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Traumatic brain injury (TBI) is a substantial cause of disability with high societal costs worldwide. In the US, where surveillance started in 1989, 3.2 million persons or 1% of the population have sustained a TBI in their lifetime. Similarly large numbers have been reported in European countries. The public health burden may increase in the next few decades, as road traffic accidents, a leading cause of TBI and currently the ninth largest contributor to disability-adjusted living years globally, are estimated to become the third largest contributor by 2030 with a particularly large rise in middle income countries. One high risk group are prisoners, where high rates of TBI have been reported, including in juvenile prisons, and where little is known about this TBI contributes to adverse outcomes following release.

Repeat offending is common after release from prison. In released English and Welsh prisoners during 2000-2004, two year re-offending rates were between 56-58%. Studies of the neuropsychiatric determinants of repeat offending have been limited, and a systematic review we conducted recently identified only four investigations that included non-mentally disordered controls. We carried out one of these studies in individuals receiving community sentences, an option advocated as a way to reduce prison numbers. The study was underpowered to examine many diagnostic subgroups, but potentially important differences were found between schizophrenia and substance misuse.

The current proposal will extend the study of reoffending risks to brain injury. We will address two questions: 1. Is a history of traumatic brain injury (TBI) associated with risk of repeat offending by comparing prisoners with TBI with non-head injured prisoners. 2. What risk factors – individual (including different diagnoses), familial, and neighbourhood – are associated with repeat offending in those with TBI. Whether these risk factors also predict other adverse outcomes, including suicide, inpatient treatment for self-harm, non-violent crime, and early psychiatric re-admission, will be explored.

For background reading on TBI and violence, see: Fazel et al, J Neurology 2009. 256(10): p. 1591-1602; Fazel et al, PLoS Medicine 2011. 8(12): p. e1001150.

On epidemiology of TBI, see: Hyder et al, NeuroRehabilitation 2007.

On TBI in prisoners, see: Schofield et al, Brain Injury Brain Injury, 2006. 20(5): p. 499-506; Williams et al, Brain Injury, 2010. 24(10): p. 1184-1188.