title: Does Traumatic Brain Injury Lead to Criminality? A Whole-Population Retrospective Cohort Study Using Linked Data.
abstract: BACKGROUND
  Traumatic brain injury (TBI) may be a risk factor for criminal behaviour however multiple factors potentially confound the association.
  
  
  METHODS
  Record linkage and Cox proportional hazards regression analyses were used to examine the association between hospital-recorded TBI (n = 7,694) and subsequent first criminal conviction in a retrospective cohort matched 1:3 with 22,905 unaffected community controls and full-sibling controls (n = 2,397). Aboriginality, substance abuse, social disadvantage, and mental illness were included in analyses as potential confounders.
  
  
  RESULTS
  In multivariable models, relative to general population controls, TBI was associated with any conviction (males: Hazard Ratio (HR) = 1.58 (95% CI 1.46 to 1.72); females: HR = 1.52 (95% CI 1.28 to 1.81)); and similar Hazard Ratios were obtained for the sibling analyses in males (HR = 1.68 (95% CI 1.31-2.18)) and females (HR 1.27 (95% CI 0.71-2.29)). TBI was also associated with violent convictions relative to the general population, (males: HR = 1.65 (95% CI 1.42 to 1.92); females HR = 1.73 (95% CI 1.21 to 2.47)), and in analyses with sibling controls in men (HR = 1.89 (95% CI 1.20-3.00)), but not in women (HR 0.73, 95% CI 0.29-1.81)).
  
  
  CONCLUSIONS
  The results support a modest causal link between TBI and criminality after comprehensive adjustment for confounding. Reducing the rate of TBI, a major public health imperative, might have benefits in terms of crime reduction.
authors.affiliation: Neuropsychiatry Service, Hunter New England Local Health District, Newcastle, NSW, Australia; Centre for Translational Neuroscience and Mental Health (CTNMH), University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Schofield
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Eva
authors.initials: E
authors.lastname: Malacova
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, WA, Australia.
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
authors.affiliation: National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: D'Este
authors.affiliation: Rehabilitation Studies Unit, University of Sydney, Sydney, NSW, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Tate
authors.affiliation: Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Reekie
authors.affiliation: Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.affiliation: Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000066479:Criminal Behavior; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014754:Violence; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult