Traumatic brain injury among men in an urban homeless shelter: observational study of rates and mechanisms of injury
Open accessAbstract
BACKGROUND: Little empiric research has investigated the interrelationship between homelessness and traumatic brain injury. The objectives of this study were to determine the rate, mechanisms and associated outcomes of traumatic brain injury among men in an urban homeless shelter. METHODS: We recruited participants from an urban men's shelter in Toronto, Ontario. Researchers administered the Brain Injury Screening Questionnaire, a semistructured interview screening tool for brain injury. Demographic information and detailed histories of brain injuries were obtained. Participants with positive and negative screening results were compared, and the rates and mechanisms of injury were analyzed by age group. RESULTS: A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range 27-81 yr) participated. Nearly half (50 [45%]) of the respondents had a positive screening result for traumatic brain injury. Of these, 73% (35/48) reported experiencing their first injury before adulthood (< 18 yr), and 87% (40/46) reported a first injury before the onset of homelessness. Among those with a positive screening result, 33 (66%) reported sustaining at least one traumatic brain injury by assault, 22 (44%) by sports or another recreational activity, 21 (42%) by motor vehicle collision and 21 (42%) by a fall. A positive screening result was significantly associated with a lifetime history of arrest or mental illness and a parental history of substance abuse. INTERPRETATION: Multiple mechanisms contributed to high rates of traumatic brain injury within a sample of homeless men. Assault was the most common mechanism, with sports and recreation, motor vehicle collisions and falls also being reported frequently by the participants. Injury commonly predated the onset of homelessness, with most participants experiencing their first injury in childhood. Additional research is needed to understand the complex interactions among homelessness, traumatic brain injury, mental illness and substance use.
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TBI is not associated with seizures in two studies.
“not associated with seizures in two studies 53,59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
TBI is not associated with drug misuse in four studies.
“and not associated with drug misuse in four studies 35,53,55,59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
TBI is associated with a history of mental illness in one study.
“and a history of mental illness in one study 59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
TBI is not associated with education in two studies.
“not associated with education in two studies 53,59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
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 [59]
TBI is associated with arrest, incarcerations, or criminal justice system involvement in five studies.
“Associated with arrest, incarcerations, or criminal justice system involvement in five studies 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 [59]
TBI is not associated with lifetime duration of homelessness or marginal housing in two studies.
“and not associated with lifetime duration of homelessness or marginal housing in two studies 53,59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
TBI is associated with a parental history of substance abuse in one study.
“Associated with a parental history of substance abuse in one study 59”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [59]
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- Authors
- Topolovec-Vranic, J., Ennis, N., Howatt, M., Ouchterlony, D., Michalak, A., Masanic, C., Colantonio, A., Hwang, S. W., Kontos, P., Stergiopoulos, V., & Cusimano, M. D.
- Affiliations
- St. Michael's Hospital (CA)
- University Health Network (CA)
- Venue
- CMAJ Open
- Publisher
- CMA Joule Inc.
- Published
- 2014-04-25
- Volume
- 2
- Issue
- 2
- Pages
- E69-E76
- ISSN
- 2291-0026 (ISSN-L)
- PMC
- PMC4084748
- OpenAlex
- W2116072852
- Cited by
- 60
- References
- 39
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2023: 9 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 8 · 2016: 5 · 2014: 3
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- CMAJ Open (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Neurotrauma Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, homelessness, injury mechanisms, assault, traffic accidents, falls, childhood injuries, mental illness, substance abuse, arrest history
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