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

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.