Social cohesion is the connectedness, sense of belonging, and solidarity within society (1). Social inclusion is the ability to fully participate in society (2) and includes trust in institutions. Groups can be excluded from full participation in society due to discrimination or structural barriers (3), which can result in marginalisation and/or segregation. Marginalisation is when groups are made powerless in society (4). Segregation is the separation of groups with dissimilar characteristics from dominant society (5).
Risk and/or Protective Factor
Social cohesion and inclusion have been linked to mental health. High social cohesion is a protective factor for mental health. Living in neighbourhoods with high social cohesion has been associated with better mental health in adults, children, and young people in comparison to neighbourhoods with low social cohesion (6,7). Social cohesion has also been suggested to reduce the negative effect of neighbourhood deprivation on mental health (6). Furthermore, trust in institutions is a protective factor, and has been linked to a decreased presence of depression (8).
Socially excluded groups may be more likely to experience poverty and deprivation and lack access to power structures that make decisions at the community, institutional, or structural levels. Marginalisation and segregation are also risk factors for mental health difficulties, as they often involve discrimination. Potentially marginalised groups include older adults, the LGBTQ+ community, refugees, poorly educated individuals, ethnic minority populations and disabled individuals (9). People who are marginalised can have impaired access to mental health care (9); influencing mental health outcomes. Furthermore, people may be segregated for characteristics such as skin colour. Residential segregation has been associated with decreased distress among Latino men, perhaps due to an increased benefit from social support in the community (10).
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4. marginalize, v.: Oxford English Dictionary [Internet]. OED Online. 2020 [cited 2020 Jan 14]. Available from: https://www.oed.com/view/Entry/114048?redirectedFrom=marginalise
5. Browne J. segregation | History, Examples, & Facts | Britannica [Internet]. Britannica. 2020 [cited 2021 Jan 14]. Available from: https://www.britannica.com/topic/segregation-sociology
6. Fone D, White J, Farewell D, Kelly M, John G, Lloyd K, et al. Effect of neighbourhood deprivation and social cohesion on mental health inequality: A multilevel population-based longitudinal study. Psychol Med [Internet]. 2014 [cited 2021 Jan 21];44(11):2449–60. Available from: https://pubmed.ncbi.nlm.nih.gov/24451050/
7. Kingsbury M, Clayborne Z, Colman I, Kirkbride JB. The protective effect of neighbourhood social cohesion on adolescent mental health following stressful life events. Psychol Med [Internet]. 2020 Jun 1 [cited 2021 Jan 22];50(8):1292–9. Available from: https://doi.org/10.1017/S0033291719001235
8. Economou M, Madianos M, Peppou LE, Souliotis K, Patelakis A, Stefanis C. Cognitive social capital and mental illness during economic crisis: A nationwide population-based study in Greece. Soc Sci Med. 2014 Jan 1;100:141–7.
9. Schueller SM, Glover AC, Rufa AK, Dowdle CL, Gross GD, Karnik NS, et al. A mobile phone–based intervention to improve mental health among homeless young adults: Pilot feasibility trial. JMIR mHealth uHealth [Internet]. 2019 Jul 1 [cited 2021 Jan 20];7(7):e12347. Available from: https://mhealth.jmir.org/2019/7/e12347
10. Nobles CJ, Valentine SE, Zepeda ED, Wang Y, Ahles EM, Shtasel DL, et al. Residential segregation and mental health among Latinos in a nationally representative survey. J Epidemiol Community Health [Internet]. 2017 Apr 1 [cited 2021 Feb 9];71(4):318–23. Available from: https://pubmed.ncbi.nlm.nih.gov/27885049/