About 25 percent of homeless individuals experience a moderate to severe traumatic brain injury (TBI) at some point in their lifetime, the study found. In comparison, a previous study found only about 2.6 percent of people in the general population experience a moderate to severe TBI involving loss of consciousness. “Individuals who are homeless or marginally housed are a vulnerable population and often have complex health challenges,” says lead study author Jacob Stubbs, of the British Columbia Mental Health and Substance Use Services Research Institute in Vancouver, Canada. “TBI can often lead to additional challenges with memory, concentration, mood, and decision-making, which may compound existing health or functioning challenges,” Stubbs adds. Overall, TBIs of any severity, including milder injuries, are about 4 times more common among homeless people. Around 53 percent of homeless people experience at least one TBI — including both milder and more severe injuries, the study found. Only about 12 percent of people in the general population will experience one or more TBIs in their lifetime, previous research has suggested. For the current analysis, researchers reviewed data from 38 previous studies examining the link between homelessness and brain injuries. They combined data from 21 of these previous studies to calculate the lifetime prevalence of TBIs overall, and they pooled data from 12 prior studies to look specifically at the lifetime prevalence of moderate to severe TBIs. One drawback of the analysis is that these smaller studies used a variety of different criteria to define the severity of brain injuries, making it possible that some people had milder or more serious injuries than the data might suggest. The studies in the analysis also weren’t controlled experiments designed to prove whether or how homelessness might directly contribute to TBIs, or if the reverse might be true, and brain injuries might lead to homelessness. “While TBI seems to be a risk factor for subsequently becoming homeless, homelessness itself is also a risk factor for TBI,” Stubbs says. “This may indicate that TBI makes it more challenging for these individuals to exit homelessness or an unstable housing situation.” In the 28 studies in the analysis that focused on health-related outcomes or changes in daily functioning following TBI, researchers found a wide range of problems associated with brain injuries, including: worse physical and mental health; increased use of health services; more involvement with the criminal justice system; younger age at first homelessness; and a higher suicide risk. People in these studies became homeless for the first time when they were almost 16 years old, on average. Assault is the most common cause of brain injuries among homeless people, Stubbs says. RELATED: 5 Ways Support Groups Help TBI Survivors With Recovery
More Diagnostic and Treatment Services in Homeless Shelters Can Help People Recover From a TBI
A TBI is caused by a bump, blow, or jolt to the head that leads to bruising, swelling, or tearing of brain tissue and disrupts the normal function of the brain, according to the Centers for Disease Control and Prevention (CDC). The severity of TBIs can range from a mild concussion with a brief change in mental status to loss of consciousness or amnesia and more lasting physical and mental health impairments. With milder injuries, people may recover within a matter of days or weeks, but more severe cases can result in months or years of recovery and sometimes leave lasting challenges with things like movement, speaking, behavior, emotional regulation, and cognitive function. More severe injuries “are very likely to lead to problems in cognition and behavior for the person’s lifetime, which can be linked to problems in education and employment,” says Huw Williams, PhD, a clinical psychologist at the University of Exeter in England, who wasn’t involved in the study. This, in turn, may make it harder for people to afford housing or follow rules that may be necessary to receive housing assistance. “Without adequate services to help people with TBI, it is likely that many will continue to end up on the streets,” Williams says. “Homeless services need to have systems in place to screen for TBI and its typical problems — impulsivity, poor memory, and planning ahead — so that they can enhance the help and support they provide,” Williams adds. “This should include working with neurological services.” In the United States and European Union alone, more than six million people experience homelessness annually, Stubbs and colleagues note. Homeless people have worse physical and mental health than other people, with a higher risk of psychotic disorders, major depression, substance use disorders, and infectious diseases, the study team wrote. They also have higher mortality rates than other people. TBI can complicate many of these health issues and make it harder for homeless people to get the care they need. “Healthcare professionals who work with this population should be aware of the high burden of TBI among these individuals, and how it relates to health and functioning,” Stubbs says. “Identifying TBI is key to facilitating targeted care for individuals who are struggling with the consequences of TBI.”
