Second, more comprehensive concepts such as social cohesion, social capital, citizenship or (multiple) poverty, were deliberately kept out of the study too, because of the general consensus in the literature that these concepts, although appearing similar to SE/SI, differ in important ways.2,10–12,20,26 Studies on socio-economic position or ethnicity and health are also out of the scope of this review as occupation, education and ethnic background are regarded as risk factors for SE and not as constituent parts.21 Nevertheless, bias to the use of key words cannot be ruled out and a more extensive search strategy could be considered in future reviews. As there is currently little consensus on the critical elements for assessing risk of bias in observational studies,27 we opted for a two-track approach. The social exclusion which families experience is rooted in the stigmatising effect attitudes in society can have on people affected by someone else’s substance misuse. Articles had to test the relationship between SE/SI and a health measure and report statistical results. and study design. Partial evidence was found in a study among patients of Assertive Outreach teams.52 In this population, alcohol abuse and dependency was associated with the social and cultural dimensions of SE, but not with the political dimension. Yet the exceptions suggest that there could be significant benefits. Most studies used self-chosen indicators without testing the psychometric properties. The cultural and social rights dimensions were not well presented and little or no significant relations with these dimensions were found. Yet, as we age, many of us are alone more often than when we were younger, leaving us vulnerable to social isolation and loneliness—and related health problems such as cognitive decline, depression, and heart disease. In men, no significant associations were found between dimensions of SE and long-term sickness.59 Partial evidence was also found in a cross-sectional study among 4941 adults demonstrating a positive association between the presence of any chronic disease and the social, economic and part of the political dimensions of SE/SI, but not with the cultural dimension.43, The literature did provide little evidence on the association between SE/SI and PH or GH in high-risk groups. The sample sizes ranged from 67 to 25 498 participants. Partial evidence was also found by Killaspy et al.53 Patients interviewed after developing a psychotic illness showed a significant deterioration in two of the four SI dimensions measured, i.e. All studies had CASP scores of 6 or more, indicating acceptable quality. On the basis of title and abstract screening, 3847 articles were excluded (figure 2). One in three studies lacked a theoretical underpinning of SE/SI. 1. The most common reason for exclusion was publication type (editorials, posters etc.) The interrater agreement for the selection of the publications was good (Cohen’s κ = 0.7731). The review, which was completed in November 2014, was carried out by Synergia Ltd. Low income, discrimination, relationship breakdown and crime or the fear of crime are just some of the factors behind disabled people being socially excluded. According to the World Health Organization (WHO), social exclusion (SE) is one of the driving forces of health inequalities.1–3 SE refers to the inability of people to participate fully in society,4 while its antipode, social inclusion (SI) refers to the situation in which individuals are fully involved in the society in which they reside, including the economic, social, cultural and political dimensions of that society.5 The pathways linking SE (and lack of SI) to poor health are complex and diverse.1 The situation of SE encompasses deprivations in areas such as social relations, material resources, access to health services and housing, which are in itself well known determinants of health.6,7 In addition, pathways leading to poor health may occur via direct and indirect causation as well as through reverse causation. To further improve homogeneity we made a distinction between often large general population studies and smaller studies in specific groups, mostly at high risk of SE. Physical functioning, impairments and symptoms such as headache and sleeplessness, were classified under PH. A retrospective cohort study showed an association between high psychological distress in elderly persons and later SE. These were: (i) positive, when a significant (P < 0.05) concordant relationship was found for all measured SE/SI dimensions (high-SE/low SI corresponds to low health outcome), (ii) negative, when an inverse association was found, (iii) no association, when the relationships between the SE/SI dimensions and health were not statistically significant and (iv) partly (+/0), when studies reported multiple associations. For each included study, the following data were extracted: study design, country, study population, sample size, dimensions and measures of SE/SI, health measure(s), confounding variables, statistical analysis and key results. Published by Oxford University Press on behalf of the European Public Health Association. ).14,15 One study systematically reviewed the impact of interventions on SI in adults with intellectual disability.16 None of these reviews reported systematically on the relationship between SE/SI and health. Given the variation in health measures and study designs, it was not possible to conduct a meta-analysis. Cognitive impairments are often assumed to underlie individuals’ difficulties with understanding health issues. Social Protection, Social Inclusion and Mental Health – Successful nations are built on the foundation of strong communities. We set out to systematically summarise existing evidence on the association between SE/SI and health and evaluate the hypotheses that high SE/low SI is associated with adverse MH, PH and GH outcomes, in the general population and in groups at high risk of SE. Conflicting evidence was only found in two studies,48,49 in which the relation between SE/SI and MH appeared to be mediated by other factors. Yet another limitation is that our review is not exhaustive. This was true for both single mothers on social assistance as for single mothers without social assistance.62. Many more people face social exclusion in the economic, political, social and cultural spheres of life, endangering their health and well-being. In elderly men, the association between SE and mortality was not significant. mortality in Japanese elderly women.57 A second longitudinal study59 points to a reverse directionality; long-term sickness absence was associated with a deterioration of the economic and social dimensions of SE in women, independent of their earlier situation. the social and economic dimensions. Preliminary evidence was promising. Emphasising rights and participation. Please check for further notifications by email. How does social exclusion contribute to the theories of social inequality in health? Next, we excluded studies not using a multidimensional construct of SE/SI (minimum two of four dimensions), studies in which health formed part of the SE/SI measure and studies using an ecological measure of SE/SI. The Challenges of Perceived Self-Management in Lupus. Mental health problems can impact on social exclusion as a result of lack of financial resources and because of the effects of illness, including low self-esteem, loss of social contacts due to hospitalisation or the impact of illness on sociability, or the stigma experienced by many of those affected by mental illness. Search strategies can be found in Supplementary file S1. 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