CMAJ • October 7, 2008; 179 (8). doi:10.1503/cmaj.080341.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Research

The effect of traumatic brain injury on the health of homeless people

Stephen W. Hwang, MD MPH, Angela Colantonio, PhD OT Reg, Shirley Chiu, MA, George Tolomiczenko, PhD MPH, Alex Kiss, PhD, Laura Cowan, BScN, Donald A. Redelmeier, MD MSHSR and Wendy Levinson, MD

From the Centre for Research on Inner City Health (Hwang, Chiu), The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital; the Division of General Internal Medicine, Department of Medicine (Hwang, Redelmeier), Department of Psychiatry (Tolomiczenko) and the Department of Medicine (Levinson), University of Toronto; the Toronto Rehabilitation Institute, Department of Occupational Science and Occupational Therapy (Colantonio), University of Toronto; the Department of Research Design and Biostatistics (Kiss), Institute for Clinical Evaluative Sciences (Redelmeier), Sunnybrook Health Sciences Centre; the Crohn's and Colitis Foundation of Canada (Tolomiczenko); and the Street Health Community Nursing Foundation (Cowan), Toronto, Ont.

Correspondence to: Dr. Stephen W. Hwang, Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto ON M5B 1W8; fax 416 864-5485; hwangs{at}smh.toronto.on.ca

Background: We sought to determine the lifetime prevalence of traumatic brain injury and its association with current health conditions in a representative sample of homeless people in Toronto, Ontario.

Methods: We surveyed 601 men and 303 women at homeless shelters and meal programs in 2004–2005 (response rate 76%). We defined traumatic brain injury as any self-reported head injury that left the person dazed, confused, disoriented or unconscious. Injuries resulting in unconsciousness lasting 30 minutes or longer were defined as moderate or severe. We assessed mental health, alcohol and drug problems in the past 30 days using the Addiction Severity Index. Physical and mental health status was assessed using the SF-12 health survey. We examined associations between traumatic brain injury and health conditions.

Results: The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness. After adjustment for demographic characteristics and lifetime duration of homelessness, a history of moderate or severe traumatic brain injury was associated with significantly increased likelihood of seizures (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8 to 5.6), mental health problems (OR 2.5, 95% CI 1.5 to 4.1), drug problems (OR 1.6, 95% CI 1.1 to 2.5), poorer physical health status (–8.3 points, 95% CI –11.1 to –5.5) and poorer mental health status (–6.0 points, 95% CI –8.3 to –3.7).

Interpretation: Prior traumatic brain injury is very common among homeless people and is associated with poorer health.


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Can. Med. Assoc. J. 2008 179: 733. [Full Text] [PDF]

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