152374 Traumatic brain injury among homeless persons

Wednesday, November 7, 2007

Stephen W. Hwang, MD, MPH , Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
Angela Colantonio, PhD , Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
Shirley Chiu, MA , Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
George Tolomiczenko, PhD, MPH, MBA , Crohn's & Colitis Foundation of Canada, Toronto, ON, Canada
Alex Kiss, PhD , Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Laura Cowan, BScN , Street Health, Toronto, ON, Canada
Don Redelmeier, MD, MSHSR , Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Wendy Levinson, MD , Department of Medicine, University of Toronto, Toronto, ON, 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:
1. Describe the prevalence and severity of traumatic brain injury (TBI) among homeless people. 2. Assess the potential role of previous TBI as a risk factor for homelessness. 3. 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.

See more of: Issues Related to the Design, Implementation, and Effectiveness of Health Services for Homeless Populations
See more of: Caucus on Homelessness