title: The high burden of traumatic brain injury and comorbidities amongst homeless adults with mental illness.
abstract: characterize the prevalence of self-reported head injury with loss of consciousness (LOC) and associated demographic, clinical and service use factors in a sample of homeless adults with mental illness.
  
  
  
  Participants in the At Home/Chez Soi study were interviewed at the time of study enrollment regarding their history of head injuries, mental and physical health diagnoses and justice system and healthcare interactions. Sociodemographic and clinical data were also collected.
  
  
  
  Over half of the 2088 study respondents (52.6%, n = 1098) reported a history of head injury with a LOC, which was associated with several demographic, clinical and service use variables in this population. With respect to specific mental health conditions, a history of head injury with LOC was associated with higher odds of current depression (OR = 2.18, CI: 1.83-2.60), manic episode or hypomanic episode (OR = 1.91, CI: 1.45-2.50), PTSD (OR = 2.98, CI: 2.44-3.65), panic disorder (OR = 2.37, CI:1.91-2.93), mood disorder (OR = 1.78, CI: 1.40-2.26) and alcohol (OR = 2.09, CI: 1.75-2.49) and drug (OR = 1.73, CI: 1.46-2.06) misuse disorders, but reduced odds of having diagnosis of a psychotic disorder (OR = 0.63, CI: 0.53-0.76). A history of head injury with LOC was also associated with increased use of variety of services, including family medicine (OR = 1.33, CI: 1.12-1.59), criminal justice system (OR = 1.50, CI: 1.25-1.80) and the emergency department (OR = 1.03, CI: 1.01-1.05).
  
  
  
  Amongst homeless adults with mental illness having a history of head injuries with LOC was independently associated with various adverse outcomes. These individuals constitute a high-risk group who may benefit from specialized services.
authors.affiliation: Trauma and Neurosurgery Program and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Topolovec-Vranic
authors.affiliation: Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Andree
authors.initials: A
authors.lastname: Schuler
authors.affiliation: Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Agnes
authors.initials: A
authors.lastname: Gozdzik
authors.affiliation: Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Somers
authors.affiliation: School of Psychology, Universite de Moncton, Moncton, NB, Canada.
authors.forename: Paul-Émile
authors.initials: PÉ
authors.lastname: Bourque
authors.affiliation: School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: C James
authors.initials: CJ
authors.lastname: Frankish
authors.affiliation: School of Psychology, Universite de Moncton, Moncton, NB, Canada.
authors.forename: Jalila
authors.initials: J
authors.lastname: Jbilou
authors.affiliation: School of Psychology, Universite de Moncton, Moncton, NB, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pakzad
authors.affiliation: Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Luis Ivan
authors.initials: LI
authors.lastname: Palma Lazgare
authors.affiliation: Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Division of General Internal Medicine, Department of Medicine, Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: hwangs@smh.ca.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology*; D015897:Comorbidity; D003244:Consciousness Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D057566:Self Report
keywords: Brain injuries; Comorbidity; Health care delivery; Homeless persons; Mental disorders; Psychiatric diagnosis