In medical practice, Bio-Psycho-Social (BPS) model has been applied for adequate perspectives in Primary Care (PC) medicine and Integrative Medicine (IM) [1,2]. BPS theory has been discussed in rather larger scope range (Figure 1).

Figure 1: Bio-Psycho-Social (BPS) Model in Primary Care (PC).

Authors have been involved in the activities of PC and IMas music therapy, art therapy and Hinohara-ism for years [3,4]. Furthermore, the concept of health or well-being needs physical, mental and spiritual aspects [5] (Figure 2). This means in rather individual scope and recent perspectives are described in this article. Regarding the influence from physical health to mental health, various reviews have been found so far [6]. In general population, this tendency has been observed concerning the health study. People associated with chronic physical problems tend to have experience of anxiety and depression for twice of general population. In contrast, people who have mental illness such as depression, bipolar disorder, or schizophrenia, apt to show impaired physical health and also psychological impairment.

When a person has co-existing physical and mental situation, one may show lower QOL and lead to continuous illness condition with bad health outcomes. People associated with certain physically chronic problem often feel mental distress problems than usual person. Among chronic mental illness, depression has been most common problem for decades. From previous study for the relationship between physical fitness and MRI finding, the subjects showed larger size of the hippocampus [7]. The hippocampus size showed shrinking with age and cognitive function, including spatial memory and retention. Keeping physical fitness can make delay for shrinking of hippocampus. People with some physical problems showed worse mental health status than general population. For such people, the rate of depression showed 3 times higher than usual level. From many studies, exercise can become a mood enhancer. Furthermore, exercise can affect long-term mental health as beneficial aspect. For example, pedaling or weight training for 6 weeks could reduce the symptoms from anxiety disorder. Furthermore, resistance training (RT) also decreased irritability feelings [8]. From these, chronic mental impairment may bring more psychological disorders such as depression. Depression would become often the antecedent problem leading to chronic physical diseases. Consequently, relationship between chronic physical disease and depression becomes reciprocal mutual influence.

Concerning the impact from mental health to physical health, various experiences and reports have been found. For example, mental illness may alter sleep cycles and hormonal balances, leading to impaired physical condition. Mental illness affects social and cognitive functioning and decreases energy levels. It reduces the motivation to take care of one's health, making it difficult to take appropriate action and leading to unhealthy eating, sleeping and exercise habits [9]. This leads to a vicious cycle of overeating, lack of exercise, insomnia, smoking and drug abuse, where all contribute to worsening physical condition. Moreover, people with hypertension and continuous headache will have stressful life [10]. Successively, prolonged physical symptoms will cause various stress, which makes body weaker and less resistant to fighting of the disease. Such stress- immune system vulnerability will link in through the brain appraisal of stress along the hypothalamus-pituitary-adrenal (HPA) axis. By activating the HPA-axis, cortisol will be secreted as stress hormone that will suppress the immune system of the body. Stress impedes the functioning of the immune system, making people more vulnerable to infections. Thoughts, emotions and mind always affect the brain, which in turn influences endocrine hormones, leading to the immune system [11]. The nervous and endocrine systems have been known to affect the immune system so far. People with mental illnesses have a significantly higher incidence of diabetes. Depression and schizophrenia affect insulin resistance, which makes them risk factors for developing type 2 diabetes (T2D). Severe mental illness is also associated with high blood pressure. These physical changes impede cardiovascular function, significantly increasing the risk of heart disease in people with mental illness. People with mental illness are up to three times more likely to suffer a stroke. Thus, mental health is a crucial factor for improving physical health and quality of life. Thus, psychological and mental states are always interconnected with physiological states. Concerning human health, three factors include physical, mental and spirituality (Figure 2).

Figure 2: Physical-Mental-Spiritual aspects for Individual Well-Being.

Spirituality shows an important role for general human health, since it can increase life quality and also life satisfaction. Lots of studies revealed a relationship between religious mind and health. As general, religiously active people tend to live longer than those who are not. From 1500 reviews of research, the connections among health, healing and spirituality were proved to be significant [12]. Some studies showed positive relationships of impact of religion on several factors of physical health, which suggests that religion can bring physical health for positive direction. From many reports, spiritual and religious engagement may influence more life satisfaction that in turn leads to mental and physical health and well-being.

There was a research on the association among religion, spirituality, morbidity, mortality, disability or recovery from illness. As a result, consistent and prospective risk reduction of mortality was found for healthy cases that were religiously active. As the opinion of researchers, spirituality pressure may contribute the protection for cardiovascular disease, associated with encouraging a healthy regular lifestyle [13]. Religiously active people can possess some factors which may become safeguard for stress enhancing their health and well-being. These benefits include relaxed meditation of the prayer, feelings of ultimate acceptance, a sense of hope in the future, and coherent and stable world view [14]. From these discovery, spirituality shows a relationship with physical health and promoting higher QOL. On the other hand, how can we make sense of the relationship among physical health, mental health and spiritual and religious belongingness?

There may be possible explanation from various points of view. For religious people, belief in the religion shows several beneficial points. They are i) promoting adequate self-control; person tends to lead healthier lifestyles with less drink or smoke [15], ii) continuance of social support; religious involvement include some communal experiences, in three major Middle Eastern religions, iii) encouraging religious marriage: it seems to be important for health and longevity and it will suppress some negative behaviors such as anxiety, depression, psychosis, suicide or substance abuse. For another feeling, they have self- satisfaction and self-acceptance, where by this feeling people can see the world from shiny side than dark side. Consequently, religious or spiritual beliefs can impact and progress human health and well-being accompanied by its ability to create a meaningful life in the future.

In summary, recent perspectives for bio-psycho-social aspects in medical practice and physical, mental and spiritual aspects in each person were described. Among them, religious people tend to feel well-being or health sensation from psychosomatic point of view. This article is hopefully useful for medical research and practice.

Conflict of interest

The authors declare no conflict of interest.

Funding

There was no funding received for this paper.

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