摘要：Objectives. We examined the prevalence of self-reported traumatic brain injury (TBI) among homeless young people and explored whether sociodemographic characteristics, mental health diagnoses, substance use, exposure to violence, or difficulties with activities of daily living (ADLs) were associated with TBI. Methods. We analyzed data from the Wilder Homelessness Study, in which participants were recruited in 2006 and 2009 from streets, shelters, and locations in Minnesota that provide services to homeless individuals. Participants completed 30-minute interviews to collect information about history of TBI, homelessness, health status, exposure to violence (e.g., childhood abuse, assault), and other aspects of functioning. Results. Of the 2732 participating adolescents and young adults, 43% reported a history of TBI. Participants with TBI became homeless at a younger age and were more likely to report mental health diagnoses, substance use, suicidality, victimization, and difficulties with ADLs. The majority of participants (51%) reported sustaining their first injury prior to becoming homeless or at the same age of their first homeless episode (10%). Conclusions. TBI occurs frequently among homeless young people and is a marker of adverse outcomes such as mental health difficulties, suicidal behavior, substance use, and victimization. Homelessness is a serious public health problem that emerges at the intersection of complex socioecological factors. According to US Department of Housing and Urban Development estimates, at least 200 000 children, adolescents, and young adults were homeless on the night of a survey conducted in January 2013, representing one third of all homeless people in the United States. 1 Homeless youths may be counted along with families but are often unaccompanied and moving between shelters or living on the streets. The unpredictable and often dangerous circumstances that accompany homelessness leave homeless individuals vulnerable to injury, illness, and victimization. Homeless individuals experience poorer health than people with stable housing and have a shorter life expectancy, 2–4 and homeless young people experience high rates of internalizing (e.g., depression), externalizing (e.g., conduct disorder), and substance use disorders. 5 A number of studies have documented cognitive difficulties, health problems, and violence exposure among homeless youths 6–10 ; however, traumatic brain injury (TBI) has garnered minimal empirical attention. TBI is a leading cause of death and disability in the United States. 11 However, a 2012 systematic review showed that only 8 studies have investigated TBI among homeless populations. 12 The lifetime prevalence of TBI in these samples ranged from 8% to 53%, with all but 1 investigation reporting a rate above 20%. Five of the 8 studies were conducted in North America, with each recruiting from a single urban area and only one sampling multiple shelters. Most were limited by modest sample sizes, with only 2 exceeding 100 participants. 13,14 Moreover, although 2 studies included adolescents, the samples were small and the prevalence of TBI among youths was not separated from that of adults. 13,14 Hwang et al. 14 and Oddy et al. 15 reported that injuries tend to occur in late adolescence, with 70% or more occurring prior to the onset of homelessness. Hwang et al. 14 also found that TBI was associated with mental health, substance use, and other difficulties. To date, no studies to our knowledge have reported TBI prevalence specifically among homeless adolescents and young adults. We sought to determine the prevalence of self-reported TBI among homeless adolescents and young adults in a population-based study and to investigate whether sociodemographic characteristics, mental health history, exposure to violence, and ability to perform routine activities of daily living (ADLs) differ between young people who report a history of TBI and those who do not. We hypothesized that homeless young people with a history of TBI would report greater difficulties in the domains assessed and that most respondents’ first TBI would precede their first episode of homelessness.
