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Abstract #152374

Stephen W. Hwang, MD, MPH¹, Angela Colantonio, PhD², Shirley Chiu, MA¹, George Tolomiczenko, PhD, MPH, MBA³, Alex Kiss, PhD⁴, Laura Cowan, BScN⁵, Don Redelmeier, MD, MSHSR⁴, and Wendy Levinson, MD⁶. (1) Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada, 416-864-5991, hwangs@smh.toronto.on.ca, (2) Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Rehabilitation Sciences Building, Toronto, ON M5G 1V7, Canada, (3) Crohn's & Colitis Foundation of Canada, 600-60 St. Clair Ave. East, Toronto, ON M4T 1N5, Canada, (4) Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, G Wing, G1-38, Toronto, ON M4N 3M5, Canada, (5) Street Health, 338 Dundas St. E., Toronto, ON M5A 2A1, Canada, (6) Department of Medicine, University of Toronto, R. Fraser Elliott Bldg. 3-805, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada

Methods: A random sample of single homeless persons was enrolled at 50 shelters and 18 meal programs in Toronto, Canada. Participants provided self-reported information on lifetime history of TBI. Mild TBI was defined as a head injury that left the person dazed or confused, but resulted in no loss of consciousness (LOC) or LOC <=30 minutes. Moderate/severe TBI was defined as a head injury resulting in LOC > 30 minutes. Age at first TBI and first episode of homelessness were used to determine whether TBI antedated the onset of homelessness.

Results: 604 males and 303 females were interviewed. Lifetime prevalence of any TBI was 53% and was significantly higher among males than females (58% vs. 42%, p=0.0001). Prevalence of moderate/severe TBI was 12%. Among individuals with a history of TBI, 72% had their first episode of TBI before the onset of homelessness. Median age at first TBI and first moderate/severe TBI was 14 and 16 years, respectively. Among homeless persons who had experienced moderate/severe TBI, 25% had done so before the age of 11 years.

Conclusion: The prevalence of TBI was very high in a representative sample of homeless people. TBI often occurred during adolescence and usually antedated the first homeless episode, raising the possibility that TBI may cause cognitive or behavioral problems that contribute to the onset of homelessness. These findings underscore the need for clinicians to obtain a careful history of TBI in homeless patients and to consider TBI as a factor contributing to neuro-psychiatric dysfunction.

Learning Objectives:

• Describe the prevalence and severity of traumatic brain injury (TBI) among homeless people.
• Assess the potential role of previous TBI as a risk factor for homelessness.
• Recognize the importance of assessing homeless people for history of TBI using simple screening questions.

Keywords: Homeless Health Care, Injury

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.