Traumatic brain injury rates and sequelae: a comparison of prisoners with a matched community sample in Australia

Association Between Traumatic Brain Injury and Psychopathic Traits Among Justice-Involved Adolescents

Traumatic brain injury (TBI) is a global public health problem and is highly prevalent among justice-involved populations. Pediatric TBI is linked with long-term negative outcomes and is correlated with substance use, criminal behavior, psychiatric disorders, and disruptions in neurocognition. These same TBI correlates are evident among youth with psychopathic traits. Given ongoing neurobiological and social development in adolescence, understanding the link between psychopathic traits and TBI in justice-involved youth is critical. A sample of 263 male adolescents were recruited from a maximum-security juvenile justice facility. Using a structural equation modeling (SEM) framework, measurement invariance of psychopathic traits (TBI ±) was tested, and psychopathy scores were accounted for in terms of TBI variables (severity, age of first TBI, total number), participant's age, IQ, substance use, and internalizing psychopathology. There was evidence of strong invariance across TBI status and those with TBI had higher affective and impulsive lifestyle psychopathic traits than adolescents without TBI. The SEM indicated that TBI severity was associated with lower IQ scores, which in turn were associated with increased lifestyle/antisocial (Factor 2) psychopathic traits. Total number of TBIs was associated with higher substance use, which was associated with both increased interpersonal/affective (Factor 1) and Factor 2 psychopathic traits. These TBI variables also had indirect associations with psychopathic traits through IQ and substance use. The findings indicate that TBI is associated with psychopathic traits and suggest that disturbances in cognition and substance use may be treatment targets for youth with TBI and psychopathic traits.

Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury

BACKGROUND

Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts.

PRIMARY OBJECTIVE

To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry.

REVIEW OF INFORMATION

Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus.

OUTCOMES

This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.

Devaluing Incarcerated Populations: Deprioritizing Incarcerated Populations for COVID-19 Vaccination

The COVID-19 pandemic has highlighted the need for increased attention to measures in place to protect the health of incarcerated populations. Correctional facilities saw massive COVID-19 outbreaks and correctional nurses have been at the forefront of efforts to control COVID-19 in correctional facilities. Before vaccines were widely available, the National Academies of Science, Engineering, and Medicine developed a framework to guide equitable COVID-19 vaccine allocation. This study assessed the use of the framework by reviewing 15 state COVID-19 vaccination plans to identify how incarcerated populations were prioritized. Thirteen initial plans could be located. Ten of these plans placed incarcerated persons in Phases 1 and 2, while 1 state placed them in Phase 3. However, subsequent versions of the plans revealed that 8 states had deprioritized incarcerated populations by no longer considering them as a unique population. The framework was developed to promote equity, however, incarcerated persons were often dis-included as a high-risk population for vaccine prioritization, prolonging their risk of COVID-19. Engaging in the opportunity to influence both policy and practice, and promote the ethical consideration of incarcerated populations may help to address both the structural (prison) challenges and larger political structures that impacted vaccine availability and ability to provide the best care possible to this high-risk population.

Self-reported traumatic brain injury in a sample of impulsive violent offenders: neuropsychiatric correlates and possible "dose effects"

Background

Traumatic brain injury (TBI) is a major public health problem that may be associated with numerous behavioral problems, including impulsivity, aggression and violence. Rates of self-reported TBI are high within offender populations, but the extent to which TBI is causally implicated in causing illegal behavior is unclear. This study examined the psychological and functional correlates of histories of traumatic brain injury in a sample of impulsive violent offenders.

Methods

Study participants, all men, had been recruited to participate in a randomized controlled trial of sertraline to reduce recidivism. Study entry criteria were an age of at least 18 years, a documented history of two or more violent offenses and a score of 70 or above on the Barratt Impulsiveness Scale. An extensive list of standardized questionnaires was administered to obtain information on previous TBI and other neuropsychiatric conditions or symptoms.

Results

In the sample of 693 men, 66% were aged between 18 and 35 years old, and 55% gave a history of TBI ("TBI+"). Overall, 55% of study participants reported at least one TBI. High levels of neuropsychiatric symptomatology were reported. In 75% of TBI+ individuals, their most severe TBI (by self-report) was associated with loss of consciousness (LOC) < 30 min. Compared to TBI- (those without history of TBI) participants, TBI+ individuals were more impulsive (Eysenck Impulsivity), irritable, angry, and reported higher levels of assaultive behavior, depressive symptomology, alcohol use disorder, suicidal ideation, suicide attempts, and lower quality of life. Potential "dose effects" of TBI severity and frequency in terms of neuropsychiatric symptomatology were identified.

Conclusion

Like other studies of offender populations, single and multiple TBIs were very common. The associations of TBI, TBI severity, and TBI frequency (i.e., TBI "burden") with adverse neuropsychiatric phenomena suggest TBI contributes importantly to offender morbidity but the select nature of the sample and cross-sectional study design constrain the interpretation of these findings.

Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital

BACKGROUND

Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services.

METHODS

We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression.

RESULTS

One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness.

CONCLUSIONS

The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.

Traumatic Brain Injury and Psychopathic Traits in Justice-Involved Adult Women

Studies have documented associations between traumatic brain injury (TBI) and mental disorders. The relationship between psychopathic personality and TBI remains poorly understood, though both are associated with similar characteristics (e.g., low empathy, aggression, disturbances in social/moral behavior). Yet, it is not clear whether assessment of psychopathic features is influenced by presence versus absence of TBI, and which aspects of TBI may be associated with psychopathic traits. This study examined the psychopathy-TBI association in justice-involved women (N = 341) with structural equation modeling. We tested if measurement invariance of psychopathic traits was evident among those with versus without TBI and which TBI variables (number, severity, age at first TBI) predicted psychopathic features in conjunction with symptoms of psychopathology, IQ, and age. Results provided evidence of measurement invariance, and more women with TBI, compared to those without, met criteria for psychopathy. Younger age of TBI and TBI severity predicted interpersonal-affective psychopathic features.

The association between self-reported traumatic brain injury, neuropsychological function, and compliance among people serving community sentences

BACKGROUND

Traumatic brain injury is overrepresented in incarcerated samples and has been linked to a number of poor correctional outcomes. Despite this, no research has explored the impact of a recent TBI on compliance outcomes for individuals serving community-based.

METHOD

We screened for a history of TBI in 106 adults on community sentences and collected compliance (arrests, sentence violations) and related variables (e.g., risk scores, substance use) over 6 months. Sixty-four participants also completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Comprehensive Trail Making Test and Color-Word Inference Test.

RESULTS

A TBI in the last year predicted a significantly higher likelihood of arrest, even when controlling for risk of reconviction and current substance use, but was not associated with non-compliance with sentence conditions nor with performance on the neuropsychological tests. In addition, no significant associations were found between performance on neuropsychological tests and measures of non-compliance.

CONCLUSIONS

TBI in the last year was an independent predictor of arrest. This result suggests that those with a recent TBI on a community sentence may need additional monitoring or support to reduce the risk of reoffending.

Traumatic brain injury is highly associated with self-reported childhood trauma within a juvenile offender cohort

PRIMARY OBJECTIVE

To identify correlates of past traumatic brain injury (TBI) in a population of young offenders.

RESEARCH DESIGN

Cross-sectional analyses were conducted on available data from a sample derived from the NSW Young People on Community Orders Health Survey.

PROCEDURES

Study participants were administered questionnaires to collect history relating to past TBI, childhood trauma, substance abuse, and psychological/psychiatric symptoms and underwent assessments of intellectual functioning. Information on offending history was accessed through Juvenile Justice administrative records.

OUTCOMES AND RESULTS

Analyses were undertaken on data from 788 young offenders (672 males and 116 females). A past TBI was reported in 39%. Symptoms of psychological distress were more prevalent in females. A history of TBI was associated with more symptoms on a Childhood Trauma Questionnaire, as well as higher psychological distress (K-10), and higher levels on standardized measures of anger/violence, post-traumatic stress, and substance abuse.

CONCLUSIONS

The experience of early life trauma warrants further consideration as an antecedent to both childhood TBI and offending which might account for some of the previously observed association of mild TBI with subsequent offending behavior.

Traumatic brain injury: a potential cause of violent crime?

Traumatic brain injury (TBI) is the biggest cause of death and disability in children and young people. TBI compromises important neurological functions for self-regulation and social behaviour and increases risk of behavioural disorder and psychiatric morbidity. Crime in young people is a major social issue. So-called early starters often continue for a lifetime. A substantial majority of young offenders are reconvicted soon after release. Multiple factors play a role in crime. We show how TBI is a risk factor for earlier, more violent, offending. TBI is linked to poor engagement in treatment, in-custody infractions, and reconviction. Schemes to assess and manage TBI are under development. These might improve engagement of offenders in forensic psychotherapeutic rehabilitation and reduce crime.

The Building Bridges project: Linking disconnected service networks in acquired brain injury and criminal justice

People with acquired brain injury (ABI) are overrepresented in prison populations across many countries. An effective service response to reduce this trend requires collaboration between the ABI and criminal justice (CJ) sectors. The Building Bridges project piloted a novel professional development model designed to increase cross-sectoral knowledge and collaboration between the ABI and CJ sectors. A total of 178 service providers from Victoria, Australia, participated in six professional development forums that included content about ABI, policing, disability and legal supports, and correctional/post-release services. Participants came from the disability, criminal justice, and health and community service sectors. Using a pre-test-post-test design with 6-month follow-up, data were obtained via a project-specific questionnaire evaluating knowledge and behaviour change among participants. Statistically significant gains in knowledge were shown at post-test and maintained at follow-up. Work-related behaviours addressing ABI/CJ issues had increased significantly within both sectors at follow-up compared to the 6 months prior to the forum. Carefully constructed professional forums improved cross-silo collaboration in the ABI/CJ sectors. This pilot project illustrates effective use of existing service resources, and highlights training as an important part of a raft of initiatives needed to address the overrepresentation of people with ABI in the CJ system.

'I am not drunk, I have an ABI': findings from a qualitative study into systematic challenges in responding to people with acquired brain injuries in the justice system

The over-representation of acquired brain injury (ABI) amongst prisoner and juvenile justice populations is a significant issue across jurisdictions. This article reports on the findings of over 100 interviews conducted in Victoria, Australia with people who have an ABI, as well as key stakeholder groups who work in, or with, the justice system. The study identified systemic problems faced by people with ABI along multiple points of the justice system continuum. Improved identification and diagnosis of ABI, well-resourced support for those with the condition, comprehensive training to improve ABI literacy among all stakeholder groups, and a more appropriate and therapeutic approach to people with ABI in the justice system are all recommended.

Prevalence of Traumatic Brain Injury in a Male Adult Prison Population and Its Association with the Offence Type

Background: The prevalence of traumatic brain injury (TBI) in prison populations has been found to vary considerably. This study aimed to determine the prevalence of TBI in a prison population in New Zealand and to identify whether age, ethnicity, offence type, security classification and sentence length were linked to TBI prevalence. Methods: All offenders admitted to a new Corrections Facility over a 6-month period (May-November 2015) were screened to understand their history of TBI. Data was merged with demographic information, details of the offence type, sentence length and security classification from the prison database. Binary logistic regression was used to identify the contribution of predictors on TBI history. Results: Of the 1,061 eligible male prisoners, 1,054 (99.3%) completed a TBI history screen. Out of the 672 (63.7%) who had sustained at least one TBI in their lifetime, 343 (32.5%) had experienced multiple injuries. One in 5 participants experienced their first TBI injury before the age of 15 years. A regression model was able to correctly classify 66.9% of cases and revealed that belonging to Māori ethnicity or being imprisoned for violent, sexual or burglary offences were independently predictive of TBI (χ2 = 9.86, p = 0.28). Conclusions: The high prevalence of TBI within male prisoners and a high proportion of injuries sustained in childhood suggest the need for routine screening for TBI to identify prisoners at risk of persistent difficulties. Interventions to support those experiencing persistent difficulties post-TBI are needed to optimise functioning and prevent reoffending.

History of traumatic brain injury in prison populations: A systematic review

Traumatic brain injury (TBI) can lead to cognitive, behavioural and social impairments. The relationship between criminality and a history of TBI has been addressed on several occasions.

OBJECTIVE

The objective of this review was to present an update on current knowledge concerning the existence of a history of TBI in prison populations.

METHODS

PubMed and PsycINFO databases were searched for relevant papers, using the PRISMA guidelines. We selected papers describing TBI prevalence among incarcerated individuals and some that also discussed the validity of such studies.

RESULTS

Thirty-three papers were selected. The majority of the papers were on prison populations in Australia (3/33), Europe (5/33) and the USA (22/33). The selected studies found prevalence rates of the history of TBI ranging from 9.7% and 100%, with an average of 46% (calculated on a total population of 9342). However, the level of evidence provided by the literature was poor according to the French national health authority scale. The majority of the prisoners were males with an average age of 37. In most of the papers (25/33), prevalence was evaluated using a questionnaire. The influence of TBI severity on criminality could not be analysed because of a lack of data in the majority of papers. Twelve papers mentioned that several comorbidities (mental health problems, use of alcohol…) were frequently found among prisoners with a history of TBI. Two papers established the validity of the use of questionnaires to screen for a history of TBI.

CONCLUSION

These results confirmed the high prevalence of a history of TBI in prison populations. However, they do not allow conclusions to be drawn about a possible link between criminality and TBI. Specific surveys need to be performed to study this issue. The authors suggest ways of improving the screening and healthcare made available to these patients.

Identifying Current Practices and Supports in Behaviour Management Following ABI in South Australian Community Settings: A Delphi Study

Objectives: To consider the strategies currently used by family care givers to manage challenging behaviour in the community following ABI, and to identify what supports are available that support family care givers in addressing this issue.

Research design: Delphi study.

Methods: Service providers (n = 8) and family care givers (n = 3) completed a three-round Delphi process with the aim of reaching consensus (75% agreement) regarding research objectives. Round 1 consisted of an open-ended questionnaire in which items were identified; these items were then rated in Round 2 and 3 using a Likert scale. Statistical aggregation then allowed for quantitative analysis.

Results: The findings suggest a number of behaviour management approaches are being used by family care givers, including basic antecedent strategies, agreeing with the person's demands, and medication. Consensus was reached that only two services in SA provide specific support to family care givers regarding behaviour management in the community: Families4Families Inc. (a peer support network) and Private Specialists (e.g., [neuro]psychologists and [neuro]psychiatrists).

Conclusions: Findings emphasise the need for more specialised services specific to educating and supporting family care givers in the management of challenging behaviours following ABI. These services should be accessible, centralised, and easy for family care givers to navigate.

Prevalence of traumatic brain injury and mental health problems among individuals within the criminal justice system

Traumatic brain injury (TBI) is associated with increased aggression and antisocial behavior. This review examined existing literature regarding TBI prevalence and associated adverse mental health among individuals within the criminal justice system. TBI prevalence varied between 12 and 82% for youths, and 23 and 87% for adults. TBI was associated with a range of negative outcomes, particularly substance abuse. However, confounding factors, including differing control groups, lack of information for timing and severity of TBI, and use of self-report measures for TBI history made it difficult to determine whether TBI was a risk factor. Future research should eliminate or counter for these confounds, to provide accurate prevalence rates of TBI and the direction of association between TBI and offending behaviors.

Efficacy of legal judgments for defendants with traumatic brain injury

BACKGROUND

Literature has compared the frequency of aggressive behaviors of the TBI population and the non-TBI population, suggesting that the TBI population is predisposed to aggressive tendencies because the injury enables impulsivity, loss of self-control, and the inability to modify behaviors. These behavior changes have consequently, been found to lead to criminal involvement. In fact, the majority of the prison population has sustained at least one TBI in their lifetime compared to the prevalence of brain injuries in the general population. However, there is little research investigating the perceptions of criminality and guilt of these individuals.

METHODS

Two experiments were conducted that investigated the perceptions of morality, level of guilt, and appropriate sentencing of crimes committed by defendants with different severities of TBI (i.e., mild, severe, and no TBI). Participants were asked to read scenarios about crimes being committed by the defendant. Experiment 1 used a 1-between (crime), 1-within (TBI) mixed design ANOVA testing three dependent variables (morality, guilt, and sentencing). Using a more in vivo jury approach, Experiment 2 used a 3 (TBI)×2 (crime) independent groups factorial design testing the three dependent measures.

RESULTS

Overall, defendants with TBI were found less guilty of their crime, perceived as behaving morally to the crime, and receiving a milder punishment relative to the no-TBI defendants.

CONCLUSIONS

In the courtroom, the defense attorney should educate the judge and/or the jury on the effects brain injuries have on the cognition, behavior, and emotions of an individual. Thus, this education will ensure the best verdict is being reached.

Longitudinal Predictors of Criminal Arrest After Traumatic Brain Injury: Results From the Traumatic Brain Injury Model System National Database

OBJECTIVE

To examine how pre-traumatic brain injury (TBI) variables and TBI-related characteristics predict post-TBI criminal arrest, using longitudinal data from the Traumatic Brain Injury Model System National Database.

SETTINGS

Medical hospitals; rehabilitation facilities.

PARTICIPANTS

Participants with documented TBI and nonmissing Traumatic Brain Injury Model System data, resulting in N = 6315 at 1 year post-TBI, N = 4982 at 2 years post-TBI, and N = 2690 at 5 years post-TBI.

DESIGN

Prospective cohort study with secondary data analysis of the relationship between pre-TBI/TBI factors and post-TBI criminal arrest as measured at 3 time points.

MAIN MEASURES

Self-report of post-TBI criminal arrest.

RESULTS

Post-TBI criminal arrest was associated with gender, age, marital status, educational attainment, pre-TBI felony, pre-TBI drug abuse, pre-TBI alcohol abuse, and violent cause of TBI. Frontal, temporal, parietal, or occipital lobe lesions from computed tomographic scans did not predict post-TBI criminal arrests. Higher numbers of post-TBI arrests were predicted by loss of consciousness (≥24 hours), combined with retention of motor function.

CONCLUSION

Premorbid variables, especially pre-TBI felonies, were strongly linked to post-TBI criminal arrests. The relationship between TBI and arrest was complex, and different brain functions (eg, physical mobility) should be considered when understanding this association. Findings highlight that for post-TBI criminal behavior, many risk factors mirror those of the non-TBI general population.

Traumatic brain injury and co-occurring problems in prison populations: A systematic review

BACKGROUND

A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population.

METHODS

Six electronic databases were systematically searched for articles published between 1980-2014. Studies were screened for inclusion based on pre-determined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool.

RESULTS

Twenty-six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good), with an overall average of 60%. Twenty-four papers included TBI prevalence rates, which ranged from 5.69-88%. Seventeen studies explored co-occurring factors including rates of aggression (n = 7), substance abuse (n = 9), anxiety and depression (n = 5), neurocognitive deficits (n = 4) and psychiatric conditions (n = 3).

CONCLUSIONS

The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured, with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI and qualitative outcomes were found.

Prevalence of traumatic brain injury and epilepsy among prisoners in France: Results of the Fleury TBI study

OBJECTIVE

The first aim of this study was to estimate the prevalence of TBI and epilepsy in a French prison population and to study variables known to be associated with TBI. The second aim was to compare prisoners with and without a history of TBI.

PARTICIPANTS

All offenders (females, males and juveniles) admitted consecutively to Fleury-Mérogis prison over a period of 3 months were included in the study.

DESIGN

During the admission procedure, offenders were interviewed by healthcare staff using a self-reported questionnaire.

RESULTS

In all, 1221 prisoners were included. The rates of TBI and epilepsy were high, with a prevalence of 30.6% and 5.9%, respectively. Psychiatric care, anxiolytic and antidepressant treatment, use of alcohol and cannabis were all significantly higher among offenders with a history of TBI. Moreover, the number of times in custody and the total time spent in jail over the preceding 5 years were significantly higher among offenders with a history of TBI.

CONCLUSIONS

These results provide further evidence that specific measures need to be developed such as, first of all, screening for TBI upon arrival in prison.

Alcohol and other drug use among Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander men entering prison in New South Wales

Introduction and aims

Prison entrants commonly have a history of problematic alcohol and other drug (AoD) use. Aboriginal and Torres Strait Islander (Indigenous) Australians are vastly overrepresented in Australian prisons with an incarceration rate 16 times that of non-Indigenous Australians. Relatively little attention has been given to the patterns of AoD use among prison entrants and we hypothesise that they may differ between Indigenous and non-Indigenous entrants. The aim of this paper is to compare the prior AoD use among Indigenous and non-Indigenous prison entrants and identify the implications for AoD treatment provision within prisons.

Design and method

Cross-sectional random sample of 200 men recently received into New South Wales (NSW) criminal justice system.

Results

During the 12 months prior to imprisonment, 106 prison entrants consumed alcohol at levels at which an intervention is recommended. Additionally during the four weeks prior to prison, 94 inmates had used illicit drugs daily. There was some overlap between these two groups; however, heroin users were less likely to consume alcohol at harmful levels. Relative to non-Indigenous entrants, Indigenous entrants prior to imprisonment used more cannabis but less amphetamine on a daily basis. There were no other significant differences between the alcohol or drug use of Indigenous and non-Indigenous prison entrants.

Discussion and conclusion

Both Indigenous and non-Indigenous men entering prison have a history of high levels of AoD use but a slightly different treatment focus may be required for Indigenous inmates.

Traumatic brain injury and early life experiences among men and women in a prison population

This study examined the proportion of men and women reporting previous traumatic brain injury (TBI) in an Ontario (Canada) prison sample by demographic characteristics; adverse life experiences; and criminal, drug, and alcohol use history. Using data from The Cost of Substance Abuse in Canada study based on a random sample from four Ontario prisons, this study found 50.4% of males and 38% of females reporting previous TBI. More TBIs occurred before the first crime for women than for men. Women with TBI experienced more early physical and sexual abuse than those without TBI. Additionally, this study shows high prevalence of early life experiences among persons, particularly women, with a history of TBI. Prisoners and prison staff should be educated on TBI and best practice for rehabilitation of TBI.

Prevalence of traumatic brain injury in the general adult population: a meta-analysis

Traumatic brain injury (TBI) is a significant public-health concern. To understand the extent of TBI, it is important to assess the prevalence of TBI in the general population. However, the prevalence of TBI in the general population can be difficult to measure because of differing definitions of TBI, differing TBI severity levels, and underreporting of sport-related TBI. Additionally, prevalence reports vary from study to study. In this present study, we used meta-analytic methods to estimate the prevalence of TBI in the adult general population. Across 15 studies, all originating from developed countries, which included 25,134 adults, 12% had a history of TBI. Men had more than twice the odds of having had a TBI than did women, suggesting that male gender is a risk factor for TBI. The adverse behavioral, cognitive and psychiatric effects associated with TBI coupled with the high prevalence of TBI identified in this study indicate that TBI is a considerable public and personal-health problem.

The challenges of reducing tobacco use among prisoners

ISSUE

The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention.

APPROACH

This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial.

KEY FINDINGS

The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons.

IMPLICATIONS

Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners.

CONCLUSIONS

As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future.

A cross-sectional survey of prevalence and correlates of suicidal ideation and suicide attempts among prisoners in New South Wales, Australia

Background

We aimed to estimate the prevalence of suicidal ideation and suicide attempt among prisoners in New South Wales, Australia; and, among prisoners reporting suicidal ideation, to identify factors associated with suicide attempt.

Methods

A cross-sectional design was used. Participants were a random, stratified sample of 996 inmates who completed a telephone survey. The estimated population prevalence of suicidal ideation and suicide attempt were calculated and differences by sex and Aboriginality were tested using χ2 tests. Correlates of suicidal ideation and suicide attempt were tested using logistic regression.

Results

One-third of inmates reported lifetime suicidal ideation and one-fifth had attempted suicide. Women and Aboriginal participants were significantly more likely than men and non-Aboriginal participants, respectively, to report attempting suicide. Correlates of suicidal ideation included violent offending, traumatic brain injury, depression, self-harm, and psychiatric hospitalisation. Univariate correlates of suicide attempt among ideators were childhood out-of-home care, parental incarceration and psychiatric hospitalization; however, none of these remained significant in a multivariate model.

Conclusions

Suicidal ideation and attempts are highly prevalent among prisoners compared to the general community. Assessment of suicide risk is a critical task for mental health clinicians in prisons. Attention should be given to ensuring assessments are gender- and culturally sensitive. Indicators of mental illness may not be accurate predictors of suicide attempt. Indicators of childhood trauma appear to be particularly relevant to risk of suicide attempt among prisoners and should be given attention as part of risk assessments.