6 ms·

Almost half of homeless men had traumatic brain injury in their lifetime

82 points by pyduan 12y ago

ribs 12y ago
Need a control group - the rate of TBI amongst non-homeless men.
- keithflower 12y ago
  The full paper[1] addresses this to some extent (my emphasis added below): "Accurate estimates of the lifetime history (prevalence) of traumatic brain injury within the general population are scarce, which makes it difficult to compare rates of injury among homeless people with rates among those in the community. Two community cohort studies suggested prevalence rates of 3.8% (for experiencing at least 1 admission to hospital for traumatic brain injury by age 35; northern Finland birth cohort) and 31.6% (for experiencing a traumatic brain injury for which the person received medical care; Christchurch, New Zealand, birth cohort). Together, these data suggest that rates may be higher among people who are homeless than within the general community. A recent study estimated that homeless men had rates of head injury 14 times higher than rates for the general population of Canada, with a rate 400 times higher among those who were chronically homeless and had drinking problems." And not oranges and oranges comparison, but[2]: "Separately, a recent study by Dr. Stephen Hwang of the hospital's Centre for Research on Inner City Health, found the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent -- seven times higher than the general population." [1] http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full [2] http://www.ncbi.nlm.nih.gov/pubmed/24651000 http://www.ncbi.nlm.nih.gov/pubmed/24651000
- gpcz 12y ago
  The paper ( http://www.biomedcentral.com/1471-2458/12/1059 http://www.biomedcentral.com/1471-2458/12/1059 ) is a meta-analysis of papers addressing this correlation. In the section "Limitations of the evidence base," the author notes the deficiency you pointed out in most papers (only two had a control group), among other deficiencies. The conclusion is a rallying cry for larger and more rigorous studies on the matter since the current (ragtag) evidence shows a noticeable correlation.
- cup 12y ago
  12% according to this reference from reddit. http://www.karger.com/Article/Abstract/343275 http://www.karger.com/Article/Abstract/343275
- jacalata 12y ago
  I was wondering that too, but the end of the article does mention it: "the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent -- seven times higher than the general population." So it sounds like the rate in the normal population is about 8%, but that's probably men and women. Even if it was entirely men that had it (unlikely), that would put the incidence in the general population of men at 16%, significantly lower. And that rate includes the ones that end up homeless.
deleted 12y ago
[deleted]
keithflower 12y ago
A link to the actual paper (full text): http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full
blairbeckwith 12y ago
Just a few weeks ago, I was walking home from work and witnessed one homeless man suckerpunch another in the face, knocking him off balance on ice and causing him to fall straight back and crack his head open on the ice. There was an instant pool of blood that started spreading quickly, with other homeless people scattering instantly. A cop arrived on the scene almost immediately. I was incredibly surprised reading this that 87% had TBI before becoming homeless. I wonder what the numbers are for repeated TBI after becoming homeless among those that had their first instance pre-homelessness.
- drawnalong 12y ago
  I'll echo what is said further down; it is good to see a reasonable look into homelessness here on HN. I literally just came bsck from a vigil for a man who died in a self-lit fire in an abandoned moving truck parked in my hometown. The vigil was attended by homeless advocates of all political stripes, had a local police officer singing at the beginning and end, and a gubernatorial candidate was around as well. The "issue of homelessness" is definitely complicated, and amongst the crowd tonight, all holding candles, were those who take stands for rental vouchers, more conservative "housing first" policies, expanded mental health care, and a few other approaches. There were plenty of compassionate Christian conservatives there who I appreciate for their emphasis on pragmatism and on human dignity, even though the solutions run against their deeply held political beliefs. As someone who has always felt just a day a way from slipping into homelessness myself, including struggling with alcoholism - the one thing I can say for certain is that the only way to address this is by continuing to address the issue honestly, trying the best we can with evidence of what works. I wish I could say I trust my faculties, but week to week its obvious I have a problem, even back when I was 9 years into sobriety.. In America, we definitely err on the side of personal liberty and responsibility, and though I agree with that in some abstract sense, it is obvious to me that moralizing the issue as one of choice, or as one of laziness vs. hard work and determination, is a failure. We can do better, and we will, but in the process we're going to have to accept responsibility for each other in a costly and politically inconvenient way. The fact that people came out tonight in my hometown to celebrate our common humanity, despite another tragic loss, is admirable. It is what defines us as a human family. Although the circumstances anger me personally, all these people tonight, and the people here on HN, prove there is a solution, even if it is a hard process and not a clear destination.
cup 12y ago
What shocked me when I used to do the soup van run in my local city was how age didn't discriminate when it came to homelessnes. I saw men (and boys) across the whole age range living in unnacceptable situations. Some of them could have been my friends for all I know as they did their best to hide their homelessness. Furthermore, I was always perplexed as to why there were far more homeless males than females. While my local government provides a number of shelters for men and women, there was never enough room for men. We would frequently scout the local homeless haunts (under bridgers, besides powerstations or in church car parks) looking for people who might need some supper. In this day and age It's pretty disagraceful in my view. I've always thought it would be nice if someone could come up with a kickstarer/kiva like hybrid where you could sponsor local homeless people with enough money to find accomodation and medical/psychological assistance.
- firstOrder 12y ago
  > it would be nice if...you could sponsor homeless people with enough money to find accomodation and medical/psychological assistance You're presuming that our society and economy isn't designed to purposefully try to get a certain percentage of people into this situation. If someone theoretically entertains the possibility that this is the case ( http://en.wikipedia.org/wiki/Reserve_army_of_labour http://en.wikipedia.org/wiki/Reserve_army_of_labour ), then that would be like building sand castles on the shore during low tide. Actually you don't have to go back to the 19th century to read about this. Read what mainstream economists openly say about NAIRU, or what Business Week and the Wall Street Journal were openly saying when the unemployment rate went below 4% in early 2000. They were pretty much calling for higher unemployment rates - as much as you can get away with in this society any way.
- Crake 12y ago
  Women have an easier time finding somewhere to stay because they are considered more valuable to society. Men are disposable, which is why far fewer resources are devoted to helping them. Women also can just get a boyfriend if they lose their job or health and need money; I've seen my female friends do this loads of times, but have yet to see it go the other way. Gender roles definitely favor women pretty heavily when it comes to financial matters.
Mz 12y ago
The aftereffects of traumatic brain injury is a very intractable problem that significantly damages a person's life. People tend to be on the street because of intractable personal problems, not because of lack of money per se. I have thought a lot about that and I often wonder what we can do to heal the bodies and minds of the homeless as our first priority instead of trying to act like homelessness itself is the problem and like getting shelter of some sort is the priority. Homeless shelters are often really crappy shelter, with no privacy and terrible air quality and so forth. I won't go to one because I am on the street to get myself well and I can't solve my problems if I can't get well. Homeless shelters are generally not clean enough for my needs. They would help keep me sick. I can't ever solve my problems by staying chronically ill. My financial problems are rooted in my health problems. I never know how to explain that effectively to other people who think a) my lack of housing proves I am incompetent and thus not credible or worth listening to and b) housing, any housing, is the single most important detail to address. Years ago, I lived for a few months in a crap trailer. My health took a turn for the worse and in some ways never recovered. I am still trying to undo the damage of those few months. I have enough income that I could probably go to someplace super cheap, like rural Alabama or Mississippi, and find a trailer for rent to live in instead of choosing to be on the street and inexpensive California where the climate is good for my health but I can't afford housing. And I never know how to explain to people that I am doing the right thing and this focus on get a home, any home, is the wrong focus and is part of the problem. I am glad to see this posted here. I think this is probably a lot better thing to post on HN than a lot of stories that wind up here which showcase specific homeless individuals and, more often than not, seem to convince people that the individual in question just needs to "be more responsible" or "make better choices."
sys32768 12y ago
My relative is almost homeless three years after a TBI in an accident he drove home from. Prior to that he was a talented contractor who supported a family and had many friends. Despite herculean efforts by friends and family and even strangers, he is fundamentally broken in ways nobody seems to understand. He still largely thinks of himself as the person he was prior to the TBI. My guess at this grim stage is the mechanisms are broken that allow him to self-correct his behavior and make accurate, up-to-date "I am" statements. Clues to this are when you confront him about his behavior or how he never bathes. He is not offended or worried but rather agitated, as if his brain short-circuits. At best you get cognitive distortions and at worst he storms away in a rage he won't remember five minutes later. Interventions and threats have no postive effect. He will talk your ear off all day about hobbies he had prior to his TBI, and if you didn't smell him or notice his pan handling sign, you might not know there is any problem. But make no mistake, invite this man to live with you and you will be tearing your hair out after two weeks and kicking him out in three, if not sooner. Every TBI is unique just as every person is. My relative does not accurately remember what parts of his brain was injured, so interviewing him would not yield much. Besides that, after this happened I read that something like 80% of TBIs do not even show on common medical imaging devices. In my relative's case there was evidence "suggestive" of DAI (diffuse axonal injury) which may explain why his deficits are so profound, but nobody can say. During therapy there was clear evidence that his deductive reasoning skills were seriously compromised, so imagine practical consequences if you cannot do simple deductive reasoning but also cannot realize it. Then of course TBI survivors are many times more likely to suffer additional TBIs. Add substance abuse and limited to no impulse control and you have a person who is a danger to himself and often society, but who also may refuse to get the level of help they truly need. In his case, he needs assisted living including someone to manage all of his money, but in his mind he does not and he appears ready to fight it until his last breath. I hope studies like this lead to more humane and informed programs to help people like him. I was just thinking this morning how unjust it is that murderers and other criminals can get room and board for life yet the best we can manage for this once talented and caring member of society is a room in a drug-infested flop house that costs half of his disability income.
- r00fus 12y ago
  It is sad we don't have a safety net any longer - we used to have asylums now we have homeless people who are mostly mentally ill in some fashion or another. I'm not sure how I'd cope if I had a relative with a similar situation. Thanks for sharing your story.
deleted 12y ago
[deleted]
tokenadult 12y ago
I tried to follow the DOI link to the underlying article, to see at least its abstract, but that link is dead. I don't see any uptake of this hospital press anywhere outside Science Daily, a press-release recycling service often decried[1] by thoughtful readers here on HN. Another kind reader here found the link to the original paper, http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full which reports "Methods We recruited participants from an urban men’s shelter in Toronto, Ontario. Researchers administered the Brain Injury Screening Questionnaire, a semistructured interview screening tool for brain injury. Demographic information and detailed histories of brain injuries were obtained. Participants with positive and negative screening results were compared, and the rates and mechanisms of injury were analyzed by age group. "Results A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range 27–81 yr) participated. Nearly half (50 [45%]) of the respondents had a positive screening result for traumatic brain injury. Of these, 73% (35/48) reported experiencing their first injury before adulthood (< 18 yr), and 87% (40/46) reported a first injury before the onset of homelessness." In other words, I think this is an interesting idea that deserves further investigation (and, for all I know, despite the statement in the article, has been investigated a lot already), but I have no idea how representative the patients that Dr. Jane Topolovec-Vranic found are of all the homeless people in her country, or what the direction of causation is here (could something that increases risk for homelessness at one and the same time increase risk for traumatic brain injury? very likely yes). Research on how to help people who have suffered brain injuries to recover from those injuries is of course a good idea, as is research on the consequences of those injuries, including social consequences like homelessness. Best of all is to figure out how to reduce risk of suffering such injuries. As the article says, "Additional research is needed to understand the complex interactions among homelessness, traumatic brain injury, mental illness and substance use." I would definitely wonder about the substance use part of that. [1] Science Daily has been decried so often on Hacker News that I have been collecting those comments for a few years. http://news.ycombinator.com/item?id=3992206 http://news.ycombinator.com/item?id=3992206 "Blogspam. "Original article (to which ScienceDaily has added precisely nothing): http://www.washington.edu/news/articles/abundance-of-rare-dna-changes-following-population-explosion-may-hold-common-disease-clues http://www.washington.edu/news/articles/abundance-of-rare-dn... "Underlying paper in Science (paywalled): http://www.sciencemag.org/content/early/2012/05/16/science.1219240 http://www.sciencemag.org/content/early/2012/05/16/science.1... "Brief writeup from Nature discussing this paper and a couple of others on similar topics: http://www.nature.com/news/humans-riddled-with-rare-genetic-variants-1.10655 http://www.nature.com/news/humans-riddled-with-rare-genetic-... http://news.ycombinator.com/item?id=4108603 http://news.ycombinator.com/item?id=4108603 "Everything I've ever seen on HN -- I don't know about Reddit -- from ScienceDaily has been a cut-and-paste copy of something else available from nearer the original source. In some cases ScienceDaily's copy is distinctly worse than the original because it lacks relevant links, enlightening pictures, etc. " . . . . if you find something there and feel like sharing it, it's pretty much always best to take ten seconds to find the original source and submit that instead of ScienceDaily." Comments about both PhysOrg and ScienceDaily: http://news.ycombinator.com/item?id=3689185 http://news.ycombinator.com/item?id=3689185 "Why hasn't sciencedaily.com or physorg been banned from HN yet?" https://news.ycombinator.com/item?id=3867348 https://news.ycombinator.com/item?id=3867348 "A useful rule of thumb is that whenever you see anything on sciencedaily.com or physorg.com, unless it's absolute nonsense there's another more direct (and often more informative) source you should link to instead." http://news.ycombinator.com/item?id=3875529 http://news.ycombinator.com/item?id=3875529 "Original source: http://www.nasa.gov/mission_pages/hinode/news/pole-asymmetry.html http://www.nasa.gov/mission_pages/hinode/news/pole-asymmetry... "What ScienceDaily has added to this: (1) They've removed one of the figures. (2) They've removed links to the Hinode and SOHO websites. (3) They've added lots of largely irrelevant links of their own, all of course to their own site(s). "Please, everyone: stop linking to ScienceDaily and PhysOrg." http://news.ycombinator.com/item?id=3867361 http://news.ycombinator.com/item?id=3867361 "Those sources don't have RSS feeds, and ScienceDaily and PhysOrg have a bad habit of not linking to such things." http://news.ycombinator.com/item?id=4083766 http://news.ycombinator.com/item?id=4083766 "Added value in PhysOrg article: zero. "Please, everyone, stop submitting links from PhysOrg and ScienceDaily. I have never ever ever seen anything on those sites that isn't either (1) bullshit or (2) a recycled press release with zero (or often negative) added value. (Sometimes it's both at once.) It only takes ten seconds' googling to find the original source."
simonster 12y ago
While it is quite plausible that brain damage associated TBI can cause homelessness, the causal influence is probably lower than the given percentages imply. According to the article: "In Canada, the leading mechanisms of traumatic brain injury leading to hospital admission over the decade 1994–1995 to 2003–2004 were motor-vehicle-related for adults less than 60 years of age and falls for those 60 years of age or older, with assaults reported as the mechanism of injury at a substantially lower rate than we have reported here." The article also shows high prevalence of alcohol/drug-related TBI in the homeless, whereas in the general population, "being struck by or against an object, motor vehicle collisions and sport-related injuries were the most common mechanisms." Together, the differences in the causes of TBI between the homeless subjects and the general population imply that, in at least some cases, the TBI and homelessness are likely to have a common cause (e.g. alcohol/drug addiction or certain personality traits). The article recognizes this possibility, but doesn't attempt to correct for it. To get a better idea of the causal effect, it would be informative to compare the homeless subjects with non-homeless controls with similar drug histories, personality traits, and socioeconomic backgrounds.

82 points by pyduan 12y ago

ribs 12y ago

Need a control group - the rate of TBI amongst non-homeless men.

keithflower 12y ago
The full paper[1] addresses this to some extent (my emphasis added below): "Accurate estimates of the lifetime history (prevalence) of traumatic brain injury within the general population are scarce, which makes it difficult to compare rates of injury among homeless people with rates among those in the community. Two community cohort studies suggested prevalence rates of 3.8% (for experiencing at least 1 admission to hospital for traumatic brain injury by age 35; northern Finland birth cohort) and 31.6% (for experiencing a traumatic brain injury for which the person received medical care; Christchurch, New Zealand, birth cohort). Together, these data suggest that rates may be higher among people who are homeless than within the general community. A recent study estimated that homeless men had rates of head injury 14 times higher than rates for the general population of Canada, with a rate 400 times higher among those who were chronically homeless and had drinking problems." And not oranges and oranges comparison, but[2]: "Separately, a recent study by Dr. Stephen Hwang of the hospital's Centre for Research on Inner City Health, found the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent -- seven times higher than the general population." [1] http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full [2] http://www.ncbi.nlm.nih.gov/pubmed/24651000 http://www.ncbi.nlm.nih.gov/pubmed/24651000
gpcz 12y ago
The paper ( http://www.biomedcentral.com/1471-2458/12/1059 http://www.biomedcentral.com/1471-2458/12/1059 ) is a meta-analysis of papers addressing this correlation. In the section "Limitations of the evidence base," the author notes the deficiency you pointed out in most papers (only two had a control group), among other deficiencies. The conclusion is a rallying cry for larger and more rigorous studies on the matter since the current (ragtag) evidence shows a noticeable correlation.
cup 12y ago
12% according to this reference from reddit. http://www.karger.com/Article/Abstract/343275 http://www.karger.com/Article/Abstract/343275
jacalata 12y ago
I was wondering that too, but the end of the article does mention it: "the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent -- seven times higher than the general population." So it sounds like the rate in the normal population is about 8%, but that's probably men and women. Even if it was entirely men that had it (unlikely), that would put the incidence in the general population of men at 16%, significantly lower. And that rate includes the ones that end up homeless.

deleted 12y ago

[deleted]

keithflower 12y ago

A link to the actual paper (full text): http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full

blairbeckwith 12y ago

Just a few weeks ago, I was walking home from work and witnessed one homeless man suckerpunch another in the face, knocking him off balance on ice and causing him to fall straight back and crack his head open on the ice. There was an instant pool of blood that started spreading quickly, with other homeless people scattering instantly. A cop arrived on the scene almost immediately. I was incredibly surprised reading this that 87% had TBI before becoming homeless. I wonder what the numbers are for repeated TBI after becoming homeless among those that had their first instance pre-homelessness.

drawnalong 12y ago
I'll echo what is said further down; it is good to see a reasonable look into homelessness here on HN. I literally just came bsck from a vigil for a man who died in a self-lit fire in an abandoned moving truck parked in my hometown. The vigil was attended by homeless advocates of all political stripes, had a local police officer singing at the beginning and end, and a gubernatorial candidate was around as well. The "issue of homelessness" is definitely complicated, and amongst the crowd tonight, all holding candles, were those who take stands for rental vouchers, more conservative "housing first" policies, expanded mental health care, and a few other approaches. There were plenty of compassionate Christian conservatives there who I appreciate for their emphasis on pragmatism and on human dignity, even though the solutions run against their deeply held political beliefs. As someone who has always felt just a day a way from slipping into homelessness myself, including struggling with alcoholism - the one thing I can say for certain is that the only way to address this is by continuing to address the issue honestly, trying the best we can with evidence of what works. I wish I could say I trust my faculties, but week to week its obvious I have a problem, even back when I was 9 years into sobriety.. In America, we definitely err on the side of personal liberty and responsibility, and though I agree with that in some abstract sense, it is obvious to me that moralizing the issue as one of choice, or as one of laziness vs. hard work and determination, is a failure. We can do better, and we will, but in the process we're going to have to accept responsibility for each other in a costly and politically inconvenient way. The fact that people came out tonight in my hometown to celebrate our common humanity, despite another tragic loss, is admirable. It is what defines us as a human family. Although the circumstances anger me personally, all these people tonight, and the people here on HN, prove there is a solution, even if it is a hard process and not a clear destination.

cup 12y ago

What shocked me when I used to do the soup van run in my local city was how age didn't discriminate when it came to homelessnes. I saw men (and boys) across the whole age range living in unnacceptable situations. Some of them could have been my friends for all I know as they did their best to hide their homelessness. Furthermore, I was always perplexed as to why there were far more homeless males than females. While my local government provides a number of shelters for men and women, there was never enough room for men. We would frequently scout the local homeless haunts (under bridgers, besides powerstations or in church car parks) looking for people who might need some supper. In this day and age It's pretty disagraceful in my view. I've always thought it would be nice if someone could come up with a kickstarer/kiva like hybrid where you could sponsor local homeless people with enough money to find accomodation and medical/psychological assistance.

firstOrder 12y ago
> it would be nice if...you could sponsor homeless people with enough money to find accomodation and medical/psychological assistance You're presuming that our society and economy isn't designed to purposefully try to get a certain percentage of people into this situation. If someone theoretically entertains the possibility that this is the case ( http://en.wikipedia.org/wiki/Reserve_army_of_labour http://en.wikipedia.org/wiki/Reserve_army_of_labour ), then that would be like building sand castles on the shore during low tide. Actually you don't have to go back to the 19th century to read about this. Read what mainstream economists openly say about NAIRU, or what Business Week and the Wall Street Journal were openly saying when the unemployment rate went below 4% in early 2000. They were pretty much calling for higher unemployment rates - as much as you can get away with in this society any way.
Crake 12y ago
Women have an easier time finding somewhere to stay because they are considered more valuable to society. Men are disposable, which is why far fewer resources are devoted to helping them. Women also can just get a boyfriend if they lose their job or health and need money; I've seen my female friends do this loads of times, but have yet to see it go the other way. Gender roles definitely favor women pretty heavily when it comes to financial matters.

Mz 12y ago

The aftereffects of traumatic brain injury is a very intractable problem that significantly damages a person's life. People tend to be on the street because of intractable personal problems, not because of lack of money per se. I have thought a lot about that and I often wonder what we can do to heal the bodies and minds of the homeless as our first priority instead of trying to act like homelessness itself is the problem and like getting shelter of some sort is the priority. Homeless shelters are often really crappy shelter, with no privacy and terrible air quality and so forth. I won't go to one because I am on the street to get myself well and I can't solve my problems if I can't get well. Homeless shelters are generally not clean enough for my needs. They would help keep me sick. I can't ever solve my problems by staying chronically ill. My financial problems are rooted in my health problems. I never know how to explain that effectively to other people who think a) my lack of housing proves I am incompetent and thus not credible or worth listening to and b) housing, any housing, is the single most important detail to address. Years ago, I lived for a few months in a crap trailer. My health took a turn for the worse and in some ways never recovered. I am still trying to undo the damage of those few months. I have enough income that I could probably go to someplace super cheap, like rural Alabama or Mississippi, and find a trailer for rent to live in instead of choosing to be on the street and inexpensive California where the climate is good for my health but I can't afford housing. And I never know how to explain to people that I am doing the right thing and this focus on get a home, any home, is the wrong focus and is part of the problem. I am glad to see this posted here. I think this is probably a lot better thing to post on HN than a lot of stories that wind up here which showcase specific homeless individuals and, more often than not, seem to convince people that the individual in question just needs to "be more responsible" or "make better choices."

sys32768 12y ago

My relative is almost homeless three years after a TBI in an accident he drove home from. Prior to that he was a talented contractor who supported a family and had many friends. Despite herculean efforts by friends and family and even strangers, he is fundamentally broken in ways nobody seems to understand. He still largely thinks of himself as the person he was prior to the TBI. My guess at this grim stage is the mechanisms are broken that allow him to self-correct his behavior and make accurate, up-to-date "I am" statements. Clues to this are when you confront him about his behavior or how he never bathes. He is not offended or worried but rather agitated, as if his brain short-circuits. At best you get cognitive distortions and at worst he storms away in a rage he won't remember five minutes later. Interventions and threats have no postive effect. He will talk your ear off all day about hobbies he had prior to his TBI, and if you didn't smell him or notice his pan handling sign, you might not know there is any problem. But make no mistake, invite this man to live with you and you will be tearing your hair out after two weeks and kicking him out in three, if not sooner. Every TBI is unique just as every person is. My relative does not accurately remember what parts of his brain was injured, so interviewing him would not yield much. Besides that, after this happened I read that something like 80% of TBIs do not even show on common medical imaging devices. In my relative's case there was evidence "suggestive" of DAI (diffuse axonal injury) which may explain why his deficits are so profound, but nobody can say. During therapy there was clear evidence that his deductive reasoning skills were seriously compromised, so imagine practical consequences if you cannot do simple deductive reasoning but also cannot realize it. Then of course TBI survivors are many times more likely to suffer additional TBIs. Add substance abuse and limited to no impulse control and you have a person who is a danger to himself and often society, but who also may refuse to get the level of help they truly need. In his case, he needs assisted living including someone to manage all of his money, but in his mind he does not and he appears ready to fight it until his last breath. I hope studies like this lead to more humane and informed programs to help people like him. I was just thinking this morning how unjust it is that murderers and other criminals can get room and board for life yet the best we can manage for this once talented and caring member of society is a room in a drug-infested flop house that costs half of his disability income.

r00fus 12y ago
It is sad we don't have a safety net any longer - we used to have asylums now we have homeless people who are mostly mentally ill in some fashion or another. I'm not sure how I'd cope if I had a relative with a similar situation. Thanks for sharing your story.

deleted 12y ago

[deleted]

tokenadult 12y ago

I tried to follow the DOI link to the underlying article, to see at least its abstract, but that link is dead. I don't see any uptake of this hospital press anywhere outside Science Daily, a press-release recycling service often decried[1] by thoughtful readers here on HN. Another kind reader here found the link to the original paper, http://www.cmajopen.ca/content/2/2/E69.full http://www.cmajopen.ca/content/2/2/E69.full which reports "Methods We recruited participants from an urban men’s shelter in Toronto, Ontario. Researchers administered the Brain Injury Screening Questionnaire, a semistructured interview screening tool for brain injury. Demographic information and detailed histories of brain injuries were obtained. Participants with positive and negative screening results were compared, and the rates and mechanisms of injury were analyzed by age group. "Results A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range 27–81 yr) participated. Nearly half (50 [45%]) of the respondents had a positive screening result for traumatic brain injury. Of these, 73% (35/48) reported experiencing their first injury before adulthood (< 18 yr), and 87% (40/46) reported a first injury before the onset of homelessness." In other words, I think this is an interesting idea that deserves further investigation (and, for all I know, despite the statement in the article, has been investigated a lot already), but I have no idea how representative the patients that Dr. Jane Topolovec-Vranic found are of all the homeless people in her country, or what the direction of causation is here (could something that increases risk for homelessness at one and the same time increase risk for traumatic brain injury? very likely yes). Research on how to help people who have suffered brain injuries to recover from those injuries is of course a good idea, as is research on the consequences of those injuries, including social consequences like homelessness. Best of all is to figure out how to reduce risk of suffering such injuries. As the article says, "Additional research is needed to understand the complex interactions among homelessness, traumatic brain injury, mental illness and substance use." I would definitely wonder about the substance use part of that. [1] Science Daily has been decried so often on Hacker News that I have been collecting those comments for a few years. http://news.ycombinator.com/item?id=3992206 http://news.ycombinator.com/item?id=3992206 "Blogspam. "Original article (to which ScienceDaily has added precisely nothing): http://www.washington.edu/news/articles/abundance-of-rare-dna-changes-following-population-explosion-may-hold-common-disease-clues http://www.washington.edu/news/articles/abundance-of-rare-dn... "Underlying paper in Science (paywalled): http://www.sciencemag.org/content/early/2012/05/16/science.1219240 http://www.sciencemag.org/content/early/2012/05/16/science.1... "Brief writeup from Nature discussing this paper and a couple of others on similar topics: http://www.nature.com/news/humans-riddled-with-rare-genetic-variants-1.10655 http://www.nature.com/news/humans-riddled-with-rare-genetic-... http://news.ycombinator.com/item?id=4108603 http://news.ycombinator.com/item?id=4108603 "Everything I've ever seen on HN -- I don't know about Reddit -- from ScienceDaily has been a cut-and-paste copy of something else available from nearer the original source. In some cases ScienceDaily's copy is distinctly worse than the original because it lacks relevant links, enlightening pictures, etc. " . . . . if you find something there and feel like sharing it, it's pretty much always best to take ten seconds to find the original source and submit that instead of ScienceDaily." Comments about both PhysOrg and ScienceDaily: http://news.ycombinator.com/item?id=3689185 http://news.ycombinator.com/item?id=3689185 "Why hasn't sciencedaily.com or physorg been banned from HN yet?" https://news.ycombinator.com/item?id=3867348 https://news.ycombinator.com/item?id=3867348 "A useful rule of thumb is that whenever you see anything on sciencedaily.com or physorg.com, unless it's absolute nonsense there's another more direct (and often more informative) source you should link to instead." http://news.ycombinator.com/item?id=3875529 http://news.ycombinator.com/item?id=3875529 "Original source: http://www.nasa.gov/mission_pages/hinode/news/pole-asymmetry.html http://www.nasa.gov/mission_pages/hinode/news/pole-asymmetry... "What ScienceDaily has added to this: (1) They've removed one of the figures. (2) They've removed links to the Hinode and SOHO websites. (3) They've added lots of largely irrelevant links of their own, all of course to their own site(s). "Please, everyone: stop linking to ScienceDaily and PhysOrg." http://news.ycombinator.com/item?id=3867361 http://news.ycombinator.com/item?id=3867361 "Those sources don't have RSS feeds, and ScienceDaily and PhysOrg have a bad habit of not linking to such things." http://news.ycombinator.com/item?id=4083766 http://news.ycombinator.com/item?id=4083766 "Added value in PhysOrg article: zero. "Please, everyone, stop submitting links from PhysOrg and ScienceDaily. I have never ever ever seen anything on those sites that isn't either (1) bullshit or (2) a recycled press release with zero (or often negative) added value. (Sometimes it's both at once.) It only takes ten seconds' googling to find the original source."

simonster 12y ago

While it is quite plausible that brain damage associated TBI can cause homelessness, the causal influence is probably lower than the given percentages imply. According to the article: "In Canada, the leading mechanisms of traumatic brain injury leading to hospital admission over the decade 1994–1995 to 2003–2004 were motor-vehicle-related for adults less than 60 years of age and falls for those 60 years of age or older, with assaults reported as the mechanism of injury at a substantially lower rate than we have reported here." The article also shows high prevalence of alcohol/drug-related TBI in the homeless, whereas in the general population, "being struck by or against an object, motor vehicle collisions and sport-related injuries were the most common mechanisms." Together, the differences in the causes of TBI between the homeless subjects and the general population imply that, in at least some cases, the TBI and homelessness are likely to have a common cause (e.g. alcohol/drug addiction or certain personality traits). The article recognizes this possibility, but doesn't attempt to correct for it. To get a better idea of the causal effect, it would be informative to compare the homeless subjects with non-homeless controls with similar drug histories, personality traits, and socioeconomic backgrounds.