Traumatic brain injury in criminal justice systems: a systematic literature review

Traumatic brain injury (TBI) is common among justice-involved persons, creating substantial health and economic burdens owing to its association with a range of adverse psychosocial outcomes. No study to date has synthesised extant knowledge about TBI across the whole criminal justice pathway. We aimed to conduct a systematic review of the literature on TBI across this pathway, from arrest through to release from custody. Following PRISMA guidelines, five key electronic databases (PubMed, PsychInfo, Medline, Embase, Cinahl), Proquest Dissertations & Theses Global, Cochrane Database of Systematic Reviews, Web of Science, and grey literature were searched up to May 2023. Fifty-six reports met inclusion criteria. Three more reports were added after review. TBI prevalence rates ranged from 5.65% to 100% with higher rates among persons experiencing federal incarceration, justice-involved adolescents, and justice-involved veterans in the US. Severity of TBI was mostly mild. Studies reported positive associations between TBI and many psychosocial outcomes including violence, incarceration rates, cognitive impairment, mood disorders, psychosis, substance use disorders, and socioeconomic deprivation. Other adverse outcomes included reduced participation in educational activities and increased utilisation of mental health services. More research is needed to establish the true prevalence of TBI in criminal justice systems and the relationship between TBI and psychosocial as well as criminogenic outcomes.