Traumatic Brain Injury Associated with Incarceration

Study finds individuals with history of traumatic brain injury are 2.5 times more likely to be incarcerated.


A new study, published in CMAJ Open, investigates the association between traumatic brain injury (TBI) and incarceration. The large-scale cohort study, conducted in Ontario, Canada, collected data from over 1.4 million individuals. Results of the study indicate that individuals with a history of TBI are 2.5 times more likely to be incarcerated. The researchers, led by Flora Matheson from the Centre for Urban Health Solutions of St. Michael’s Hospital, state:

“These findings contribute to emerging research suggesting that TBI is an important risk factor for criminal justice involvement and builds on this evidence.”

TBI is a significant public health concern and can lead to cognitive impairment and changes in behavior. Researchers have noted that there are higher rates of individuals with a history of TBI in correctional facilities than the general population. Individuals with TBI may exhibit more aggression and impulsivity and researchers have questioned whether these behavioral changes make it more likely that individuals with TBI will become involved with the criminal justice system.

Photo credit: flickr/greenflames09
Photo credit: flickr/greenflames09

The researchers conducted a cohort study in order “to determine if prior TBI was associated with an increased risk of incarceration among men and women.” Data was collected from over 1.4 million young adults in Ontario from 1997 to 2011.

About 5% of the sample experienced a TBI. Adjusting for confounding factors such as age, gender, or mental health diagnosis, the researchers found that individuals with TBI were about 2.5 times more likely to be incarcerated than individuals without a history of TBI. The authors state, “The relative association was similar among men and women, and was upheld in a variety of sensitivity analyses, although estimates were less precise and not always significant among women.” The researchers also found that men who had multiple TBIs had an even higher risk of incarceration than men with only one TBI.

This study is one of the largest investigations into the association between TBI and incarceration and provides evidence that those who have a history of TBI are at higher risk for being incarcerated. The authors recommend, “Future research should focus on primary, secondary and tertiary prevention, which may help to reduce incarceration or improve the outcomes of persons with TBI who are incarcerated.” In a press release to Medical Xpress, Matheson reported, “This may be just the tip of the iceberg as our study focused only on people with more serious TBI.” The researchers call for more studies on how different severities and mechanisms of injury could impact risk of incarceration.



McIsaac, K. E., Moser, A., Moineddin, R., Keown, L. A., Wilton, G. Stewart, L. A., … Matheson, F. I. (2016). Association between traumatic brain injury and incarceration: A population-based cohort study. CMAJ Open, 4(4), E746-E753. doi:10.9778/cmajo.20160072 (Abstract)


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  1. Thank you for this post. I think TBI needs to be highlighted as a hidden issue in the MIA world and in the Mental Health world. It would be great if someone from the NFL post concussion community would post blog.
    There are connections but the powers that be have done such a solid job of keeping everyone separate that it is so hard to make good and thus fruitful connections.

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  2. I’m supposed to be surprised, when I already know TBI’s shorten the attention span and heighten a sufferer’s impulsivity? Since I also realize that shrinks are usually weak on neurology, as that involves brain hardware, I find neuroleptic use to be more scary than I did before reading the essay.

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  3. I worked for several years as a psychologist in a residential treatment facility for drug and alcohol abusers. It seemed to me the tests I used on incoming patients showed a disproportionately high incidence of TBI which their histories usually substantiated. I began recommending further procedures to investigate TBIs but was severely censured by the head psychiatrist who said I was driving up costs and putting the facility at risk in accreditation inspections. But I still think it would help patients like this to know that a their TBI, and not lack of “will power,” has caused their unusual susceptibility to substance abuse. Usually their ambition is “to drink (or use) like my friends do,” and this would let them know why they can’t, just as diabetics can’t eat like their friends do.

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    • Of course it would be sensible for the patients, but not for the professional staff, because it would mean the prior education and training of the staff members was inadequate and therefore inferior- maybe the valuable chestnuts of learning the staff acquired in school were actually worm-riddled.

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  4. I think that another thing people may need to be aware of is the effect that TBI has on social skills. I am talking about nuisance crimes and apologies (or very belated apologies).

    When your whole social universe is turned upside down; then you are stunned and it may take decades just to realize that you yourself may have been responsible. At the same time, I think that the general public needs to know that TBI survivors may be extremely slow to understand that they have become political scapegoats.

    People like me were very slow in learning to read; and I was almost always struggling in math. My TBI was not something that anyone discussed; because my mom was negligent in the 1966 driveway car accident.
    I got run over by her friend Mrs. Moore’s car as she was backing out of our driveway at 8550 Keller Road; Cincinnati, OH 45243.

    It is also true that I never had an official TBI diagnosis. However, I know that this was because of political considerations–not the facts. The reason my parents did not want an official TBI diagnosis was because they did not want to be officially negligent (which they were).

    I can still feel the large indentations in my skull. TBI injuries are injuries that can ruin your life.
    On the other hand, restorative justice, can and should be used to allow people to get on with their lives.
    It is about the child, who is now grown but committed a nuisance crime decades ago; being allowed to have an honest conversation (including a face to face apology) to anyone he wants to, including a parent who was negligent 53 years ago.

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  5. All of that said, I don’t think it is unreasonable for the community to prompt the TBI survivor to apologize for nuisance crime behavior. This could have saved 38 years of scapegoating; and a lot of time and energy for all of the people involved.

    I think that would be very progressive and pro-active behavior by the community leaders. It is restorative justice that should happen ASAP. Don’t wait 38 years for the TBI survivor to figure out the conspiracy that has been built around him to make him a political scapegoat.

    But if the community leaders do wait 38 years for the TBI survivor to understand his situation; then they still have an obligation to begin restorative justice. The TBI survivor has suffered long enough through the years of over and covert shaming; and the whole family has made mistakes that need reconciliation.

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  6. There seems to be very little discussion between the obvious links between TBI survivors and DSM labels.
    I am certain that there are probably thousands of people who have suffered the double whammy of a brain injury–only to get further humiliation and punishment from a phony DSM label.

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    • I should say: Traumatic Brain Injuries associated with Psych diagnoses.

      The two go together more often than people acknowledge. I think it is just another example of the
      scapegoating of the individual. There is almost always more to the story if society wants to know the truth.
      One is an actual injury; while the diagnoses are scapegoating tools.

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  7. This is what they mean when they say “adding insult to injury.” The first problem is the very real TBI injury.

    The second problem is the insult, that is the phony DSM labels that are put on the victim, often after bad behavior that often occurs because the first problem– trauma–was avoided by the parents and the community.

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