Predispose, precipitate, perpetuate, and protect: how diet and the gut influence mental health in emerging adulthood

Abstract

Medicine often employs the 4Ps of predisposing, precipitating, perpetuating, and protective factors to identify salient influences on illness states, and to help guide patient care. Mental illness is a significant cause of morbidity and mortality worldwide. Mental health is a complex combination of biological, psychological, environmental, and social factors. There is growing interest in the gut-brain-microbiome (GBM) axis and its impact on mental health. We use the medical model of the 4Ps to explore factors involving the connection between nutrition and the GBM axis and their associated risks with mental health problems in emerging adults (EAs), a life stage when mental illness onset is the most common. We review the impact of current dietary trends on the GBM and on mental health, and the role that gut microbiome-based interventions can have in modulating the GBM axis of EAs. We discuss the implications of gut health on the GBM and areas for clinical intervention.

Keywords: clinical formulation; emerging adult; gut-brain microbiome axis; nutrition; preventive psychiatry; psychiatry.

Figure 1

The 4P’s of gut-brain microbiome axis and mental health (created with BioRender.com). These four factors contribute to mental health outcomes for emerging adults via the gut-brain microbiome axis. (A) Predisposing factors may occur before birth or early in life. (B) Precipitating and perpetuating factors include dietary habits in early life and into adulthood. (C) Protective factors may counteract precipitating and perpetuating factors.