History of Brain Injury High Among the Homeless

Traumatic brain injury common among homeless men

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Homelessness is a complex problem with many causes, often including mental illness and alcohol and drug addiction. There may be another component to homelessness shared by many.

In a recent study, almost half of homeless men surveyed by Toronto researchers had a history of traumatic brain injury.

"If you have had a severe blow to the head, see your doctor."

This recent study was led by Jane Topolovec-Vranic, PhD, a clinical researcher in the Neuroscience Research Program in St. Michael’s Hospital in Toronto.

Traumatic brain injury (TBI) is a jolt or blow to the head that disrupts the function of the brain.

Dr. Topolovec-Vranic and colleagues enrolled homeless men from one Toronto homeless shelter in their study between August 2011 and May 2012. The men were aged 27 to 81, and 111 of them were followed for one year.

The men were given the Brain Injury Screening Questionnaire to determine lifetime incidence of TBI. This questionnaire asked 100 questions, ranging from whether the men had a TBI to what they recalled about the injury and how they functioned mentally after the injury. These homeless men were also asked how severe their injury had been, from having no loss of consciousness (mild) to being unconscious for more than 24 hours (severe). The questionnaire also asked about their medication use, if they had been diagnosed with fetal alcohol syndrome and about their psychiatric history. The men were paid $20 for their time.

Of the 45 percent of the men who reported having had a TBI, 87 percent said it happened before they became homeless.

Half of those who said they’d had TBI reported more than one head injury, and 70 percent of the men said their head injuries occurred in childhood, the researchers found.

Of the men who had TBI, 60 percent said their injury was due to assault, and this was particularly true for men aged 40 and over. Forty-four percent said their injury was caused from a non-violent means, such as playing sports, and 42 percent blamed a motor vehicle accident. Another 21 percent linked their TBI to a fall.

Men who were under 40 years of age were most likely to say their head injury resulted from falls after taking drugs or during an alcohol blackout.

The researchers also learned that men who had TBIs were more likely to have a history of being arrested or having mental illness, and they more frequently said they had parents with a history of substance abuse.

Recognition that a TBI sustained in childhood or early teenage years could predispose someone to homelessness may challenge some assumptions that homelessness is a conscious choice made by these individuals, or just the result of their addictions or mental illness, said Dr. Topolovec-Vranic in a press-release.

This study by Dr. Topolovec-Vranic and team was published April 25 in CMAJ Open.

In another recent study led by Stephen Hwang, MD, of the Centre for Research on Inner City Health at St. Michael’s Hospital, the researchers found the number of people who were homeless or vulnerably housed and who had a TBI may be as high as 61 percent — seven times higher than the general population.

In their study following 981 homeless men for  a year, having a history of TBI was associated with more emergency department visits, more arrests and incarcerations and more often being the victim of a physical assault in that one year alone, compared to homeless men who did not report a TBI.

This study by Dr. Hwang and team appeared in the April edition of the Journal of Head Trauma Rehabilitation.

Neither of the study’s authors disclosed any conflicts of interest.

Review Date: 
April 28, 2014
Last Updated:
April 28, 2014