Associations between deprived life circumstances, wellbeing and self-rated health in a socially marginalized population

Background: Previous studies of self-rated health among socially marginalized people provide insufficient understandings of what influences their self-rated health. This study aimed to examine how disadvantaged life circumstances (homelessness, substance abuse, poverty) and general well-being were associated with poor self-rated health among the socially marginalized. Methods: In a nationwide survey in Denmark, 1348 users of shelters, drop-in centres, treatment centres and social psychiatric centres answered a self-administered questionnaire. We analysed data using logistic regression. Results: Disadvantaged life circumstances and well-being were associated with self-rated health, also when controlling for illness, mental disorder and age. Male respondents exposed to two or more disadvantaged life circumstances had higher odds of poor self-rated health [odds ratio (OR): 2.96; 95% confidence interval (CI): 1.80-4.87] than males exposed to fewer disadvantages. A low sense of personal well-being implied higher odds of poor self-rated health among both men and women. Among men, not showering regularly (OR: 1.81; 95% CI: 1.17-2.79), and among women, not eating varied food (OR: 2.24; 95% CI: 1.20-4.20) and exposure to physical violence (borderline significant) implied higher odds of poor self-rated health. Male and female respondents reporting lack of sleep and loneliness (borderline significant among women) had higher odds of poor self-rated health. Conclusions: The poor self-rated health among socially marginalized is strongly associated with massive social problems, poor living conditions and poor well-being. This study elucidates the need for more broadly based and holistic initiatives by both the health sector and the social services, incorporating health promotion initiatives into social work.