Social disadvantage and brain injury

There is growing evidence that those in socially peripheral and disadvantaged groups are more likely to have suffered an acquired brain injury (ABI), particularly a traumatic brain injury (TBI). What is less clear is whether this association is due to common risk factors for social exclusion and for brain injury, or whether each increases the risk of the other. Of course, the likely answer is that these factors are not mutually exclusive and that each factor or combination of factors plays some part in increasing this association. It is the aim of this chapter to examine the current evidence in order to understand this association better and to look at the implications of this analysis in terms of intervention for both the prevention and treatment of brain injury and for addressing social exclusion.

The most common form of ABI (brain injury that occurs after birth) is TBI. TBI is caused by physical impact to the head, either by sudden acceleration or sudden deceleration. TBI often leads to a characteristic pattern of deficits that makes the demands of life more difficult to meet. Common problems include cognitive deficits, such as memory, concentration and executive problems. Executive problems affect a person's ability to problem-solve, plan and organise goal-directed behaviour. In addition, certain non-cognitive neurobehavioural changes are common, such as reduced ability to regulate emotion, disinhibition, impulsivity and problems with social cognition. The latter affect a person's ability to read social cues and to moderate their behaviour so that it is appropriate to the situation.

It is easy to speculate about how these deficits could lead the individual to become marginalised by society as they affect many of the core skills required to conform to accepted patterns of behaviour. Cognitive problems make it difficult to maintain work in the open market. Other neurobehavioural deficits make it difficult to maintain social relationships, both at work and outside work. Such difficulties can therefore clearly have an impact on the likelihood of becoming homeless, falling foul of the law and failing to cope adequately with the demands of civilian life after time spent in the structured and regulated world of the military.