Lifetime Prevalence of Traumatic Brain Injury in the Previously Unhoused Population

Abstract

It is well described in the literature that the unhoused or previously unhoused population has a higher prevalence of traumatic brain injuries (TBI) as compared to the general population. Some of the various long-term consequences of TBIs are cognitive/functional impairments, attention deficits, and impulsive/risky behavior. Therefore, because a large proportion of the unhoused population may be experiencing the persistent challenges that stem from unidentified TBIs, identification and education of those involved in supportive services to the unhoused could result in more effective support for long-term housing success. This project compared rates of TBIs in two permanent supportive housing models that are run by the nonprofit Beacon Inc. Interviews were conducted according to the Ohio State University TBI ID tool. This screening test included several subcategories of TBI: occurrence of moderate or severe TBI (“worst”), occurrence of first severe TBI before age 20 (“first”), and occurrence of multiple TBIs within a short time period (“multiple”). Residents of the clustered site had a higher incidence of TBI (78%, n=32) than residents of the scattered sites (41%, n=17). Both groups had a higher prevalence of TBI than the nationwide average of 18.2% with p values of 0.02 and <0.001, respectively. Failure to diagnose TBIs, especially in the unhoused population, is common due to lack of healthcare accessibility and medical distrust. This gap in care may lead to underdiagnosis and therefore untreated, unacknowledged long-term consequences. Furthermore, those cognitive consequences have been shown to contribute to the cycle of homelessness by predisposing patients to future TBIs via assault, substance abuse, and falls, further hampering their ability to exit homelessness. Having an understanding of clients’ cognitive history can better inform case workers of their clients’ ability to live independently and perform daily tasks of living. Therefore, with this information, case managers may be able to better understand what supports are necessary for clients’ long-term housing success.