UBC Theses and Dissertations
Brain injury and brain health among individuals living in homelessness or precarious housing Stubbs, Jacob L.
Individuals living in homelessness or precarious housing experience poorer health and earlier mortality than the general population. The overall objective of this work was to characterize the role of traumatic brain injury in the health of these individuals, and evaluate quantitative structural magnetic resonance imaging (MRI) measures of brain structure among these individuals. First, we conducted a systematic review and meta-analysis on the prevalence, incidence, and role of traumatic brain injury in the health of these individuals. We found that more than half of individuals living in homelessness or precarious housing had experienced a traumatic brain injury during their lifetime, while more than one in five had experienced a moderate or severe traumatic brain injury. History of traumatic brain injury was associated with poorer mental and physical health, and poorer functioning. Next, we evaluated quantitative MRI measures of brain macrostructure and microstructure among these individuals compared to a general population sample. Using data from a large study of individuals living in homelessness or precarious housing (n=312), we found that older age was associated with more whole-brain atrophy and decrements in white matter measures as compared to the general population sample (n=382). History of traumatic brain injury, stimulant dependence, and heroin dependence were associated with further decrements in these MRI measures. Finally, we evaluated longitudinal trajectories of these MRI measures among individuals living in homelessness or precarious housing (n=300) and how these trajectories were associated with health and functioning. Rates of change varied across regions of interest, and traumatic brain injury, cardiovascular risk scores, alcohol dependence, and opioid dependence were associated with further decrements in these MRI measures. More rapid decline in MRI measures was associated with declining physical health, declining cognitive functioning, and mortality. Overall, we found that traumatic brain injury is more prevalent among individuals living in homelessness or precarious housing than in the general population, and that traumatic brain injury and other risk factors are associated with decrements in MRI measures of brain structure. A concerted effort is needed to ameliorate the brain health disparities experienced by individuals living in homelessness or precarious housing.
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