplicated records were also removed to avoid redundancy. Furthermore, articles whose thematic scope did not correspond to the objectives of the review—such as works unrelated to psychiatric interventions or biopsychosocial models—were disregarded to preserve the focus and validity of the synthesis. Study Selection Process All retrieved records were imported into a reference management software, and duplicates were removed. Two independent reviewers screened the titles and abstracts, followed by full-text reviews to assess eligibility. Disagreements were resolved through discussion or consultation with a third reviewer. Data Extraction and Analysis Relevant data were extracted using a standardized form, including information on study characteristics, types of interventions, outcomes assessed, and key findings. A qualitative synthesis of the evidence was conducted to summarize the main results and identify research gaps. RESULTS Pharmacological Advances In recent years, pharmacological developments in the field of psychiatry have shown significant progress, with the introduction of new compounds that offer more favorable tolerability profiles and a reduced incidence of adverse effects. A prominent example is multimodal antidepressants, such as vortioxetine, which acts as a selective serotonin reuptake inhibitor and a modulator of serotonergic receptors. This pharmacodynamic profile allows for a broader effect on depressive symptoms, with additional benefits in the cognitive domain (Baldwin et al., 2016; McIntyre et al., 2014). Similarly, third-generation antipsychotics, such as cariprazine and brexpiprazole, represent an advancement in the treatment of schizophrenia and affective disorders. Both agents act as partial agonists at D2/D3 receptors and antagonists at the 5-HT2A receptor, resulting in improvements in negative and cognitive symptoms, along with a more favorable adverse effect profile compared to traditional antipsychotics (Marder et al., 2021). In addition, promising research is being conducted in the field of pharmacogenetics, aiming to identify genetic biomarkers that can predict therapeutic response and tolerability to various psychotropic medications. These tools may enable a more personalized approach to the treatment of psychiatric disorders. However, their clinical application remains limited due to interindividual genetic variability and the need for additional longitudinal and multicenter studies to validate their effectiveness (Bousman & Dunlop, 2018). Third-Wave Psychotherapies Third-wave psychotherapies represent an evolution within the field of cognitive-behavioral therapies (CBT), integrating elements such as mindfulness, acceptance, compassion, personal values, and cultural contexts. These therapeutic approaches place less emphasis on directly modifying the content of thoughts, focusing instead on changing the individual’s relationship with their thoughts, emotions, and internal experiences (Hayes et al., 2011). Origins and Evolution The first wave of behavioral psychological therapies emerged from the strictly behaviorist approach (Skinner, 1953), which concentrated on modifying observable behavior through classical and operant conditioning. The second wave introduced cognitive components, emphasizing the restructuring of dysfunctional thoughts (Beck, 1976; Ellis, 1962). The third wave, which began to take shape in the late 20th and early 21st centuries, adopts a more contextual and functional perspective on human suffering. Main Third-Wave Therapies Acceptance and Commitment Therapy (ACT) Developed by Steven C. Hayes, ACT emphasizes the acceptance of internal experiences rather than attempts to eliminate them. It is grounded in Relational Frame Theory (RFT), a theory of language and cognition. Its primary objective is to foster psychological flexibility, defined as the ability to remain present, open to experiences, and committed to actions aligned with personal values (Hayes et al., 2012). Dialectical Behavior Therapy (DBT) Originally developed by Marsha Linehan for the treatment of borderline personality disorder, DBT combines behavioral techniques with mindfulness practices and a dialectical philosophy. It focuses on balancing acceptance and change, assisting individuals in regulating intense emotions and improving interpersonal relationships (Linehan, 1993). Mindfulness-Based Cognitive Therapy (MBCT) Developed by Segal, Williams, and Teasdale (2002), MBCT integrates mindfulness meditation with traditional CBT. It has shown particular efficacy in preventing depressive relapse. Patients are taught to observe their thoughts and emotions without automatically reacting to them, thereby disrupting cycles of rumination and experiential avoidance. Compassion-Focused Therapy (CFT) Developed by Paul Gilbert, CFT aims to cultivate compassion toward oneself and others, making it especially beneficial for individuals with high levels of shame or self-criticism (Gilbert, 2010). Grounded in the evolutionary understanding of human motivational and affective systems, this therapy employs exercises designed to activate the care and safety system. Mindfulness-Based Stress Reduction (MBSR) Initially developed by Jon Kabat-Zinn (1994) as a non-clinical intervention, MBSR has been widely adopted in therapeutic settings. It utilizes mindfulness meditation to reduce stress and improve quality of life, fostering a healthier relationship with suffering. Common Features of Third-Wave Therapies Third-wave therapies are characterized by several core features, including the incorporation of mindfulness and meditation practices, an emphasis on acceptance, compassion, and alignment with personal values, and the promotion of psychological and emotional flexibility. These approaches also place greater attention on the integration of cultural, existential, and spiritual contexts, and focus on processes rather than the specific content of thoughts, emphasizing how individuals relate to their experiences rather than the experiences themselves. Empirical Evidence and Effectiveness A growing body of research supports the efficacy of these therapies across a wide range of disorders, including depression, anxiety, personality disorders, chronic pain, and addictions (A-Tjak et al., 2015; Öst, 2008). For example, ACT has demonstrated outcomes comparable to traditional CBT, with additional advantages in patient satisfaction and long-term maintenance of therapeutic gains (Powers et al., 2009). Criticisms and Considerations Despite their widespread adoption, third-wave therapies have also faced criticism. Concerns have been raised regarding their lack of clear differentiation from earlier therapeutic approaches, methodological heterogeneity in efficacy studies, and the commercialization of mindfulness. Nevertheless, such critiques have contributed to greater scientific rigor and improvements in clinical protocols. Digital Technologies in Mental Health The advancement of digital technologies has profoundly transformed the field of mental health over the past decade, a shift further accelerated by the COVID-19 pandemic. Among the most notable innovations are telepsychiatry platforms, mobile applications for emotional self-management, and artificial intelligence-based chatbots. These tools have overcome geographical and structural barriers, enhancing access to mental health services in traditionally underserved settings, such as rural areas or regions with limited resources (Torous et al., 2020; Mohr et al., 2017). Telepsychiatry—defined as the use of telecommunications technologies to provide psychiatric care remotely—has proven effective and acceptable to both clinicians and patients. Its utilization surged during the pandemic due to the necessity of maintaining social distancing, leading to greater familiarity with these services and their consolidation within mental health care systems (Shore et al., 2020). Likewise, mobile applications allow users to monitor their emotional states, engage in mindfulness exercises, track symptoms, and receive real-time feedback, thereby enhancing self-awareness and treatment adherence (Firth et al., 2017). Mental health chatbots, such as Woebot and Wysa, employ natural language processing algorithms to deliver emotional support and cognitive-behavioral coping strategies. While these tools do not replace clinical care, they may serve as valuable adjuncts, particularly for early or low-threshold interventions (Fulmer et al., 2018). Nevertheless, significant challenges remain concerning ethics, data privacy, the scientific validation of these tools, and equitable digital access. Effective integration of digital technologies requires appropriate regulatory frameworks, professional training, and ongoing evaluation of their effectiveness and societal impact (Torous & Wykes, 2020). Collaborative Care and Social Determinants of Mental Health Collaborative care models, which integrate psychiatry with primary care and social work, have demonstrated effectiveness in managing common mental disorders, particularly within primary care settings. This approach fosters interdisciplinary, patient-centered care, leading to improved treatment adherence, reduced chronicity of disorders, and enhanced clinical and functional outcomes (Archer et al., 2012). Moreover, there is increasing recognition that interventions addressing the social determinants of health—such as poverty, unemployment, food insecurity, and interpersonal violence—are essential for reducing relapse rates and promoting sustained recovery. These factors directly influence the onset, course, and prognosis of mental disorders, underscoring the need for comprehensive strategies in effective therapeutic approaches (Compton & Shim, 2015; Lund et al., 2010). In this regard, collaborative care models incorporating community-based actions and social policy initiatives can play a pivotal role in the primary and secondary prevention of mental health disorders. Early identification of social risk factors, coupled with timely interventions such as support networks, employment programs, or housing assistance, may reduce the risk of chronicity and significantly improve patients’ quality of life (Patel et al., 2018). DISCUSSION AND CONCLUSION The findings presented in this review reflect a paradigmatic shift in contemporary psychiatry, characterized by the progressive integration of the biopsychosocial model as both a theoretical and clinical foundation. Introduced by George Engel in 1977, this model emerged as a critique of the reductionist perspective of the biomedical paradigm, proposing a more holistic understanding of health and mental illness (Engel, 1977). Although conceptualized more than four decades ago, the model has gained renewed relevance in the face of current mental health challenges, particularly in contexts marked by high social vulnerability, humanitarian crises, and structural inequalities that affect the psychological well-being of large segments of the population (WHO, 2022; Kleinman, 2009). One of the main contributions of the biopsychosocial approach lies in its capacity to integrate various levels of analysis—from the molecular to the community level—thus enabling more comprehensive and personalized interventions. This model considers not only clinical symptoms but also living conditions, culture, social environment, and patient resources (Ghaemi, 2010; Borrell-Carrió et al., 2004). Such a perspective is particularly relevant in Latin America, where mental health is deeply shaped by factors such as poverty, structural violence, racism, forced migration, and limited access to mental health services (Minoletti et al., 2015; Pan American Health Organization [PAHO], 2018). In the pharmacological domain, advances in second- and third-generation psychotropic medications, along with research in genetics and neurobiology, have enabled more targeted treatments for certain disorders, with fewer adverse effects and improved safety profiles (Nestler et al., 2002). Nonetheless, it remains evident that pharmacological treatment alone—without the complement of psychotherapeutic interventions or consideration of psychosocial factors—is associated with lower treatment adherence, higher relapse rates, and reduced patient satisfaction (Moncrieff & Kirsch, 2015; Deacon, 2013). In other words, pharmacotherapy may be necessary, but it is rarely sufficient on its own. From a psychotherapeutic perspective, third-wave therapies—such as Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Compassion-Focused Therapy (CFT)—have demonstrated effectiveness in addressing a variety of disorders, including those with high medical comorbidity or a history of complex trauma. These therapies emphasize processes such as mindfulness, emotional regulation, and psychological flexibility (Hayes et al., 2012; Linehan, 1993). Among adolescents, LGBTI+ populations, and survivors of violence, these approaches have shown promising results (Viana et al., 2021). However, their systematic implementation in public health systems remains limited, mainly due to a lack of specialized training and financial resources. The rapid growth of digital technologies has been among the most disruptive phenomena in mental health over the past decade. Digital interventions—including mobile apps, telepsychiatry, e-health platforms, and therapeutic chatbots—hold significant potential to expand access to care in remote or underserved areas (Torous et al., 2020; Naslund et al., 2017). However, they also raise new ethical and clinical challenges: the use of tools without scientific validation, risks to the privacy of sensitive data, disparities in internet access, and the potential depersonalization of the therapeutic relationship (Anthes, 2016). Thus, it is imperative to establish clear regulatory frameworks, empirically validate digital tools, and ensure appropriate clinical oversight of these technologies. In parallel, collaborative care models have shown effectiveness in improving clinical outcomes, enhancing user satisfaction, and reducing health system costs (Unützer et al., 2002; Archer et al., 2012). These models integrate primary and mental health care, promoting networking among psychiatrists, general practitioners, psychologists, social workers, and occupational therapists under shared protocols. However, their sustainability requires not only empirical evidence but also political will, adequate financial resources, and a culturally sensitive approach (Patel et al., 2018). It is important to note that despite technological and therapeutic advances, many of these innovations remain inaccessible to large segments of the population. Gaps between countries—and within countries—are significant, particularly in rural areas, Indigenous communities, and marginalized urban neighborhoods (Lund et al., 2010; Saraceno et al., 2007). In this regard, contemporary psychiatry bears an ethical responsibility not only to generate new knowledge but also to advocate for public policies that promote equity and social justice in mental health. 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G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78 (2), 73–80. https://doi.org/10.1159/000190790 Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., Sridhar, D., & Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370 (9593), 1164–1174. https://doi.org/10.1016/S0140-6736(07)61263-X Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse . Guilford Press. Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., Krupinski, E., Myers, K., Shore, P., Kaftarian, E., & Hilty, D. (2020). Best practices in videoconferencing-based telemental health. Telemedicine and e-Health, 26 (11), 827–832. https://doi.org/10.1089/tmj.2020.0177 Skinner, B. F. (1953). Science and human behavior . Free Press. Torous, J., & Wykes, T. (2020). Opportunities from the coronavirus disease 2019 pandemic for transforming psychiatric care with telehealth. JAMA Psychiatry, 77 (12), 1205–1206. https://doi.org/10.1001/jamapsychiatry.2020.1640 Torous, J., Lipschitz, J., Ng, M., & Firth, J. (2020). Dropout rates in clinical trials of smartphone apps for depressive symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 263 , 413–419. https://doi.org/10.1016/j.jad.2019.11.067 Twenge, J. M. (2019). The age of anxiety? Birth cohort change in anxiety and neuroticism, 1952–1993. Journal of Personality and Social Psychology, 116 (3), e1–e17. https://doi.org/10.1037/pspp0000226 Unützer, J., Schoenbaum, M., Druss, B. G., & Katon, W. J. (2002). Transforming mental health care at the interface with general medicine: Report for the President’s New Freedom Commission on Mental Health. Psychiatric Services, 53 (11), 1467–1474. https://doi.org/10.1176/appi.ps.53.11.1467 World Health Organization. (2021). Mental health atlas 2020 . World Health Organization. https://iris.who.int/handle/10665/345946. World Health Organization. (2022). World mental health report: Transforming mental health for all . World Health Organization. https://iris.who.int/handle/10665/356119. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7576884","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":512713079,"identity":"38e14c81-08d4-489e-a0ff-11501f962cbc","order_by":0,"name":"Fernando Filipe Paulos Vieira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYBAC9gYwxQxmHGAwYGDgB/ETCnBr4TkA1QJigLVIggxJMCBSCxgYgBn4tLD3Pnvwc4e1HI90j+GBDwX35I3Pr0788MCAQZ5f7AB2LTzHzQ17z6Qb88icMTg4w6DYcNuNt5slgA4znDk7AasWe4k0NgnetsOJ+yXSEg7zGCQwbrtxdgNIS4LBbexaeOSfsUn+BWrpAWn5Y5Bgv3nG2c0/8GqRYGOT5gVrST5wmMEgIXEDf+82/LbwpLFJy7aB/HL4wMEeg4TkGTd4t1kkGEjg9AsP+zE2ybdtoBBrbP7w40+CbX//2c03f1TYyPNLY9eCABJwRgIKlxgt/AeIUD0KRsEoGAUjCQAAQ+JfTyEQ3W4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-1026-3969","institution":"University of Sao Paulo","correspondingAuthor":true,"prefix":"","firstName":"Fernando","middleName":"Filipe Paulos","lastName":"Vieira","suffix":""}],"badges":[],"createdAt":"2025-09-09 20:13:33","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7576884/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7576884/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91078665,"identity":"8b6a8f26-412b-463b-88c4-a8a90d8860d9","added_by":"auto","created_at":"2025-09-11 11:20:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":534488,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow Diagram – Study Selection\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7576884/v1/69c8565978cd5c311962d8be.jpeg"},{"id":91080435,"identity":"4c482787-0689-437d-afda-d0ae097a427b","added_by":"auto","created_at":"2025-09-11 11:36:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1176394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7576884/v1/6e2ccf93-dc93-4ca2-be32-a2e5f13880fa.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e Recent advances in psychiatry: a systematic review of biopsychosocial approaches in the treatment of common mental disorders \u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMental health has emerged as one of the foremost public health challenges of the 21st century. According to the World Health Organization (WHO), more than one in eight individuals worldwide experiences some form of mental disorder, representing approximately 13% of the global population (World Health Organization [WHO], 2022). Among the most prevalent common mental disorders (CMDs) are depression, anxiety disorders, and post-traumatic stress disorder (PTSD), all of which contribute significantly to the global burden of disability. Indeed, depression alone is estimated to be the leading cause of years lived with disability (YLD) worldwide (GBD 2019 Mental Disorders Collaborators, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite advances in neuroscience and psychopharmacology, rates of timely diagnosis, adequate treatment, and functional recovery remain unsatisfactory in many regions of the world, particularly in low- and middle-income countries, where resources are limited and structural barriers to mental health care persist (Patel et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The treatment gap\u0026mdash;the disparity between those who require care and those who actually receive it\u0026mdash;remains alarming: in certain areas, up to 85% of individuals with CMDs do not receive specialized care (WHO, 2021).\u003c/p\u003e\u003cp\u003eHistorically, psychiatry has been dominated by a biomedical approach focused on the neurobiological underpinnings of mental disorders. This model has enabled significant advances in the development of psychotropic medications, functional neuroimaging, and psychiatric genetics (Insel \u0026amp; Quirion, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). However, it has been widely criticized for its reductionism, as it focuses almost exclusively on the biological correlates of psychological suffering, without adequately integrating the psychological and social factors that also affect mental health (Bracken et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn response to these limitations, the biopsychosocial model, proposed by George Engel in 1977, has gained prominence as a more integrative paradigm. This model posits that health and illness processes cannot be understood solely through biology; instead, they must also take into account the personal, relational, and social contexts of the patient (Engel, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1977\u003c/span\u003e). The biopsychosocial model aligns with a more humanistic and holistic vision of mental health care, recognizing the subjectivity of suffering and the need for multimodal therapeutic approaches.\u003c/p\u003e\u003cp\u003eIn recent decades, both clinical and social contexts have changed substantially. New forms of psychological distress have emerged, associated with phenomena such as job insecurity, structural unemployment, urban social isolation, and digital hyperconnectivity\u0026mdash;all of which can exacerbate stress, anxiety, and depression (Crisp et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Twenge, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Furthermore, patients\u0026rsquo; expectations have evolved towards more person-centered, participatory, and culturally sensitive forms of care.\u003c/p\u003e\u003cp\u003eThe COVID-19 pandemic further intensified many of these trends, leading to an unprecedented increase in the prevalence of affective and anxiety disorders, particularly among young people, women, and vulnerable populations (Moreno et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Simultaneously, the health crisis accelerated the adoption of digital technologies in mental health care, highlighting the potential of telepsychiatry, mobile self-help applications, and online therapy programs as tools to expand access and reduce treatment gaps (Torous et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis scenario underscores the urgent need to reassess and update the therapeutic approaches employed in psychiatry. Interventions focused exclusively on pharmacological prescription have proven insufficient to address the complexity of contemporary psychological suffering. Therefore, it is essential to incorporate evidence-based psychotherapeutic strategies\u0026mdash;such as cognitive-behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions\u0026mdash;while also strengthening community mental health programs and integrating psychiatric care into primary health care services (Kazdin \u0026amp; Rabbitt, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; WHO, 2021).\u003c/p\u003e\u003cp\u003eMoreover, particular emphasis must be placed on the active consideration of the social determinants of mental health, such as poverty, violence, discrimination, structural racism, and gender inequalities, as key factors in the etiology and persistence of common mental disorders (Lund et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The integration of a human rights and social justice perspective into psychiatric practice thus becomes essential.\u003c/p\u003e\u003cp\u003eThis article aims to provide a narrative review of the most relevant advances in contemporary psychiatry, with a particular focus on the biopsychosocial model and its application to the management of common mental disorders. Recent developments in psychopharmacology, psychotherapy, and digital interventions will be explored, alongside successful experiences in collaborative, community-based, and integrated care. Through this review, the article seeks to offer a critical, contextualized, and constructive perspective on the future direction of psychiatry within both the Latin American and global contexts.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a systematic literature review design to identify and synthesize evidence on psychiatric interventions for common mental disorders. The review followed a structured and reproducible methodology, including a comprehensive search of electronic databases, predefined inclusion and exclusion criteria, and a standardized data extraction process. The study design was guided by the PRISMA 2020 statement to ensure transparency and methodological rigor.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive search of the literature was performed in three electronic databases: PubMed, Scopus, and SciELO, covering the period from January 2015 to December 2024. The search combined keywords and MeSH terms related to common mental disorders, psychiatric interventions, biopsychosocial models, pharmacological treatments, psychotherapy, and integrative approaches. Boolean operators (AND, OR) were applied to refine the search and ensure the retrieval of relevant studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were designed to ensure that the review focused on high-quality and relevant studies. Therefore, only original investigations or systematic reviews with solid methodological foundations were considered. The time frame (2015\u0026ndash;2024) was selected to capture the most up-to-date scientific contributions. In addition, linguistic inclusion (English, Spanish, and Portuguese) allowed for a broader and more representative sample of the literature. Finally, the studies needed to specifically examine psychiatric interventions or the use of biopsychosocial models in the treatment of CMDs, guaranteeing thematic coherence with the objectives of the review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo maintain methodological rigor, studies with evident design flaws, insufficient clarity in their procedures, or those that failed to meet peer-review standards were excluded. Duplicated records were also removed to avoid redundancy. Furthermore, articles whose thematic scope did not correspond to the objectives of the review\u0026mdash;such as works unrelated to psychiatric interventions or biopsychosocial models\u0026mdash;were disregarded to preserve the focus and validity of the synthesis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Selection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll retrieved records were imported into a reference management software, and duplicates were removed. Two independent reviewers screened the titles and abstracts, followed by full-text reviews to assess eligibility. Disagreements were resolved through discussion or consultation with a third reviewer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Extraction and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelevant data were extracted using a standardized form, including information on study characteristics, types of interventions, outcomes assessed, and key findings. A qualitative synthesis of the evidence was conducted to summarize the main results and identify research gaps.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePharmacological Advances\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn recent years, pharmacological developments in the field of psychiatry have shown significant progress, with the introduction of new compounds that offer more favorable tolerability profiles and a reduced incidence of adverse effects. A prominent example is multimodal antidepressants, such as vortioxetine, which acts as a selective serotonin reuptake inhibitor and a modulator of serotonergic receptors. This pharmacodynamic profile allows for a broader effect on depressive symptoms, with additional benefits in the cognitive domain (Baldwin et al., 2016; McIntyre et al., 2014).\u003c/p\u003e\n\u003cp\u003eSimilarly, third-generation antipsychotics, such as cariprazine and brexpiprazole, represent an advancement in the treatment of schizophrenia and affective disorders. Both agents act as partial agonists at D2/D3 receptors and antagonists at the 5-HT2A receptor, resulting in improvements in negative and cognitive symptoms, along with a more favorable adverse effect profile compared to traditional antipsychotics (Marder et al., 2021).\u003c/p\u003e\n\u003cp\u003eIn addition, promising research is being conducted in the field of pharmacogenetics, aiming to identify genetic biomarkers that can predict therapeutic response and tolerability to various psychotropic medications. These tools may enable a more personalized approach to the treatment of psychiatric disorders. However, their clinical application remains limited due to interindividual genetic variability and the need for additional longitudinal and multicenter studies to validate their effectiveness (Bousman \u0026amp; Dunlop, 2018).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThird-Wave Psychotherapies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThird-wave psychotherapies represent an evolution within the field of cognitive-behavioral therapies (CBT), integrating elements such as mindfulness, acceptance, compassion, personal values, and cultural contexts. These therapeutic approaches place less emphasis on directly modifying the content of thoughts, focusing instead on changing the individual\u0026rsquo;s relationship with their thoughts, emotions, and internal experiences (Hayes et al., 2011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOrigins and Evolution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first wave of behavioral psychological therapies emerged from the strictly behaviorist approach (Skinner, 1953), which concentrated on modifying observable behavior through classical and operant conditioning. The second wave introduced cognitive components, emphasizing the restructuring of dysfunctional thoughts (Beck, 1976; Ellis, 1962). The third wave, which began to take shape in the late 20th and early 21st centuries, adopts a more contextual and functional perspective on human suffering.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Third-Wave Therapies\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcceptance and Commitment Therapy (ACT)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Steven C. Hayes, ACT emphasizes the acceptance of internal experiences rather than attempts to eliminate them. It is grounded in Relational Frame Theory (RFT), a theory of language and cognition.\u003c/p\u003e\n\u003cp\u003eIts primary objective is to foster psychological flexibility, defined as the ability to remain present, open to experiences, and committed to actions aligned with personal values (Hayes et al., 2012). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDialectical Behavior Therapy (DBT)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOriginally developed by Marsha Linehan for the treatment of borderline personality disorder, DBT combines behavioral techniques with mindfulness practices and a dialectical philosophy.\u003c/p\u003e\n\u003cp\u003eIt focuses on balancing acceptance and change, assisting individuals in regulating intense emotions and improving interpersonal relationships (Linehan, 1993).\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMindfulness-Based Cognitive Therapy (MBCT)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Segal, Williams, and Teasdale (2002), MBCT integrates mindfulness meditation with traditional CBT. It has shown particular efficacy in preventing depressive relapse. Patients are taught to observe their thoughts and emotions without automatically reacting to them, thereby disrupting cycles of rumination and experiential avoidance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompassion-Focused Therapy (CFT)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Paul Gilbert, CFT aims to cultivate compassion toward oneself and others, making it especially beneficial for individuals with high levels of shame or self-criticism (Gilbert, 2010). Grounded in the evolutionary understanding of human motivational and affective systems, this therapy employs exercises designed to activate the care and safety system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMindfulness-Based Stress Reduction (MBSR)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially developed by Jon Kabat-Zinn (1994) as a non-clinical intervention, MBSR has been widely adopted in therapeutic settings. It utilizes mindfulness meditation to reduce stress and improve quality of life, fostering a healthier relationship with suffering.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommon Features of Third-Wave Therapies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThird-wave therapies are characterized by several core features, including the incorporation of mindfulness and meditation practices, an emphasis on acceptance, compassion, and alignment with personal values, and the promotion of psychological and emotional flexibility. These approaches also place greater attention on the integration of cultural, existential, and spiritual contexts, and focus on processes rather than the specific content of thoughts, emphasizing how individuals relate to their experiences rather than the experiences themselves.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmpirical Evidence and Effectiveness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA growing body of research supports the efficacy of these therapies across a wide range of disorders, including depression, anxiety, personality disorders, chronic pain, and addictions (A-Tjak et al., 2015; \u0026Ouml;st, 2008). For example, ACT has demonstrated outcomes comparable to traditional CBT, with additional advantages in patient satisfaction and long-term maintenance of therapeutic gains (Powers et al., 2009). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCriticisms and Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite their widespread adoption, third-wave therapies have also faced criticism. Concerns have been raised regarding their lack of clear differentiation from earlier therapeutic approaches, methodological heterogeneity in efficacy studies, and the commercialization of mindfulness. Nevertheless, such critiques have contributed to greater scientific rigor and improvements in clinical protocols.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDigital Technologies in Mental Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe advancement of digital technologies has profoundly transformed the field of mental health over the past decade, a shift further accelerated by the COVID-19 pandemic. Among the most notable innovations are telepsychiatry platforms, mobile applications for emotional self-management, and artificial intelligence-based chatbots. These tools have overcome geographical and structural barriers, enhancing access to mental health services in traditionally underserved settings, such as rural areas or regions with limited resources (Torous et al., 2020; Mohr et al., 2017).\u003c/p\u003e\n\u003cp\u003eTelepsychiatry\u0026mdash;defined as the use of telecommunications technologies to provide psychiatric care remotely\u0026mdash;has proven effective and acceptable to both clinicians and patients. Its utilization surged during the pandemic due to the necessity of maintaining social distancing, leading to greater familiarity with these services and their consolidation within mental health care systems (Shore et al., 2020).\u003c/p\u003e\n\u003cp\u003eLikewise, mobile applications allow users to monitor their emotional states, engage in mindfulness exercises, track symptoms, and receive real-time feedback, thereby enhancing self-awareness and treatment adherence (Firth et al., 2017). Mental health chatbots, such as Woebot and Wysa, employ natural language processing algorithms to deliver emotional support and cognitive-behavioral coping strategies. While these tools do not replace clinical care, they may serve as valuable adjuncts, particularly for early or low-threshold interventions (Fulmer et al., 2018).\u003c/p\u003e\n\u003cp\u003eNevertheless, significant challenges remain concerning ethics, data privacy, the scientific validation of these tools, and equitable digital access. Effective integration of digital technologies requires appropriate regulatory frameworks, professional training, and ongoing evaluation of their effectiveness and societal impact (Torous \u0026amp; Wykes, 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCollaborative Care and Social Determinants of Mental Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollaborative care models, which integrate psychiatry with primary care and social work, have demonstrated effectiveness in managing common mental disorders, particularly within primary care settings. This approach fosters interdisciplinary, patient-centered care, leading to improved treatment adherence, reduced chronicity of disorders, and enhanced clinical and functional outcomes (Archer et al., 2012).\u003c/p\u003e\n\u003cp\u003eMoreover, there is increasing recognition that interventions addressing the social determinants of health\u0026mdash;such as poverty, unemployment, food insecurity, and interpersonal violence\u0026mdash;are essential for reducing relapse rates and promoting sustained recovery. These factors directly influence the onset, course, and prognosis of mental disorders, underscoring the need for comprehensive strategies in effective therapeutic approaches (Compton \u0026amp; Shim, 2015; Lund et al., 2010).\u003c/p\u003e\n\u003cp\u003eIn this regard, collaborative care models incorporating community-based actions and social policy initiatives can play a pivotal role in the primary and secondary prevention of mental health disorders. Early identification of social risk factors, coupled with timely interventions such as support networks, employment programs, or housing assistance, may reduce the risk of chronicity and significantly improve patients\u0026rsquo; quality of life (Patel et al., 2018).\u003c/p\u003e"},{"header":"DISCUSSION AND CONCLUSION ","content":"\u003cp\u003eThe findings presented in this review reflect a paradigmatic shift in contemporary psychiatry, characterized by the progressive integration of the biopsychosocial model as both a theoretical and clinical foundation. Introduced by George Engel in 1977, this model emerged as a critique of the reductionist perspective of the biomedical paradigm, proposing a more holistic understanding of health and mental illness (Engel, 1977). Although conceptualized more than four decades ago, the model has gained renewed relevance in the face of current mental health challenges, particularly in contexts marked by high social vulnerability, humanitarian crises, and structural inequalities that affect the psychological well-being of large segments of the population (WHO, 2022; Kleinman, 2009).\u003c/p\u003e\n\u003cp\u003eOne of the main contributions of the biopsychosocial approach lies in its capacity to integrate various levels of analysis\u0026mdash;from the molecular to the community level\u0026mdash;thus enabling more comprehensive and personalized interventions. This model considers not only clinical symptoms but also living conditions, culture, social environment, and patient resources (Ghaemi, 2010; Borrell-Carri\u0026oacute; et al., 2004).\u0026nbsp;Such a perspective is particularly relevant in Latin America, where mental health is deeply shaped by factors such as poverty, structural violence, racism, forced migration, and limited access to mental health services (Minoletti et al., 2015;\u0026nbsp;Pan American Health Organization [PAHO], 2018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the pharmacological domain, advances in second- and third-generation psychotropic medications, along with research in genetics and neurobiology, have enabled more targeted treatments for certain disorders, with fewer adverse effects and improved safety profiles (Nestler et al., 2002). Nonetheless, it remains evident that pharmacological treatment alone\u0026mdash;without the complement of psychotherapeutic interventions or consideration of psychosocial factors\u0026mdash;is associated with lower treatment adherence, higher relapse rates, and reduced patient satisfaction (Moncrieff \u0026amp; Kirsch, 2015; Deacon, 2013). In other words, pharmacotherapy may be necessary, but it is rarely sufficient on its own.\u003c/p\u003e\n\u003cp\u003eFrom a psychotherapeutic perspective, third-wave therapies\u0026mdash;such as Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Compassion-Focused Therapy (CFT)\u0026mdash;have demonstrated effectiveness in addressing a variety of disorders, including those with high medical comorbidity or a history of complex trauma. These therapies emphasize processes such as mindfulness, emotional regulation, and psychological flexibility (Hayes et al., 2012;\u0026nbsp;Linehan, 1993). Among adolescents, LGBTI+ populations, and survivors of violence, these approaches have shown promising results (Viana et al., 2021). However, their systematic implementation in public health systems remains limited, mainly due to a lack of specialized training and financial resources.\u003c/p\u003e\n\u003cp\u003eThe rapid growth of digital technologies has been among the most disruptive phenomena in mental health over the past decade. Digital interventions\u0026mdash;including mobile apps, telepsychiatry, e-health platforms, and therapeutic chatbots\u0026mdash;hold significant potential to expand access to care in remote or underserved areas (Torous et al., 2020; Naslund et al., 2017). However, they also raise new ethical and clinical challenges: the use of tools without scientific validation, risks to the privacy of sensitive data, disparities in internet access, and the potential depersonalization of the therapeutic relationship (Anthes, 2016). Thus, it is imperative to establish clear regulatory frameworks, empirically validate digital tools, and ensure appropriate clinical oversight of these technologies.\u003c/p\u003e\n\u003cp\u003eIn parallel, collaborative care models have shown effectiveness in improving clinical outcomes, enhancing user satisfaction, and reducing health system costs (Un\u0026uuml;tzer et al., 2002; Archer et al., 2012). These models integrate primary and mental health care, promoting networking among psychiatrists, general practitioners, psychologists, social workers, and occupational therapists under shared protocols. However, their sustainability requires not only empirical evidence but also political will, adequate financial resources, and a culturally sensitive approach (Patel et al., 2018).\u003c/p\u003e\n\u003cp\u003eIt is important to note that despite technological and therapeutic advances, many of these innovations remain inaccessible to large segments of the population. Gaps between countries\u0026mdash;and within countries\u0026mdash;are significant, particularly in rural areas, Indigenous communities, and marginalized urban neighborhoods (Lund et al., 2010; Saraceno et al., 2007). In this regard, contemporary psychiatry bears an ethical responsibility not only to generate new knowledge but also to advocate for public policies that promote equity and social justice in mental health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychiatry in the 21st century stands at a transformative juncture. It can no longer rely solely on biologically-based paradigms or standardized solutions. The complexity of mental disorders demands an intersectoral, context-sensitive, and evidence-based approach. When genuinely applied, the biopsychosocial model enables not only more effective and humane care, but also greater sensitivity to the sociocultural realities that shape mental health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003eThe author declare having no conflict of interest.\u003c/p\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eA-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., \u0026amp; Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. \u003cem\u003ePsychotherapy and Psychosomatics,\u003c/em\u003e \u003cem\u003e84\u003c/em\u003e(1), 30\u0026ndash;36. https://doi.org/10.1159/000365764\u003c/li\u003e\n\u003cli\u003eAnthes, E. (2016). 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Transforming mental health care at the interface with general medicine: Report for the President\u0026rsquo;s New Freedom Commission on Mental Health. \u003cem\u003ePsychiatric Services, 53\u003c/em\u003e(11), 1467\u0026ndash;1474. https://doi.org/10.1176/appi.ps.53.11.1467 \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2021). \u003cem\u003eMental health atlas 2020\u003c/em\u003e. World Health Organization. https://iris.who.int/handle/10665/345946.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2022). \u003cem\u003eWorld mental health report: Transforming mental health for all\u003c/em\u003e. World Health Organization. https://iris.who.int/handle/10665/356119.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Sao Paulo","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Psychiatry, mental health, biopsychosocial model, common mental disorders, integrated therapies","lastPublishedDoi":"10.21203/rs.3.rs-7576884/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7576884/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eCommon mental disorders (CMDs), including depression, anxiety, and post-traumatic stress disorder, remain leading causes of global disability. Over the past decades, a more integrated view of psychiatric treatment has been promoted.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo analyze recent advances in psychiatry, with special emphasis on the biopsychosocial model applied to the treatment of CMDs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA systematic literature review was conducted using peer-reviewed articles published between 2015 and 2024 in PubMed, Scopus, and SciELO. Studies in English, Spanish, and Portuguese were included.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSignificant advances were identified in second- and third-generation pharmacotherapy, third-wave psychotherapies (e.g., ACT and mindfulness), and the increasing use of digital tools in mental health care. Collaborative care models have proven effective in improving treatment adherence and clinical outcomes in primary care settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003eThe findings highlight the relevance of adopting a biopsychosocial framework that transcends the traditional biomedical paradigm. Advances in pharmacological and psychotherapeutic approaches demonstrate the need for tailored interventions, while the integration of digital health tools and collaborative care underscores the importance of accessibility, continuity, and equity in treatment. Nonetheless, challenges persist, including disparities in resource distribution, cultural adaptability of interventions, and the risk of over-reliance on technology without sufficient human support. Future research should focus on refining integrative models that ensure scalability and sustainability across diverse health systems.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Contemporary psychiatry is evolving toward interdisciplinary, patient-centered, evidence-based practice, integrating biological, psychological, and social components.\u003c/p\u003e","manuscriptTitle":"Recent advances in psychiatry: a systematic review of biopsychosocial approaches in the treatment of common mental disorders","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 11:20:39","doi":"10.21203/rs.3.rs-7576884/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45896976-21ec-4191-baf2-48bab5cdc993","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54464293,"name":"Psychiatry"}],"tags":[],"updatedAt":"2025-09-11T11:20:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 11:20:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7576884","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7576884","identity":"rs-7576884","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}