A mixed-methods study of mental and physical health inequalities in people who have experienced socially exclusion

“社会排斥”指的是某些群体被排除在主流社会之外的过程。例如，经历过无家可归、入狱或从事性工作的人经常被引用为榜样。最近的证据表明，这些群体经历了极端的健康不平等，包括不利的心理和身体健康、死亡率上升和获得服务的障碍。然而，对那些被社会排斥的人的心理和身体健康如何相互作用的理解仍然很少。评论人士还呼吁进一步澄清“社会排斥”的性质，以及可能导致社会排斥的生命过程中的交叉因素(如物质匮乏、童年创伤和社会/经济边缘化)。这项混合方法研究将提供对上述群体的身心健康不平等的系统评估，丰富了有过社会排斥经历的人的观点。这个项目的案例合作伙伴，重新思考精神疾病，是一个慈善机构，以致力于解决精神疾病患者的社会排斥问题而闻名。在他们的支持下，学生将能够接触到亲身经历过社会排斥的人，这将为研究的定性部分提供信息，以及接触到服务用户参与小组，从而加强研究的共同成果。重新思考将提供独特的传播机会。这些成果将为ReThink与NHS就为这些群体共同制作社区服务的工作提供信息。该项目的目的是：评估社会排斥群体的心理和身体健康问题的流行率，以及与死亡率的关系。了解心理/身体健康共病和服务使用如何与社会排斥相互作用。研究的定量部分将使用2007年和2014年成人精神病发病率调查(APMS)以及临床记录互动搜索(CRIS)病例登记的信息。APMS是一项具有全国代表性的调查，提供有关心理和身体健康以及社会排斥经历(如无家可归)的信息。CRIS是伦敦南部使用二级精神卫生服务的患者的去身份电子健康记录的病例登记，将提供有关服务使用和死亡的信息的临床队列。将对有过社会排斥经历的人进行定性访谈，以调查获得医疗保健时的障碍和促进者。这项研究的结果将提供社会排斥和健康之间相互作用的整体图景。

'Social exclusion' describes the process whereby certain groups are excluded from mainstream society. For example, people who have experienced homelessness, prison or engaged in sex work are often cited as exemplars. Recent evidence indicates that these groups experience extreme health inequalities, including adverse mental and physical health, elevated mortality and barriers to accessing services. Yet an understanding of how mental and physical health interact in those who are socially excluded remains poorly understood. Commentators have also called for further conceptual clarity on the nature of 'social exclusion' and intersectional factors (such as material deprivation, childhood trauma and social/economic marginalisation) over the life-course which may lead to social exclusion. This mixed methods study will provide systematic assessments of physical and mental health inequalities in the above groups, enriched by the perspectives of people with lived experience of social exclusion. The CASE partner for this project, Rethink Mental Illness, are a charity known for their commitment to tackling social exclusion in people with mental illness. With their support, the student will be able to access people who have first-hand experience of social exclusion which will inform the qualitative part of the study, as well as access to service user involvement groups, enhancing co-production of the research. Rethink will provide unique opportunities for dissemination. The outputs will inform Rethink's work with the NHS on the coproduction of community services for these groups. The project aims are to:Assess the prevalence of mental and physical health problems for socially excluded groups, and associations with mortality.Understand how mental/physical health comorbidities and service use interact with social exclusion The quantitative part of the study will use information from the Adult Psychiatric Morbidity Surveys (APMS) from 2007 and 2014, as well as the Clinical Record Interactive Search (CRIS) case register. The APMS is a nationally representative survey with information on mental and physical health, as well as experiences of social exclusion (e.g. homelessness). CRIS is a case register of de-identified Electronic Health Records of patients using secondary mental health services in south London and will provide a clinical cohort with information on service use and deaths. Qualitative interviews will be conducted with people with lived experience of social exclusion to investigate barriers and facilitators when accessing healthcare. The outputs from this research will provide a holistic picture of the interplay between social exclusion and health.