Challenges Associated With Screening for Traumatic Brain Injury Among US Veterans Seeking Homeless Services
Leah M. Russell, Maria D. Devore, Sean M. Barnes, Jeri E. Forster, Trisha A. Hostetter, and Lisa A. Brenner are with the Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education and Clinical Center (MIRECC), Denver, CO. Ann Elizabeth Montgomery and Vincent Kane are with the Veterans Affairs National Center on Homelessness Among Veterans, Philadelphia, PA. Roger Casey is with the Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL. Vincent Kane is a guest editor for this supplement issue.American Journal of Public Health (Impact Factor: 4.55). 10/2013; 103. DOI: 10.2105/AJPH.2013.301485
We identified the prevalence of traumatic brain injury (TBI) among homeless veterans and assessed the TBI-4, a screening tool created to identify TBI history. Between May 2010 and October 2011, 800 US veterans from two hospitals, one eastern (n = 122) and one western (n = 678) completed some or all measures. Findings suggested that 47% of veterans seeking homeless services had a probable history of TBI (data for prevalence obtained only at the western hospital). However, psychometric results from the screening measure suggested that this may be an underestimate and supported comprehensive assessment of TBI in this population. (Am J Public Health. Published online ahead of print October 22, 2013: e1-e2. doi:10.2105/AJPH.2013.301485).
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ABSTRACT: Background Among the myriad problems facing homeless populations, traumatic brain injury (TBI) has received relatively little clinical or research attention. Both homelessness and sustaining a TBI share risk factors, and both conditions are associated with increased negative psychiatric outcomes. This research aimed to increase understanding regarding TBI and associated rates of mental illness, self-reported suicidal thoughts and behaviors, psychiatric hospitalizations, and all-cause mortality among homeless Veterans. Methods At two metropolitan VA Medical Centers, 863 Veterans seeking homeless services completed a TBI screening measure (TBI-4). Subsequently, 318 consented to a clinical interview including the Ohio State University TBI Identification (OSU TBI-ID) and the MINI International Neuropsychiatric Interview (MINI). The MINI was used to determine the prevalence of mental illness. Clinical outcomes were culled from medical records for the years prior to and one year following each Veteran’s study enrollment. Hypotheses were that: (1) relative to Veterans without a history of TBI per the TBI-4 and/or the OSU TBI-ID, Veterans with a history of TBI would have significantly more mental health diagnoses, self-reported suicidal thoughts and behaviors, psychiatric hospitalizations, and all-cause mortality. Results In an initial analysis of these data reported in the American Journal of Public Health (Russell et al., 2013) we found that 47% of Veterans seeking homeless services had a probable history of TBI. Preliminary results from the secondary analyses for this presentation indicate that Veterans with a history of TBI as indicated by the OSU TBI-ID have significantly more psychological disorders than Veterans who do not have history of a TBI (p<.01). Similarly, significantly more Veterans with a history of TBI reported suicidal thoughts or behaviors than Veterans without a history of TBI (OR 5.15; 95% CI: 2.25,11.77; p<.0001). No significant differences were found in regard to psychiatric hospitalizations. Analyses regarding all-cause mortality are currently underway. Characteristics of TBIs in this population will also be described. Conclusion The prevalence of TBI among Veterans seeking homeless services is markedly high. Despite the many adversities already facing Veterans seeking homeless services, having a TBI was still associated with greater comorbid mental health diagnoses and self-reported suicidal thoughts and behaviors. These findings highlight the importance of comprehensive TBI assessments and regular evaluation of suicide risk.142nd APHA Annual Meeting and Exposition 2014; 11/2014
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