The lifetime prevalence of hospitalised head injury in Scottish prisons: A population study

Abstract

BackgroundThere is mounting evidence that associates brain injury and offending behaviour, and there is a need to understand the epidemiology of head injury in prisoners in order to plan interventions to reduce associated disability and risk of reoffending. This is the first study to determine the lifetime prevalence of hospitalised head injury (HHI) in a national population of current prison inmates. In addition characteristics of prisoners with HHI and were compared to prisoners without HHI to discover whether those with HI differed demographically.MethodsWhole life hospital records of everyone aged 35 years or younger and resident in a prison in Scotland on a census date in 2015 were electronically linked via their unique NHS identifier and checked for ICD-9 and 10 codes for head injury. Using a case-control design, these data were compared with a sample from the general population matched 3:1 for age, gender and area-based social deprivation. Comparison of demographic variables was made between prisoners with and without HHI.ResultsHHI was found in 24.7% (1,080/4,374) of prisoners and was significantly more prevalent than found in the matched general population sample (18.2%; 2394/13122; OR 2.10; 95%CI 1.87, 2.16). The prevalence of HHI in prisoners and controls was similar with the exception of a higher risk of HHI in prisoners in lower deprivation quintiles. Having three or more HHI was more common in prisoners (OR 3.04; 95%CI 2.33, 3.97) as were HHI with ICD codes for intracranial injuries (OR 1.81; 95% CI 1.54, 2.11), suggesting that more severe HHI is more prevalent in prisoners than the general population. The distributions within demographic variables and the characteristics of HHI admissions in prisoners with and without a history of HHI were similar.ConclusionPrisoners in Scotland aged 35 years or younger have a higher lifetime prevalence of HHI than the general population and are more likely to have had repeated HI or intracranial injuries. Further work is required to elucidate the correspondence between self-report of HI and hospitalised records and to ascertain persisting effects of HI in prisoners and the need for services to reduce associated disability and risk of reoffending.

The prevalence, characteristics, and impact of head injury in female prisoners: a systematic PRISMA review

“…Nine of the twelve studies investigated adults in prison and three, juveniles in prison (27)(28)(29). One was a national prison population study that included adults and juveniles (4). One further study included adults and a single juvenile prisoner; only the adult data were considered in this review (30; see table 3).…”

“…Moderate-severe HI (LoC > 30 minutes) was reported as 22% and 37% in two adult studies (32,34) and 12.5% in one juvenile study (28). Another considered lifetime hospital admissions with HI in the population of females in Scotland who were under the age of 36 years and in prison (n=248) using ICD codes, and reported a HI prevalence of 19% (4).…”

“…Evidence for an association between head injury (HI) and offending is mounting (1). Two meta-analyses on prisoners with HI estimated a lifetime prevalence of 51% (2) and 60% (3) on the basis of self-report and a recent national prison population study as 25% on the basis of lifetime hospital admissions (4). These figures are high compared to an estimated prevalence of HI of 12% in the general population (5).…”

“…In this review, the term HI is preferred to traumatic brain injury (TBI) because in most instances, studies are based on self-report where the occurrence of an injury to the head may be likely, but brain injury is inferred and might not have occurred (10). Also, data linkage studies on hospitalisation use ICD codes which are designated as 'head injury' and again it is not clear whether TBI has occurred for some codes (4).…”

The Psychosocial Impact of Neurobehavioral Disability

“…The evidence relating to abnormal moral development and sociopathic patterns of behavior after injury to the vmPFC in childhood may explain why such a high number of offenders in custody have a history of head/brain injury. Williams (163) reported prevalence rates for TBI in young incarcerated male offenders (average age 16 years) as high as 60%, while McMillan et al (164) recently found that the prevalence of hospitalized head injury in prisoners (24.7 per cent; 1080/4,374) was significantly higher than a matched general population sample (18.2 per cent; 2394/13122). In a systematic review of youth offending, Hughes et al (165) reported prevalence rates of brain injury amongst incarcerated youth of between 16.5 and 72.1 per cent.…”