Brain Injury Among Homeless May Be At Least 4 Times That of General Population

The homeless population has a disproportionately high lifetime prevalence of traumatic brain injury (TBI), according to a new study led by the University of British Columbia (UBC).

TBI can range from a mild concussion to a severe head injury. It is caused by a blow to the head or body, a wound that breaks through the skull, a fall, or another injury that jars or shakes the brain causing bruising, swelling, or tearing of brain tissue.

Over time, many individuals recover from a mild brain injury, but some people, especially those who have sustained repeated or severe injuries, may have long-term problems with movement, learning, or speaking.

For the analysis, the researchers looked at 38 published papers from six high-income countries — Australia, Canada, Japan, South Korea, the U.K., and the U.S. — which included people of any age who were either homeless, in unstable housing situations, or seeking services for homeless people.

They examined the number of new cases and existing cases of TBI, and the association between TBI and health or functioning outcomes.

The findings, appearing in The Lancet Public Health journal, reveal that one in two (53 percent) homeless people have had a TBI, and one in four (25 percent) have sustained a TBI that is moderate or severe.

The researchers estimate that the lifetime prevalence of TBI in people who are homeless or in unstable housing situations could potentially be up to four times higher than in the general population.

Meanwhile, the lifetime prevalence of moderate or severe TBI in this population could be nearly 10 times higher than estimates in the general population.

“I find it especially striking that we found such a high prevalence of moderate or severe TBI,” said  Jacob Stubbs, the study’s lead author and a PhD student.

“Our work emphasizes that health care workers be aware of the burden of TBI in this population, and how it relates to health and functioning.”

Based on the data, the researchers were unable to determine whether TBI increased the risk of homelessness or vice versa. While more research is needed to better understand the link, the researchers say the results suggest that providing stable housing might reduce the risk for TBI.

“More research is definitely needed. TBI is an underappreciated and significant factor in the health and functioning of this vulnerable group of people,” said the study’s senior author, Dr. William Panenka.  H ie is assistant professor in the UBC faculty of medicine, a member of the BC Provincial Neuropsychiatry Program at UBC and a part of the BC Mental Health and Substance Use Services Research Institute.

Their findings suggest that TBI is consistently associated with poorer self-reported physical and mental health, suicidality and suicide risk, memory concerns, increased health service use and criminal justice system involvement.

The authors suggest a need for health-care workers to have increased awareness of the burden and associated effects of TBI in people who are homeless, noting that more comprehensive assessments of their health — including checking for a history of TBI — may help improve outcomes.

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