Welcome to the information page for the ongoing INCLUDE study! See below for an overview of the project along with how to contact us if you have questions or would like more information.

For the INCLUDE study, a team of doctors and researchers at Trinity College Dublin and the HSE are working to understand how different kinds of social exclusion such as being homeless, being in prison, and/or using methadone impact the use of hospital services. We will do this by analysing past health, homelessness, and prison data.

To do so, St. James’s Hospital, the Mater Hospital, the HSE, the Irish Prisons Service, and Dublin City Council are combining information about people who have used their services. These data will be transferred securely from each partner organisation to the HSE where they will be safely stored and analysed by a very small number of HSE employees who are trained in data security and confidentiality.

More information is available from include@hse.ie or by phone 0862811985

Inequality is rising world-wide. We know that social exclusion, such as that experienced by homeless people, people with substance use disorders, prisoners and certain minorities (Travellers, aboriginal people) has a profound effect on health. We know that people in these frequently overlapping groups have a much higher risk of having experienced severe psychological trauma in childhood and/or adulthood, and that this affects their mental health and behaviour. We know that they have more chronic illnesses and a much shorter life-expectancy than others. We know that people who are socially excluded frequently have contact with multiple health and social care services across their life-span. In Ireland at present, there is no method of identifying people who are socially excluded in national-level health databases and therefore we are not able to track their use of health and social services.  

The aim of this project is to understand the health needs of people experiencing social exclusion. Two different approaches are being used in the study. One is focused on data-linking by creating a database unifying different data sources that will enable us to identify people who are socially excluded and see where services should be targeted to improve their health outcomes. The second is focused on explaining social processes which cause social exclusion to emerge on a societal scale by undertaking a realist review. Together the two approaches will answer aspects of the same question: who are people who are socially excluded and how can we understand more about them.  

Research team: Prof Clíona Ní Cheallaigh, Prof Mark Roantree, Dr Paul Kavanagh, Dr Rikke Siersbaek, Chris O'Donnell, Dr Sarah Parker, Dr John Ford, Prof Sara Burke.  

Many people who experience social exclusion, such as homelessness, have complex psychological and social needs due to severe childhood trauma. Clinicians have observed that homeless people in their forties and fifties have diseases like osteoporosis and dementia that are typically seen in older people. At the moment, we do not fully understand this premature ageing in homeless people. To address this gap in knowledge, the PATH study hopes to measure physical and mental decline in homeless individuals using methods from the Irish Longitudinal Study on Ageing (TILDA). 

We already know that stress affects our immune system. Similar studies done in mice have shown that social stress leads to increased inflammation from immune cells. Inflammation is a natural response of the body's immune system to injury or infection. It is a necessary and beneficial response that helps the body fight off harmful agents and heal damaged tissue. However, long-term or excessive inflammation can lead to various health problems, including autoimmune disorders, cancer, depression, and premature ageing. This study aims to investigate if childhood trauma and stress experienced by homeless people causes problems with their immune systems , which can lead to more rapid ageing. The findings of this study hope to lead to better healthcare and outcomes for homeless people in Dublin. 

Research team:  Prof Cliona Ní Cheallaigh, Ailbhe Herity 

Differential attainment encompasses the systematic difference in outcomes between demographic groups who undertake the same assessment and is known to occur within medical education. Differentials that exist due to varied abilities are to be expected and are appropriate. Factors such as gender, ethnicity, religion, disability status and socioeconomic status should not unfairly impact on the training and progression of medical students and doctors. This research aims to identify to what extent differential attainment exists within undergraduate and postgraduate medical education in Ireland, to determine what factors contribute to differential attainment within medical education in Ireland and to design and evaluate the feasibility and potential impact of an intervention that addresses differential attainment. 

Researcher: Dr Cathy Cunningham, PhD candidate  

The AESS-Vax Study, a first-of-its-kind vaccine response study examining the effects of stress and low socioeconomic status on vaccine-induced immunity to SARS-CoV-2, the virus that causes Covid-19. Conor is also involved in the PATH-I study, exploring the role of the immune system in driving accelerated ageing in the homeless population. Results from his time as a Research Assistant in the Social Immunology Lab show an association between homelessness and a persistent low grade inflammatory state previously implicated in accelerated ageing and dysregulated immune responses to common pathogens.  

 Researcher: Conor Reddy, PhD Candidate 

Translational simulation for trauma informed care (TS4TIC) seeks to use translational simulation - where teams of hospital staff and patient representatives train together by recreating scenarios of care between a patient and a team of staff in as near-reality as possible – to promote psychological trauma-informed care as a way to improve service delivery within acute hospital settings. The outcome of this project will be a co-developed Toolkit for the application of translational simulation to promote trauma-informed care within health care settings. 

Find out more here.

Research team: Prof Frédérique Vallières, Prof Clíona Ní Cheallaigh, Dr Ganzamungu Zihindula and Sinead McGarry