In the Journals

One in two homeless people has a TBI

Jacob L. Stubbs

More than half of people who are homeless or dwell in unstable housing may have experienced a traumatic brain injury, according to results of a systematic review and meta-analysis published in The Lancet Public Health.

“Health care providers should be aware of the burden of TBI in this population,” Jacob L. Stubbs, BKin, a PhD student in the department of psychiatry at the University of British Columbia, Vancouver, told Healio Psychiatry. “Identifying a history of serious injury or new TBIs may allow for more targeted care. However, more research is urgently needed to better understand this issue.”

According to Stubbs and colleagues, a previous systematic review and previous studies have suggested that the lifetime incidence and prevalence of TBI in homeless and marginally housed individuals might be significantly higher than the general population. However, they noted that the present study is the first meta-analysis to their knowledge to evaluate TBI prevalence and incidence in these specific populations.

The researchers searched for original research studies that reported data on the association between TBI and one or more health- or function-related outcome measures, or on the prevalence or incidence of TBI. They included studies with clearly identifiable groups or subgroups of individuals who were homeless, seeking services for homeless people or marginally housed.

Among 21 studies with data from 11,417 individuals, the lifetime prevalence of any severity of TBI in homeless and marginally housed individuals was 53.4% (95% CI, 47.6-59.1). Among 12 studies with data from 6,302 individuals, the lifetime prevalence of moderate or severe TBI was 24.9% (95% CI, 16.3-35.9). Several factors significantly moderated estimated lifetime prevalence of any severity of TBI — the definition of TBI, the method used to determine TBI history and the age of the sample. The researchers noted that TBI was consistently associated with poorer self-reported mental and physical health, higher suicide risk and suicidality, memory concerns and increased criminal justice system involvement and health service use.

“Confirmation of structural brain damage caused by TBI might facilitate triage and referral to specialized services, such as cognitive rehabilitation, which could improve functional outcomes,” the researchers wrote. “Furthermore, imaging findings might positively inform the patient-caregiver relationship (eg, by increasing understanding of challenging behaviors that might be attributable to damage visible on neuroimaging).”

In a related editorial, Jesse T. Young, PhD, MPH, BSc, and Nathan Hughes, PhD, of Murdoch Children’s Research Institute in Melbourne, Australia, offered potential solutions to ameliorate the burden of TBIs among this population.

“Given the increasing evidence for a potential causal relationship, a randomized controlled trial investigating the effect of a housing intervention on TBI incidence is both feasible and warranted,” they wrote. “The Housing First model, in which homeless people are provided immediate access to permanent, noncontingent housing, has been found to reduce hospital contact for injury. Establishing the effectiveness of a Housing First approach in preventing TBI among people at risk of housing instability should be a public health priority for researchers and policy makers.” – by Joe Gramigna

Disclosures: Hughes, Stubbs and Young report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Jacob L. Stubbs

More than half of people who are homeless or dwell in unstable housing may have experienced a traumatic brain injury, according to results of a systematic review and meta-analysis published in The Lancet Public Health.

“Health care providers should be aware of the burden of TBI in this population,” Jacob L. Stubbs, BKin, a PhD student in the department of psychiatry at the University of British Columbia, Vancouver, told Healio Psychiatry. “Identifying a history of serious injury or new TBIs may allow for more targeted care. However, more research is urgently needed to better understand this issue.”

According to Stubbs and colleagues, a previous systematic review and previous studies have suggested that the lifetime incidence and prevalence of TBI in homeless and marginally housed individuals might be significantly higher than the general population. However, they noted that the present study is the first meta-analysis to their knowledge to evaluate TBI prevalence and incidence in these specific populations.

The researchers searched for original research studies that reported data on the association between TBI and one or more health- or function-related outcome measures, or on the prevalence or incidence of TBI. They included studies with clearly identifiable groups or subgroups of individuals who were homeless, seeking services for homeless people or marginally housed.

Among 21 studies with data from 11,417 individuals, the lifetime prevalence of any severity of TBI in homeless and marginally housed individuals was 53.4% (95% CI, 47.6-59.1). Among 12 studies with data from 6,302 individuals, the lifetime prevalence of moderate or severe TBI was 24.9% (95% CI, 16.3-35.9). Several factors significantly moderated estimated lifetime prevalence of any severity of TBI — the definition of TBI, the method used to determine TBI history and the age of the sample. The researchers noted that TBI was consistently associated with poorer self-reported mental and physical health, higher suicide risk and suicidality, memory concerns and increased criminal justice system involvement and health service use.

“Confirmation of structural brain damage caused by TBI might facilitate triage and referral to specialized services, such as cognitive rehabilitation, which could improve functional outcomes,” the researchers wrote. “Furthermore, imaging findings might positively inform the patient-caregiver relationship (eg, by increasing understanding of challenging behaviors that might be attributable to damage visible on neuroimaging).”

In a related editorial, Jesse T. Young, PhD, MPH, BSc, and Nathan Hughes, PhD, of Murdoch Children’s Research Institute in Melbourne, Australia, offered potential solutions to ameliorate the burden of TBIs among this population.

“Given the increasing evidence for a potential causal relationship, a randomized controlled trial investigating the effect of a housing intervention on TBI incidence is both feasible and warranted,” they wrote. “The Housing First model, in which homeless people are provided immediate access to permanent, noncontingent housing, has been found to reduce hospital contact for injury. Establishing the effectiveness of a Housing First approach in preventing TBI among people at risk of housing instability should be a public health priority for researchers and policy makers.” – by Joe Gramigna

Disclosures: Hughes, Stubbs and Young report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.