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Open Access Highly Accessed Research article

Traumatic brain injury among people who are homeless: a systematic review

Jane Topolovec-Vranic1*, Naomi Ennis2, Angela Colantonio3, Michael D Cusimano4, Stephen W Hwang5, Pia Kontos6, Donna Ouchterlony7 and Vicky Stergiopoulos8

Author Affiliations

1 Trauma and Neurosurgery Program, Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital; Department of Occupational Science and Occupational Therapy, University of Toronto, 30 Bond Street, Bond 3-012, Toronto, ON M5B 1W8, Canada

2 Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada

3 Toronto Rehabilitation Institute; Occupational Science and Occupational Therapy, Rehabilitation and Public Health Sciences, University of Toronto, Toronto, Canada

4 Injury Prevention Research Office, Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital; Division of Neurosurgery, University of Toronto, Toronto, Canada

5 Center for Research on Inner City Health, Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada

6 Toronto Rehabilitation Institute-University Health Network; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

7 Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada

8 Center for Research on Inner City Health, Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital; Department of Psychiatry, University of Toronto, Toronto, Canada

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BMC Public Health 2012, 12:1059  doi:10.1186/1471-2458-12-1059

Published: 8 December 2012

Abstract

Background

Homelessness and poverty are important social problems, and reducing the prevalence of homelessness and the incidence of injury and illness among people who are homeless would have significant financial, societal, and individual implications. Recent research has identified high rates of traumatic brain injury (TBI) among this population, but to date there has not been a review of the literature on this topic. The objective of this systematic review was to review the current state of the literature on TBI and homelessness in order to identify knowledge gaps and direct future research.

Methods

A systematic literature search was conducted in PsycINFO (1887–2012), Embase (1947–2012), and MEDLINE/Pubmed (1966–2012) to identify all published research studies on TBI and homelessness. Data on setting, sampling, outcome measures, and rate of TBI were extracted from these studies.

Results

Eight research studies were identified. The rate of TBI among samples of persons who were homeless varied across studies, ranging from 8%-53%. Across the studies there was generally little information to adequately describe the research setting, sample sizes were small and consisted mainly of adult males, demographic information was not well described, and validated screening tools were rarely used. The methodological quality of the studies included was generally moderate and there was little information to illustrate that the studies were adequately powered or that study samples were representative of the source population. There was also an absence of qualitative studies in the literature.

Conclusions

The rate of TBI is higher among persons who are homeless as compared to the general population. Both descriptive and interventional studies of individuals who are homeless should include a psychometrically sound measure of history of TBI and related disability. Education of caregivers of persons who are at risk of becoming, or are homeless, should involve training on TBI. Dissemination of knowledge to key stakeholders such as people who are homeless, their families, and public policy makers is also advocated.

Keywords:
Traumatic brain injury; Homelessness; Systematic review