A new study published today in The Lancet Public Health Journal finds traumatic brain injury (TBI) an under-appreciated problem among the homeless, who the study suggests experience a disproportionately high lifetime prevalence of TBI.

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Study finds half of homeless people may have experienced a traumatic head injury

December 03, 2019
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A new study suggests that half of homeless people may have experienced a traumatic brain injury (TBI) in their lifetime, highlighting the need for greater awareness among healthcare workers of TBI’s consequences. SFU psychology professor Allen Thornton was part of the research team working on the study, published this week in the Lancet Public Health Journal.

“TBI is an under-appreciated problem of homeless and marginalized persons that is linked to subsequent neuropsychological and psychiatric disorders,” notes Thornton, who worked with lead researchers at UBC, based at the British Columbia Mental Health and Substance Use Services' Research Institute.

SFU psychology professor Allen Thornton

The study involved a systematic review and the first meta-analysis of TBI prevalence in homeless and marginally housed persons. The team analysed 38 studies from six high-income countries (Canada, the US, the UK, Australian, Japan and South Korea) published between 1995 and 2018. The authors also examined the number of new and existing cases of TBI and associations between TBI and health or functioning outcomes.

In addition to finding that homeless people experience a disproportionately high lifetime prevalence of TBI, the researchers estimate that almost one in four homeless people have experienced a TBI that is moderate or severe.

The researchers suggest that TBI is consistently associated with poorer self-reported physical and mental health, suicide risk, memory concerns and higher involvement in the criminal justice system, although they say further research is needed.

The authors point out that healthcare workers need to be more aware of the associated effects of TBI in people who are homeless, and that the impact of TBIs on the homeless requires closer scrutiny. They further suggest that a more comprehensive assessment of their health, including checks for TBI history, may help to improve care for the homeless, and that stable housing might also help to lower the risk.

Thornton heads SFU’s Human Neuropsychology Laboratory. His contributions include his involvement for the past 10 years in a Canada Institutes of Health Research (CIHR)-funded investigation into the challenges experienced by marginally housed and homeless persons. 

Recently, the team has focused on the role that traumatic brain injuries may play in a broad range of medical, social and psychological challenges that marginalized persons experience.

The Lancet paper quantitatively reviewed existing research, which included the team’s data collected as part of a ‘hotel study,’ in which researchers, over a 10-year period, tracked the health and psychological impacts of living in single-room occupancy hotels in Vancouver’s Downtown Eastside.

The group also has an ongoing initiative that will further detail brain injury incidence and health outcomes, including the neurocognitive impacts.

The Lancet study was funded by a Canadian Institute of Public Health Research project grant. It was co-authored by researchers from SFU, the Vancouver Coastal Health Research Unit, the B.C. Provincial Neuropsychiatry Program, the British Columbia Mental Health and Substance Use Services, and UBC’s Department of Psychiatry.