Addi van Bergen

Chapter 2 34 pre-eclamptic conditions and severe haemorrhage specifically [44], on headache and sleeplessness [47] and severe physical illness or disability [48]. No significant associations were found with severe haemorrhage and uterine rupture [44], with obesity [47], and with the PH domain of the WHOQOL-BREF [34]. This domain covers among others pain, physical problems, sleep and energy. General health in the general population Evidence was found for the association between high SE/ low SI and adverse GH in the general population. Our hypothesis was supported by 80% of the combined sample (32,537 persons, 3 out of 6 instances) [46, 53, 54], partly supported by 16% of the sample (6,481 persons; 2 instances) [41, 47] and not supported by 4% of the sample (1,604 persons; 1 instance) [41]. The results were heavily influenced by one large cross-sectional study in 25,498 adults in Spain which found significant relationships between SE factors and socioeconomic inequalities in self-assessed health, presence of any chronic disease and limitations in daily activity due to health problems [54]. Two cohort studies showed positive associations between SE and disability onset and persistent disability [46, 53], and onset and persistence of low self-assessed health. A third cohort study showed partial evidence [41]. In women, long-term sickness absence adjusted for age and previous SE increased the risk of the combination of economic and social exclusion, but not of the combination of economic and cultural exclusion. In men, no significant associations were found between dimensions of SE and long-term sickness [41]. Partial evidence was also found in a cross-sectional study among 4,941 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 [47]. Physical health and general health in high-risk groups The literature did provide little evidence on the association between SE/SI and PH or GH in high-risk groups. The number of studies was low, with one study on PH [51] and one study (2 instances) on GH [55]. In HIV patients, physical symptoms and impairments and difficulties in day-to-day activities due to illness were associated with low SI [51]. In single mothers, self- assessed health was not associated with SE. This was true for both single mothers on social assistance as for single mothers without social assistance [55]. DISCUSSION 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. The evidence base is currently strongest for the association between SE/SI