Impact of Traumatic Brain Injury and Overdose on Health Outcomes in Precariously Housed Adults

Background

Traumatic brain injuries (TBIs) and non-fatal overdoses (NFODs) have both been associated with poorer quality of life and cognition. However, the combined effects of TBIs and NFODs and the cumulative burden of numerous injuries on health and functioning outcomes have not been examined. We aimed to examine the effect of TBIs and NFODs on cognition, disability, and quality of life in a precariously housed sample.

Methods

Participants completed the Montreal Cognitive Assessment (MoCA), WHO Disability Assessment Schedule (WHODAS-36), Short Form-36 (SF-36), and self-report histories of NFOD and TBI. Participants were categorized as no injury (n = 19), NFOD only (n = 26), TBI only (n = 48), and NFOD+TBI (n = 107). Injuries were also examined by frequency (0: n = 19, 1-2: n = 36, 3-5: n = 63, 6-9: n = 45, 10: n = 38). Groups were compared using linear regression, adjusted for age, gender, education, and Charlson Comorbidity Index score.

Results

The mean age of participants was 52.5 (SD = 7.9) years and 24.0% were female. MoCA scores were not associated with NFOD or TBI history, or injury burden. Disability scores were significantly higher for those with TBI (B = 13.2, p=.02) and NFOD+TBI (B = 16.8, p=.001). TBI history was associated with lower SF-36 mental component scores (MCS; B=-11.0, p=.003), while NFOD+TBI was associated with significantly lower MCS (B=-9.9, p=.003) and physical component scores (PCS; B=-6.0, p=.02). Increasing injury burden was associated with stepwise increases in disability (3-5: B = 13.1, p=.01; 6-9: B = 15.9, p=.003; 10: B = 26.4, p<.001) and decreases in MCS (3-5: B=-9.2, p=.009; 6-9: B=-9.3, p=.01; 10: B=-13.9, p<.001) and PCS (10: B=-8.6, p=.004).

Conclusions

NFOD and TBI, as well as cumulative injury burden were strongly associated with greater disability and poorer quality of life but not with cognitive performance. These findings highlight the potential contribution of NFOD and TBI to decline in precariously housed populations.

Key messages

• Traumatic brain injury and non-fatal overdose, alone and combined, are linked to greater disability and poorer quality of life in precariously housed adults, highlighting a substantial health burden.

• Cumulative injury burden shows a stepwise association with poorer disability and quality of life, underscoring the need for prevention targeting repeated injuries in vulnerable populations.