Losing Stable Housing After Brain Injury: What Does the Research Say? (Research Summary)

A multidisciplinary research team from Vancouver, BC published a research study in The Canadian Journal of Psychiatry exploring the relationship between brain injury and losing stable housing. Studies like this show that brain injury should be a part of the housing crisis conversation. We need to work together to ensure individuals do not fall through the cracks after sustaining a brain injury.

What do we already know?

> 200,000 people experience homelessness annually in Canada

This study used the terms “homeless” and “precariously housed”

• Precariously housed refers to individuals who are not formally homeless but live in shelters, single-occupancy hotels, rooming houses, etc.

Over half of individuals experiencing homelessness have a traumatic brain injury (TBI)

• And 1 in 5 will have a moderate or severe TBI
• Not everyone with a TBI experiences loss of consciousness (LOC), but LOC usually indicates a more severe TBI
• After severe TBI, income loss, deterioration in medical and decision-making capacity, & decline in self-advocacy abilities may occur

Research shows that most people sustain their first TBI before becoming homeless

What did they want to know?

Researchers from Vancouver, BC, Canada were interested in understanding the lifetime history of TBI in homeless and precariously housed individuals

They predicted that:

(1) More severe TBI would occur closer to the initial loss of stable housing

• Impacts of severe TBI may make it more difficult to maintain income & housing

(2) TBI closer in time to the initial loss of stable housing would be associated with a longer duration of homelessness

• Stress of unstable housing may negatively affect brain injury recovery (making it more difficult to obtain stable housing)

What did they do?

Hotel Study

• 285 participants: Homelessness or precariously housed (living in single-room occupancy hotels) individuals in Vancouver
• Followed over 10 years, ongoing check-ins
• Completed general health questionnaires, neuropsychological assessments, neuropsychiatric examinations

What did they measure?

Lifetime history of TBI

• Brain Injury Screening Questionnaire (BISQ), a structured, self-report screening tool
• Classified as mild, moderate, or severe TBI
• Recorded mechanism of injury (e.g., car accident, assault, abuse, sports)

Lifetime duration of homelessness or precarious housing (# days)

What did they find?

82% reported at least 1 lifetime TBI

• More than 1 TBI: 65%
• Moderate or severe TBI: 21%
• Younger adults sustained more TBIs per year (multiple brain injuries have cumulative impacts)

Most common causes of TBI were assault (in men) and physical abuse (in women)

Age when initial loss of stable housing occurred

• No difference between those with vs. without TBI

Moderate-severe vs. mild TBI

• First moderate-severe TBI occurred closer to initial loss of stable housing
• (We know that moderate-severe TBI typically associated with greater impact on functioning)

58% sustained first TBI before becoming homeless

• 74% sustained first TBI before becoming precariously housed
• Less likely for TBI to happen after loss of stable housing

TBI closer in time to initial loss of stable housing was associated with longer lifetime duration of homelessness/precarious housing

• Sustain TBI > lose housing soon after > longer time spent without housing

What does this mean?

Prevalence of TBI (including moderate-severe TBI) is higher in homeless/precariously housed populations than the general population

• People experiencing homelessness/precarious housing should be screened for TBI
• Need early identification and collaborative support from service providers

Factors such as age and gender need to be considered to provide customized support for homeless/precariously housed individuals with brain injury

People who are newly homeless/precariously housed may be dealing with brain injury impacts

• Persisting symptoms may make it harder for individuals to keep and find stable housing

Source:

Stubbs, J. L., Thornton, A. E., Gicas, K. M., O’Connor, T. A., Livingston, E. M., Lu, H. Y., … & Panenka, W. J. (2022). Characterizing traumatic brain injury and its association with losing stable housing in a community-based sample. The Canadian Journal of Psychiatry, 67(3), 207-215.

doi: 10.1177/07067437211000665

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Related research summaries:

• TBI in Mental Health and Substance Use Service Settings