NHS Health Scotland
Outcome Indicators
4.11 There are associations between one or more of the long-term mental health outcomes and each of the intermediate outcomes: social inclusion, participation, increased equality/decreased inequality and decreased discrimination

Social exclusion
There is evidence that social exclusion is both a cause and consequence of mental health problems.[1] There is evidence that unemployment is associated with mental health problems, aspects of mental wellbeing and suicide.[2, 3, 4] Mental health problems are also associated with less education.[2]

There is evidence of an association between participation and mental health outcomes. A significant inverse association has been found between participation and mental health problems and a positive correlation has been found between life satisfaction and participation.[2]

Inequalities and discrimination
Inequality is both a cause and consequence of mental health problems.[3] Mental health problems are more common in socially disadvantaged populations and amongst people living in areas of deprivation. They are associated with unemployment, less education, low income or material standard of living.[2] The evidence for the impact of income inequality on wellbeing (largely assessed by life satisfaction) is mixed but according to Dolan et al [4] relative income has a significant negative relationship to happiness and life satisfaction.[2] In Scotland, a recent survey found that disadvantaged groups were more likely to have below average mental wellbeing as measured by WEMWBS.[6]

There is evidence that discrimination on the grounds of race, gender, religion, disability, age and sexuality is associated with mental health problems.[2]


  1. Rogers A & Pilgrim D (2003). Mental health and inequality. Palgrave Macmillan: Basingstoke.

  2. Parkinson J (2007). Establishing a core set of national, sustainable mental health indicators for adults in Scotland: Final report. NHS Health Scotland: Glasgow.

  3. Fryers T, Melzer D, Jenkins R (2003). Social inequalities and the common mental disorders: A systematic review of the evidence, Social Psychiatry and Psychiatric Epidemiology, 38 (5): 229-237.

  4. McLean H, Maxwell M, Platt S, Harris F & Jepson R (2008). Risk and Protective Factors for suicide and suicidal behaviour: A literature review. Scottish Government Social Research, Edinburgh.

  5. Dolan, P., Peasgood, T. & White, M. (2006). Review of research on the influence on personal well-being and application to police making. Defra: London.

  6. Davidson S et al (2009). Well? What Do You Think? (2008): The Fourth National Scottish Survey of Public Attitudes to Mental Wellbeing and Mental Health Problems. Scottish Government Social Research: Edinburgh.

  7. Pickett K.E, James O.W, Wilkinson R.G. (2006). Income inequality and the prevalence of mental illness: a preliminary international analysis. Journal of Epidemiology and Community Health, 60(7): 646–647.