Traumatic Brain Injury and Its Risk Factors in a Homeless Population.

OBJECTIVE: To characterize the traumatic brain injury (TBI) profile and its associated risk factors in homeless individuals in Santa Clara County, CA. DESIGN: Observational cohort study. SETTING: Two homeless shelter health clinics in Santa Clara County, CA. PARTICIPANTS: Currently or recently homeless individuals seeking health care at 2 homeless shelter health clinics between August 2013 and May 2014. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, TBI incidence and characteristics. RESULTS: The findings indicate that TBI history in the homeless population was higher (79.7%) than in the general population (12%). Almost half of the population (49.2%) reported that their TBI occurred before the age of 18. Of the participants, 68.2% reported sustaining a TBI with loss of consciousness. TBI caused by violence (60%) was lower in this cohort than other homeless cohorts but was the main cause of injury regardless of age. Alcoholism was a risk factor for having more TBIs. No differences in TBI profile were found between sexes. CONCLUSIONS: Our findings underscore the need for more research on the lifetime risk factors associated with TBI to prevent and reduce the number of brain injuries in homeless populations.

A Pediatric Profile of a Homeless Patient in San Jose, California.

The causes of homelessness are complex and poorly understood. This paper describes the homeless population in Santa Clara County, California in terms of Adverse Childhood Events, Traumatic Brain Injuries (TBIs), and family breakdown. Respondents reported severely traumatic childhoods; 78.7% grew up in a household with a person with drug or alcohol dependence and 64.6% endured psychological abuse as a child. Seventy-six percent of subjects recalled at least one TBI, 58.4% with loss of consciousness. Nineteen percent were in foster care as children and 40.2% reported having someone other than a parent as a primary caregiver. Fifty-three percent felt they had moved too much as children, and 37.5% had experienced homelessness as children. Santa Clara County has both the highest median income and the highest rate of unsheltered homelessness in the nation. Leaders and community members should work together to improve the lives of the home-less and to prevent another generation of homeless people.