The incidence and risk factors for incarceration for violence after traumatic brain injury

BACKGROUND: There is increasing evidence to suggest that Traumatic Brain Injury (TBI) is implicated in increased incarceration for violence. TBI is commonly experienced by vulnerable populations who are at greater risk of violent offending due to health and social comorbidities. However, the impact of comorbid risk on outcomes of incarceration for violence is underexplored. Through retrospective data linkage, the current study aimed to identify the rate of incarceration for violence post-TBI and explore the impact of key risk factors in a cohort of 5899 survivors of TBI identified through hospital emergency department (in Victoria, Australia) presentations for TBI (age: M = 21.60, SD = 2.29; sex: males n = 4130, 70.01%, females n = 1769, 29.99%; Indigenous status: Indigenous Australian n = 136, 2.31%, non-Indigenous Australian n = 5763, 97.69%). RESULTS: The incidence rate for incarceration for violence was 409.31 per 100,000 person-years with incarceration occurring, on average, 2.63 (IQR = 4.56) years post-TBI. Risk of incarceration was almost four times higher for individuals who reported pre-TBI incarceration for violence (HR = 3.80, 95% CI [1.89-7.69]) but was not impacted by pre-TBI incarceration for non-violent crimes. Post-TBI incarceration for non-violent crimes demonstrated an increased risk that ranged from 11 (one incarceration, 95% CI [6.66-19.43]) to almost 25 times higher (four or more incarcerations 95% CI [9.42-64.39]) compared to individuals who were not incarcerated. Pre-and-post-TBI substance and substance use treatment demonstrated an increased risk for incarceration for violence that was 17 (pre-TBI: HR = 17.27 95% CI [11.44-26.06]), 19 (post-TBI: HR = 19.32, 95% CI [13.32-28.02]), and almost three (substance use treatment: HR = 2.46-4.67, 95% CI [1.55-18.53]) times higher than those without indicators of substance use or substance use treatment.. Comparatively, only pre-TBI mental health (HR = 4.16, 95% CI [2.62-6.57]) and mental health treatment (HR = 2.68-5.3, 95% CI [1.11-28.03]) significantly increased risk by four and almost three times respectively. CONCLUSIONS: The findings suggest TBI is a key risk factor for incarceration for violence that is exacerbated by health and social vulnerabilities experienced pre-TBI and post-TBI. There may be key opportunities prior to prison contact and after release from prison to provide appropriate intervention that accommodates for TBI-related changes and effectively addresses needs before they manifest into violent offending outcomes.