The high burden of traumatic brain injury and comorbidities amongst homeless adults with mental illness

Topolovec-Vranic, Jane; Schuler, Andrée; Gozdzik, Agnes; Somers, Julian M.; Bourque, Paul; Frankish, C. James; Jbilou, Jalila; Pakzad, Sarah; Lazgare, Luis Ivan Palma; Hwang, Stephen

doi:10.1016/j.jpsychires.2016.12.004

Cited by 41 publications

(65 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Table 1 illustrates the characteristics of the articles included in this study. Of the 31 studies, 12 were conducted in the USA [37–40, 42–44, 47, 49, 55, 58, 60], four were conducted in Canada [45, 48, 57, 59], three conducted in German [20, 21, 41], two conducted in Ethiopia [7, 51], two conducted in France [22, 62], two conducted in Scotland) [56, 61], one conducted in China [63], one conducted in Spain [38], one conducted in the UK [50], one conducted in Japan [52], one conducted in Ireland [53], one conducted in Serbia [46], and one conducted in Australia [54]. The studies were published between 1984, and 2017, with the sample size ranging between 33 participants in the German and 29,143 participants in Canada.…”

Section: Resultsmentioning

confidence: 99%

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

Ayano¹,

2019

View full text Add to dashboard Cite

BackgroundSchizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. This systematic review and meta-analysis aimed to estimate the pooled prevalence of schizophrenia and other psychotic disorders among homeless people.MethodsPubMed, Embase, and Scopus were searched to identify pertinent studies. We used a fixed- or random-effect meta-analysis to pool data from the included studies depending on the anticipated heterogeneity. A predesigned search strategy, as well as inclusion and exclusion criteria, were used. We also performed subgroup and sensitivity analysis and Cochran’s Q- and the I2 test was employed to compute heterogeneity. Egger’s test and visual inspection of the symmetry in funnel plots were used to assess publication bias.ResultsThirty-one studies involving 51,925 homeless people were included in the final analysis. The meta-analysis showed a remarkably higher prevalence of psychosis [21.21% (95% CI:13.73, 31.29), I2 = 99.43%], schizophrenia [10.29% (95%, CI: 6.44, 16.02), I2 = 98.76%], schizophreniform disorder [2.48% (95% CI: 6.16, 28.11), I2 = 88.84%] schizoaffective disorder [3.53% (95% CI: 1.33, 9.05), I2 = 31.63%,] as well as psychotic disorders not otherwise specified [9% (95% CI: 6.92, 11.62), I2 = 33.38%] among homeless people. The prevalence estimate of psychosis was higher in developing (29.16%) as compared to developed (18.80%) countries. Similarly, the prevalence of schizophrenia was highest in developing (22.15%) than developed (8.83%) countries.ConclusionThis systematic review and meta-analysis revealed that schizophrenia and other psychotic disorders are highly prevalent among homeless people, indicating an urgent need for studies to help develop better mechanisms of prevention, detection as well as treatment of those disorders among homeless people.

show abstract

Section: Resultsmentioning

confidence: 99%

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

Ayano¹,

2019

View full text Add to dashboard Cite

show abstract

“…Individuals who have experienced homelessness have an increased risk of mental health conditions, substance use, and chronic health conditions, as well as an increased incidence of brain injury (Foster et al, 2010;Jones et al, 2009;Stubbs et al, 2019;Substance Abuse and Mental Health Administration, 2011;Topolovec-Vranic et al, 2017;Zlotnick & Zerger, 2008). Each of these conditions can contribute to decreased cognitive performance, and those with multiple chronic conditions are more likely to experience negative impacts on functional cognition (American Occupational Therapy Association [AOTA], 2019; Pelimanni & Jehkonen, 2019;Wei et al, 2019).…”

Section: Literature Review Occupational Therapy and Homelessnessmentioning

confidence: 99%

Occupational Therapy in Integrated Primary Care: Addressing the Needs of Individuals Experiencing Homelessness

Synovec¹,

Merryman²,

Brusca³

2020

The Open Journal of Occupational Therapy

View full text Add to dashboard Cite

Background: Current health care policy supports occupational therapy services with individuals experiencing homelessness in primary care settings. Research on the impact of interventions is needed to support this emerging practice area. Method: : A retrospective, descriptive study was completed following the initiation of full-time occupational therapy services in an integrated primary setting and Federally Qualified Health Center (FQHC) for clients experiencing homelessness. This study evaluated: (a) percentage of referred clients who engaged in ongoing intervention; (b) diagnostic demographics of those referred; (c) functional goal types and frequency; (d) a comparison of preintervention Canadian Occupational Performance Measure (COPM) scores with postintervention scores. Results: : Analysis of data revealed clients referred for occupational therapy services present with complex co-morbidities. t tests for matched pairs (p < .05) revealed that participants had a statistically significant improvement in COPM performance scores (69%) and in COPM satisfaction scores (73%) between baseline and postintervention. Diagnostic subgroups had a similar rate of improvement. Analysis of client identified COPM goals revealed a high rate of instrumental activity of daily living focused goals. Conclusion: : Integration of full-time occupational therapy services into FQHC settings increases client access to functional-based rehabilitation services that address physical and behavioral health. Individuals experiencing homelessness demonstrate improvement toward functional goals using client-centered goal setting processes and interventions. Comments The authors report no potential conflicts of interest.

show abstract

“…Homeless characteristics such as residential instability or substance use were associated with sustaining TBI (Stubbs et al 2020 ). Another study found those homeless with a history of head injury with loss of consciousness was associated with higher odds of depression, manic or hypomanic episodes, post-traumatic stress disorder, panic disorder, mood disorder, and alcohol and drug misuse disorders (Topolovec-Vranic et al 2017 ). This bidirectional relationship between TBI and homelessness is important to understand for physicians and care providers to address the impact of TBI on the homeless population.…”

Section: Introductionmentioning

confidence: 99%

Disparities in triage and management of the homeless and the elderly trauma patient

et al. 2020

View full text Add to dashboard Cite

Background: Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community. Methods: A retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed. Results: Of 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates. Conclusions: Homeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to preexisting health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.

show abstract

The high burden of traumatic brain injury and comorbidities amongst homeless adults with mental illness

Cited by 41 publications

References 50 publications

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

Occupational Therapy in Integrated Primary Care: Addressing the Needs of Individuals Experiencing Homelessness

Disparities in triage and management of the homeless and the elderly trauma patient

Contact Info

Product

Resources

About