Homeless with TBI more likely to visit ER
Homeless and vulnerably housed people who
have suffered a traumatic brain injury at some point in their life
are more likely to visit an Emergency Department, be arrested or
incarcerated, or be victims of physical assault, new research has
"Given the high costs of Emergency Department visits and the
burden of crime on society, these findings have important public
health and criminal justice implications," the researchers from St.
Michael's Hospital wrote today in the Journal of Head Trauma
Traumatic brain injuries, such as concussions, are about seven
times more common among homeless people than the general
population. Traumatic brain injuries, or TBIs, are associated with
many other health problems such as seizures, mental health
problems, alcohol and drug misuse and poorer overall physical and
mental health. Homeless people are also known to be frequent users
of health care facilities, especially emergency departments.
Dr. Stephen Hwang of the hospital's Centre for Research on Inner
City Health said this is one of the first studies of its kind to
investigate health care use among homeless and vulnerably housed
populations with a history of TBI--and one of the largest such
The findings come from an ongoing study of changes in the health
and housing status of 1,200 homeless and vulnerably housed single
adults in Vancouver, Toronto and Ottawa. The study, known as the
Health and Housing in Transition (HHiT) study, has been following
participants for up to four years.
Of the study participants, 61 per cent said they had suffered a
TBI in their lifetime (69 per cent in Vancouver, 64 per cent in
Ottawa and 50 per cent in Toronto).
The study found that homeless people with a history of TBI
- About 1.5 times more likely to have visited an emergency
department in the previous year-possibly due to long-term cognitive
effects of the original TBI, as previous research suggests people
with TBI are high users of health care services up to five years
after original injury. Dr. Hwang said that high emergency
department use could also be related to health problems related to
the TBI, such as seizures or substance use.
- Almost twice as likely to have been arrested or incarcerated in
the previous year. Dr. Hwang said this could be due to impaired
cognition or personality disturbances following TBI.
- Almost three times more likely to have experienced a physical
assault in the previous year. This is consistent with previous
studies that suggested people with a history of TBI are more likely
to be victims of violent crime. Dr. Hwang said that this is one of
the first studies of its kind among people who are homeless and
vulnerably housed to suggest that sustaining a TBI is an
independent risk factor for becoming a future victim of physical
"Screening homeless and vulnerably housed people for TBI and
helping them to better manage behaviors after brain injuries could
help improve outcomes and potentially reduce the use of costly
health care and legal services," said Matthew To, the lead author
of the paper and a research student at St. Michael's Hospital.
References and further information