{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:01:18Z","timestamp":1790103678677,"version":"4.0.1"},"reference-count":538,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sci.","Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Recovery from schizophrenia-spectrum disorders is increasingly recognized as achievable, yet no synthesis has simultaneously examined long-term outcome rates, intervention effectiveness, cognitive predictors, social determinants, personal-recovery trajectories, and mediating mechanisms within a unified framework. This systematic review aimed to address these six domains and to propose an integrative theoretical model of functional recovery, applying meta-analysis where the evidence permitted and structured narrative synthesis elsewhere. Methods: Seven databases (PubMed\/MEDLINE, PsycINFO, Embase, Cochrane CENTRAL, Web of Science, Scopus, CINAHL) were searched through December 2025 following PRISMA 2020 and MOOSE guidance. We extracted eligible records (longitudinal designs, \u22656 months, adults with schizophrenia-spectrum disorders reporting functional outcomes) into two structured databases, then consolidated and de-duplicated them, yielding 467 unique papers. After topical screening and a duplicate audit, we retained 368 studies (1980\u20132025) and grouped them into six thematic clusters. A pre-specified rule pooled only clusters with at least five independent primary studies. Proportions were pooled with the Freeman\u2013Tukey transformation and associations with Fisher\u2019s z under DerSimonian\u2013Laird random-effects models; certainty was appraised with GRADE. Results: Three pools met the threshold. Long-term functional recovery was 35.4% (95% CI 22.6\u201349.4; k = 11) and symptomatic remission 39.6% (95% CI 29.3\u201350.5; k = 7), both with very high heterogeneity (I2 = 92\u201398%) and low certainty. The pooled association between psychological mediators and functional outcome was weak and imprecise (r = 0.23; 95% CI \u22120.09\u20130.51; k = 7; very low certainty), reflecting facilitators (positive mental health, social support, self-efficacy, hope) and barriers (internalized stigma, substance-use comorbidity, longer duration of untreated psychosis, persistent negative symptoms) acting in opposite directions. The questions concerning specific interventions, cognitive prediction, rehabilitation, and personal recovery were synthesized narratively: structured psychosocial and combined interventions and integrated rehabilitation were associated with small-to-medium functional gains; cognition, particularly social cognition and motivation, predicted later functioning; and personal recovery followed a course partly independent of clinical status. Conclusions: Recovery and remission are attainable for a substantial minority but remain heterogeneous and modestly certain. The proposed Multi-Pathway Dynamic Recovery Model organizes the evidence into five testable principles\u2014an ordered recovery hierarchy, social-cognitive mediation of the cognition\u2013function link, an early-phase intervention window, social-ecological embedding, and self-reinforcing feedback loops, offered as a hypothesis-generating framework rather than a validated structure. Services should prioritize comprehensive early intervention, target social cognition and stigma, and address structural determinants to optimize long-term recovery.<\/jats:p>","DOI":"10.3390\/brainsci16090993","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:56:41Z","timestamp":1790099801000},"page":"993","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychosocial Interventions, Recovery, and Mediating Mechanisms in Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis of Longitudinal Studies"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3197-2019","authenticated-orcid":false,"given":"Evgenia","family":"Gkintoni","sequence":"first","affiliation":[{"name":"Laboratory of Public Health, Epidemiology & Quality of Life, Department of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3601-1222","authenticated-orcid":false,"given":"Ignatia","family":"Farmakopoulou","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences and Social Work, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-4643","authenticated-orcid":false,"given":"Maria","family":"Theodoratou","sequence":"additional","affiliation":[{"name":"Hellenic Open University, 26335 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Panagioti","sequence":"additional","affiliation":[{"name":"Division of Population Health, Health Services, Research and Primary Care, University of Manchester, Manchester M13 9PG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Peritogiannis, V., Ninou, A., and Samakouri, M. 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