Traumatic Brain Injury and Early Life Experiences Among Men and Women in a Prison Population

Abstract

This study examined the proportion of men and women reporting previous traumatic brain injury (TBI) in an Ontario (Canada) prison sample by demographic characteristics; adverse life experiences; and criminal, drug, and alcohol use history. Using data from The Cost of Substance Abuse in Canada study based on a random sample from four Ontario prisons, this study found 50.4% of males and 38% of females reporting previous TBI. More TBIs occurred before the first crime for women than for men. Women with TBI experienced more early physical and sexual abuse than those without TBI. Additionally, this study shows high prevalence of early life experiences among persons, particularly women, with a history of TBI. Prisoners and prison staff should be educated on TBI and best practice for rehabilitation of TBI.

Keywords

traumatic brain injury prison sex differences gender differences

Traumatic brain injury (TBI), typically caused by an external blow to the head, is a leading cause of death and disability worldwide (Canadian Institute for Health Information, 2007; Graham & Cardon, 2008; Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999) and places a substantial economic burden on the health care system (Chen et al., 2012; Finkelstein, Corso, & Miller, 2006; Graham & Cardon, 2008). TBI can result from a variety of mechanisms, including physical abuse, falls, sport-related injuries, and motor vehicle collisions.

While TBI affects a wide range of individuals in the general population, an elevated rate of a history of TBI has been reported in vulnerable populations such as the homeless, substance abusers, and prison populations (Hwang et al., 2008; Shiroma, Ferguson, & Pickelsimer, 2010). Individuals involved in criminal behavior, particularly violent crime, are disproportionately affected, supporting an association between TBI and both violent and nonviolent criminal behaviors. While the nature and direction of the association remains unclear, some researchers have found TBI to be an independent predictor of criminal and violent behaviors, imprisonment, and reoffend (Hawley & Maden, 2003; León-Carrión & Ramos, 2003; Williams et al., 2010). To date, in Canada, we have examined prevalence of a history of TBI in a forensic psychiatry population but there are no studies on persons in correctional facilities (Colantonio, Stamenova, Abramowitz, Clarke, & Christensen, 2007). This information is critical in the Canadian context and provides North American estimates of TBI in a publicly insured population. Furthermore, there has been a need to better understand early life exposures that may predate TBI among forensic populations as this provides important information that can potentially be used to prevent a TBI as well as negative physical and social consequences. These histories are rarely addressed by gender and TBI status, and as such constitute a knowledge gap.

The objective of this study is to examine the proportion of men and women who report a history of a TBI in a prison sample in Ontario, Canada. We also aim to examine the associated demographic characteristics, early adverse life experiences profile, crime, and drug and alcohol history, by TBI status and sex.

Methods

Design

This was a cross-sectional study ancillary to a larger study titled “The Cost of Substance Abuse in Canada” (CSAC; Collins et al., 2006). Ethics approval was obtained through the Toronto Rehabilitation Institute.

Participants

Four prisons—three for male inmates and one for females—participated in the study. The recruitment procedures varied slightly at each institution but were all based on random samples taken from a list of newly admitted prisoners (less than 2 weeks) from each institution. Each day, for a 3-month period, a list of all inmates newly admitted to each prison during the previous day was prepared by a prison officer and given to the interviewer. From that list, the interviewer randomly selected inmates to be contacted for participation in the study (participation of the prison officers was needed in order to contact these individuals). Exclusionary criteria for the study were inability to understand and speak fluently in English and evidence of psychiatric problems that would interfere with understanding of interview procedures. Persons who were placed in isolation were not excluded from the study; however, the interviewers did not have access to this population.

We approached 388 inmates (213 males and 175 females) for an interview. After excluding those who were ineligible or who refused to participate, 235 (131 males and 104 females) were interviewed. This resulted in an overall response rate of 72% (131 of the 180 males [72.8%]; and 104 of the 146 females [71.2%]). Our sample overall was largely White and born in Canada.

Assessment of TBI and Other Exposure Variables

A private room was used to conduct interviews with consenting inmates. On average, each interview lasted 1 hour. Participants were interviewed using a short form of the Computerized Lifestyle Assessment Instrument that allows for the collection of data on drug and alcohol consumption habits (tobacco, alcohol, and psychoactive drug use) to determine an individual’s lifetime extent of alcohol and drug use. It also considers the history of criminal involvement categorized as violent or nonviolent. Demographic variables such as age, ethnicity, and origin of birth were also collected. Adverse life experiences occurring between the ages of 0 and 15 years, such as physical abuse, sexual abuse, neglect, witnessing family violence, and family drug and alcohol abuse, were also identified. Addiction was measured through the Alcohol Dependence Scale and the Drug Abuse Screening Test (Collins et al., 2006).

Participants were asked a series of questions regarding their history of brain injury. The following two questions on history of TBI, TBI severity, and hospital admission for TBI were adapted from questions used to ascertain a history of TBI in prison populations (Slaughter, Fann, & Ehde, 2003): (1) Have you ever had an injury to the head, which knocked you out or at least left you dazed, confused, or disoriented? (2) How many injuries like this have you had over your lifetime?

Prisoners who reported having a history of TBI received follow-up questions regarding injury event details such as time of incident, age, loss of consciousness (LOC; yes/no), LOC duration, and whether they were admitted to hospital. Persons who reported an LOC of 30 minutes or less in duration were categorized as having experienced mild injury and those who reported an LOC of more than 30 minutes were categorized as having sustained a moderate or severe injury. These measures of injury severity were based on the American Congress of Rehabilitation Medicine’s definition of mild TBI (1993), which has been used in a previous study of TBI in the homeless population (Hwang et al., 2008).

Statistical Analyses

Descriptive statistics such as frequency distributions, mean, median, range, standard deviation, and interquartile range were calculated. A combination of univariate and bivariate analyses was used to describe the overall sample and the sample was stratified by sex and TBI status. A combination of chi-square analysis (for categorical outcomes) and Student t-test and Mann–Whitney test (for continuous outcomes) was used to compare TBI versus non-TBI groups within the two sex groups.

Results

Of the 235 individuals who participated in the survey, 102 (43.4%) reported a history of TBI, 125 (53.2%) did not experience a TBI, and 8 (3.4%) did not reply to the question. Of those who reported a history of TBI, 64 (62.7%) were males and 38 (37.3%) were females. When these numbers were considered in relation to all participants who replied to the question regarding past TBI incidents, 50.4% of all men and 38% of all women reported a TBI that included an alteration in consciousness. Male prisoners with TBI were significantly younger on average compared to males without TBI (p = .036). Our sample overall was largely Wite and born in Canada (Table 1).

Table 1.

Gender-Specific Characteristics by Lifetime History of TBI.

	Males (n = 127)			Females (n = 100)
Variables	TBI (n = 64)	Non-TBI (n = 63)		TBI (n = 38)	Non-TBI (n = 62)
	n (%)	n (%)	p	n (%)	n (%)	p
Birthplace (Canada)	56 (87.5)	50 (79.4)	.217	35 (92.1)	56 (90.3)	.762
Ethnicity (White)	46 (71.9)	35 (55.6)	.056	24 (63.2)	34 (54.8)	.413
Age, mean (SD)^a	32.5 (9.6)	36.6 (12.0)	.036	35.1 (10.6)	33.6 (10.3)	.467
Age groups (years)^a
18 to 24	15 (23.5)	12 (19.0)	.199	7 (18.4)	14 (23.0)	.958
25 to 34	24 (37.5)	18 (28.6)		13 (34.2)	19 (31.1)
35 to 44	15 (23.4)	13 (20.6)		13 (34.2)	20 (32.8)
45 and over	10 (15.6)	20 (31.7)		5 (13.2)	8 (13.1)

Note. n = 227. TBI = traumatic brain injury. ^a n = 99 for females; TBI, n = 38; and non-TBI, n = 61.

The majority of male and female prisoners with TBI reported mild injury based on the length of unconsciousness (Table 2). The percentage of inmates who reported a TBI that resulted in a hospital visit was 42.5% for males and 29% for females. Most prisoners with TBI (N = 83, 84%) reported that they were admitted to a hospital for their brain injury. Overall, 41 individuals (44%) reported having one TBI in the past, 32 individuals (34%) reported two TBIs, and 20 individuals (22%) reported three or more TBIs.

Table 2.

TBI Severity by LOC (TBI Group Only).

	Male (n = 64)	Female (n = 38)	p
	n (%)	n (%)	p
Severity
Non-LOC	17 (26.6)	6 (15.8)	.452
Mild	22 (34.4)	13 (34.2)
Moderate or severe	21 (32.8)	14 (36.8)
Missing or unsure	4 (6.2)	5 (13.2)
Hospital visit^a
Yes	54 (84.4)	29 (82.9)	.844
No	10 (15.6)	6 (17.1)

Note. n = 102. LOC = loss of consciousness; TBI = traumatic brain injury. ^aMissing cases in hospital visit = 3.

The average age of the first TBI was 19.6 years for men and 21.4 for women prisoners. However, the mean age of first crime was lower. We found that 54.3% of the female prisoners reported experiencing their first TBI prior to or in the same year as their first criminal offense compared to 31.7% of the male prisoners, χ²(1, N = 98) = 4.78, p = .0289 (Table 4). The results indicated a higher prevalence for substance abuse (female: 41.2%; male: 27.4%) and alcohol use (female: 31.4%; male: 23.8%) among women than men after first TBI. Male prisoners with TBI reported consuming alcohol and engaging in criminal activity at an earlier age on average compared to prisoners without TBI (Table 3).

Table 3.

Gender-Specific Mean Ages of First Alcohol/Drug Use, Crime, and TBI.

	Males (n = 124)			Females (n = 100)
Variables	TBI Mean (SD)	Non-TBI Mean (SD)	p	TBI Mean (SD)	Non-TBI Mean (SD)	p
Age at first alcohol drink^a	12.5 (4.0)	14.6 (6.1)	.018	12.7 (4.4)	13.9 (4.3)	.192
Age at first drug use^b	14.2 (3.6)	15.2 (3.8)	.167	17.1 (7.8)	16.2 (6.8)	.586
Age at first crime	15.0 (7.0)	19.1 (10.9)	.015	19.4 (11.8)	19.1 (9.5)	.911
Age at first TBI^c	19.6 (10.6)	NA	NA	21.4 (11.8)	NA	NA

Note. TBI = traumatic brain injury. ^a n = 125 for males and n = 98 for females. ^b n = 110 for males and n = 95 for females. ^c n = 64 for males and n = 35 for females.

Table 4.

Gender Specific for Criminal and Other Behavioral Activities Following the First TBI.

Incidences Before First TBI	Male (n = 63)	Female (n = 35)	Total (n = 98)
Incidences Before First TBI	n (%)	n (%)	n (%)
First TBI before or same year of first crime	20 (31.7)	19 (54.3)	39 (39.8)
First TBI before or same year of first substance abuse^a	17 (27.4)	14 (41.2)	31 (32.3)
First TBI before or same year of first drink	15 (23.8)	11 (31.4)	26 (26.5)

Note. TBI = traumatic brain injury. ^a n = 62 for males and n = 34 for females.

Sex differences were also found when adverse life events were examined (Table 5). Across a range of indicators, including physical and sexual abuse, neglect, family alcohol abuse, family drug abuse, and witness of family violence, females with TBI had significantly higher rates of abuse than females without TBI and males overall. Male inmates with TBI had a significantly higher percentage of family alcohol abuse relative to their non-TBI counterparts. There were no significant differences among the types of crimes committed between males and females with TBI, with most crimes being categorized as nonviolent overall (Table 6).

Table 5.

Gender-Specific Life Experiences in Ages Between 0 and 15 Years.

	Males (n = 125)			Females (n = 99)
Variables	TBI (n = 62)	Non-TBI (n = 63)		TBI (n = 37)	Non-TBI (n = 62)
	n (%)	n (%)	p	n (%)	n (%)	p
Physical abuse	24 (38.7)	21 (33.3)	.531	25 (67.6)	28 (45.2)	.031
Sexual abuse	11 (17.7)	5 (7.9)	.101	22 (59.5)	23 (37.1)	.031
Neglect	23 (37.1)	19 (30.2)	.412	19 (51.4)	26 (41.9)	.363
Alcohol abuse (family)	40 (64.5)	29 (46.0)	.038	29 (78.4)	37 (59.7)	.056
Drug abuse (family)	17 (27.4)	10 (15.9)	.117	18 (48.6)	19 (30.6)	.073
Witness family violence	30 (48.4)	22 (34.9)	.127	24 (64.9)	34 (54.8)	.327

Note. TBI = traumatic brain injury.

Table 6.

Gender-Specific Violent- and Nonviolent-Related Behavior.

	Males (n = 127)			Females (n = 100)
Types of crime	TBI (n = 64)	Non-TBI (n = 63)		TBI (n = 38)	Non-TBI (n = 62)
	n (%)	n (%)	p	n (%)	n (%)	p
Nonviolent crime	49 (76.6)	46 (73.0)	.645	32 (84.2)	54 (87.1)	.686
Violent crime	15 (23.4)	17 (27.0)		6 (15.8)	8 (12.9)

Note. Violent crimes include murder, manslaughter, infanticide or criminal negligence, attempted murder, assault or wounding, abduction or kidnapping, and sex offenses.

Nonviolent crimes include:

- Gainful crimes: robbery, attempted robbery or armed robbery, break and enter (including burglary), theft (including shoplifting, vehicle theft), possession of stolen property, fraud or forgery, extortion, prostitution, gaming and betting.

- Drug crimes: drug importation, trafficking, possession, and cultivating.

- Other crimes: possession of weapon, driving while impaired, other traffic offenses, mischief or vandalism, public disorder, escape, being unlawfully at large, parole/probation violation, default of fine payment, other type of offenses. TBI = traumatic brain injury.

Discussion

This is the first study of TBI among prisoners in Canada to our knowledge and one of the few that examines both males and females in correctional facilities. A history of TBI was more commonly reported among male than female inmates. Conversely, a recently published review estimating the prevalence of TBI among inmates by sex found a higher prevalence among female inmates in one study (Shiroma, Ferguson, et al., 2010). Previous literature stated that TBI is more prevalent among males than females in incarcerated populations and in the general population overall (Ferguson, Pickelsimer, Corrigan, Bogner, & Wald, 2012; Jackson, Hardy, Persson, & Holland, 2011). Our findings reflect similar demographic trends in the general population in Canada where TBI is more common among males (Colantonio, Saverino, et al., 2010).

Our study attempted to shed light on the directionality of relationship between head injury and criminal activity by sex. We found different patterns by sex, where females were significantly more likely to have had a TBI prior to criminal involvement than males. This relationship was not investigated extensively and should be explored further. However, other researchers have assessed the directionality of the relationship between head injury and criminal activity in a prison sample and found that many of the prisoners reported having a previous TBI (Perkes, Schofield, Butler, & Hollis, 2011; Sarapata, Herrmann, Johnson, & Aycock, 1998). Similarly, a study focusing on female prison inmates indicated that of all 113 inmates, 95% had neurologic histories predating crime (Brewer-Smyth, Burgess, & Shults, 2004). These studies showed a strong correlation between TBI and crime but made no conclusive causal association.

There was a high prevalence of alcohol/substance abuse among the prison population, including those with a history of brain injury. Only 7% of males and 8% of females reported no alcohol or substance abuse. This has been found in most studies (Corrigan & Bogner, 2007; West, 2011). Indeed, our results indicate a high prevalence of alcohol/substance abuse prior to first TBI in the prison population. It is known that substance use is common in the TBI population and complicates the rehabilitation process (West, 2011). Persons with dual diagnoses of TBI and substance abuse are often unattended as current brain injury and mental health programs may not have the expertise and resources to address the complex issues of persons within this group (Colantonio, Howse, et al., 2010). Specialized programs addressing both needs are emerging in both the United States and Canada (Lemsky et al., 2005; Olson-Madden, Brenner, Corrigan, Emrick, & Britton, 2012).

The extent of childhood abuse reported in our sample was particularly striking among female inmates with TBI. High rates of past physical and sexual abuse among female inmates have been found in other studies (Brewer-Smyth et al., 2004). Furthermore, there have been numerous studies documenting childhood sexual abuse that is highest among female prisoners (M. Glasser, Kolvin, Campbell & A. Glasser, 2001; McDaniels-Wilson & Belknap, 2013). It has been hypothesized that childhood stress can adversely affect brain development (Brewer-Smyth et al., 2004). These findings support sensitivity to the nature of past abuses in addressing the psychological and other health needs of inmates. Our findings also suggest the need for screening for TBI among persons who have had a history of physical and sexual abuse earlier in life. Furthermore, this study suggests the importance of screening for TBI in at-risk children such as wards of the state, as well as for other psychological and neurological conditions, with the goal of providing appropriate interventions to prevent negative consequences such as involvement in crime and homelessness. Women with TBI have been associated with potential risk for abuse (Tsukada et al., 2012.)

Shiroma, Pickelsimer et al., 2010 found that TBI is associated with a significantly higher in-prison behavioral infraction rate compared to prisoners without a history of TBI among both male and female prisoners in a statewide prison population. The rate of violent behavioral infraction that involved medical attention increased by 144% (relative risk [RR] = 2.44) for females with TBI versus females without TBI, compared to an 86% increase among males (RR = 1.86). Introducing behavioral and cognitive strategies to inhibit behavioral disturbances that include violent behaviors could reduce injuries among staff and inmates as well as lead to better correction management. For instance, staff can be trained to recognize behaviors such as failure to respond or slowness to act as a potential sign of cognitive disability rather than an act of defiance (Yuhasz, 2013).

Thus, we advocate education among law enforcement and correctional facilities that includes the recognition and management of TBI. These programs are critical given the substantial percentage of offender populations affected by brain injury. The format and content of educational sessions should be developed and tailored in collaboration with corrections staff, persons with brain injury, and other relevant stakeholders. Overall, studies have shown a lack of understanding and misconceptions about TBI among the general, clinical, and correctional health care professionals. Education about brain injury for correctional staff has the potential to greatly improve their relationship with inmates and the delivery of health care services in the prison setting (Yuhasz, 2013).

These findings suggest that screening for TBI should be implemented within parole, court diversion, or correctional programs. Overlooking a history of TBI may lead to missing a critical factor that can be addressed in correctional and medical rehabilitation and that can improve outcomes after release. Rehabilitation can include compensatory and communication strategies to prevent social failure and recidivism and improve community integration (Cicerone et al., 2011; Dahlberg et al., 2007). Strategies of this kind have been shown to be effective in the general population. It is not clear to what extent our population may have been offered these types of interventions. A U.S. study reported limited rehabilitation that includes neuropsychological interventions such as cognitive retraining among inmates (Brewer-Smyth et al., 2004).

Our study could only include a parsimonious measure of a history of brain injury used successfully in other studies (Hwang et al., 2008; Slaughter et al., 2003). Future studies could consider a more detailed screening instrument such as the Ohio State Questionnaire, which was validated on a prison population after this study was conducted (Bogner & Corrigan, 2009). This instrument has more initial questions dedicated to recalling injury events such as recall of injuries involving automobiles and assaults, which are major causes of TBI. We also recognize that childhood TBI may be missed in reporting, especially if it occurred earlier in life and/or goes unreported or is misdiagnosed. This is a serious consideration, given the history of abuse.

Furthermore, the questionnaire in this study did not focus on the circumstances of injuries (e.g., intimate partner violence). Future studies could include a more detailed assessment of TBI that goes beyond a basic history and includes more gender-related questions. The influence of severity of brain injury and number of brain injuries reported should also be investigated. A larger sample of male and female inmates would permit more complex analyses by sex.

Our findings clearly identify the need to address brain injuries in both male and female prison populations and to advocate for the development of a comprehensive strategy for effective screening and management of TBI in forensic populations. This includes (1) a comprehensive education of staff working in the correctional system enabling them to identify persons with history of TBI, (2) TBI-specific vocational evaluation/rehabilitation programs, with targeted drug and alcohol abuse supports, and (3) inmate referrals to various TBI support organizations. An important consideration in working with all offender populations is to acknowledge a history of childhood abuse, particularly how it differs by sex. The presence and strength of associations between TBI and vulnerabilities, such as history of alcohol and drug use and childhood abuse among prison populations, underline the importance of educating correctional staff and care providers in order to enhance the effectiveness of rehabilitation efforts. The need for counseling or other tailored approaches that consider sex differences in order to address these scarring early life experiences is advocated. It is not known to what extent these factors are addressed in correctional facilities in Canada or in rehabilitation by health and social service professionals; this needs to be explored further in terms of implications for correctional facilities.

Footnotes

Authors’ Note

The authors acknowledge the support of the Toronto Rehabilitation Institute, which receives funding under the provincial rehabilitation program from the Ministry of Health and Long-term Care in Ontario. The views expressed do not necessarily reflect those of the Ministry.

Acknowledgments

We thank Lin Haag, Sandra Sokoloff, Margaret Polanyi, Nicole Hofstein, and Pravheen Thurairajah for their assistance.

Declaration of Conflicting Interests

The authors disclosed no conflicts of interest with respect to the research, authorship, and/or publication of this article. For information about JCHC’s disclosure policy, please see the Self-Study Exam.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by funding from Health Canada, the Ontario Neurotrauma Foundation (ONF), the Canadian Traumatic Brain Injury and Violence Research Team through the Canadian Institutes of Health Research (CIHR) Strategic Team in Applied Research Injury (#TIR-103946), a CIHR Research Chair in Gender, Work and Health (# CGW-126580), and the Saunderson Family Chair in Acquired Brain Injury Research.

References

American Congress of Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 86–87.

Bogner

, Corrigan

J. D.

(2009). Reliability and predictive validity of the Ohio State University TBI identification method with prisoners. Journal of Head Trauma Rehabilitation, 24, 279–291.

Brewer-Smyth

, Burgess

A. W.

, Shults

(2004). Physical and sexual abuse, salivary cortisol, and neurologic correlates of violent criminal behavior in female prison inmates. Biological Psychiatry, 55, 21–31.

Canadian Institute for Health Information. (2007). The burden of neurological disease, disorders and injuries in Canada. Ottawa, Ontario: Author.

Chen

, Bushmeneva

, Zagorski

, Colantonio

, Parsons

, Wodchis

(2012). Direct cost associated with acquired brain injury in Ontario. BMC Neurology, 12, 76. doi:10.1186/1471-2377-12-76

Cicerone

K. D.

, Langenbahn

D. M.

, Braden

, Malec

J. F.

, Kalmar

, Fraas

, Ashman

(2011). Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008. Archives of Physical Medicine and Rehabilitation, 92, 519–530.

Colantonio

, Howse

, Kirsh

, Chiu

, Zulla

, Levy

(2010). Living environments for people with moderate to severe acquired brain injury. Healthcare Policy, 5, e120–e138.

Colantonio

, Saverino

, Zagorski

, Swaine

, Lewko

, Jaglal

, Vernich

(2010). Hospitalizations and emergency department visits for TBI in Ontario. Canadian Journal of Neurological Sciences, 37, 783–790.

Colantonio

, Stamenova

, Abramowitz

, Clarke

, Christensen

(2007). Brain injury in a forensic psychiatry population. Brain injury, 21, 1353–1360.

10.

Collins

D. A.

, Lapsley

, Brochu

, Easton

, Pérez-Gómez

, Rehm

, Single

(2006). International guidelines for the estimation of the avoidable costs of substance abuse. Ottawa, Canada: Health Canada.

11.

Corrigan

J. D.

, Bogner

(2007). Interventions to promote retention in substance abuse treatment. Brain Injury, 21, 343–356.

12.

Dahlberg

C. A.

, Cusick

C. P.

, Hawley

L. A.

, Newman

J. K.

, Morey

C. E.

, Harrison-Felix

C. L.

, Whiteneck

G. G.

(2007). Treatment efficacy of social communication skills training after traumatic brain injury: A randomized treatment and deferred treatment controlled trial. Archives of Physical Medicine and Rehabilitation, 88, 1561–1573.

13.

Ferguson

P. L.

, Pickelsimer

E. E.

, Corrigan

J. D.

, Bogner

J. A.

, Wald

(2012). Prevalence of traumatic brain injury among prisoners in South Carolina. Journal of Head Trauma Rehabilitation, 27, E11-E20.

14.

Finkelstein

, Corso

P. S.

, Miller

T. R.

(2006). The incidence and economic burden of injuries in the United States. Oxford, England: Oxford University Press.

15.

Glasser

, Kolvin

, Campbell

, Glasser

, Leitch

, Farrelly

(2001). Cycle of child sexual abuse: Links between being a victim and becoming a perpetrator. British Journal of Psychiatry, 179, 482–494.

16.

Graham

D. P.

, Cardon

A. L.

(2008). An update on substance use and treatment following traumatic brain injury. Annals of the New York Academy of Sciences, 1141, 148–162.

17.

Hawley

C. A.

, Maden

(2003). Mentally disordered offenders with a history of previous head injury: Are they more difficult to discharge?. Brain Injury, 17, 743–758.

18.

Hwang

S. W.

, Colantonio

, Chiu

, Tolomiczenko

, Kiss

, Cowan

, Levinson

(2008). The effect of traumatic brain injury on the health of homeless people. Canadian Medical Association Journal, 179, 779–784.

19.

Jackson

, Hardy

, Persson

, Holland

(2011). Acquired brain injury in the Victorian prison system (Corrections Research Paper Series, Report 04). Victoria, Australia: Department of Justice.

20.

Lemsky

, Chisven

, Godden

, James

, Schwalb

, Kaufman

, Greer

(2005). Substance abuse/brain injury client workbook. Retrieved from http://www.brainline.org/content/2009/10/subi-client-workbook.html

21.

León-Carrión

, Ramos

F. J. C.

(2003). Blows to the head during development can predispose to violent criminal behaviour: Rehabilitation of consequences of head injury is a measure for crime prevention. Brain Injury, 17, 207–216.

22.

McDaniels-Wilson

, Belknap

(2008). The extensive sexual violation and sexual abuse histories of incarcerated women. Violence Against Women, 14, 1090–1127.

23.

Olson-Madden

J. H.

, Brenner

L. A.

, Corrigan

J. D.

, Emrick

C. D.

, Britton

P. C

. (2012). Substance use and mild traumatic brain injury risk reduction and prevention: A novel model for treatment. Rehabilitation Research and Practice, Article ID 1 74579, 6 pages. doi:10.1155/2012/174579

24.

Perkes

, Schofield

P. W.

, Butler

, Hollis

S. J.

(2011). Traumatic brain injury rates and sequelae: A comparison of prisoners with a matched community sample in Australia. Brain Injury, 25, 131–141.

25.

Sarapata

, Herrmann

, Johnson

, Aycock

(1998). The role of head injury in cognitive functioning, emotional adjustment and criminal behaviour. Brain Injury, 12, 821–842.

26.

Shiroma

E. J.

, Ferguson

P. L.

, Pickelsimer

E. E.

(2010). Prevalence of traumatic brain injury in an offender population: A meta-analysis. Journal of Correctional Health Care, 16, 147–159.

27.

Shiroma

E. J.

, Pickelsimer

E. E.

, Ferguson

P. L.

, Gebregziabher

, Lattimore

P. K.

, Nicholas

J. S.

, Hunt

K. J.

(2010). Association of medically attended traumatic brain injury and in-prison behavioral infractions: A statewide longitudinal study. Journal of Correctional Health Care, 16 (4), 273–286.

28.

Slaughter

, Fann

J. R.

, Ehde

(2003). Traumatic brain injury in a county jail population: Prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury, 17, 731–741.

29.

Thurman

D. J.

, Alverson

, Dunn

K. A.

, Guerrero

, Sniezek

J. E.

(1999). Traumatic brain injury in the United States: A public health perspective. Journal of Head Trauma Rehabilitation, 1 4, 602–615.

30.

Tsukada

, Yoshida

, Colantonio

, Sokoloff

, Kontos

, Harris

(2012). Women living with acquired brain injury: Pilot study of community health and well-being needs. Brain Injury, 26, 774–775.

31.

West

S. L.

(2011). Substance use among persons with traumatic brain injury: A review. NeuroRehabilitation, 29, 1–8.

32.

Williams

W. H.

, Mewse

A. J.

, Tonks

, Mills

, Burgess

C. N.

, Cordan

(2010). Traumatic brain injury in a prison population: Prevalence and risk for re-offending. Brain Injury, 24, 1184–1188.

33.

Yuhasz

(2013). Misconception about traumatic brain injury among correctional health care professionals. Journal of Correctional Health Care, 19, 135–143.