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Over 50% of homeless people may have experienced a head injury: study

A UBC-led study has found that people who are homeless experience a disproportionately high lifetime prevalence of traumatic brain injury (TBI).
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A UBC-led study has found that people who are homeless experience a disproportionately high lifetime prevalence of traumatic brain injury (TBI).

Published today in The Lancet Public Health, the meta-analysis is the first to look at the rate of TBI in people who are homeless or in unstable housing conditions; it looked at 38 studies published between 1995 and 2018.

The results suggest that over half of homeless people experience TBI (53 per cent). What's more, one-in-four (25 per cent) experience a TBI that is moderate or severe.

Researchers also found that the lifetime prevalence of TBI in people who are homeless and in unstable housing situations could be up to four times higher than the general population. In addition, the study found that, "the lifetime prevalence of moderate or severe TBI in this population could be nearly 10 times higher than estimates in the general population."

With this in mind, researchers were unable to determine whether TBI increased the risk of homelessness or whether homelessness increased in the risk of TBI. However, the results suggest that providing stable housing may lower the risk for TBI.

“More research is definitely needed. TBI is an under-appreciated and significant factor in the health and functioning of this vulnerable group of people,” says the study’s senior author Dr. William Panenka, 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.

“I find it especially striking that we found such a high prevalence of moderate or severe TBI,” says Jacob Stubbs, the study’s lead author and a PhD student in Panenka’s laboratory. “Our work emphasizes that healthcare workers be aware of the burden of TBI in this population, and how it relates to health and functioning.”

The study adds that 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.

While most people recover from a mild brain injury, others may have long-lasting problems with movement, learning, or speaking. Specifically, the 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.

Report authors emphasized the need for greater awareness in health-care about TBI in order to treat its burden and effects in people who are homeless.

The study was funded by a Canadian Institutes of Health Research project grant. It was co-authored by researchers from Simon Fraser University, the Vancouver Coastal Health Research Unit, the B.C. Provincial Neuropsychiatry Program, BC Mental Health and Substance Use Services, and the department of psychiatry at UBC.