Traumatic Brain Injury and Health-Related Quality of Life in Incarcerated Adults

Background and Purpose: Adults incarcerated in prison report disproportionate rates of traumatic brain injury (TBI). Research of TBI within incarcerated adults is still at an early stage and has been focused on determining prevalence and identifying risk factors for TBI in the population. While these questions are important, there is a need to also investigate factors, such as health-related quality of life, that can provide a more nuanced picture of how TBI impacts incarcerated adults. For example, rehabilitation medicine has identified health-related quality of life (HRQoL) as a vital outcome because it provides a more holistic picture of TBI by assessing for impairments, disabilities, and the need for intervention. Therefore, the current study undertook an initial investigation into whether the self-report of TBI is associated with levels of HRQoL in a sample of incarcerated adults.

Methods: The study sample consisted of 80 incarcerated adults. These participants were part of a randomized control trial of a reentry program. The sample was selected from two men’s facilities and one women’s facility. TBI was assessed with two questions asking for lifetime events of both mild TBI as well as moderate to severe TBI. HRQoL was measured with the RAND 36-Item Health Survey 1.0 that assess for the domains of physical functioning, bodily pain, emotional well-being, social functioning, energy/fatigue, general overall health, and role limitations due to either physical or emotional problems. The following controls were accounted for in all models: lifetime mental health disorder, lifetime substance use disorder, childhood trauma, education level, race, gender, and age. Multiple imputation with chained equations was used to handle missing data. Analysis was conducted in STATA 14 and consisted of multivariate linear regression modeling for each of the HRQoL domains. HC3 robust standard errors were used when homogeneity of variance was found to be violated.

Results: Preliminary analysis showed participants with TBI to have higher rates of mental health disorder (p = .03) and substance use disorder (p = .02). Unadjusted differences in the HRQoL subscales found those with TBI to have lower scores on six subscales, with significant differences found for physical functioning (p = .01), energy/fatigue (p = .04), and general health (p = .001). Multivariate linear regression found TBI to be negatively associated with physical functioning (b = -8.00, p = .02) and general health (b = -9.50, p = .02).

Conclusions and Implications: Study results suggest that TBI history is a significant predictor of HRQoL, particularly physical functioning and general health, in a sample of incarcerated adults. This relationship was found even when accounting for a mental health and substance abuse history, childhood trauma, and the participant’s education level. Importantly, these findings should be viewed as only preliminary and provide support for further research into the relationship between TBI and HRQoL in incarcerated adults. Social worker research should be a leader in shifting correctional rehabilitation towards important outcomes of well-being, like HRQoL, that are often overlooked when designing interventions for incarcerated adults.