Pathways to well-being: Untangling the causal relationships among biopsychosocial variables

Soc Sci Med. 2021 Mar;272:112846. doi: 10.1016/j.socscimed.2020.112846. Epub 2020 Feb 10.


Rationale: The biopsychosocial (BPS) model that challenged the historically dominant biomedical model remains influential today. This model considers biological, psychological, and social factors that can contribute to health and illness. Yet, a growing body of literature has been highly critical of the model for being too vague and for not providing details as to how the three factors of the model interact and contribute to health and illness.

Objective: Because biological, psychological, and social factors can be considered as distinct 'systems' that can be conceptually separated, defined, and measured, we sought to examine interrelationships among these factors.

Method: By employing analytical reasoning and carefully considering relevant research evidence of direct pathways among biological, psychological, and social factors as applicable to an individual's health and well-being, this article introduces an updated theoretical model: the BPS-Pathways model.

Results: We present all six potential pathways among biological (B), psychological (P), and social (S) factors of the model, and explain how these pathways can potentially contribute to subjective well-being and to objective physical health outcomes. The influential pathways that lead to subjective well-being are S→P and B→P pathways, although these pathways can be impacted by psychological factors that differ among individuals. For objective health outcomes, the P→B and S→B pathways appear to be important, where the latter pathway is mediated by psychological factors. We additionally highlight the importance of systematically understanding subjective experience, which represents an epistemologically distinct domain, and describe how subjective experience can explain individual differences in causal pathways.

Conclusions: The BPS-Pathways model presents a framework that can have important implications for clinical practice, as well as research, and can be useful for tailoring personalized medicine.

Keywords: BPS-Pathways; Biopsychosocial model; Health care model; Health promotion; Integrative health; Personalized medicine; Subjective experience; Subjective well-being.

Publication types

  • Review