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In psychological studies, a distinction is often made between distal and proximal factors. Risks to health and recovery do not occur in isolation. The chain of events leading to an adverse health outcome includes both proximal and distal causes. Proximal factors act directly or almost directly to cause mental illness, and distal causes are further back in the causal chain and typically act through a number of intermediary causes. As such, a distal risk factor is a risk factor that represents an underlying vulnerability for a particular condition or event. A distal risk factor does not predict that the condition or event is imminent, but rather that a person may be at risk for the condition at some time in the future.

Examples of risk factors

In other words, risk factors are those characteristics and circumstances that can be directly (i.e. proximal) or indirectly (i.e. distal) associated with mental illness, poor responses to interventions, and relapse. These items are presented as examples, and we are by no means suggesting that the links always exist as there are many factors that develop in tandem to increase the probability of mental illness and poor prognosis to intervention.

Proximal and Distal Risk Factors

Next, we look at examples of distal and proximal protective factors.