Abstract
BACKGROUND: This qualitative case study explores the potential for operationalizing the social science framework of structural vulnerability through integrating it into the classic 4P model of biopsychosocial case formulation. METHODS: Through phenomenological analysis of data from a series of longitudinal in-depth interviews with the case study participant, a middle-aged Native American man recently initiated on buprenorphine-naloxone for opioid use disorder after undergoing below-the-knee leg amputation, the study developed a biopsychosocial-structural case formulation identifying predisposing, precipitating, perpetuating, and protective factors contributing to the participant's deteriorating health. RESULTS: Key findings from this case formulation facilitate reconceptualization of the participant's acute symptomology and high-risk behavior as manifestations of structural violence and historical trauma. CONCLUSION: Adopting the diachronic approach inherent to the 4P factor model allowed for temporal expansion of analysis, which emphasizes the cumulative and compounding health effects of living with chronic structural vulnerability.