Traumatic brain injury among people who are homeless: a systematic review

Abstract

BackgroundHomelessness and poverty are important social problems, and reducing the prevalence of homelessness and the incidence of injury and illness among people who are homeless would have significant financial, societal, and individual implications. Recent research has identified high rates of traumatic brain injury (TBI) among this population, but to date there has not been a review of the literature on this topic. The objective of this systematic review was to review the current state of the literature on TBI and homelessness in order to identify knowledge gaps and direct future research.MethodsA systematic literature search was conducted in PsycINFO (1887–2012), Embase (1947–2012), and MEDLINE/Pubmed (1966–2012) to identify all published research studies on TBI and homelessness. Data on setting, sampling, outcome measures, and rate of TBI were extracted from these studies.ResultsEight research studies were identified. The rate of TBI among samples of persons who were homeless varied across studies, ranging from 8%-53%. Across the studies there was generally little information to adequately describe the research setting, sample sizes were small and consisted mainly of adult males, demographic information was not well described, and validated screening tools were rarely used. The methodological quality of the studies included was generally moderate and there was little information to illustrate that the studies were adequately powered or that study samples were representative of the source population. There was also an absence of qualitative studies in the literature.ConclusionsThe rate of TBI is higher among persons who are homeless as compared to the general population. Both descriptive and interventional studies of individuals who are homeless should include a psychometrically sound measure of history of TBI and related disability. Education of caregivers of persons who are at risk of becoming, or are homeless, should involve training on TBI. Dissemination of knowledge to key stakeholders such as people who are homeless, their families, and public policy makers is also advocated.

Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot: Multicenter Implementation of the Common Data Elements for Traumatic Brain Injury

“…It is traditionally difficult to assess TBI histories of the unsheltered homeless, with few successful studies and inherent variability in sampling. 39 In TRACK-TBI, some individuals required nearly 20 attempts to make contact. Follow-up can be improved by not enrolling these patients, but excluding these patients may bias certain studies and reduce the generalizability of the results.…”

Clarifying the link between traumatic brain injury and homelessness: Workshop proceedings

“…Cognitive impairment may increase the risk of becoming and remaining homeless [24] and substance abuse both increases the risk of becoming homeless [25] and the risk of sustaining a TBI [26]. The interplay between such factors could contribute to a high prevalence of TBI among people who are homeless [14,[27][28][29][30][31][32], with rates ranging from 8-53% indicated in the literature [33].…”

Patología dual en poblaciones especiales: una revisión narrativa

“…Se ha documentado que las principales causas de mortalidad en esta población están vinculadas con el uso de sustancias y los trastornos mentales, como los daños no-intencionados (caídas, quemaduras, accidentes de tránsito), las conductas autolesivas, los intentos de suicidio, el envenenamiento (por consumo de medicamentos o sustancias ilícitas) y los traumas cráneo-encefálicos (Beijer, Andreasson, Ågren, & Fugelstad, 2011;Fazel et al, 2008;Nielsen et al, 2011;Pascual et al, 2008;Topolovec-Vranic et al, 2012;Unger et al, 1997).…”