Many of us would think that homelessness is usually a result of personal choice or socio-economic factors, but three studies reveal that a previous traumatic brain injury (TBI) could have also caused homelessness among men because of the personality and cognitive problems attached to it. 

A TBI can happen in various scenarios: during playtime or sports-related activities, bomb blast and accidental fall, crash or bump onto something. Research says that many of the people with TB can continue with their normal lives, though some don't stay the same. 

The first study, titled Traumatic brain injury among men in an urban homeless shelter: observational study of rates and mechanisms of injury, shows 45 percent of 111 recruited homeless men, aged 27 to 81 and came from a shelter in Toronto, suffered from TBI at some point. Of these, 70 percent obtained the injuries in their childhood or teenage years. Study shows 87 percent of those individuals suffered an injury prior to becoming homeless. Unfortunately, 60 percent of the TBIs came from assault, 44 percent from recreation and sports and 42 percent from falls and motor vehicle collisions.

"You have a concussion, and you can't concentrate or focus. Their thinking abilities and personalities change. They can't manage at work, and they may lose their job, and eventually lose their families. And then it's a negative spiral," said Dr. Jane Topolovec-Vranic, the study's lead author and clinical researcher of the Neuroscience Research Program at St. Michael's Hospital where the study was conducted. 

She likewise said in a statement that it's essential that health care professionals who work with homeless individuals to have awareness of any TBI-related history because of the discovery of the link between TBI and seizures, substance abuse, overall poor physical health and mental health issues. She also emphasizes that this makes it even more significant to observe young people suffering from TBIs for behavioral and health changes. 

Identified as the most common cause of TBIs in men less than 40 years old were accidental falls from alcohol or drug blackouts, and assault for men more than 40 years old. 

The first study was published by CMAJ Open and funded by the Ontario Neurotrauma Foundation and the Canadian Institutes of Health Research. 

The second study, titled Traumatic Brain Injury Among Newly Admitted Adolescents in the New York City Jail System, shows that almost half of the entire newly admitted juveniles in the New York City (NYC) corrective system suffered TBI, which resulted to amnesia, loss of consciousness or both. This is as opposed to previous studies that reveal 15 to 30 percent of adolescents who have TBI but are not imprisoned, says Dr. Homer Venters, one author of the study and assistant health commissioner in NYC. 

"Elevated prevalence and incidence of TBI among incarcerated adolescents may relate to criminal justice involvement as well as friction in jail," the study says. 

Conducted in 2012, the study involved 300 boys and 84 girls aged 16-18 years old found to have assault-related TBIs. The study poses significance not only in studying injury-related impacts but opens a window of opportunity as well for a discussion on violence, substance abuse and mental health among American adolescents. 

Meanwhile, national expert on head injuries and professor John D. Corrigan of the Department of Physical Medicine and Rehabilitation at the Ohio State University said further research shows that inmates with brains hit by trauma have higher rates of substance abuse, breaking rules in jail and trouble re-entering the society after being detained. 

"You need to train the correction officers to understand brain injuries so that when somebody may be acting rude or answering back or forgetting what they're supposed to do, it's not a sign of maladaptive misbehavior or disrespect, it's a sign of a brain injury," said expert on brain injury, Wayne Gordon, at the Mount Sinai Hospital in New York.

The Journal of Adolescent Health published the second study.

The third study, Healthcare Utilization, Legal Incidents, and Victimization Following Traumatic Brain Injury in Homeless and Vulnerably Housed Individuals: A Prospective Cohort Study, published by the Journal of Head Trauma Rehabilitation has similar findings that observed homeless and vulnerably housed individuals in Vancouver, Toronto and Ottawa. 

"Homeless and vulnerably housed individuals with a lifetime history of TBI are more likely to be ED [emergency department] users, arrested or incarcerated, and victims of physical assault over a 1-year follow-up period even after adjustment for health status and other confounders," the study says.

Study author Dr. Stephen Hwang said that the number of homeless or vulnerably housed individuals who also experienced TBI in the past may be as high as 61 percent, which is higher seven times than the general population. The study suggests the results have implications on criminal justice and public health as well as highlight the need for efficient screening, treatment and rehabilitation of TBI-related cases.

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