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The biopsychosocial assessment refers to a series of questions asked at the beginning of treatment of an individual that obtain information about the major physical (bio), psychological, and social issues of the individual. This approach is called holistic because it posits that separate issues are often related. The course of a physical illness could influence social interaction or psychological function, or a social and familial background might have an impact on a biological or psychological problem. By asking a series of questions that may establish the most important elements in each of these spheres, a better treatment plan may be derived.
A number of practitioners use biopsychosocial assessment, including social workers, psychiatrists, doctors of osteopathy, and psychotherapists. Not all medical or therapeutic practitioners use this form. Some argue that the automatic assumption that biological, psychological and social spheres are related is unproven. Most practitioners conversely argue that the whole is greater than the sum of the parts and there is increasing evidence that each sphere has a strong influence on the other spheres.
It’s useful to examine some of the questions that might be asked in a biopsychosocial assessment. Questions covering the biological sphere could include any history of disease, addiction, surgeries, medication use, and family history of illness. Sociological questions may concern family, living arrangements, relationships, finances, and stability of work, home, and school arrangements. Psychological assessment could have questions that cover the presence of psychiatric illness, strong stressors like recent bereavements, and risk of suicide.
A biopsychosocial assessment may take one to two hours, depending on its extent and how much history a client has. To save time, the patient could fill out parts of the assessment, such as a family history of illnesses. Some assessments are more in-depth than others. A competency-based assessment may also include getting information that is considered strengths-based, and this model is often used in social work direct practice, where the strengths-based approach is favored. A social worker could note features like proven ability to recover from problems (resilience) or strong familial ties that might aid a person in recovering from a present problem.
While the assessment is holistic, it is often directed toward treating a problem in a specific sphere. A doctor of osteopathy would want to treat a medical or bio problem and might look at how psychosocial features contribute to it. The therapist could be helping a patient with a psychological issue, and would evaluate its social and physical components. The social worker might be trying to solve a client’s social problem and would want to know the biological and psychological aspects that could be exacerbating it.
Any good biopsychosocial assessment needs to take into account that people may either lie intentionally or by omission. Ongoing assessment after an initial examination is useful to determine if a problem has been appropriately explored in all three spheres or whether new information creates new ways to visualize a targeted issue.
Could you name such an assessment? The Beck Hopelessness Scale is based on a psychological model, without addressing social or biological components. Is it intended to be administered with other assessments to create a biopsychosocial understanding?
I understand that monetary and time limitations may make it difficult, but it is a shame that this process is not more widely accepted and utilized in all three areas mentioned in the article.
More and more people are diagnosed every year with depression, anxiety and similar conditions that have long been classified as psychological.
However, these conditions and so many others have direct impacts on our physical well-being. In many cases, this can also to social problems, like unemployment, eating disorders, which are definitely physical and psychological problems, and drug use, just to name a few.
Hopefully someday, these biopsychosocial assessments will be common practice. It could mean no more therapists and doctors guessing or contradicting each others' advice and a clear picture of the best way to treat each individual.
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