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Traumatic Brain Injury, Mental Health, Substance Use, and Offending Among Incarcerated Young People

Moore, Elizabeth PhD, B SocSc; Indig, Devon PhD, BSc, MPH; Haysom, Leigh PhD, MBBS, FRACP (Paeds), MSc (Med), MMed (Clin Epi)

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: May/June 2014 - Volume 29 - Issue 3 - p 239–247
doi: 10.1097/HTR.0b013e31828f9876
Original Articles

Objective: Despite being at high risk, little is known about traumatic brain injuries (TBIs) among incarcerated young people. This study aims to describe the prevalence of TBI among incarcerated young people and assess the association with mental health, substance use, and offending behaviors.

Setting: The 2009 NSW Young People in Custody Health Survey was conducted in 9 juvenile detention centers.

Participants: A total of 361 young people agreed to participate, representing 80% of all incarcerated young people.

Main Measures: Young people were asked if they ever had a head injury where they became unconscious or “blacked-out.” The survey used the Kiddie Schedule for Affective Disorders for Children to assess for psychiatric disorders, the Alcohol Use Disorder Identification Test, and the Severity of Dependence Scale to measure problematic substance use.

Results: The sample comprised 88% man, 48% Aboriginal, with an average age of 17 years. One-third (32%) of young people reported ever experiencing a TBI, and 13% reported multiple TBIs. The majority (92%) of “most serious” TBIs were defined as mild, and the most common cause was an assault (62% woman, 34% man). Young people who reported a history of TBI (compared with those reporting no TBI) were significantly more likely to be diagnosed with a mental health disorder, psychological distress, a history of bullying, problematic substance use, participation in fights, and offending behaviors. Reporting multiple (>2) TBIs conferred a higher risk of psychological disorders and problematic substance use.

Conclusions: Incarcerated young people have high rates of TBI. Enhanced detection of TBI among incarcerated young people will assist clinicians in addressing the associated psychosocial sequelae.

Centre for Health Research in Criminal Justice (Drs Moore and Indig) and Adolescent Health (Dr Haysom), Justice Health; and School of Public Health and Community Medicine, University of New South Wales (Dr Indig), Sydney, Australia.

Corresponding Author: Elizabeth Moore, PhD, B SocSc, Centre for Health Research in Criminal Justice, Justice Health, Sydney, Australia (

The authors thank the research team members from Juvenile Justice and Justice Health, and to those other staff who provided operational support for the 2009 Young People in Custody Health Survey (2009 YPICHS). They also thank Juvenile Justice, Justice Health, and Centre for Aboriginal Health in the New South Wales Ministry of Health for funding the study, and to the young people who kindly participated in the YPICHS study.

The study was funded by Juvenile Justice, Justice Health, and Centre for Aboriginal Health in the New South Wales Ministry of Health, Australia.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins