Introduction. Meta-analyses of self-report in offenders suggest that 50-60% have sustained a head injury (HI). However, there is little reported evidence about persisting effects and service need is not clear. We present here preliminary data from one of a series of projects in Scotland that are associated with the development of a health service for people with HI in the criminal justice system (1).

Methods. A cross-sectional, between-subjects methodology considered disability outcome in 81 males incarcerated in prisons in Scotland. Participants were screened for occurrence and severity of HI. Outcome measures were the Glasgow Outcome at Discharge Scale for disability, cognitive tests (Symbol Digit Modalities, Auditory Verbal Learning Test, Trail Making Test, and Hayling Sentence Completion Test, Word Memory Test ), and the Hospital Anxiety and Depression Scale. Severity of HI was determined by duration of loss of consciousness (LoC), where moderate-severe groupings had indicated LoC of greater than 30 minutes, and by the total number of HIs sustained. Group scores were compared to assess disability and cognitive impairment as a function of HI severity and to estimate level of need. 

Results. Most of the sample (74%) of 81 offenders lived in areas of high social deprivation before sentencing and were representative of the prison population in Scotland with respect to age and socioeconomic background. All but one self-reported at least one HI, and of these, most (88%) reported more than one HI, with a further 20% self-reporting a moderate-severe HI. The average age of first HI was 10 years. The majority had been convicted of violent offences (84%), and 88% had sustained a HI prior to their first conviction. Multivariable regression indicated that longer duration of LoC was associated with poorer scores on Symbol Digit Modalities, higher anxiety, and with disability after adjusting for covariates (age, years of education, effort score and previous problematic alcohol and/or substance use). Overall, 31-56% of prisoners with moderate-severe HI had cognitive deficits, anxiety, and disability. 

Conclusion. These initial data tentatively suggest that about 20% of male prisoners with HI require assessment and a further half of these require intervention because of persisting cognitive impairment and/or disability. This is an on-going study hence these are preliminary results. 

1 http://www.nphn.scot.nhs.uk/wp-content/uploads/2016/07/NPHN-Brain-Injury-and-Offending-Final-Report.pdf

Head Injury and associated Disability in Male Prisoners