Behavioral health is brain health among men with brain injury in the criminal legal system

Cognitive impairments are associated with poor outcomes for persons in criminal justice. Traumatic brain injury (TBI) causes cognitive impairments, but cognitive impairments are also associated with other behavioral health comorbidities like mental illness, substance abuse, trauma history and suicidality. Research has not yet quantified the relative risk for cognitive impairments conferred by behavioral health and traditional brain injury-related vulnerabilities. This study examined clinical interview and computerized cognitive test data from 156 men in the criminal legal system with a reported history of traumatic brain injury that included a loss of consciousness (LOC). To identify which factors best predicted cognition, three hierarchical linear regressions were conducted with measures of learning, attention and inhibition as the independent variables. Age, history of mental illness and history of suicide attempt emerged as significant predictors of poor performance on measures of learning and attention. Men with a history of mental illness exhibited poorer impulse control. Overall, behavioral health comorbidities were significant predictors of cognitive outcomes and outperformed brain injury-related characteristics. Results from this study suggest that, while TBI is a risk factor for cognitive impairment, the adverse behavioral health comorbidities associated with TBI are even more critical. In this way, behavioral health is critical to brain health. Importantly, this group of vulnerable men is characterized by a history of substance abuse (97.1%), mental illness (77.6%) and attempts to die by suicide (37.8%) which is almost 10 times higher than the general population base rate of suicidal behavior. Understanding the vulnerabilities of these men, including the contributions of behavioral health comorbidities to cognitive impairment, can help prioritize interventions in systems where resources and staff time are limited.

Traumatic brain injury; Jail; Probation; Mental illness; Behavioral health; Cognition

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