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Concept: Biopsychosocial model

138

The importance of how disease and illness are conceptualised lies in the fact that such definition is paramount to understand the boundaries and scope of responsibility associated with medical work. In this paper, we aim to provide an overview of the interplay of these understandings in shaping the nature of medical work, philosophically, and in practice. We first discuss the emergence of the biopsychosocial model as an attempt to both challenge and broaden the traditional biomedical model. Then, we outline the main criticisms associated with the biopsychosocial model and note a range of contributions addressing the shortcomings of the model as initially formulated. Despite recurrent criticisms and uneven uptake, the biopsychosocial model has gone on to influence core aspects of medical practice, education, and research across many areas of medicine. One of these areas is adolescent medicine, which provides a particularly good exemplar to examine the contemporary challenges associated with the practical application of the biopsychosocial model. We conclude that a more optimal use of existing bodies of evidence, bringing together evidence-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, can help to bridge the gap between philosophy and practice.

Concepts: Medicine, Disease, Avicenna, Philosophy of science, Psychiatry, Biopsychosocial model, Biomedical model, Medical models

135

Little is known about the dose-response relationship between recreational arts engagement (for enjoyment, entertainment or as a hobby, rather than therapy) and mental well-being in the general population. The quantification of this relationship is of value to: (1) health professionals, clinicians and researchers interested in utilising the arts as a method for improving mental health; (2) to health promoters and policy makers in the development of population based health messages, policy and practice; and (3) to members of the general public in maintaining or improving their own well-being. As guided by theories of social epidemiology and the biopsychosocial model of health, the first aim of this study was to determine if there was a relationship between arts engagement (hours per year) and mental well-being in the general population. If an association was demonstrated, the second aim was to quantify this relationship.

Concepts: Scientific method, Health, Epidemiology, Psychiatry, Personal life, The arts, Arts, Biopsychosocial model

88

Despite widespread acceptance of the ‘biopsychosocial model’, the aetiology of mental health problems has provoked debate amongst researchers and practitioners for decades. The role of psychological factors in the development of mental health problems remains particularly contentious, and to date there has not been a large enough dataset to conduct the necessary multivariate analysis of whether psychological factors influence, or are influenced by, mental health. This study reports on the first empirical, multivariate, test of the relationships between the key elements of the biospychosocial model of mental ill-health.

Concepts: Scientific method, Psychology, Medicine, The Key, Interpersonal relationship, Mental disorder, Psychiatry, Biopsychosocial model

62

To assess the perception of diseases and the willingness to use public-tax revenue for their treatment among relevant stakeholders.

Concepts: Medicine, Epidemiology, Disease, Infectious disease, Biopsychosocial model

28

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PURPOSE: The aim of this study was to provide the first prospective longitudinal assessment of anxiety and depression in patients with a benign intracranial meningioma (WHO° I). METHODS: The Hospital Anxiety and Depression Scale was applied prior to (t1) and directly after (t2) neurosurgery as well as 6 months after surgery (t3). The research was conducted in a single treatment centre in Germany. Numerous sociodemographic, medical, psychological and cognitive accompanying measures were assessed. The study population consisted of 52 meningioma patients. Additionally, a control group of 24 patients with malignant brain tumours (astrocytoma WHO° III) was assessed. RESULTS: In meningioma patients, anxiety was high prior to surgery but declined significantly after successful neurosurgical treatment. Low levels of depression were observed at all times. In contrast, astrocytoma patients showed constantly high levels of anxiety whilst depression increased over the course of the disease. Numerous medical, psychosocial and psychological factors were associated with psychiatric morbidity in meningioma patients. CONCLUSIONS: In conclusion, psychiatric morbidity of patients with benign intracranial meningiomas was comparable to that of the general population after successful neurosurgical treatment. Numerous associated factors suggest complex relationships within a biopsychosocial model. However, due to the small sample size and recruitment in a single institution, our results are of limited generalisability and need cross-validation in future studies.

Concepts: Psychology, Sample size, Surgery, Brain tumor, Neurosurgery, Psychiatry, Meningioma, Biopsychosocial model

27

OBJECTIVE: To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. DISCUSSION: Engel’s BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. CONCLUSION: Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. PRACTICE IMPLICATIONS: A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices.

Concepts: Scientific method, Das Model, Psychiatry, Interview, Best practice, Biopsychosocial model, Biomedical model, Medical models

26

Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, that dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A biopsychosocial-spiritual model is proposed for adults with chronic pain from SCD, because it embraces the whole person. This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel’s model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research.

Concepts: Disease, Research, Vector space, Sickle-cell disease, Sickle, Biopsychosocial model, Biomedical model, Medical models

25

The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.

Concepts: Medicine, Epidemiology, Disease, Infectious disease, Death, Demography, Actuarial science, Biopsychosocial model

25

Vulvodynia is a common and debilitating chronic pain syndrome characterised by neuropathic-type pain. Localised provoked vulvodynia is the most common type, followed by generalised unprovoked vulvodynia. Vulvodynia is a diagnosis of exclusion. The cause is unknown but current research suggests an underlying predisposition to increased sensitivity to pain and peripheral and central neural sensitisation. Musculoskeletal factors also play an important role. Vulvodynia has a significant impact on the quality of life, mood, functional ability and relationships of patients and their partners. It is highly associated with anxiety and depression. Treatment needs to follow a biopsychosocial model and be tailored to the patient. A multimodal and multidisciplinary approach is often most effective. We have suggested a therapeutic ladder.

Concepts: Anxiety, Psychology, Medical terms, Patient, Pain, Chronic pain, Myofascial pain syndrome, Biopsychosocial model