10 minute read
Traumatic Brain Injury and Arrest Probability: Racial/Ethnic Considerations
Mickeal Pugh Jr., MS • Paul B. Perrin, PhD
Nearly 27 million cases of traumatic brain injury (TBI) occur globally each year1, and TBI has become one of the fastest growing conditions contributing to death and disability. James and colleagues1 reported 8.1 million new global cases of TBIcaused long-term disability in 2016 (e.g., at least one year of disability). Given TBI’s widespread prevalence across the globe and the diversity of populations impacted, considerations for health disparities are paramount.
Regarding race/ethnicity in the U.S., American Indian/Alaskan Natives have the highest rates of age-adjusted hospitalization, whereas Asian individuals have the lowest.2 The U.S. Black population annually experiences TBI at 485 per 100,000 people, whereas the White population’s rate is 399 per 100,000.3 TBI can be caused by falls, motor vehicle collisions, sports-related mechanisms, or violence, and racial/ethnic disparities in a violent mechanism of injury exist.4 – 9 Latinx people with TBI experience reduced long-term rehabilitation outcomes as well as higher rates of disability postinjury relative to White individuals.8 Black TBI patient populations similarly report worse functional independence and higher disability than their White counterparts.10 White people with TBI experience a greater degree of secure work and independence in comparison to Black and Latinx individuals.11 – 12 Black patients with TBI who endorse more traditional cultural beliefs, such as religiosity, cultural distrust, and family values, show lower overall neuropsychological performance.13 Prior literature has shown Black, Latinx, Asian, and Native American people with TBI to be more likely unemployed than White individuals.14 Further, Latinx people with TBI are less likely to receive disability-related support from their employers compared to White people15, even after controlling for education and injury cause.7, 16 Black patients with TBI report higher depression and posttraumatic stress compared to White individuals.17 – 18
Racial/ethnic disparities in TBI rates and outcomes may overlap directly with experiences in the criminal justice system. Perkinson19 classified the criminal justice system as a system of racial and social control instead of its intent to alleviate crime. The incarceration rate in the U.S. is approximately six to seven times higher than the rates of Western European nations.20 – 21 One in three Black and one in six Latino men will be incarcerated in their lifetime, compared to six percent of White men. 22
Lifetime TBI rates among incarcerated adults and juveniles are 60% and 30%, respectively.23 – 25 History of TBI is associated with a higher likelihood of psychiatric diagnosis, a greater number of previous lifetime arrests, and violent TBI cause.26 Vaughn and colleagues26 found that 53% of individuals who were released from a correctional facility experienced recidivism between one and two-and-a-half years. Notably, previous TBI, racial/ethnic minority status, and arrest history were associated with recidivism. Outside of TBI contexts, studies have shown systemic racial/ethnic inequality of resource allocation and state-level criminal policy contributing to higher recidivism rates for Black and ex-convicted persons.27 – 29 Male sex30 – 32, younger age,31 lower educational achievement, and prior arrest history,32-33 are associated with increased arrest likelihood. Individuals who received mental health treatment for major depressive disorder34 or alcohol and substance misuse32 , 34 are more likely to experience criminal arrest in the future. Additionally, individuals who sustained TBI via assault are more likely to report arrest prior to injury.30
Arrest outcomes may be linked to racial/ethnic disparities observed in TBI risk, cause, and post-injury outcomes. Individuals from racial/ ethnic minority backgrounds may endure similar social structures that contribute to criminal arrests and barriers regarding post-TBI rehabilitation. This series of relationships inform a set of clinical and public health considerations which are supported by previous research. For example, if someone with TBI who is also from a racial/ethnic minority background is younger, male, less educated, with a pre-injury arrest history or pre-injury substance use issues, and without competitive pre-injury employment, these variables could put them at risk for arrest after TBI.
In conclusion, clinicians in rehabilitation settings may provide unique and tailored rehabilitation support for patients with characteristics putting them at risk for arrest after TBI, including being of a racial/ethnic minority background. Racial/ethnic considerations for arrest outcomes are justified by findings in psychological and criminal justice literature. Culturally informed care should be considered among Native American, Black, and Latinx populations by incorporating a social justice lens in their treatment planning. Doing so may introduce conversation about racial/ethnic disparities in arrest probability outcomes for people with TBI among rehabilitation providers. These efforts could be at the structural level, with including employment trials in rehabilitation, and at the individual level, with assessment of injury, health, and sociodemographic risks that contribute to reduced rehabilitation outcomes, including criminal arrests.
References
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Transitions from prison to community: Understanding individual pathways. Annual Review of Sociology. Vinland Center provides drug and alcohol treatment for adults with 2003;29(1):89-113. doi:10.1146/annurev.soc.29.010202.095931 30. cognitive disabilities, including traumatic brain injury, fetal alcohol Kolakowsky-Hayner SA, Kreutzer JS. Pre-injury crime, substance abuse, and neurobehavioural functioning after traumatic brain injury. Brain Injury. 2001;15(1):53-63. doi:10.1080/02699050150209138 spectrum disorder and learning disabilities. We make all possible 31. accommodations for cognitive deficits and individual learning styles. Colantonio A, Stamenova V, Abramowitz C, Clarke D, Christensen B. Brain injury in a forensic psychiatry population. Brain Injury. 2007;21(13-14):1353-1360. doi:10.1080/02699050701785054 32. Located in Loretto, Minnesota — just 20 miles west of Minneapolis.Perron BE, Howard MO. Prevalence and correlates of traumatic brain injury among Delinquent Youths. Criminal Behaviour and Mental Health. 2008;18(4):243-255. 33. Williams WH, Mewse AJ, Tonks J, Mills S, Burgess CN, Cordan G. Traumatic brain injury in a prison population: Prevalence and risk for re-offending. 02699052.2010.495697 (763)479-3555 • VinlandCenter.orgBrain Injury. 2010;24(10):1184-1188. doi:10.3109/ 34. Moore E, Indig D, Haysom L. Traumatic brain injury, mental health, substance use, and offending among incarcerated young people. Journal of Head Trauma Rehabilitation. 2014;29(3):239-247. doi:10.1097/htr.0b013e31828f9876 Mickeal Pugh Jr, MS, is a PhD candidate in Counseling Psychology at Virginia Commonwealth University. Currently, he is completing his predoctoral internship at the University of Washington specializing in Rehabilitation Psychology. Mike received his BS in Psychology from Lebanon Valley College and a Master’s in Clinical Psychology from Loyola University Maryland. He began his doctoral studies at Virginia Commonwealth University where he completed the bulk of his clinical rehabilitation training in VA hospitals and academic medical centers. Mike has been involved in numerous research projects focused on psychological adjustment and cultural factors that contribute to rehabilitation and health outcomes. Paul Perrin, PhD, is a Professor of Psychology and Physical Medicine & Rehabilitation at Virginia Commonwealth University, where he is the Director of the Health Psychology PhD Program. He has a joint appointment as a research psychologist at the Central Virginia Veterans Affairs Health Care System, where he co-directs the Polytrauma Rehabilitation Center Traumatic Brain Injury Model Systems Program. Paul's area of research is called "Social Justice in Disability and Health," and he is passionate about using and teaching students to use science in order to fight oppression in all of its forms, particularly as it manifests itself in within health care systems and rehabilitation services in the U.S. and globally. He teaches undergraduate and doctoral courses on health disparities, social determinants of health, multiculturalism, community intervention, research methods, and applied multivariate statistics.
Restore-Ragland Restore-Roswell Restore-Lilburn
Restore Neurobehavioral Center is a residential, post acute healthcare organization dedicated exclusively to serving adults with acquired brain injury who also present with moderate to severe behavioral problems. Services range from intensive inpatient neuro-rehabilitation and transitional community re-entry services to long term supported living services. Restore Neurobehavioral Center, located in a suburb north of Atlanta, is the site of our inpatient post acute neuro-rehabilitation program as well as one of our supported living sites. We operate two other community living sites, Restore-Lilburn (GA) and Restore-Ragland (AL).
