ArticlePDF Available

Biopsychosocial model - The integrated approach to health and disease

Authors:
  • University of Applied Health Sciences, Zagreb, Croatia

Abstract and Figures

The biomedical model of health and disease dominates in current medical practice. The model attributes key role to biological determinants and explains disease as a condition caused by external pathogens or disorders in the functions of organs and body systems. Such an approach has its historic justification and has proved effective in the control of massive infectious diseases. However, now that chronic non-infectious diseases prevail, its efficacy has not only become questionable, but also the issue has been raised of its economic justification. The extension of biomedical approach and attribution of equal importance to psychosocial factors have become an imperative in the improvement of treatment efficacy and disease control, together with humanisation of relations between health staff and patients. A new biopsychosocial model has been suggested, that takes into account all relevant determinants of health and disease and that supports the integration of biological, psychological and social factors in the assessment, prevention and treatment of diseases. It does not diminish the significance of biological factors, but extends a rather narrow approach. The biopsychosocial model served as incentive for many studies of how psychological and social factors influence the development, course and outcome of a disease, giving rise to the development of interdisciplinary field--particularly the fields of health psychology and psychoneuroimmunology. Their contribution to better understanding of the impact of psychosocial factors on health stimulates greater interest of medical theory and practice in more holistic approach to a patient. However, the changes of the old, organ oriented approach are still too slow and too narrow.
Content may be subject to copyright.
Coll. Antropol. 33 (2009) 1: 303–310
Professional paper
Biopsychosocial Model – The Integrated
Approach to Health and Disease
Mladen Havelka, Jasminka Despot Lu~anin and Damir Lu~anin
Department of Health Psychology, University of Applied Health Studies, Zagreb, Croatia
ABSTRACT
The biomedical model of health and disease dominates in current medical practice. The model attributes key role to
biological determinants and explains disease as a condition caused by external pathogens or disorders in the functions of
organs and body systems. Such an approach has its historic justification and has proved effective in the control of mas-
sive infectious diseases. However, now that chronic non-infectious diseases prevail, its efficacy has not only become ques-
tionable, but also the issue has been raised of its economic justification. The extension of biomedical approach and attri-
bution of equal importance to psychosocial factors have become an imperative in the improvement of treatment efficacy
and disease control, together with humanisation of relations between health staff and patients. A new biopsychosocial
model has been suggested, that takes into account all relevant determinants of health and disease and that supports the
integration of biological, psychological and social factors in the assessment, prevention and treatment of diseases. It does
not diminish the significance of biological factors, but extends a rather narrow approach. The biopsychosocial model
served as incentive for many studies o how psychological and social factors influence the development, course and out-
come of a disease, giving rise to the development of interdisciplinary field – particularly the fields of health psychology
and psychoneuroimmunology. Their contribution to better understanding of the impact of psychosocial factors on health
stimulates greater interest of medical theory and practice in more holistic approach to a patient. However, the changes of
the old, organ oriented approach are still too slow and too narrow.
Key words: biopsychosocial model, health psychology, behavioural medicine
Introduction
The assumption that disease is not exclusively the
disorder occurring at the cellular, tissue, and organ lev-
els, but rather the state of the organism as a whole with
equally important effects of biological, psychological and
social factors, is practically as old as the written history
of mankind. Hence the more surprising is the fact that
still today, after ample scientific evidence about close in-
terrelation between biological, social and psychological
factors in health issues and development of disease, in
medical theory and practice there still dominate biomedi-
cal approaches, the approaches the attribute key role to
organic aspects of diseases1.
According to biomedical model, diseases are caused by
injury which may be either external or internal in origin.
External causes of disease are divided into physical,
chemical and microbiologic. Internal causes of disease
fall into three large categories – vascular, immunologic
and metabolic.
Such an organ-oriented medical practice stimulates
the development of medical techniques and procedures
that extend the knowledge about cell, tissue and organ
functioning, and by which the mechanisms of develop-
ment and treatment of certain somatic diseases can be re-
vealed. However, by not taking into account wider psycho-
social aspects of diseases, such organ oriented approach
has little to offer in guiding the kind of preventive efforts
that are needed to reduce the incidence of chronic diseases
by changing health beliefs, attitudes and behaviour.
On the other hand, this approach also leads to de-
humanisation of modern medical practice and produces
dissatisfaction of people in need of health services. Con-
trary to that and provoked by such practice, numerous
complementary and alternative approaches are devel-
oped as direct consequence of dissatisfaction with official
medicine2. In the frame of biomedical model medical in-
terest is focused more on disease than the patient, more
303
Received for publication December 30, 2008
on search for cellular and molecular levels of bodily func-
tions than the functioning of the body as a whole. Fur-
ther development of technology, scientific research and
new medical knowledge are viewed upon as the future
universal remedy that will soon solve health problems of
humans and eradicate all severe diseases. The develop-
ment of natural sciences, specifically chemistry, molecu-
lar biology, pharmacology, physics, electronics – undoubt-
edly substantiate these hopes. The discovery of »intelli-
gent drugs«, major improvement in the efficiency and ac-
curacy of diagnostic procedures, marked enhancement of
surgical techniques, successful revealing of tumour de-
velopment mechanism, all to the revolutionary decipher-
ing of human genome, significantly contribute to the
strengthening of the position of those who are in favour
of organic and technology oriented visions of medical
practice development. Although its proven efficacy can-
not be denied, the dominance of such an approach could
lead not only to further dehumanisation of relations be-
tween medical staff and their patients, but socially even
more dangerous situation occurring as a result of such an
increase in health expenditures which even the most af-
fluent societies would not be able to sustain without sig-
nificant restriction in the rights to health care. In spite of
this the models that take into account the interrelations
between physical, mental and social aspects, considering
it among other more humane, cheaper and even more ef-
ficient – have very small, if any, influence on modern
medical theory and practice.
The causes can be traced far back in ancient history
and are mostly related to fundamental philosophical con-
cern about the relation between soul and body, i.e. be-
tween psychological and biological. This everlasting philo-
sophical and religious dilemma was in different historical
periods addressed in different ways and from different
viewpoints.
The History of Biomedical Approach
The earliest systematically written evidence on the
knowledge about the relation between soul and body, be-
tween physiological, or organic, and psychological, can be
found in the period from the year 500 to 300 B.C. in the
writings of ancient Greek philosophers. Already Hippoc-
rates, about the year 500 B.C., spoke about a certain type
of holistic approach to health and disease, stating that
health depends on correct proportions of body fluids,
which insure good health when in harmony and disease
when in disharmony – the harmony being influenced by
external, natural factors, hence its lack results in di-
sease3. In these early writings the signs of multifactorial
model of disease may be seen together with the impor-
tance of natural, extra-organic factors influencing health
and development of disease. Although even at that time
the dualistic approach prevailed in the understanding of
soul and body, still the human behaviour was considered
an important factor in health and in treatment of disease.
The balance of body humours, considered the most im-
portant health factors, could be achieved by proper be-
haviour, regular nutrition, utilisation of natural prepara-
tions, avoidance of physical exertion. The role of a physi-
cian was to help in the establishment of healing condi-
tion, serving as a mediator between the patient and the
nature4. The subordination of medicine to nature was a
most important of the whole Hippocratic medicine. It is
implied in the emphasis which Hippocrates places on the
control of the patient s regimen, especially the elements
of his diet, the exercise and the general circumstances of
his life. Medicines or drugs perform an auxiliary func-
tion. Surgery is always a last resort. The physician must
combat the disease along with the patient and must
therefore know the patient as an individual, and all the
relevant circumstances of his life as well as particular cir-
cumstances of the disease. The practice of medicine thus
appears to require more than scientific knowledge of
health and disease. It requires the knowledge and skills
to persuade the patient to cooperate. The man, not the
disease, is to be treated, and to treat him well, physician
must examine the man as a whole, not merely the organ
or body part in which the disorder seems to be located.
The relationship of the physician to his patient is itself a
therapeutic factor and underlies the effectiveness of his
skill in all other respects.
The greatest difference between this and later ap-
proaches to health was in emphasising the importance of
the patient and her/his entire surrounding and behav-
iour, contrary to the emphasis on specific features and
symptoms of a disease. Indeed, these early assumptions
of multiple actions of various factors on health are the
beginning of present-day holistic approach to health, the
approach according to which the individual should take
over the responsibility for one’s own health by employing
the forms of behaviour that preserve health and treat
disease. Based on the same principle, Democritus states
that »people who pray for their good health do not under-
stand that it is them who have control over it«4.
The holism of that time, when the personality of a pa-
tient was more important than the disease, gradually dis-
appeared in later years.
Galen, a much more influential physician of ancient
time, directed the early holistic concept elaborated by
Hippocrates toward searching »local pathology«, i.e. or-
ganic damage to organs and tissues and its effect on
health.
Galen also spoke of holistic approach to disease and
opposed to specialistic models seen in ancient Egypt
medicine. Treatment of the disorders part as if it could be
isolated from the living unity of the whole man is, to
Galen, one of the deplorable consequences in medical
practice of atomism or mechanism in medical theory[4].
But by anatomical studies on animal cadavers, be-
cause in pagan Rome dissection and autopsy of the hu-
man body was forbidden, Galen came to a conclusion
that practically all diseases were caused by pathological
lesions in organs and that different lesions caused differ-
ent diseases. He was of opinion that there was not any
disease that could develop without evident disorders in
certain parts of the body. The concept about direct link
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
304
between bodily disorders and development of disease
turned the attention of medicine of that time toward mil-
lennial studies of external influences on human health.
Treatment started to be based exclusively on one-dimen-
sional model of disease, i.e. that resulting from physio-
logical changes in organ functioning, which only deep-
ened the old dichotomy between the soul and the body5.
In medieval period in Europe the development of
medicine underwent significant regression and so did
other ideas and knowledge about body-mind relations. It
was not before the 13th century that new ideas about
body-mind relations appear. Saint Thomas Aquinas, a fa-
mous philosopher of the Dominican order, rejected in his
writings the idea of soul and body as separate entities.
The new position within the Church itself, actualised by
the only recognised philosopher and scientist at that
time, gave rise to interests in further discussions about
the perennial problem of body-mind relations, the inter-
ests that by the beginning the Renaissance led to wide
movement of re-questioning the »eternal truths« about
the world in general, and hence abut health and particu-
larly about disease.
The scientific revolution that commenced at the be-
ginning of the 15th century was for a long time strongly
influenced by French philosopher Rene Descartes and
his categorical opinion about body and mind being com-
pletely separated. Although Descartes was of opinion
that mind and body could communicate through certain
parts of the brain, the basic idea was that the spirit, or
soul, functioned by one set of rules, or principles, while
the body functioned by entirely different mechanisms.
Rapid development of science leads to new discoveries in
medicine, to understanding of the mechanisms of human
blood flow, respiratory system functioning, the mecha-
nisms of digestive and other body systems, the discovery
of a microscope; for all of these medicine turned toward
looking for physiological causes and means of treatment
of most common bodily illnesses. Diagnostic efficacy and
treatment of diseases are significantly improved, espe-
cially when microorganisms as causative agents of many
diseases have been identified. The introduction of hy-
gienic measures, e.g. the extensive use of soap for medici-
nal purposes, concerns about water purity, sanitary waste
disposal, etc., contribute to significant positive effects on
human health. Prevention of diseases by vaccination fur-
ther increases the efficacy of treatment and strengthens
the biomedical concept of disease.
However, despite the evident efficacy, more and more
criticism is addressed to the biomedical concept, the most
common one being that it reduces the disease to the low-
est level, i.e. to cell and tissues, not taking into consider-
ation other factors, such as natural surrounding, social
environment, mental states, etc. Furthermore, it is a sin-
gle-factorial model describing diseases only as a disorder
in biological functioning of the body; it is based on dual
concept of body and mind; it considers body and mind to
be two separate entities in spite of ample scientific evi-
dence of complex interactions between body and mind; it
over-emphasises disease, ignoring health and important
role of medicine in preserving health and not only in the
treatment of disease.
The Need for New Biopsychosocial
Approach
The consequences of such a narrow approach may be
seen in exclusive focusing of medical procedures on chan-
ging the disease condition by surgical, radiological, phar-
macological and similar methods, which is almost a me-
chanical approach to disease where human body is viewed
as a complex organic mechanism that the physicians will
fix whenever a dysfunction in it occurs. The assumption
here is that there is strict division between the non-ma-
terial spirit, i.e. thoughts, attitudes, beliefs, feelings, etc,
and the material body, i.e. bones, skin, organs. Every
change in bodily function thus occurs separately from
the changes in mental functions, and vice versa.
The approach to health and disease based on such as-
sumptions was quite successful during the times when
acute infectious diseases prevailed, caused by one agent
only, the diseases that were of major medical concern at
the end of the 19th and beginning of the 20th century. Yet
the efficacy of biomedical model became highly question-
able when massive new non-infectious chronic diseases
occurred, in the development of which there participated
numerous risk factors, among which a great number of
psychological and social factors4.
The model that was highly efficient in controlling the
diseases caused by one agent suddenly became extremely
inefficient in the prevention and therapy of diseases
caused by simultaneous interaction of numerous differ-
ent causes and risk factors. The new diseases could not
be efficiently controlled by extensive vaccination of the
population nor merely organ-oriented therapeutic meth-
ods. The model became too narrow and the need to over-
come it was substantiated by ever increasing scientific
evidence about psychological and social effects on health
and disease.
In his paper »The need for a new medical model«,
published in the Science magazine in 19771, Georg Engel,
specialist in internal medicine and psychiatry, criticises
the existing biomedical modes and sets foundations for a
new bio biopsychosocial model by which he supports the
integration of biological, psychological and social factors
in the study, prevention and treatment of disease.
According to Engel the biomedical model is a reduc-
tionistic one since it is based on the philosophical princi-
ple that complex problems are derived from simple pri-
mary principles, according to which the causes of diseases
can best be explained at the simplest (cellular) levels;
also, that it is dualistic in terms of separating the mental
from somatic processes. Engel further states that the
biomedical model has almost become a medical dogma re-
quiring that all diseases, including the mental ones, be
conceptualised on primarily physical, chemical and other
biological mechanisms. He also claims that the border-
line between disease and health has never been clear and
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
305
that simple biological determinants of diseases are stron-
gly influenced by cultural, social and psychological condi-
tions and states.
Engel provides concrete reasons for which he is of
opinion that new approach is needed in modern medi-
cine, like for instance, that patients with the same diag-
nosis and laboratory tests can present with completely
different course of disease for different psychosocial cha-
racteristics; that for proper diagnosis it is necessary to
extensively interview the patient during which impor-
tant, not only biomedical, information can be obtained
for correct diagnosis and treatment method; that psy-
chosocial factors often determine whether the patients
considers her/himself sick or in need for medical assis-
tance; that psychosocial factors are interrelated with the
biological ones to the extent that they may influence the
course and outcome of treatment; that emotional rela-
tions between patients and physicians can affect the
speed of recovery, etc.
The proposal to introduce new wider model of health
does not diminish the importance of the biological in the
development and treatment of disease, but widens a too
narrow understanding of health and disease. Such an in-
teraction takes place within one unique system specific
for each individual, a system within which all three ma-
jor subsystems communicate by exchanging information,
energy and other substances. The centre of interest in
biopsychosocial model is not the disease but a sick indi-
vidual. In the diagnosis and treatment, beside medical
procedures, the model employs all other methods related
to psychological and social aspect, i.e. those requiring ac-
tive participation of psychological, social, economic, an-
thropological and other professionals whose expertise
will only contribute to the increase in health care effi-
cacy, humanisation of relations within health system and
significant savings in health expenditure. The model
stimulates team work and interdisciplinary approach in
both medical research and practice, contributing also to
more rapid and successful development of medicine it-
self. In a number of important medical fields, like for in-
stance the issue of pain control, the holistic theories,
those taking into account multiple factors in the onset
and therapy of single symptoms, help in formation of at-
titudes about the importance of other factors beside the
biological ones.
The Role of Biopsychosocial Model
The role of biopsychosocial model is particularly im-
portant in the studies of how psychological stress affects
the development of somatic diseases, since they have
identified numerous facts about the interactions between
the nervous, endocrine, immune and other organic sys-
tems in stressful situations. Many mechanisms of direct
influence of stress on single organ and system functions
have been established together with the indirect ones,
like for instance increase in stress induced risk beha-
viour6. Wide evidence of the accuracy of Melzack and
Wall’s holistic pain theory, i.e. the »gate control theory«,
has further contributed to the development and affirma-
tion of psychological techniques in pain control pro-
grams, techniques that together with surgical and phar-
macological methods improve the condition of patients
suffering from unnecessary and chronic pain7.
Yet, despite being directed toward changes in medi-
cine and its development, for it was indeed proposed by
physicians and not psychologists or sociologists, the bio-
psychosocial model has contributed more to structural
changes in psychology and sociology. In medicine the
model provided the greatest contribution in the develop-
ment of preventive programs in public health and the
smallest in clinical medical practice. However, its influ-
ence is significant in education of medical professionals
in terms of introducing many behavioural sciences topics
in medical and nursing study curricula. Specific influ-
ence may be noticed in psychiatric education and extend-
ing of psychiatric approaches to somatic and not only
psychic disorders, like for example in liaison psychiatry.
The Engel model significantly influenced the develop-
ment of interdisciplinary studies of biological-psychologi-
cal-social relations, resulting in the development of new
disciplines, namely the psychoneuroendocrinology and
psychoneuro-immunology.
The emphasis on physician-patient relationship led to
studies about communication between health staff and
patients, and the influence of communication to health
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
306
Fig. 1. Relations between biological, psychological and social aspects in biosociopsychological model of health and disease
(according to Serafino3).
behaviour of the patient, first of all compliance with
health advice and instruction8. Great contribution of
biopsychosocial model may be seen in the development of
new fields of psychological science. Because of increased
interest in the influence of mental states on health and
disease, behavioural medicine and health psychology have
started to develop. There is no doubt that the biopsy-
chosocial model shows its greatest influence on the devel-
opment of health psychology9,10.
Behavioural Medicine and Health
Psychology
Although the basic concepts of psychological theory
explaining the mental-physical relation have always been
present (stress and body health, emotions and body im-
munity, coping with disease, social support and disease,
health behaviour, personality and disease, life styles and
health, patients’ life quality, etc), and although the use of
psychological techniques in preservation of health and
treatment of diseases has been practiced for a long time,
it is only about the beginning of 80-is of the 20th century
that the overall theoretical and practical (applied) ap-
proach of psychology and psychologists to complex prob-
lems of health preservation and treatment of somatic dis-
eases has begun4.
Clinical psychology and occupational psychology to a
certain extent have long been the only branches of ap-
plied psychology mostly related to health care and medi-
cal profession. However, clinical psychology was primar-
ily focused on diagnosis and therapy of mental diseases,
which psychological processes acting upon the onset and
course of somatic diseases were somewhat detached from
the usual activities and wider interest of clinical psychol-
ogists within a health care system11.
Such interests of psychologists in health care can well
be understood for the 50-is of the 20th century, the time
when clinical psychology begins to develop as an alterna-
tive to a rather obsolete psychoanalytical approach. At
that time the infectious and parasitic diseases prevailed,
and in their development and treatment the psychologi-
cal processes did not have any specific role. Hence, as a
priority task, clinical psychologists focused themselves
on finding alternative methods of diagnosis and therapy
of mental diseases based on new ideas of behavioural and
cognitive psychology. Because of the dominant psycho-
analytical approach in explaining the causes and treat-
ment of mental diseases, the clinical psychologists were
directed toward proving the importance and efficacy of
clinical psychological procedures and techniques in the
diagnosis and therapy of mental diseases.
When the causes of somatic diseases began to change
and the increasing influence of psychological factors on
the development of new diseases of modern society, na-
mely the massive non-infectious chronic diseases, started
to occur, about the end of the 70-is of the 20th century
grows the interest of psychologists in how mental states
affect the onset and course of somatic diseases. Grad-
ually the knowledge about the effects of mental states on
somatic diseases starts to be systematically analysed and
psychological procedures and techniques in the field of
health preservation and treatment of somatic, and not
only mental, diseases are used.
The tradition of psychosomatic approach in the 30-is
of the 20th century, as a basis to increasing number of sci-
entific ideas concerning the influence of psychosocial fac-
tors on health, gives rise to the development of a new dis-
cipline around the 70-ties – the behavioural medicine,
and health psychology at the beginning of 1980. Accord-
ing to the logic of the biopsychosocial model, the previ-
ously used dichotomy of »psychosomatic« and »non-psy-
chosomatic« diseases became obsolete. A new term is
introduced about 1970, namely the »behavioural medi-
cine«, relating to the field within which the activities of
psychologists working in health care system would be ex-
tended. The term describes and defines the »interdisci-
plinary field concerned with the development and inte-
gration of the behavioural and biomedical science and
techniques relevant to health and illness and the applica-
tion of this knowledge and these techniques to prevention,
diagnosis, treatment and rehabilitation.« Psychoses, neu-
roses and addiction are included in this area only if they
lead to physical disorders as end results12. The terms and
the wide area it covers were subject to significant criti-
cism. Too much of »behaviourism«, which is only one of
many psychological theories, and particularly the use of
»medicine« as a term, caused its rather short duration.
In 1979 Stone et al in their Health Psychology textbook,
a pioneering effort in the field, discuss in detail many
topics and contents of the new field of psychology, the
field defined as part of psychological science instead of me-
dical one, the field in which the use of the term »health«
instead of »medicine« widens the approach no only the is-
sues of treatment of diseases, but preservation of health,
i.e. prevention of diseases. Matarazzo, the first president
of American Psychological Society Division of Health
Psychology, established in 1978, defines health psychol-
ogy as »…the aggregate of specific, educational, scientific
and professional contributions of the discipline of psycho-
logy to the promotion and maintenance of health, the pre-
vention and treatment of illnesses, the identification of
etiological and diagnostic correlates of health and illness
and related dysfunctions, and the analysis and improve-
ment of the health care system and health policy«13.
Rapid development of health psychology following its
initial conceptual definitions, is instigated by numerous
factors, among which mostly by increasing knowledge
about insufficient efficacy of traditional medical appro-
ach to health and disease in prevention and therapy of
more and more frequent occurrence of chronic non-infec-
tious diseases. Many studies of the influence of social,
cultural, psychological and other »non-medical« factors
in the onset and development of massive, especially chro-
nic cardiovascular and cerebrovascular diseases contrib-
ute to the development not only of health psychology, but
of other allied disciplines as well, the medical sociology in
particular14.
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
307
Before 1980 the reference literature in the field of ap-
plied psychology in medicine and health care mostly re-
lates to the topics of pathopsychology. However, during
the past 20 years great number of general textbooks of
health psychology have been published and they discuss
the basic fields of health psychology, like for instance;
psychological factors of health risks, prevention tech-
niques of risk factors, psychological aspects of individual
symptoms, diagnoses and medical procedures, the influ-
ence of psychological stress to the occurrence and course
of disease, adherence to expert advice and instruction,
importance of communication between health profes-
sionals and patients, psychological interventions in criti-
cal health conditions, psychological mechanisms of pain,
and other.
Several magazines were initiate in the field of health
psychology, among which the British Journal of Health
Psychology, Psychology and Health, and Health Psychol-
ogy, in which there are published many theoretical and
methodology papers discussing the application and effi-
cacy of health psychology techniques in the solving of
many modern health and medical problems, together
with specific problems of different groups of patients
(e.g. cardiovascular, kidney, oncological and other). Such
a vigorous development resulted in significantly greater
participation of psychologists in health care practice.
The number of psychologist who apply the knowl-
edge, skills and techniques of health psychology in health
care practice also increases, and they extend the area of
their participation from the traditional clinical psycho-
logical diagnosis and psychotherapy to the application of
methods and techniques of health psychology. These ac-
tivities will gradually extend to the following:
Application of techniques modifying risk health behav-
iour
Application of psychological techniques in pain control
Application of anti-stress programs in patients at risk
Application of psychological techniques in the streng-
thening of immune reactions to illness
Improvement of communication between health staff
and the patients
Introduction of programs of life quality improvement
for chronic patients, physically disabled individuals,
the elderly functionally disabled individuals
Development and application of overall rehabilitation
of the disabled
Evaluation of efficacy of individual psychological tech-
niques in the prevention and treatment of illness
Development and application of techniques of psycho-
logical assistance and support for the terminally ill pa-
tients and their families (cancer, AIDS)
Identification of individuals at high risk of getting a
disease.
Critical Views of the Biopsychosocial Model
The critics of biopsychosocial model state that it is
mostly a biomedical model, that biological factors are
still superimposed to the psychological and social ones,
that the theoretical basis of the model is not clear enough,
that the disadvantage of the model is the lack of a com-
mon language/system of concepts (i.e. psychological and
medical terminology exist parallel and unconnected),
and that the complex relations between causes and ef-
fects of factors within each subsystem, i.e. biological, psy-
chological and social, influencing the state of health and
occurrence of disease, are not properly known15,16.An
-
other opinion is that by proposing a model so conceived,
Engel, as a physician, wanted to incorporate the so-called
»external enemy« into the medical model and thus pro-
tect the official medicine from severe criticism for not ta-
king into account mental and social factors, and also from
significant resentment and antagonism of medical care
users toward complementary and alternative medicine.
Another group of critics base their opinions on certain
study results reported by advocates of biopsychosocial
model, who on the basis of its assumptions carried out re-
search with rather disappointing results. For example,
Smith17 investigated the thesis about the benefits of
biopsychosocial model in the understanding of etiological
factors of chronic diseases, illustrating by the studies of
factors influencing the development of peptic ulcer and
ischemic heart diseases. Based on the obtained results he
reports that it is not possible to definitely claim that
there exists influence of psychosocial factors on aetiology
of these diseases through the psychoneuroendocrinolo-
gical mediating mechanisms.
The assumption that psychosocial risk factors act on
the occurrence of physical diseases instigated extensive
studies aimed at decreasing the morbidity and mortality
from coronary heart diseases by acting on negative forms
of health behaviour. In the Multiple Risk Factor Inter-
vention study (MRFIT) about 13 thousand middle-aged
male subjects were included who had clear signs of coro-
nary risk (they were all smokers, had elevated choles-
terol level and elevated blood pressure), but no symp-
toms of coronary disease. The study participants were
included into the program of reducing the intensity of
risk behaviour. After 7 years, the program evaluation
showed disappointing results, i.e. only minor changes in
health behaviour and practically no effects either to coro-
nary morbidity or mortality18.
Such and similar results of efforts in individual inter-
ventions on health behaviour, fortunately did not results
in general rejection of the basic model, but rather in ex-
tension of research concepts and search for causes of fail-
ure in conceptual and methodological approaches. One of
the explanations for the obtained results was that health
behaviour was observed out of the community context,
that health behaviour in general depended on sociocul-
tural factors and to a lesser extent on individual personal
variables. Hence the community interventions were desi-
gned during which the whole community was stimulated
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
308
to accept positive health behaviour and not only the indi-
viduals at risk. This led to the development of community
psychology – another discipline of health psychology19.
The third group of critics refers to the question of pro-
fessional participation in solving the problems of health
and disease, i.e. the competition in conquering new space
for research and participation in health and medical
practice by experts who are uncommonly included in
medical practice in biomedical model so far – first of all
health psychologists, clinical psychologist and medical
sociologists. By frequently pointing out that the new ap-
proach in medicine opens limitless opportunities for re-
search in health psychology and direct participation in
health practice, the critics of this model state that it only
confirms their doubts that psychologists have taken the
advantage of widely accepting the new medical model
mostly for reasons to ensure part of an increasingly rich
health cake to their profession20.
Conclusion
The conclusion should be the answer to the question
made at the beginning – why, with all the evidence on
close relation between biological, social and psychological
factors in health and disease, within medical theory and
practice still dominates a narrow biomedical approach,
the approach that attributes the critical role to organic
aspects and neglects psychological and social influences.
Some of the reasons have been discussed in the paper,
whereas should be analysed in future studies of complex
relations within medicine and more complex ones be-
tween medicine and other professions.
The resistance of medical schools against the intro-
duction of subjects from behavioural sciences into regu-
lar curricula of university medical school still persists.
The acceptance of biomedical model as a dogma does not
only impede the introduction of new contents into educa-
tional curricula of future medical professionals, but blocks
experts of other professions to teach at university schools
of medicine. If the idea that the disease is an exclusively
»biological« event is generally assumed, then, of course,
there is no reason to include other professions, e.g. psy-
chologists, sociologists and non-medical experts into the
education of medical professionals, an consequently into
the process of treatment of disease, since only physicians
can do that.
Engel is also of opinion that schools of medicine cre-
ate hostile atmosphere for experts interested in interdis-
ciplinary biopsychosocial studies and oppose to their par-
ticipation in medical education programs. In this way a
large corpus of knowledge about the influence of psycho-
soscial factors on health and disease remains unknown
to most medical professionals. The statements like, »emo-
tional aspects of organic diseases are not essential either
to the development or to the course of disease, and there-
fore medical students need not learn about them«, and
many similar ones, Engel attributes to the »blinding ef-
fect of biomedical dogma.«1.
Aspirations toward »biomedical exclusivity« can also
be seen in efforts to introduce non-medical methods and
techniques in medical practice. These are often not vie-
wed with benevolence, as a possible and welcome assis-
tance in more efficient solving of everyday health prob-
lems, but rather as attempts of unwelcome intruders
aimed at threatening the established professional posi-
tion of physicians in health care.
A professional dominance like that is well reflected in
the existing model of health care practice, the model that
rejects criticism and isolates medical profession from al-
ternative views and relations with professions which
might assist in clarification of health problems and pro-
motion of health care9.
The words of Georg Engel, the man who takes the
greatest credit for introduction of biopsychosocial model,
published in the Science magazine and discussing the fu-
ture of biopsychosocial approach, may well serve as final
conclusion:
»But nothing will change all until they control re-
sources and gain wisdom to dare reject exclusive relying
on biomedicine as the only approach to health care1.
Acknowledgement
The authors thank Mrs. Srebrenka @uri} Havelka for
translating the text.
REFERENCES
1.ENGEL GL, Science, 196, (1977) 129.–36. — 2. HAVELKA M, Con-
textual Aspects of Communication as a Factor of Physician – Patient Re-
lationship. MS. Thesis, In Croat. (University of Zagreb, Zagreb, 1981). —
3. SERAFINO EP, Health Psychology – Biopsychosocial Interaction.
(Wiley, New York, 2005). — 4. STONE GC, COHEN F, ADLER NE, Health
Psychology (Jossey – Bass, San Francisco, 1979). — 5. SUTON S, BAUM
A, JOHNSTON M, (Eds) The Sage Handbook of Health Psychology, (Sage,
London, 2004). — 6. FINK G, (Ed) Encyclopaedia of Stress. (Academic
Press, San Diego, 2000). — 7. MCMAHON SB, KOLTZENBERG M, Wall
and Melzack Textbook of Pain. (Elsevier, New York, 2003). — 8. LEY P,
SPELMAN MS, Communicating with patients. (Staples Press, London,
1967). — 9. HAVELKA M, Development of Health Psychology in Educa-
tion and Health Care System in Croatia, In Abstracts, (VI European Con-
gress of Psychology, Roma, 1999). — 10.VEDHARA K, IRWIN R, Human
Psychoneuroimmunology, (University Press, Oxford, 2005). — 11. HAVEL-
KA M, Health Psychology, In Croat. (University of Zagreb, Zagreb,1995).
— 12. SCHWARTZ GE, WEISS SM, Journal of Behavioral Medicine, 1
(1977) 3–12. — 13. MATARAZZO JD, American Psychologist, 35 (1980)
807–817. — 14. JOHNSON, DW; JOHNSON, M, (Eds) Health Psychology,
(Elsevier, New York, 2001). — 15. ARMSTRONG D, Social Science and
Medicine, 25 (1987) 213–218. — 16. OGDEN J, Journal of Health Psy-
chology, 2 (1997) 21–29. — 17. SMITH GD, The Biopsychosocial Appro-
ach: a Note of Caution, In WHITE P, Biopsychosocial Medicine – An Inte-
grated Approach to Understanding illness, (University Press, Oxford, 2006).
— 18. Multiple Risk Factor Intervention Trial Research Group, Journal
of American Medical Association, 248 (1988) 1465–1477. — 19. DUFFY
KG, WONG, FY, Community Psychology (A and B, Boston, 2003). — 20.
STAM HJ, A Sound Mind in a Sound Body – A Critical Historical Analysis
of Health Psychology, in Murray M, Critical Health Psychology, (Palgrave
– McMillan, New York, 2004).
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
309
M. Havelka
Department of Health Psychology, University of Applied Health Studies, Zagreb, Mlinarska 38, Croatia
e-mail: mladen.havelka@zvu.hr
BIOPSIHOSOCIJALNI MODEL: CJELOVITI PRISTUP ZDRAVLJU I BOLESTI
SA@ETAK
U medicinskoj teoriji i praksi dominira biomedicinski model zdravlja i bolesti koji biolo{kim odrednicama pridaje
klju~nu ulogu, tuma~e}i bolest kao stanje uvjetovano vanjskim patogenim ~initeljima ili poreme}ajem funkcija organa i
organskih sustava. Ovakav pristup ima svoje povijesno opravdanje i pokazao je veliku efikasnost u suzbijanju masovnih
zaraznih bolesti. Me|utim, prevladavanjem kroni~nih nezaraznih bolesti, ne samo da je upitnom postala njegova efi-
kasnost, ve} se postavlja i pitanje njegove ekonomske opravdanosti. Pro{irenje biomedicinskog pristupa i pridavanje
jednake va`nosti psihosocijalnim odrednicama, pokazalo se imperativom kako u pobolj{anju efikasnosti lije~enja i suz-
bijanja bolesti, tako i u humanizaciji odnosa izme|u zdravstvenog osoblja i pacijenata. Predlo`en je novi, biopsihoso-
cijalni model, koji svim relevantnim odrednicama zdravlja i bolesti pridaje jednak zna~aj i podupire integraciju biolo-
{kih, psiholo{kih i socijalnih ~imbenika u prou~avanju, prevenciji i lije~enju bolesti. Njime se ne umanjuje zna~aj biolo{kih
~inilaca, ve} nadopunjuje preuski pristup. Biopsihosocijalni model potakao je brojna ista`ivanja utjecaja psiholo{kih i
socijalnih ~inilaca na nastajanje, tijek i ishod bolesti a time i razvoj novih interdisciplinarnih podru~ja – posebice zdrav-
stvene psihologije i psihoneuroimunologije. Njihov doprinos boljem razumijevanju djelovanja psihosocijalnih ~inilaca
na zdravlje, poti~e i ve}e zanimanje medicinske teorije i prakse za cjelovitijim pristupom pacijentu. Me|utim, promjene
starog, organicisti~ki usmjerenog pristupa zbivaju presporo i u premalom opsegu.
M. Havelka et al.: Biopsychosocial Model, Coll. Antropol. 33 (2009) 1: 303–310
310
... Whole-person care. Whole-person care refers to the integration of biological, psychological, and social factors in the study, prevention, and treatment of disease (Havelka, Lucanin, & Lucanin, 2009;Stineman, 2011). This is a stark contrast to biomedical approaches in that the center of interest is not the disease but the sick individual. ...
... This model states that diseases are caused by injury, which may be either external (physical, chemical, and microbiological) or internal (vascular, immunologic, and metabolic) in origin (Havelka et al., 2009). However, this was not the case historically. ...
... Earliest written evidence on the relations between body and soul, between physiological and psychological, can be found in the period from the year 500 to 300 B.C. in the writings of ancient Greek philosophers (Havelka et al., 2009). Hippocrates, about the year 500 B.C. spoke about holistic approaches to health and disease, stating that health depends on correct proportions of body fluids, which ensure good health when in harmony and disease in disharmony. ...
Thesis
There is increasing evidence documenting music therapy’s effectiveness in addressing physical, communication, cognitive, and psycho-social-emotional needs of patients undergoing rehabilitation. Despite the burgeoning research base, only 16% of music therapists work in medical settings (AMTA, 2016). The purpose of this study is to examine the dosage effect of music therapy on whole-person care in adult inpatient rehabilitation. Forty-eight participants were randomly assigned into three conditions: control group (standard rehabilitative care/therapies); group 1 (individual music therapy once per week); and group 2 (individual music therapy thrice per week). As part of standard care, all participants also received a 30-minute group music therapy session once per week. Results indicated significant improvements in physical well-being, as measured by the Functional Independence Measure (FIM), from admission to discharge in all treatment groups. Patients who received more individual music therapy experienced greater improvements in total FIM scores, specifically in physical and body mobility subscores. Results showed that the control group and group 1 had significant improvements in psychological well-being, as measured by the self-reported 12-Item Well-Being Questionnaire (W-BQ12), from admission to discharge. Group 2’s improvements, however, were not statistically significant. Significant positive correlations between FIM and W-BQ12 were also found, which lends support for mind-body connections in physical rehabilitation. Responses from the interviews were predominately positive regarding music therapy’s role in adult inpatient rehabilitation. The results suggest that music therapy can enhance whole-person care in physical rehabilitation settings and potentially reduce overall cost of care. More research is required to determine appropriate dosage levels and combinations of individual and group music therapy to promote physical and psychological well-being in adult inpatient rehabilitation.
... Although there are various studies examining burnout, there is a lack of a holistic view-including whether biological, psychological, and socio-environmental factors (based on the established health and disease model) are sufficient to describe the onset of the syndrome. and leisure environment, etc.)], as well as cultural and spiritual aspects as supplementary dimensions (Sulmasy, 2002;Suls and Rothman, 2004;McGee and Torosian, 2006;Esch, 2008aEsch, , 2011Esch, , 2019Havelka et al., 2009;Babalola et al., 2017;Berry et al., 2017;Listopad et al., 2021). There is preliminary evidence that spirituality, meaningfulness, faith, and trust are pain-and stressreducing and essential within a holistic model of health and disease (Sulmasy, 2002;McGee and Torosian, 2006;Esch, 2008aEsch, , 2011Esch, , 2019Saad et al., 2017;Listopad et al., 2021). ...
... The bio-psycho-social model of health and disease was postulated more than four decades ago by Engel (1977). According to the model, biological, psychological, and socio-environmental aspects play an important role in the development of health and disease and should therefore be considered in the description, prevention, and treatment of diseases (Engel, 1977;Egger, 2008;Havelka et al., 2009;Babalola et al., 2017;Lehman et al., 2017). In general, the (i) biological dimension refers to the physical elements of the body that influence and determine mental and physical health (Havelka et al., 2009;Lehman et al., 2017). ...
... According to the model, biological, psychological, and socio-environmental aspects play an important role in the development of health and disease and should therefore be considered in the description, prevention, and treatment of diseases (Engel, 1977;Egger, 2008;Havelka et al., 2009;Babalola et al., 2017;Lehman et al., 2017). In general, the (i) biological dimension refers to the physical elements of the body that influence and determine mental and physical health (Havelka et al., 2009;Lehman et al., 2017). The (ii) psychological dimension consists of cognitive, emotional, motivational, attitudinal, and behavioral aspects and encompasses the role of self, identity, personality, as well as various coping strategies (Suls and Rothman, 2004;Egger, 2008;Lehman et al., 2017). ...
Article
Full-text available
Background: Burnout is a widespread, multifactorial, and mainly psychological phenomenon. The pathogenesis of burnout is commonly described within the bio-psycho-social model of health and disease. Recent literature suggests that the phenomenon of burnout may be broader so that the three dimensions might not reflect the multifaceted and complex nature of the syndrome. Consequently, this review aims to identify the diversity of factors related to burnout, to define overarching categories based on these, and to clarify whether the bio-psycho-social model adequately describes the pathogenesis of burnout—holistically and sufficiently. Method: Five online databases (PubMed, PubPsych, PsychARTICLES, Psychology and Behavioral Sciences Collection, and Google Scholar) were systematically searched using defined search terms to identify relevant studies. The publication date was set between January 1981 and November 2020. Based on the selected literature, we identified factors related to burnout. We aggregated these factors into a comprehensible list and assigned them to overarching categories. Then, we assigned the factors to the dimensions of an extended model of health and disease. Results: We identified a total of 40 burnout-related factors and 10 overarching categories. Our results show that in addition to biological, psychological, and socio-environmental factors, various factors that can be assigned to a spiritual and work cultural dimension also play an important role in the onset of burnout. Conclusion: An extended bio-psycho-socio-spirito-cultural model is necessary to describe the pathogenesis of burnout. Therefore, future studies should also focus on spiritual and work cultural factors when investigating burnout. Furthermore, these factors should not be neglected in future developments of diagnosis, treatment, and prevention options.
... The biomedical model relies on the notion of disease (Wade and Halligan, 2004;Havelka et al., 2009), and is characterised by its sequence of aetiology → pathology → manifestation. ...
... This factor may be internal (vascular, immunological, and metabolic) or external (physical, chemical, and microbiological) in origin. The biomedical model views disease as a separate entity (i.e., independent of the individual affected), and therefore an individual involved is assumed to undergo medical procedures, such as surgery, radiology, and pharmacology, which physicians will manage in their entirety (Havelka et al., 2009;Engel, 1977). This means that the biomedical model emphasises the pathology of the disease and generally does not consider personal and other factors that may influence its severity, outcome, treatment or prevention. ...
... With these notions, the biomedical model helped to enhance the understanding of disease or illness and useful treatment (Havelka et al., 2009), particularly at a time when acute infectious diseases caused by a single agent were the foremost health concern. Nowadays, the view is that disease causation is multifactorial, including individual, social, and environmental factors (Parascandola, 2011). ...
Thesis
Introduction Low back pain (LBP) is a global public health problem. It is a highly prevalent and significant source of negative social, psychological, and economic burden. In Ethiopia, LBP ranked in the top ten causes of age standardised disability-adjusted life years (DALYs) in 2015. From 1990 to 2015, while DALYs caused by all other top 30 contributors (such as measles, malaria, and protein energy malnutrition) were shown to decrease, DALYs caused by LBP and sense organ diseases continued to increase (Misganaw et al., 2017b). This shows that combined with neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia, which are the common causes of DALYs in sub-Saharan Africa (Vos et al., 2013), LBP may pose a serious burden in Ethiopia. Primary prevention strategies have limited potential while timely and appropriate diagnosis and tailored treatment plans can reduce the burden of pain and improve patient outcomes. A better understanding of the epidemiology of health care utilisation for LBP in resource-limited communities like Ethiopia is therefore significantly important for future health care pathways development (Lentz et al., 2018). Objectives The aims of this study were 1) to develop and validate a measurement instrument used to measure determinants of health care utilisation for LBP, and 2) to investigate the epidemiology of health care utilisation for low back pain in Ethiopia. Methods To develop and validate the measurement instrument, a comprehensive review of the literature was undertaken and the relevant domains of potential determinants of health care utilisation for LBP were identified. Items relating to each domain were then generated, translated, and reviewed by an expert panel for content validity, clarity, and to suggest other items which may have been omitted. Factorial validity and internal consistency reliability were assessed by conducting principal component and parallel analyses, and Cronbach's alpha calculation, respectively, using a data from 1303 completed questions. The intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate the temporal stability of the instrument. The investigation of health care utilisation and hospital admission for LBP included a total of 1981 people with LBP. The calculation involved a single population proportion formula, with an expected prevalence of health care utilisation for LBP (p = 50%), 95% level of confidence, 4% margin of error, 3 design effect, and a 10% non-response. The study was conducted in June-November 2018 in South-West Shewa zone of Oromia regional state, Ethiopia. The study participants were selected using a multistage sampling technique with a systematic random sampling method. Data were collected using the Oromo language version of the instrument using the interview technique. Data entry was made using Epi-Info version 7.0, where it was exported to SPSS 23.0 and checked for accuracy. Finally, data analyses were carried out using R version 3.5.1. Health care utilisation and hospital admission for LBP were estimated as prevalence rates with 95% confidence intervals (CIs). The log-binomial regression model was fitted to determine prevalence ratios (PR) with 95% CIs in identifying factors associated with health care utilisation and hospital admission for LBP. Estimates of population parameters were also presented with 95% CIs and p-values. For all applications of inferential statistics, a p-value of < 0.05 was taken as the significance level. Results The content validity index of the items forming the newly developed measurement instrument ranged between 0.80 and 1.00 with the modified Kappa coefficient ranged between 0.79 and 1.00. The parallel analysis showed that there were six components with Eigenvalues exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00. The lifetime prevalence of health care utilisation for LBP was 36.1%, 95% CI: 33.9-38.1 and the annual prevalence was 30%, 95% CI: 27.9-32.2. Of the total 543 individuals with a one-year history of presentation to health care facilities for LBP, 78 (14.4%, 95% CI: 11.6-17.3) were hospitalised for the pain, with an average length of stay (LOS) 7.4 days, 95% CI: 6.4-8.8. Several socio-demographic variables, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors, such as beliefs about the pain, depressive symptoms, and sleeping problem/insomnia were independently associated with health care utilisation for LBP. Hospital admission for LBP was also found to be associated with gender, age, living conditions, residential environment, alcohol consumption status, intensity of pain, and presence of additional spinal pain. Conclusions The newly developed measurement instrument has an overall good level of psychometric properties measured as content and factorial validity, internal consistency reliability, and temporal stability. The most decisive factors explaining variations in health care utilisation and hospital admission for LBP were also determined. There were potential inequalities between urban and rural populations in accessing the Ethiopian health care system with relatively better services. This study also highlighted the burden of LBP to individuals and the already overloaded and fragile Ethiopian health care system. It may be prudent that the Ethiopian health care policy makers develop the necessary strategies to meet the health needs of both urban and rural populations with LBP. Further research evidence is also needed on LBP patient referral procedures in the Ethiopian health care system to inform the health policy makers regarding appropriate management strategies capable of dealing with the increasing epidemiology of LBP and associated health needs of people experiencing the pain.
... The biomedical model relies on the notion of disease (Havelka et al., 2009), which is characterised by its sequence of aetiology to pathology to manifestation. The assumption behind this model is that every disease has a specific causal factor that physically affects the human body. ...
... This factor may be internal (vascular, immunological, and metabolic) or external (physical, chemical, and microbiological) in origin. The biomedical model views disease as a separate entity (i.e., independent of the individual affected), and therefore an individual involved is assumed to undergo medical procedures, such as surgery, radiology, and pharmacology, which physicians will manage in their entirety (Havelka et al., 2009). This means that the biomedical model emphasises the pathology of the disease and generally does not consider personal and other factors that may influence its severity, outcome, treatment, or prevention. ...
... With these notions, the biomedical model helped to enhance the understanding of disease or illness and useful treatment (Havelka et al., 2009), particularly at a time when acute infectious diseases caused by a single agent were the foremost health concern. Nowadays, the view is that disease causation is multifactorial, including individual, social, and environmental factors (Parascandola, 2011). ...
Article
Background: Theories are integral to a research project, providing the logic underlying what, how, and/or why a particular phenomenon happens. Alternatively, models are used to guide a research project by representing theories and visualising the structural framework of causal pathways by showing the different levels of analysis. With the rise in chronic and behaviour-related diseases, health behaviour theories and models have a particular importance in designing appropriate and research led behavioural intervention strategies. However, there is a dearth of papers that explain the role of behavioural theories and models in research projects. Aims: The aim of this paper is to synthesise existing evidence on the relevance of health behaviour theories and models in research projects. Methods: This paper reviews health behaviour theories and models commonly underpinning research projects in public health and clinical practices. The electronic databases, such as MEDLINE, CINAHL, and Scopus, as well as the search engines Google and Google Scholar were searched to identify health behaviour theories and models. Results: Theories and models are essential in a research project. Theories provide the underlying reason for the occurrence of a phenomenon by explaining what the key drivers and outcomes of the target phenomenon are and why, and what underlying processes are responsible for causing that phenomenon. Models on the other hand provide guidance to a research project and assist in visualising the structural framework of causal pathways by showing the different levels of analysis. Health behaviour theories and models in particular offer valuable insights for designing effective and sustainable research projects for improved public health practice. Conclusions: By employing appropriate health behaviour theory and/or model as a research framework, researchers will be able to identify relevant variables and translate these into clinical and public health practices.
... A limitation in using physiological signals to assess pain is that physiological mechanisms can be further affected by personal factors, like gender [74] , age [75] , and health status (which is particularly true in cancer). In some cases, cancer pathology itself can lead to a change in physiological mechanisms, which can be misinterpreted and related to the pain experience [76] . This limitation should be overcome, in the future, by analyzing larger patient cohorts. . ...
... As highlighted in the European Society for Medical Oncology position paper [78] , a patient-centered approach is needed for cancer treatment, and this approach should also be translated to pain assessment. To reach this goal, implementing a biopsychosocial model [76] for pain assessment could overcome the limitations imposed by the current tools, providing a complete picture of the pain state that considers all the different aspects that converge in the pain experience. ...
Article
Background and objective Pain is one of the most debilitating symptoms in persons with cancer. Still, its assessment is often neglected both by patients and healthcare professionals. There is increasing interest in conducting pain assessment and monitoring via physiological signals that promise to overcome the limitations of state-of-the-art pain assessment tools. This systematic review aims to evaluate existing experimental studies to identify the most promising methods and results for objectively quantifying cancer patients’ pain experience. Methods Four electronic databases (Pubmed, Compendex, Scopus, Web of Science) were systematically searched for articles published up to October 2020. Results Fourteen studies (528 participants) were included in the review. The selected studies analyzed seven physiological signals. Blood pressure and ECG were the most used signals. Sixteen physiological parameters showed significant changes in association with pain. The studies were fairly consistent in stating that heart rate, the low-frequency to high-frequency component ratio (LF/HF), and systolic blood pressure positively correlate with the pain. Conclusions Current evidence supports the hypothesis that physiological signals can help objectively quantify, at least in part, cancer patients’ pain experience. While there is much more to be done to obtain a reliable pain assessment method, this review takes an essential first step by highlighting issues that should be taken into account in future research: use of a wearable device for pervasive recording in a real-world context, implementation of a big-data approach possibly supported by AI, including multiple stratification factors (e.g., cancer site and stage, source of pain, demographic and psychosocial data), and better-defined recording procedures. Improved methods and algorithms could then become valuable add-ons in taking charge of cancer patients.
... La investigación biopsicosocial revela relaciones más complejas al vincular factores psicosociales y biológicos con problemas de salud, considerando la multidimensionalidad de la sexualidad. Sin embargo, tampoco escapa a la criticas ante un sistema no consensuado de conceptos y por el complejo diseño de investigación requerido para recopilar y analizar datos provenientes de distintas disciplinas (Havelka et al, 2009;Schubert, 2010). ...
Article
Full-text available
Para las instituciones sanitarias, las disfunciones sexuales son el eje central de los programas de salud sexual de las personas mayores. Desde la Sociología se distinguen dos posicionamientos: uno basado en el modelo biomédico que las concibe como enfermedades; y en oposición a este, otro que utiliza el término “problema sexual” al posicionarse en el modelo biopsicosocial. Se indaga en la conceptualización de las disfunciones y de los problemas sexuales de la población española. Se realiza un análisis generacional y de género a través de la Encuesta Nacional de Salud Sexual (ENSS, 2009), representativa para toda la población. Los resultados indican que a lo largo del ciclo vital se experimentan malestares sexuales no siendo exclusivos de la vejez, y que es el modelo sexual reproductor, fomentado por las instituciones biomédicas, el promotor de este al restringir las prácticas al coito y constreñir la expresión del deseo y placer sexual.
Article
The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not have a well-defined position in contemporary residency training throughout North America. While residents receive in-depth exposure to diverse aspects of what to prescribe in their psychopharmacological training, and they work with patients’ subjective and relational meaning and the quality of the therapeutic alliance in their psychotherapy rotations, an integrated approach to how to prescribe is generally lacking. Despite many legitimate challenges, the authors suggest that teaching an integrated approach that incorporates objective, subjective, and relational factors in the provision of psychopharmacology and utilizing evidence-based principles of individualized care should be prioritized in both residency training and the provision of psychiatric treatment as a whole.
Article
This study explored perceptions of mental illness and the mentally ill in a South African setting. Informants were a purposive sample of 16 undergraduate students (female = 10, male = 6; age range = 18 to 25 years). Data were collected using semi-structured interviews on their existing understandings of mental illness. Thematic analysis yielded five major themes of mental illness as: (i) strange behaviours; (ii) imbalances in life orientations; (iii) unpredictability and undependability; (iv) biopsychosocial phenomenon; and (v) treatable, not curable. Participants regarded laughing, shouting, or swearing in socially unacceptable contexts as indicating mental unwellness and a danger to self or others. Participants perceived that mental illness is caused by various biopsychosocial systems including damage to the foetus in the mother’s womb, injuries, or accidents causing brain damage. Further participants noted that familial wrongdoing resulting in a curse from the ancestors may also result in mental illness. These beliefs may influence the students’ engagement with the mentally ill in community settings in ways important for recovery intervention design and implementation.
Chapter
Sexuality is an important component of human life that can be experienced and expressed in various ways. The interplay of biological, psychological, and social elements has an impact on sexuality. Because sexuality is a multi-causal, multidimensional complex phenomenon, sexual health and dysfunction should be addressed through a multidisciplinary biopsychosocial framework. The biopsychosocial model (BPS) is a paradigm that allows a clinician to explore the cause of a condition or disease based on a combination of biological, psychological, and social factors, and if so, to guide the diagnosis, education, and treatment process using as much evidence-based information as possible. The main principles of the BPS model and the algorithm for the management of sexual dysfunction are discussed in this chapter. When it comes to rare sexual medicine disorders, where evidence and knowledge are scarce, using a BPS approach is a must, as it can lead to a better understanding of the factors at play and, at the very least, allow treatments to be tailored to the patient’s needs.
Article
The increase in the prevalence of gastrointestinal (GI) conditions is an emerging global health concern. Studies of the impact on the lives of individuals living with GI conditions such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) typically focus on biological elements, such as symptomology and treatment efficacy. Comparatively fewer studies have explored the psychological and social aspects of GI conditions, which could provide key information needed to better understand the impact of GI conditions on people and their lived experiences. In this review, existing literature concerning the psychosocial factors and well‐being outcomes associated with GI conditions was reviewed using a scoping methodology. Sixty‐eight studies were selected for inclusion. Of these studies, the well‐being outcomes most frequently addressed, for both IBS and IBD, were quality of life and health‐related quality of life, and the most frequently addressed psychosocial factors were social support and coping. These outcomes are largely consistent with those identified for other medical conditions explored using the biopsychosocial model of health, with some exploration of the lived experiences of those with a GI condition.
Article
The Yale Conference on Behavioral Medicine brought a diverse group of behavioral and biomedical scientists together for the purpose of arriving at an interdisciplinary yet consensual definition, statement of goals, and set of recommendations regarding the emerging field of behavioral medicine. It was proposed that behavioral medicine be defined as the field concerned with the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and techniques to prevention, diagnosis, treatment, and rehabilitation. Psychosis, neurosis, and substance abuse are included only insofar as they contribute to physical disorders as an end point. The rationale behind this definition and proposals for future developments in the field are discussed.
Article
Textbooks in health psychology and medical sociology describe these disciplines as a challenge to the biomedical model. In particular, they purport to contest biomedicine's concepts of illness causality, a dualistic individual and outcomes. This article examines support for this 'rhetoric' and examines the discrepancy between the stated aims of these disciplines and the 'reality' of their explanatory frameworks. In addition, this discrepancy is analysed in terms of the implicit acceptance and privileging of a biomedical perspective within psychosocial theories. The article then examines explanations for this discrepancy first in terms of the potential function of the 'rhetoric' and then in terms of the reflections of this rhetorical challenge in the construction and dissolution of the boundaries of the human body.
HAVELKA M, Contextual Aspects of Communication as a Factor of Physician -Patient Relationship
  • Engel Gl
ENGEL GL, Science, 196, (1977) 129.-36. -2. HAVELKA M, Contextual Aspects of Communication as a Factor of Physician -Patient Relationship. MS. Thesis, In Croat. (University of Zagreb, Zagreb, 1981). -
The Sage Handbook of Health PsychologyEd) Encyclopaedia of Stress Communicating with patients — 9. HAVELKA M, Development of Health Psychology in Education and Health Care System in Croatia
  • Serafino Ep
  • Health Psychology
  • – Biopsychosocial Interaction
  • Stone
  • Gc
  • Adler Cohen F
  • – Nejossey
  • Bass
  • Francisco 5 San
  • Baum A Suton S
  • Johnston M
  • Spelman Ley P
  • Ms
SERAFINO EP, Health Psychology – Biopsychosocial Interaction. (Wiley, New York, 2005). — 4. STONE GC, COHEN F, ADLER NE, Health Psychology (Jossey – Bass, San Francisco, 1979). — 5. SUTON S, BAUM A, JOHNSTON M, (Eds) The Sage Handbook of Health Psychology, (Sage, London, 2004). — 6. FINK G, (Ed) Encyclopaedia of Stress. (Academic Press, San Diego, 2000). — 7. MCMAHON SB, KOLTZENBERG M, Wall and Melzack Textbook of Pain. (Elsevier, New York, 2003). — 8. LEY P, SPELMAN MS, Communicating with patients. (Staples Press, London, 1967). — 9. HAVELKA M, Development of Health Psychology in Education and Health Care System in Croatia, In Abstracts, (VI European Congress of Psychology, Roma, 1999). — 10.VEDHARA K, IRWIN R, Human Psychoneuroimmunology, (University Press, Oxford, 2005). — 11. HAVEL- KA M, Health Psychology, In Croat. (University of Zagreb, Zagreb,1995).
The Biopsychosocial Approach: a Note of Caution
  • — Schwartz
  • Weiss Ge
  • Sm
— 12. SCHWARTZ GE, WEISS SM, Journal of Behavioral Medicine, 1 (1977) 3–12. — 13. MATARAZZO JD, American Psychologist, 35 (1980) 807–817. — 14. JOHNSON, DW; JOHNSON, M, (Eds) Health Psychology, (Elsevier, New York, 2001). — 15. ARMSTRONG D, Social Science and Medicine, 25 (1987) 213–218. — 16. OGDEN J, Journal of Health Psychology, 2 (1997) 21–29. — 17. SMITH GD, The Biopsychosocial Approach: a Note of Caution, In WHITE P, Biopsychosocial Medicine – An Integrated Approach to Understanding illness, (University Press, Oxford, 2006).
— 19 — 20. STAM HJ, A Sound Mind in a Sound Body – A Critical Historical Analysis of Health Psychology
  • Duffy Kg
  • Fy Wong
  • Community Psychology
— 18. Multiple Risk Factor Intervention Trial Research Group, Journal of American Medical Association, 248 (1988) 1465–1477. — 19. DUFFY KG, WONG, FY, Community Psychology (A and B, Boston, 2003). — 20. STAM HJ, A Sound Mind in a Sound Body – A Critical Historical Analysis of Health Psychology, in Murray M, Critical Health Psychology, (Palgrave – McMillan, New York, 2004).
Mind in a Sound Body -A Critical Historical Analysis of Health Psychology
  • Stam Hj
  • Sound
STAM HJ, A Sound Mind in a Sound Body -A Critical Historical Analysis of Health Psychology, in Murray M, Critical Health Psychology, (Palgrave -McMillan, New York, 2004).