Challenges Associated With Screening for Traumatic Brain Injury Among US Veterans Seeking Homeless Services

ArticleinAmerican Journal of Public Health 103(S2) · October 2013with19 Reads
DOI: 10.2105/AJPH.2013.301485 · Source: PubMed
Abstract
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).
  • [Show abstract] [Hide abstract] 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.
    Conference Paper · Nov 2014 · Journal of Health Care for the Poor and Underserved
  • [Show abstract] [Hide abstract] ABSTRACT: This hypothesis-generating research describes the characteristics of traumatic brain injuries (TBIs) sustained among 229 Veterans seeking homeless services. Nearly all participants (83%) had sustained at least one TBI prior to their first episode of homelessness. Among participants with a TBI, assaults, transportation-related accidents, and falls were the most common causes of these injuries. Thirty percent of individuals sustained injuries with severity levels that would be expected to be associated with ongoing TBI-related deficits. Forty-three percent of the Veterans sustained at least one brain injury following their first episode of homelessness. Median lifetime number of TBIs was three. The severity of TBIs was similar among Veterans who sustained injuries before or after their first incident of homelessness. Findings suggest that future research should directly examine the potential bi-directional relationship between TBI and homelessness, as well as the impact of TBI-related deficits on Veterans' ability to benefit from homeless services and/or maintain stable housing.
    Full-text · Article · Feb 2015