Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration

Bonow, Robert H., MD; Wang, Jin, PhD; Zatzick, Douglas F., MD; Rivara, Frederick P., MD, MPH; Rowhani-Rahbar, Ali, MD, PhD

The Journal of Head Trauma Rehabilitation: January/February 2019 - Volume 34 - Issue 1 - p E61–E69
doi: 10.1097/HTR.0000000000000413
Focus on Clinical Research and Practice

Objective: To examine whether patients with traumatic brain injury (TBI) are at higher risk for subsequent crime perpetration compared with injured patients without TBI and those hospitalized for reasons other than injury.

Setting and Participants: Patients hospitalized in Washington State from 2006-2007.

Design: A retrospective cohort study using linked statewide datasets.

Main measures: Primary outcomes were arrest for any violent or nonviolent crime within 5 years of discharge. Adjusted subhazard ratios were calculated using regression models incorporating death as a competing risk.

Results: Compared with uninjured patients (n = 158 247), the adjusted rate of arrest for any crime was greater among injured patients with TBI (n = 6894; subdistribution hazard ratios [sHR], 1.57; 95% confidence interval [CI], 1.49-1.62) and without TBI (n = 40 035; sHR, 1.55; 95% CI, 1.49-1.62). When patients with TBI were directly compared with injured patients without TBI, no effect of TBI on subsequent arrests was found (sHR, 1.02; 95% CI, 0.94-1.11). TBI did not increase the likelihood of either violent or nonviolent crime when these outcomes were examined separately.

Conclusions: TBI survivors do not appear to be at increased risk for criminality compared with injured individuals without TBI. However, injured persons with or without TBI may be at elevated risk of crime perpetration compared with those who are uninjured.

Harborview Injury Prevention Research Center (Drs Bonow, Wang, Zatzick, Rivara, and Rowhani-Rahbar), Department of Neurological Surgery (Dr Bonow), Department of Psychiatry and Behavioral Sciences (Dr Zatzick), Department of Pediatrics (Dr Rivara), and Department of Epidemiology (Dr Rowhani-Rahbar), University of Washington, Seattle.

Corresponding Author: Robert H. Bonow, MD, Harborview Injury Prevention Research Center, University of Washington, Seattle, WA 98104 (

The authors thank Bill O'Brien of the University of Washington and colleagues at the Washington State Patrol and the Washington State Department of Health for their contributions.

R.H.B. received partial, indirect salary support via an educational grant to the University of Washington, Department of Neurological Surgery, from Codman Neuro. Funding for the dataset used in this study was provided by the city of Seattle. These entities had no role in the design, conduct, or reporting of this work.

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.