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  

The 'CIPHER' Study is comprehensively investigating cognitive impairment in people experiencing long-term homelessness in Dublin. Having commenced in February 2024, the study has recruited and assessed 80 adults living in long-term homelessness, and aims to perform deep cognitive phenotyping, alongside MR brain imaging assessment, in a cohort of adults living in long-term homelessness for the first time. 

Researcher: Dr Georgia Richard

Disparities in healthcare access remain for persons experiencing social exclusion (PESE), such as homelessness.  PESE face complex health needs, limited healthcare access, and increased exposure to traumatic life experiences. It is important to consider a trauma-informed and integrated care approaches when developing a digital technology for them, and they should be involved as key stakeholders to ensure equitable care. This research, which started in September 2023, aims to develop a set of end-user requirements for a mobile health record app that PESE can use when accessing healthcare. The opiate substitution therapy is used as a case study to ground the research and demonstrate the complexity and necessity of developing a set of end-user requirements for this mobile health record app. The research intends to bridge the gap between technological advancement and equitable healthcare, and to promote trauma-informed and integrated care within an acute hospital-based Inclusion Health Service with links to community-based services.

You can learn more about the research by clicking on the following link: https://viewer.ipaper.io/trinity-development-and-alumni/school-newsletters/pulse-newsletter-2024/?page=20.

Researcher: Felicien Izaturwanaho 

Michael Hevey is a Registered Advanced Nurse Practitioner (RANP) specialising in Inclusion Mental Health within the Dublin South Central (South City) Mental Health Service and St. James’s Hospital. He possesses over thirty years of professional experience as a mental health nurse, with twenty of those years dedicated to community mental health services.  Michael is presently engaged in doctoral studies centred on the implementation of an Inclusion Mental Health Liaison Service, which accepts referrals from healthcare providers and, importantly, also from key workers within homeless services, thereby facilitating access to specialist assistance and support for individuals experiencing homelessness. He is enrolled at UCDSNMHS and has been awarded a scholarship from the same institution to support this research endeavour.  

Researcher: Michael Hevey, Registered Advanced Nurse Practitioner (RANP)