Jiang YL, Samah NA, Xiao ZS. Forever chemicals and mental health: A systematic review of per- and polyfluoroalkyl substances-related psychiatric outcomes and mechanistic insights. World J Psychiatry 2026; 16(3): 112022 [DOI: 10.5498/wjp.v16.i3.112022]
Corresponding Author of This Article
Yi-Lin Jiang, PhD, Faculty of Educational Sciences and Technology, Universiti Teknologi Malaysia, Skudai, Johor Bahru 81310, Johor, Malaysia. yilinjiangs@foxmail.com
Research Domain of This Article
Psychology, Multidisciplinary
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Mar 19, 2026; 16(3): 112022 Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.112022
Forever chemicals and mental health: A systematic review of per- and polyfluoroalkyl substances-related psychiatric outcomes and mechanistic insights
Yi-Lin Jiang, Narina A Samah, Zhan-Shuo Xiao
Yi-Lin Jiang, Narina A Samah, Faculty of Educational Sciences and Technology, Universiti Teknologi Malaysia, Johor Bahru 81310, Johor, Malaysia
Zhan-Shuo Xiao, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
Co-corresponding authors: Yi-Lin Jiang and Narina A Samah.
Author contributions: Jiang YL wrote the original draft; Samah NA contributed to conceptualization, writing, reviewing, and editing; Jiang YL, Samah NA, and Xiao ZS participated in drafting the manuscript; Jiang YL and Samah NA contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Yi-Lin Jiang, PhD, Faculty of Educational Sciences and Technology, Universiti Teknologi Malaysia, Skudai, Johor Bahru 81310, Johor, Malaysia. yilinjiangs@foxmail.com
Received: July 16, 2025 Revised: July 27, 2025 Accepted: November 12, 2025 Published online: March 19, 2026 Processing time: 226 Days and 23.1 Hours
Abstract
BACKGROUND
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants increasingly associated with adverse health outcomes, including psychiatric disorders. Although most research has focused on physiological toxicities, emerging evidence indicates that PFAS exposure may also disrupt central nervous system function - particularly among vulnerable populations such as children, adolescents, and pregnant women.
AIM
To answer the following two critical questions: What key findings regarding the impacts of PFAS exposure on psychiatric outcomes have emerged in the past five years? What research trends currently prevail in terms of methodologies, targeted populations, and mechanistic investigations?
METHODS
A systematic search guided by the PRISMA framework was conducted using Web of Science and Scopus, covering studies published between July 2021 and July 2025. Nineteen eligible studies were identified and thematically analyzed.
RESULTS
The article found increasing evidence linking PFAS exposure to psychiatric conditions, including depression, attention-deficit/hyperactivity disorder, autism spectrum disorder, and cognitive impairments. Proposed mechanisms include thyroid hormone disruption, neuroinflammation, and increased blood-brain barrier permeability. However, inconsistencies in findings - stemming from variability in exposure timing, PFAS compound types, and methodological approaches - remain a significant challenge.
CONCLUSION
Despite growing evidence of PFAS-related neuropsychiatric risks, current research is limited by methodological heterogeneity and incomplete mechanistic understanding. Future research should prioritize longitudinal designs, integrate multi-omics approaches, and refine exposure assessments. Urgent action is needed to incorporate scientific insights into public health policy, particularly for socioeconomically and environmentally vulnerable communities disproportionately exposed to PFAS.
Core Tip: This article synthesizes recent evidence linking per- and polyfluoroalkyl substances (PFAS) exposure to psychiatric disorders. It highlights the growing relevance of PFAS in psychiatric research, especially concerning children, pregnant women, and socioeconomically vulnerable populations. By examining epidemiological trends and biological mechanisms, the review underscores the urgent need for interdisciplinary research and policy action to mitigate the mental health risks posed by these persistent environmental contaminants.
