302028
Traumatic Brain Injury, Suicidal Thoughts and Behaviors, and Negative Psychiatric Outcomes among Veterans Seeking Homeless Services
Among the myriad problems facing homeless populations, traumatic brain injury (TBI) has received relatively little clinical or research attention. Both homelessness and sustaining a TBI share risk factors, and both conditions are associated with increased negative psychiatric outcomes. This research aimed to increase understanding regarding TBI and associated rates of mental illness, self-reported suicidal thoughts and behaviors, psychiatric hospitalizations, and all-cause mortality among homeless Veterans.
Methods
At two metropolitan VA Medical Centers, 863 Veterans seeking homeless services completed a TBI screening measure (TBI-4). Subsequently, 318 consented to a clinical interview including the Ohio State University TBI Identification (OSU TBI-ID) and the MINI International Neuropsychiatric Interview (MINI). The MINI was used to determine the prevalence of mental illness. Clinical outcomes were culled from medical records for the years prior to and one year following each Veteran’s study enrollment. Hypotheses were that: (1) relative to Veterans without a history of TBI per the TBI-4 and/or the OSU TBI-ID, Veterans with a history of TBI would have significantly more mental health diagnoses, self-reported suicidal thoughts and behaviors, psychiatric hospitalizations, and all-cause mortality.
Results
In an initial analysis of these data reported in the American Journal of Public Health (Russell et al., 2013) we found that 47% of Veterans seeking homeless services had a probable history of TBI. Preliminary results from the secondary analyses for this presentation indicate that Veterans with a history of TBI as indicated by the OSU TBI-ID have significantly more psychological disorders than Veterans who do not have history of a TBI (p<.01). Similarly, significantly more Veterans with a history of TBI reported suicidal thoughts or behaviors than Veterans without a history of TBI (OR 5.15; 95% CI: 2.25,11.77; p<.0001). No significant differences were found in regard to psychiatric hospitalizations. Analyses regarding all-cause mortality are currently underway. Characteristics of TBIs in this population will also be described.
Conclusion
The prevalence of TBI among Veterans seeking homeless services is markedly high. Despite the many adversities already facing Veterans seeking homeless services, having a TBI was still associated with greater comorbid mental health diagnoses and self-reported suicidal thoughts and behaviors. These findings highlight the importance of comprehensive TBI assessments and regular evaluation of suicide risk.
Learning Areas:
Provision of health care to the publicSocial and behavioral sciences
Learning Objectives:
Discuss the association between TBI and mental health diagnoses, self-reported suicidal thoughts and behaviors, and negative psychiatric outcomes among Veterans seeking homeless services.
Keyword(s): Homelessness, Mental Health
Qualified on the content I am responsible for because: Dr. Lisa A. Brenner is a Board Certified Rehabilitation Psychologist, and an Associate Professor of Psychiatry, Neurology, and Physical Medicine and Rehabilitation at the University of Colorado, Anschutz School of Medicine, and the Director of the Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education, and Clinical Center (MIRECC; http://www.mirecc.va.gov/visn19/). Her primary area of research interest is traumatic brain injury, co-morbid psychiatric disorders, and negative psychiatric outcomes including suicide. She has numerous peer-reviewed publications.
Any relevant financial relationships? No
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.