Rethinking the biopsychosocial model of health: Understanding health as a dynamic system

Abstract

The biopsychosocial model has dominated research and theory in health psychology. This article expands the biopsychosocial model by applying systems theories proposed by developmental scholars, including Bronfenbrenner's ecological models and Sameroff's transactional model, as well as contemporary philosophical work on dynamic systems. The proposed dynamic biopsychosocial model construes human health as a product of the reciprocal influences of biological, psychological, interpersonal, and macrosystem contextual dynamics that unfold over personal and historical time. The importance, or centrality, of these influences varies within a person over time. The model is explicated using two hypothetical case studies derived from existing interdisciplinary health research. Implications for health, theory, research, and policy are discussed. | RETHINKING THE BIOPSYCHOSOCIAL MODEL OF HEALTH: UNDERSTANDING HEALTH AS A DYNAMIC SYSTEMDynamic interpersonal, biological, and psychological systems interact with contextual factors to shape health over the life span. This manuscript integrates theoretical perspectives that promote health understanding and considers the implications of these perspectives for research and policy related to health psychology. We first outline the dynamic biopsychosocial model of health, highlighting its conceptual roots and then present two hypothetical research-based examples that clarify the model's utility for understanding health.The model shown in Figure 1 and discussed below is an expanded version of the biopsychosocial model. The model integrates existing conceptualizations of the biopsychosocial model (Engel, 1980) with other systems models, especially those proposed by Urie Bronfenbrenner, Arnold Sameroff, and Evan Thompson. The major goals of this paper are to (a) explain the interactive elements of the dynamic biopsychosocial model and (b) use Bronfenbrenner's work to elaborate interpersonal dynamics in social environments and introduce centrality as a factor that modulates influences on health. | COMPONENTS OF A DYNAMIC BIOPSYCHOSOCIAL MODEL OF HEALTHThis model conceptualizes biological, psychological, interpersonal, and contextual effects on health as dynamics. Each dynamic captures a set of interactive forces or systems that affect health. The term dynamics is used to emphasize that

Barriers to and facilitators of employment for people with psychiatric disabilities in Africa: a scoping review

“…Despite the fact that in this study we identified certain biological, psychological, interpersonal and contextual factors that are shown to influence the employment of our study group, it is also important to bear in mind the interconnectedness and mutual influence of these factors as presented by Lehman et al [25]. All the biological, psychological and interpersonal challenges that persons with psychiatric disabilities experience are interrelated and also influenced by contextual factors that operate in their environment.…”

“…Identified barriers and facilitators will be discussed separately in accordance with the dynamic representation of bio-psycho-social model by Lehman et al [25]. …”

“…family structure and support [23], prevalence of stigmatizing beliefs in the community and existing policy documents [24]. In order to discuss this broad spectrum in a systematic way, the expansion of the bio-psycho-social model by [25] was adopted. This model builds on conventional bio-psycho-social approaches [26] by introducing a dynamic systems perspective and applying Bronfenbrenner’s theories of development in order to underline the social influences.…”

“…Studies suggest that this employment gap is especially evident in low- and middle-income countries (LMICs) because of the underlying socioeconomic and political reasons affecting the employment market and social welfare policies [1,2].

10.1080/16549716.2018.1463658-F0001Figure 1.PRISMA flowchart of study selection process.

10.1080/16549716.2018.1463658-F0002Figure 2.Adapted from Lehman et al [25] showing the dynamic interaction of bio-psycho-social factors in the employability of persons with psychiatric disabilities.

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“…Adapted from Lehman et al [25] showing the dynamic interaction of bio-psycho-social factors in the employability of persons with psychiatric disabilities.…”