Traumatic brain injury among Vancouver’s homeless at endemic levels: SFU Psychology study

The study, published today in the journal EClinicalMedicine-Lancet, involved detailed monthly TBI screens of 326 precariously housed persons in Vancouver’s Downtown Eastside.

During one year of observation, 31 per cent of homeless and precariously housed persons reported acquiring at least one TBI. This proportion was considerably higher than that previously reported in similar samples and likely reflected the more intensive and rigorous monthly monitoring approach used by the researchers to detect TBIs.

"The rates of TBIs we revealed were endemic," says Tiffany O’Connor, the study’s lead author, and recent PhD graduate in SFU’s Department of Psychology, whose doctoral research is partially based upon this work. "Considering that these community members often experience cognitive impairment, social and occupational challenges, and numerous comorbid conditions (e.g., psychiatric and neurological), the high rates of TBI captured highlight the need to prioritize prevention and outreach approaches to this population."Tiffany O'Connor

Statistical imputation to account for missing data estimated even higher rates. The investigators also reported that of those injured, 61 per cent reported one TBI and 39 per cent reported multiple injuries over the observation year.

Falls accounted for 45 per cent of the TBIs, followed by assaults at 25 per cent. Rates of TBIs amongst males and females were similar, but females were at higher odds to sustain a TBI from a fall, while males were at higher odds for TBI from assault.

As has been done in more privileged populations at risk for TBI, comprehensive educational outreach may prevent possible debilitating effects arising with the accumulation of multiple TBIs over time.

An interview conducted with O'Connor for EClinicalMedicine-Lancet's "In conversation with..." about this study can be found here.

The research team was led by SFU psychology professor Allen Thornton and UBC psychiatry professors William Panenka and William Honer. Other SFU investigators included psychology professor Wendy Loken Thornton and statistics and actuarial science professor X. Joan Hu. The British Columbia Mental Health and Substance Use Services Research Institute supported this project. This study builds on a previous meta-analysis that was conducted by these investigators that appeared in Lancet Public Health in 2019.

The study was funded by Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, SFU’s Vice-President Research Undergraduate Student Research Award, and SFU’s Psychology Department Research Grant.