University Nursing Essay: Biopsychosocial Patient Analysis

This essay analyzes the care of a 52-year-old male patient, Mr. X, admitted with depression, hypertension, and hyperlipidemia, incorporating biological, psychological, and sociological perspectives. It explores the patient's anatomy and physiology in relation to his health conditions, including the impact of depression on brain structure and neurotransmitter imbalances. The essay uses the biopsychosocial model to examine the causes of Mr. X's depression, considering his medical history, socioeconomic status, and coping mechanisms. It defines health, well-being, and illness, discussing the adverse effects of depression on the patient and his family, including biological and psychosocial impacts, and explores the application of Erickson’s theory. Furthermore, the essay uses the health belief model to identify facilitators and barriers to health promotion, and the role of nurses in addressing these barriers. The conclusion summarizes the debilitating effects of depression and the importance of comprehensive patient care.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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The main purpose of this essay is to explore the anatomy and physiology of a patient who
was given care during recent placement. The essay will explore the meaning of health and well-
being by exploring biological, psychological and sociological perspectives. Key theories that will
be used an argument in the essay includes Erickson’s theory and the health belief model. The
patient who was under care during the clinical placement was Mr. X (pseudonym used to protect
privacy and confidentiality), a 52 year old male who admitted to the hospital with extreme
symptoms of depression. He had history of other medical conditions like hypertension and
hyperlipidemia. He had drinking habits too as he consumed 30 units/week. His BMI was
29kg/m2. The review of his past social history shows he used to work in power plant. He lived in
a 2 storey home with his wife and three children. Though he is at risk of obesity, he does not
enjoy exercise. Based on Mr. X’s family history, it has been found that his family had a history
of cardiovascular disease (CVD). His mother diet at the age of 50 from ischemic heart disease
(IHD)
The current health issue for Mr. X was presence of depressive symptoms. In such
patients, pathological changes in the brain anatomy are seen. The change in the anatomical
structure of the brain is confirmed by MRI. Studies on evaluation of gray and white matter of
brain in patients with depression have revealed changes in the frontal lobe, temporal lobe and
amygdala. Impairment in the structural and functional condition contributes to disease severity
too (Zhang et al. 2018). According to the DSM-V criteria, some of the classic symptoms of
major depressive disorder includes depressed mood, loss of interest in activities, insomnia,
fatigue, feelings of worthlessness, weight changes and suicidal ideation for more than two weeks.
These symptoms are seen due to changes in the concentration of neurotransmitters in the brain.
Deficiency in the monoaminergic neurotransmitter norepinephrine and dopamine also result in

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the above symptoms. Other neurotransmitters involved in the physiology of depression include
serotonin and imbalances in these brain chemicals contribute to depression (Zhang 2019). These
changes might be the cause behind depressive symptom of Mr. X too.
To consider the cause of depression in Mr. X , there is a need to evaluate the cause of
illness from biopsychosocial perspective. The biopsychosocial model of health includes
consideration of biological, social and psychological factors to interpret health and well-being in
an individual (Wade and Halligan 2017). In the context of Mr. X, the biological cause behind his
depression was impact of his physical health history on his condition. For instance, he was a
patient with hypertension and hyperlipidemia. Hyperlipidemia is a condition that is associated
with high level of fats in the blood. The evidence by Chuang et al. (2014) indicates that risk of
depression is high in patients with hyperlipidemia and it also results in other co-morbidities like
hypertension and diabetes. Thus, Mr. X also had hypertension and the burden of both the illness
and its management was the cause behind his depressive symptoms.
In the case of social factors, it can be examined whether the patient has any exposure to
adverse social factors such as lack of social support, experience of traumatic situation, early
separation and social stressors. Stressful social events trigger change in brain functioning
resulting in depression. In case of Mr. X, he had no history of traumatic events and he did not
suffered from social isolation as he lived with his wife and children. However, one social factor
that could be linked to his depression is that his poor socioeconomic status (SES). He is working
in a powerplant and his low income might be one stressor for him. Various studies have shown
relation between SES and depression. Freeman et al. (2016) revealed inequalities in income and
wealth as a crucial determinant of depression. Similarly, indicated that lower is an individual’s

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SES, the poorer is their health outcome and risk of chronic disease. Lower occupational status
and lower income is associated with higher odds of depression.
The psychological factors that might be influencing depression in an individual include
presence of negative thought patterns, poor judgment skills and impaired emotional intelligence.
The innate temperament of any individual might be leading to risk of depression. In the context
of Mr. X, he is found is poor coping skills too. This is said because he has multiple health issues
such as hypertension, hylipidemia, risk of obesity and alcohol use. Despite this, his coping style
has not changed. Instead of engaging in positive coping style such as exercise to improve his
health status, he liked to go to pub and drink alcohol. Thus, his temperament did not changes
despite illness. Research literature argues that positive coping styles such as help seeking and
positive thinking is associated with less depression, whereas negative coping style such as
avoidance is associated with depressive outcomes and poor mental health. The study also
revealed that 22% of patients are binge drinkers, which is a form of avoidance coping styles
(Getnet, Medhin and Alem 2019). Hence, psychological and biological factors together are the
cause behind depression in Mr. X.
Illness is a subjective concept that mainly describes personal experience of a disease.
There are many diseases that lead to ill-health in an individual. This may include infectious
disease such as malaria and influenza and chronic disease such as diabetes and heart disease. In
contrast, cccording to World Health Organization (2020), health is defined as a state of complete
physical, mental and social well-being, whereas well-being is defined as a positive state where
health is framed as a positive aspiration. It may mean achieving positive state in all areas such as
physical, social and mental health. Wellness is defined as the state of being in good health and
free from disease. From individual perspective, illness is seen only when there is a disease.

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However, wellness does not merely mean absence of disease. It means social, emotional and
cultural well-being of an individual (WHO, 2020).
Any disease condition is associated with various adverse impacts both on patient and
their family members. Firstly, depression has biological impact on patients. The influence
extends beyond quality of life and functioning outcomes. Depression is associated with high rise
of overall mortality and development of other physical health conditions such as diabetes,
hypertension, obesity and heart disease (Penninx et al., 2013). This effect was evident in case of
Mr. X as he was also a hypertensive and obese patient. There is an increase in risk of somatic
morbidity in patients too. By referring to a meta-analyses, Penninx et al. (2013) revealed about
the impact of depression on risk of developing Alzheimer’s disease and stroke too. Depressed
persons are most likely to be unhealthy as they often drink excessive amount of alcohol and
remain physically inactive. This effect was seen for Mr. X as he was also consuming alcohol and
had no interest in physical activity. Depression is associated with metabolic dysregulation too as
evidence has shown increase in triglycerides level and decrease in HDL cholesterol for people
who are depressed (Penninx et al. 2013). Thus, depressive patients are at more risk of chronic
health conditions.
Persistent symptom of depression is associated with impaired psychosocial functioning
and poor work performance. The study by Fried and Nesse (2014) indicated that depressive
symptom is associated with negative effect on five domains of psychosocial functioning such as
work, home management, social activities, private activities and close relationship. Some of the
most debilitating symptoms of depression include sadness and poor concentration and this has
impact on social relationship as well as daily life and social activities. In addition, other
symptoms such as early insomnia affect an individual ability to work. Their work performance is

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seriously hampered. There are many research evidences which have confirmed that depressed
employees have tough time on job and they exhibit more job loss and poor productivity due to
severity of their depression (Reznik et al. 2015; Bernburg et al. 2016). Fried and Nesse (2014)
explained that loss of interest in activities affected depressive person’s ability to socialize and
they prefer staying alone instead of spending time with family. As per Mr. X’s wife disclosure,
Mr. X was showing similar symptoms too. Furthermore, sad mood negative affects home
management activities and the ability to maintain self-hygiene. Thus, through these impacts, it
can be concluded that depression is a complex and severe illness that adversely affect all
dimensions of wellbeing. According to Erickson’s theory, there are several conflict areas that
lead to failure in mastering or completing any task. In case of depression, conflict between
intimacy vs isolation takes place because of loss of interest in activities (Scheck 2014).
Moreover, diagnosis of depression is a burden not only for patient but also for their
family members. It can deteriorate the health of all family members as seeing their loved ones in
depressed state leads to emotional trauma for them. They find it hard to manage unusual
behaviour of their loved one. In addition, the need to continuously monitor family members with
depression disrupts their own social functioning and networks resulting in feelings of anxiety and
maladaptive coping for family caregivers too (Fekadu et al. 2019). This can be said as some
psychosocial side-effect which can be better understood from the perspective of Erickson’s
theory. According to the theory of Erikson’s psychosocial development, one of the stages is
identity vs role confusion. This form of conflict is most common witnessed by family caregivers
as they fail to deal with negative behavioural changes of their loved ones (Scheck 2014).
In case of Mr. X, many health promoting factors need to be identified to increase his
current negative health behaviour and reduce the risk of depression. The facilitators and barrier

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to health promotion can be identified by using the concepts of the health belief model. The health
belief model is based on the assumption that a person’s beliefs about an illness determines
whether they are likely to adopt a positive health behaviour or not. Mr. X was engaged in many
negative health behaviours (Castonguay, Filer and Pitts 2016). For example, he was physically
inactive and consuming alcohol. There are some barriers to his health promotion because if he
continues with this behaviour, it may further deteriorate his health and increase risk of other
disease. Other barrier to his health promotion is his educational level. As he has low level of
education, he may have little understanding regarding the way each of his disease condition may
be influenced by negative health habits like poor diet patterns, physical inactivity and alcohol
consumption. Hence, this gives the implication to provide health education in the context of
depression and its management so that Mr. X health status could shift from illness to wellness. It
is crucial that the nurse who are involved care of such patient take active steps to recognized
these barriers and make necessary modification to facilitate promoting behaviours in such
patient. Nurse can identify barriers by active monitoring and communication with patient.
Markle-Reid et al. (2014) supports the role of nurse in collaboration with depressive patient and
education them about positive health behaviour to promote health. They can introduce patient to
positive coping styles such as distraction and engagement in meaningful activities to alleviate
symptom of depression. They can instil hope; enhance their confidence level and their ability to
adhere to treatment regimens.
From the analysis of biopsychosocial aspects of depression on a patient during clinical
placement, it can be concluded that depressions is a debilitating condition that adversely affects
all aspects of well-being. By the analysis of the cause of depression using the biopsychosocial
model, it was found that depression is a mental health disorder that is caused because of genetic

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vulnerabilities, poor coping styles and poor social factors such as low SES. Moreover, the
analysis of the impact of depression indicated that depression must be actively managed as it
increased risk of other disease like diabetes, hypertension, stroke and cholesterol levels. The
essay also revealed how depression affects psychosocial function of affected individuals by
disrupting their social relationship, work performance and engagement in daily life activities.
The review of health promoting factors for patients like Mr. X suggested that nurses planning
health care plan for such patients must consider facilitators and barriers that would affect disease
management too.

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