The effect of traumatic brain injury on the health of homeless people
Open accessAbstract
BACKGROUND: We sought to determine the lifetime prevalence of traumatic brain injury and its association with current health conditions in a representative sample of homeless people in Toronto, Ontario. METHODS: We surveyed 601 men and 303 women at homeless shelters and meal programs in 2004-2005 (response rate 76%). We defined traumatic brain injury as any self-reported head injury that left the person dazed, confused, disoriented or unconscious. Injuries resulting in unconsciousness lasting 30 minutes or longer were defined as moderate or severe. We assessed mental health, alcohol and drug problems in the past 30 days using the Addiction Severity Index. Physical and mental health status was assessed using the SF-12 health survey. We examined associations between traumatic brain injury and health conditions. RESULTS: The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness. After adjustment for demographic characteristics and lifetime duration of homelessness, a history of moderate or severe traumatic brain injury was associated with significantly increased likelihood of seizures (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8 to 5.6), mental health problems (OR 2.5, 95% CI 1.5 to 4.1), drug problems (OR 1.6, 95% CI 1.1 to 2.5), poorer physical health status (-8.3 points, 95% CI -11.1 to -5.5) and poorer mental health status (-6.0 points, 95% CI -8.3 to -3.7). INTERPRETATION: Prior traumatic brain injury is very common among homeless people and is associated with poorer health.
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Between 27% and 52% of homeless people were physically or sexually assaulted in the previous year.
“Findings from studies show that between 27% and 52% of homeless individuals were physically or sexually assaulted in the previous year.97-99”
From The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations (2014) · cites this paper as [97]
The introduction states that homeless people are frequently victims of assault, supporting the general point. It gives no 27%–52% estimate, does not distinguish physical from sexual assault, and does not specify the previous year. The Strengths and limitations section also says the study did not collect the circumstances of participants’ brain injuries. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTBI is associated with poorer self-reported physical health in three studies.
“Associated with poorer self-reported physical health in three studies 39,53,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
TBI is associated with having seizures in three studies.
“Associated with having seizures in three studies 19,39,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
TBI is associated with drug misuse in four studies.
“Associated with drug misuse in four studies 39,43,58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
TBI is associated with poorer self-reported mental health in three studies.
“Associated with poorer self-reported mental health in three studies 39,53,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
TBI is associated with alcohol misuse in five studies.
“Associated with alcohol misuse in five studies, 39,43,53,58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
Between 51% and 92% of participants experienced their first TBI before their first experience of homelessness or marginal housing.
“Between 51% and 92% of participants experienced their first TBI before their first experience of homelessness or marginal housing 29,39,43,50,53,59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [39]
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Self-citation
- Authors
- Hwang, S. W., Colantonio, A., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., Redelmeier, D. A., & Levinson, W.
- Affiliations
- St. Michael's Hospital (CA)
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2008-09-16
- Volume
- 179
- Issue
- 8
- Pages
- 779-784
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC2553875
- OpenAlex
- W2080014213
- Cited by
- 194
- References
- 30
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 8 · 2023: 14 · 2022: 8 · 2021: 12 · 2020: 17 · 2019: 12 · 2018: 9 · 2017: 10 · 2016: 17 · 2015: 12 · 2014: 21 · 2013: 13 · 2012: 13
- FWCI
- 9.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Funders
- Institute for Clinical Evaluative Sciences
- Ontario Neurotrauma Foundation
- Ontario Ministry of Health and Long-Term Care
- Toronto Rehabilitation Institute
- Agency for Healthcare Research and Quality (R01 HS014129-01, 1r01hs014129-01, R01 HS014129)
- Canadian Institutes of Health Research (62736_1, 80066_1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, homelessness, lifetime prevalence, moderate to severe head injury, seizures, mental illness, substance use disorders, physical health status, homeless shelters, Toronto
- MeSH terms
- Adolescent, Adult, Aged, Attitude to Health, Brain Injuries, Cross-Sectional Studies, Female, Follow-Up Studies, Health Status, Ill-Housed Persons, Humans, Male, Mental Health, Middle Aged, Ontario, Probability, Reference Values, Risk Factors, Risk-Taking, Socioeconomic Factors, Injury Severity Score, Comorbidity, Causality, Incidence, Survival Rate, Substance-Related Disorders
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