1
|
Zhang S, Ouyang X, Yang K, Shen Y, Zheng S, Wang R, Sheng X, Ge M, Yang M, Zhou X. An Exploration of Depression and Aggression Among Patients with Schizophrenia in China Rural Community. Psychol Res Behav Manag 2024; 17:1717-1726. [PMID: 38660458 PMCID: PMC11041961 DOI: 10.2147/prbm.s453891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose In schizophrenia, aggressive conduct is frequent. And depressed mood can also contribute to the occurrence of aggressive behaviors. The aim of this study was to investigate the risk factors for the occurrence of aggression in stable schizophrenia patients in rural China, mainly to investigate the role of depressed mood in the occurrence of aggression in schizophrenia patients. Patients and Methods This is a cross-sectional study conducted in the townships surrounding Chaohu City, Anhui Province, China. Patients' depressive mood was evaluated using the PHQ-9 (The 9-item Patient Health Questionnaire). Patients' aggressiveness was evaluated using the Modified Overt Aggression Scale (MOAS). A score of ≥4 was used as a threshold and divided into aggressive and non-aggressive groups. Results This study comprised a total of 821 schizophrenia patients. Among them, the prevalence of having aggressive behavior was 18.8%. After correcting for confounders, logistic regression analysis showed that low education level (OR=0.470, 95% CI 0.254-0.870; p=0.016), living with family (OR=0.383, 95% CI 0.174-0.845; p=0.017) depressed mood (OR=1.147, 95% CI 1.112-1.184; p<0.001) was significantly associated with the risk of aggressive behavior in patients with schizophrenia. Multivariate linear regression indicated that higher levels of aggression were linked with lower levels of education and higher depressive mood. Conclusion This study suggests that aggression is more common in patients with stable schizophrenia, and lower levels of education and higher levels of depression are associated risk factors for its occurrence. Living alone may be helpful in reducing the likelihood of aggression.
Collapse
Affiliation(s)
- Shaofei Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xu Ouyang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Kefei Yang
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Yunyun Shen
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Siyuan Zheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Ruoqi Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xuanlian Sheng
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Menglin Ge
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Meng Yang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
- Chaohu Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei City, People’s Republic of China
- Second Affiliated Hospital of Anhui Medical University, Hefei City, People’s Republic of China
| |
Collapse
|
2
|
Guo Y, Yang X, Wang D, Fan R, Liang Y, Wang R, Xiang H, Liu Y, Liu X. Prevalence of violence to others among individuals with schizophrenia in China: A systematic review and meta-analysis. Front Psychiatry 2022; 13:939329. [PMID: 35935404 PMCID: PMC9354073 DOI: 10.3389/fpsyt.2022.939329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023] Open
Abstract
Background Violence to others (hereinafter referred to as "violence-TO") is common in individuals with schizophrenia. The reported prevalence of violence-TO among schizophrenics ranges widely in existing studies. Improved prevalence estimates and identification of moderators are needed to guide future management and research. Methods We searched EBSCO, EMBASE, Medline, PubMed, Science Direct, Web of Science, CNKI, VIP, WANFANG data, and CBM for relevant articles published before June 5, 2022. Meanwhile, violence-TO was summarized into four categories: (a) violence-TO on the reviews of official criminal or psychiatric records (type I); (b) less serious forms of violence-TO (type II); (c) physical acts causing demonstrable harm to victims (type III); (d) homicide (type IV). We did meta-analysis for the above types of violence-TO, respectively, and applied subgroup analyses and meta-regression analyses to investigate the source of heterogeneity. Results A total of 56 studies were eligible in this study and 34 of them were high-quality. The prevalence of type I to type IV in individuals with schizophrenia in China was 23.83% (95% CI: 18.38-29.75%), 23.16% (95% CI: 8.04-42.97%), 17.19% (95%CI: 8.52-28.04%), and 0.62% (95% CI: 0.08-1.54%) respectively. The results of the subgroup analysis showed that the prevalence of type I was higher among subjects in the inland than in the coastal non-economic zone, while the prevalence of type III was the highest in the coastal economic zone, followed by the inland region and the lowest in the coastal non-economic zone. The results of multivariate meta-regression analyses showed that: patient source in type I (β = 0.15, P < 0.01), patient source (β = 0.47, P < 0.01), and proportion of male (β = 0.19, P < 0.01) in type II, age (β = 0.25, P < 0.01), and GDP per capita (β = 0.05, P = 0.01) in type III were statistically significant. Conclusion The prevalence of different types of violence-TO and their influencing factors varied. Therefore, the authorities should take different management measures. In addition to individual factors, regional factors may also affect violence-TO, which suggests the need for a multi-sectorial approach to prevention and treatment for subjects in different regions and adopting targeted control strategies. Systematic Review Registration [www.ClinicalTrials.gov], identifier [CRD42021269767].
Collapse
Affiliation(s)
- Yi Guo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xianmei Yang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, Mianyang, China
| | - Dan Wang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, Mianyang, China
| | - Ruoxin Fan
- Sichuan Mental Health Center, The Third Hospital of Mianyang, Mianyang, China
| | - Yiying Liang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rongke Wang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, Mianyang, China
| | - Hu Xiang
- Sichuan Mental Health Center, The Third Hospital of Mianyang, Mianyang, China
| | - Yuanyuan Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiang Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Yu T, Zhang X, Liu X, Xu C, Deng C. The Prediction and Influential Factors of Violence in Male Schizophrenia Patients With Machine Learning Algorithms. Front Psychiatry 2022; 13:799899. [PMID: 35360130 PMCID: PMC8962616 DOI: 10.3389/fpsyt.2022.799899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early to identify male schizophrenia patients with violence is important for the performance of targeted measures and closer monitoring, but it is difficult to use conventional risk factors. This study is aimed to employ machine learning (ML) algorithms combined with routine data to predict violent behavior among male schizophrenia patients. Moreover, the identified best model might be utilized to calculate the probability of an individual committing violence. METHOD We enrolled a total of 397 male schizophrenia patients and randomly stratified them into the training set and the testing set, in a 7:3 ratio. We used eight ML algorithms to develop the predictive models. The main variables as input features selected by the least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) were integrated into prediction models for violence among male schizophrenia patients. In the training set, 10 × 10-fold cross-validation was conducted to adjust the parameters. In the testing set, we evaluated and compared the predictive performance of eight ML algorithms in terms of area under the curve (AUC) for the receiver operating characteristic curve. RESULT Our results showed the prevalence of violence among male schizophrenia patients was 36.8%. The LASSO and LR identified main risk factors for violent behavior in patients with schizophrenia integrated into the predictive models, including lower education level [0.556 (0.378-0.816)], having cigarette smoking [2.121 (1.191-3.779)], higher positive syndrome [1.016 (1.002-1.031)] and higher social disability screening schedule (SDSS) [1.081 (1.026-1.139)]. The Neural Net (nnet) with an AUC of 0.6673 (0.5599-0.7748) had better prediction ability than that of other algorithms. CONCLUSION ML algorithms are useful in early identifying male schizophrenia patients with violence and helping clinicians take preventive measures.
Collapse
Affiliation(s)
- Tao Yu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xulai Zhang
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xiuyan Liu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Chunyuan Xu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Chenchen Deng
- Anhui Province Maternity and Child Health Hospital, Hefei, China
| |
Collapse
|
4
|
Camus D, Dan Glauser ES, Gholamrezaee M, Gasser J, Moulin V. Factors associated with repetitive violent behavior of psychiatric inpatients. Psychiatry Res 2021; 296:113643. [PMID: 33352415 DOI: 10.1016/j.psychres.2020.113643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB.
Collapse
Affiliation(s)
- Didier Camus
- Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Elise S Dan Glauser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland
| | - Mehdi Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Jacques Gasser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
| | - Valerie Moulin
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
| |
Collapse
|
5
|
Breaking down long-term chronic aggression within a forensic hospital system. CNS Spectr 2020; 25:216-222. [PMID: 32331057 DOI: 10.1017/s1092852919001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Historically, patients with multiple acts of aggression, or chronic aggressors, have been studied as one large group. It was our objective to subdivide this group into those patients who engage in physical aggression consistently over multiple years and see if common characteristics of chronic aggressors could classify patients into an aggressive or nonaggressive group. METHOD Within a forensic hospital system, patients who had committed 5 acts of physical aggression, per year, for 3 years (2010 and 2015) were reviewed. Data was collected on clinical and demographic characteristics that have shown to be associated with chronically aggressive patients and compared to nonaggressive matched controls. Data collection and analysis were completed to determine if the variables could classify patients into an aggressive or nonaggressive group. RESULTS Analysis showed that 2 variables, the presence of a cognitive disorder and a history of suicidal behaviors were significant in the univariate and multivariate analyses. The 2 variables were able to correctly classify 76.7% of the cases. CONCLUSION A cognitive disorder, a history of suicidal behavior, and increased age were factors associated with this subgroup of aggressive patients. Clinicians may want to explore treatment programs aimed at these clinical factors including cognitive rehabilitation and social cognition treatments, which have been shown to reduce aggression in cognitively impaired populations.
Collapse
|
6
|
Ladois-Do Pilar Rei A, Chraïbi S. [Patients assaulted in psychiatric institutions: Literature review and clinical implications]. Rev Epidemiol Sante Publique 2017; 66:53-62. [PMID: 29223515 DOI: 10.1016/j.respe.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/30/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. METHODS To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults. Secondly, we examined the issue of sexual and physical assaults between patients receiving treatment in a psychiatric ward. In this context, we studied possible occurrence of posttraumatic stress disorder associated with exposure to assaults of this kind. RESULTS In certain cases, potentially traumatic exposure to violence was unknown to the medical staff or not taken into consideration. This would induce a risk of later development of posttraumatic stress disorder that would not be treated during the stay in psychiatry. CONCLUSION To date, few scientific studies have focused on the proportion of patients assaulted by other patients during treatment in a psychiatric ward and the subsequent development of peritraumatic reactions and/or posttraumatic stress disorder associated with these assaults. We know that an insufficient number of public and private health institutions report the existence of such facts to the competent authorities. Also, a minority of clinicians and caregivers are trained in screening and management of trauma victims. Yet, these issues are particularly relevant in the scope of public health and health promotion.
Collapse
Affiliation(s)
- A Ladois-Do Pilar Rei
- Centre hospitalier de Lannemezan, CMP Théophile-Gautier, 1, rue Théophile-Gautier, 65000 Tarbes, France.
| | - S Chraïbi
- Laboratoire cliniques pathologique et interculturelle (LCPI), université Toulouse Jean-Jaurès, 5, allées Antonio-Machado, 31058 Toulouse, France
| |
Collapse
|
7
|
Iennaco JD, Whittemore R, Dixon J. Aggressive Event Incidence using the Staff Observation of Aggression Scale-Revised (SOAS-R): A Longitudinal Study. Psychiatr Q 2017; 88:485-499. [PMID: 27562175 DOI: 10.1007/s11126-016-9462-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to identify aggressive event incidence rates in the inpatient psychiatric setting, describe characteristics of events and differences based on aggression target and type (verbal vs. physical). A longitudinal study was carried out of aggressive events identified by workers in four inpatient psychiatric units using the Staff Observation of Aggression Scale-Revised (SOAS-R) over 6 weeks. A total of 113 aggressive events were recorded resulting in a rate of 13.27 events per bed per year. Verbal aggression was demonstrated in 86 % and physical aggression in 57 % of events. Most events (70.8 %, n = 81) targeted a worker. Compared to other targets, workers were 3.4 times more likely to feel threatened (95 % CI 1.2-9.6, χ2 = 5.08, p = 0.0242), and less likely to have a visible injury (OR 0.15, 95 % CI 0.04-0.6; χ2 = 7.1, p = 0.0078). Event severity ranged from 0 to 21 with a mean of 9.5(SD = 5.1), with 20 % considered severe. Verbal events had lower mean severity of 6.5(SD = 3.8) versus physical events with a severity of 11.8(SD = 4.8; t = 6.5, df = 111, p < 0.0001). In 57.5 % of events there was no consequence to the victim. For most events (76 %) resolution included workers talking to the patient, while 54 % involved use of medication. Restrictive measures (physical hold, seclusion or physical restraint) were involved in 24.8 % of events. Aggression incidence was similar to incidence found in other studies. Workers were the target of most aggressive events and many were identified as having no understandable provocation. Further understanding of event characteristics will promote more effective prevention and management of aggressive events.
Collapse
|
8
|
Rothärmel M, Poirier MF, Levacon G, Kazour F, Bleher S, Gastal D, Lazareth S, Lebain P, Olari M, Oukebdane R, Rengade CE, Themines J, Abbar M, Dollfus S, Gassiot A, Haouzir S, Januel D, Millet B, Olié JP, Stamatiadis L, Terra JL, Bénichou J, Campion D, Guillin O. [Association between the violence in the community and the aggressive behaviors of psychotics during their hospitalizations]. Encephale 2017. [PMID: 28641816 DOI: 10.1016/j.encep.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Violence is a common issue in psychiatry and has multiple determiners. The aim of this study is to assess the psychotic inpatients' violence in association with the violence of the neighborhood from which the patients are drawn and to estimate the impact of this environmental factor with regard to other factors. METHOD A prospective multicenter study was led in nine French cities. Eligible patients were psychotic involuntary patients hospitalized in the cities' psychiatric wards. During their treatments, any kind of aggressive behavior by the patients has been reported by the Overt Aggression Scale (OAS). RESULTS From June 2010 to May 2011, 95 patients have been included. Seventy-nine per cent of the patients were violent during their hospitalizations. In a bivariate analysis, inpatient violence was significantly associated with different factors: male gender, patient violence history, substance abuse, manic or mixed disorder, the symptoms severity measured by the BPRS, the insight degree and the city crime rate. In a multivariate analysis, the only significant factors associated with the patients' violence were substance abuse, the symptoms severity and the crime rates from the different patients' cities. CONCLUSION These results suggest that violence within the psychotic patients' neighborhood could represent a risk of violence during their treatments.
Collapse
Affiliation(s)
- M Rothärmel
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France.
| | - M-F Poirier
- Service hospitalo-universitaire de santé mentale et de thérapeutique, centre hospitalier Saint-Anne, 75014 Paris, France
| | - G Levacon
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France
| | - F Kazour
- Service de psychiatrie, faculté de médecine, Beyrouth, Liban
| | - S Bleher
- Service hospitalo-universitaire, centre hospitalier Guillaume-Régnier, 35703 Rennes, France
| | - D Gastal
- Unité de recherche clinique 93G03, établissement public de santé de Ville Evrard, 93330 Neuilly-sur-Marne, France
| | - S Lazareth
- Service de psychiatrie A1, centre hospitalo-universitaire de Nîmes, 30900 Nîmes, France
| | - P Lebain
- Service hospitalo-universitaire, centre Esquirol, centre hospitalo-universitaire de Caen, 14003 Caen, France
| | - M Olari
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France
| | - R Oukebdane
- Service de psychiatrie 93G01, établissement public de santé de Ville Evrard, 93200 Saint-Denis, France
| | - C-E Rengade
- Service de psychiatrie 69G012, centre hospitalier du Vinatier, 69500 Bron, France
| | - J Themines
- Unité intersectoriel de psychiatrie, centre hospitalier Sainte-Marie, 12032 Rodez, France
| | - M Abbar
- Service de psychiatrie A1, centre hospitalo-universitaire de Nîmes, 30900 Nîmes, France
| | - S Dollfus
- Service hospitalo-universitaire, centre Esquirol, centre hospitalo-universitaire de Caen, 14003 Caen, France
| | - A Gassiot
- Unité intersectoriel de psychiatrie, centre hospitalier Sainte-Marie, 12032 Rodez, France
| | - S Haouzir
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France
| | - D Januel
- Unité de recherche clinique 93G03, établissement public de santé de Ville Evrard, 93330 Neuilly-sur-Marne, France
| | - B Millet
- Service hospitalo-universitaire, centre hospitalier Guillaume-Régnier, 35703 Rennes, France
| | - J-P Olié
- Service hospitalo-universitaire de santé mentale et de thérapeutique, centre hospitalier Saint-Anne, 75014 Paris, France
| | - L Stamatiadis
- Service de psychiatrie 93G01, établissement public de santé de Ville Evrard, 93200 Saint-Denis, France
| | - J-L Terra
- Service de psychiatrie 69G012, centre hospitalier du Vinatier, 69500 Bron, France
| | - J Bénichou
- Unité de biostatistiques et de méthodologie, centre hospitalo-universitaire de Rouen, 76000 Rouen, France
| | - D Campion
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France; Unité U1079, université de Rouen, 76000 Rouen, France
| | - O Guillin
- Service hospitalo-universitaire, centre hospitalier du Rouvray, 4, rue Paul-Eluard, 76300 Sotteville-lès-Rouen, France; Unité U1079, université de Rouen, 76000 Rouen, France
| |
Collapse
|
9
|
Abstract
Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence.
Collapse
|
10
|
Zhou JS, Zhong BL, Xiang YT, Chen Q, Cao XL, Correll CU, Ungvari GS, Chiu HFK, Lai KYC, Wang XP. Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis. Asia Pac Psychiatry 2016; 8:60-9. [PMID: 26346165 DOI: 10.1111/appy.12209] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/28/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China. METHODS Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis. RESULTS The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies). CONCLUSIONS Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.
Collapse
Affiliation(s)
- Jian-Song Zhou
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Qiongni Chen
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| | - Xiao-Lan Cao
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York City, NY, USA
| | - Gabor S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.,Marian Centre, The University of Notre Dame Australia, Perth, WA, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kelly Y C Lai
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Ping Wang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China
| |
Collapse
|
11
|
Al-Sagarat AY, Hamdan-Mansour AM, Al-Sarayreh F, Nawafleh H, Moxham L. Prevalence of aggressive behaviours among inpatients with psychiatric disorders: A case study analysis from Jordan. Nurs Health Sci 2015; 18:172-9. [DOI: 10.1111/nhs.12239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/21/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmad Y. Al-Sagarat
- Department of community and Mental Health Nursing; Mutah University; Al-Karak Jordan
| | | | - Faris Al-Sarayreh
- Department of community and Mental Health Nursing; Mutah University; Al-Karak Jordan
| | - Hani Nawafleh
- Nursing department; Al-Hussein Bin Talal University; Ma'an Jordan
| | - Lorna Moxham
- School of Nursing; University of Wollongong; New South Wales Australia
| |
Collapse
|
12
|
Andreasson H, Nyman M, Krona H, Meyer L, Anckarsäter H, Nilsson T, Hofvander B. Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:635-642. [PMID: 24631525 DOI: 10.1016/j.ijlp.2014.02.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n=125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.
Collapse
Affiliation(s)
- Helena Andreasson
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden.
| | - Marielle Nyman
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Hedvig Krona
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Lennart Meyer
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Henrik Anckarsäter
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden
| | - Thomas Nilsson
- Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden
| | - Björn Hofvander
- Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden; Department of Psychiatry, Autism Research Centre, Cambridge University, UK
| |
Collapse
|
13
|
Abstract
Previous reviews of the literature from 1976 to 2000 documented two categories of assaultive psychiatric patients: (1) male patients with schizophrenic illness and histories of violence toward others and substance use disorder and (2) male/female patients with personality disorders and histories of violence toward others, personal victimization, and substance use. The present study reviewed the published findings on American assaultive patients from 2000 to 2012. The present findings partially supported the earlier findings in that patients with schizophrenic illness continued to present the greatest risk for assault. However, personality disordered patients were not equal in assault risk to patients with affective disorders. Possible explanations for these findings and a detailed methodological review are presented.
Collapse
|
14
|
Nourse R, Reade C, Stoltzfus J, Mittal V. Demographics, clinical characteristics, and treatment of aggressive patients admitted to the acute behavioral unit of a community general hospital: a prospective observational study. Prim Care Companion CNS Disord 2014; 16:13m01589. [PMID: 25317364 DOI: 10.4088/pcc.13m01589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/11/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Aggressive patients are not uncommon in acute inpatient behavioral health units of general hospitals. Prior research identifies various predictors associated with aggressive inpatient behavior. This prospective observational study examines the demographic and clinical characteristics of aggressive inpatients and the routine medications these patients were receiving at discharge. METHOD Thirty-six adults diagnosed with a DSM-IV mental disorder who met 2 of 6 established inclusion criteria for high violence risk and a Clinical Global Impressions-Severity of Illness (CGI-S) scale score ≥ 4 were observed for a maximum of 28 days on the 23-bed case mix acute behavioral health unit of St Luke's University Hospital, Bethlehem, Pennsylvania, from January 2012 to May 2013. Primary outcome measures were the Modified Overt Aggression Scale (MOAS) and CGI-S; secondary measures were symptom outcome measures and demographic and clinical characteristics data. Analysis was conducted using repeated measures methodology. RESULTS Younger males with a history of previous violence, psychiatric admissions, and symptoms of severe agitation were more at risk for aggressive behavior. Positive psychotic symptoms, a diagnosis of bipolar disorder, substance use, and comorbid personality disorders also increased risk. Significant improvements from baseline to last visit were observed for the CGI-S and MOAS (P < .001 for both), with a significant correlation between the MOAS and CGI-S at last visit (P < .001). Only the symptom of agitation was significantly correlated to MOAS scores at both baseline and last visit (P < .001). CONCLUSION Patients significantly improved over time in both severity of illness and level of aggression.
Collapse
Affiliation(s)
- Rosemary Nourse
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Cynthia Reade
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Jill Stoltzfus
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| | - Vikrant Mittal
- Department of Psychiatry (Ms Nourse), Behavioral Health Services (Dr Mittal and Ms Reade) and Research Institute (Dr Stoltzfus), St Luke's University Hospital, Bethlehem, Pennsylvania
| |
Collapse
|
15
|
Dickens G, Piccirillo M, Alderman N. Causes and management of aggression and violence in a forensic mental health service: perspectives of nurses and patients. Int J Ment Health Nurs 2013; 22:532-44. [PMID: 23167989 DOI: 10.1111/j.1447-0349.2012.00888.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.
Collapse
|
16
|
Grenyer BFS, Lewis KL, Ilkiw-Lavalle O, Deane R, Milicevic D, Pai N. The developmental and social history of repetitively aggressive mental health patients. Aust N Z J Psychiatry 2013; 47:463-9. [PMID: 23341475 DOI: 10.1177/0004867412474106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A small subgroup of patients is primarily responsible for the large number of aggressive and violent incidents in psychiatric inpatient units. This study aims to identify the developmental, social and interpersonal histories of repeatedly aggressive patients in order to better understand their treatment needs. METHODS A total of 1269 consecutive inpatients were studied over 18 months, identifying 64 who were repeatedly aggressive; 128 non-aggressive patients were randomly matched to the aggressive patients by age, sex and diagnosis. Developmental, social, interpersonal and familial histories were obtained from a chart review. RESULTS Repeatedly aggressive patients were significantly more likely to have had a history of aggression, physical and sexual abuse, and experienced interpersonal problems and parental divorce. CONCLUSIONS Aggressive patients do not just need short-term skills training, but interventions that target interpersonal and personality disorder deficits associated with their developmental histories.
Collapse
Affiliation(s)
- Brin F S Grenyer
- School of Psychology, University of Wollongong, NSW 2522, Australia.
| | | | | | | | | | | |
Collapse
|
17
|
Linette D, Francis S. Climate control: creating a multifaceted approach to decreasing aggressive and assaultive behaviors in an inpatient setting. J Psychosoc Nurs Ment Health Serv 2011; 49:30-5; quiz 44-5. [PMID: 22007853 DOI: 10.3928/02793695-20111004-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/17/2011] [Indexed: 11/20/2022]
Abstract
Creating an environment that is safe for everyone is a goal for all inpatient mental health units. How to address the aggressive and assaultive behaviors is the challenge. This article discusses how using a multidisciplinary team with a variety of approaches can help create a culture that supports safety.
Collapse
Affiliation(s)
- Donna Linette
- GEO Care Inc., South Florida State Hospital, Pembroke Pines, Florida 33025, USA.
| | | |
Collapse
|
18
|
Lynch DM, Noel HC. Integrating DSM-IV Factors to Predict Violence in High-Risk Psychiatric Patients. J Forensic Sci 2010; 55:121-8. [DOI: 10.1111/j.1556-4029.2009.01197.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Vandamme MJ. Schizophrénie et violence : facteurs cliniques, infracliniques et sociaux. ANNALES MEDICO-PSYCHOLOGIQUES 2009. [DOI: 10.1016/j.amp.2009.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Allen DE, de Nesnera A, Souther JW. Executive-level reviews of seclusion and restraint promote interdisciplinary collaboration and innovation. J Am Psychiatr Nurses Assoc 2009; 15:260-4. [PMID: 21665812 DOI: 10.1177/1078390309342749] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elimination of seclusion and restraint requires support at all levels of an organization, especially from leaders who visibly champion and communicate their vision. Nurses, physicians, educators, and administrators at New Hampshire Hospital, an acute psychiatric inpatient facility, have established a standard meeting time and place for an executive-level review of every episode of seclusion and restraint. The standing meeting demonstrates the organization's commitment to caring for both patients and staff. The daily meetings foster a spirit of interdisciplinary collaboration, where direct care staff have the opportunity to tell their stories and share their ideas and concerns in an environment that is caring, supportive, and devoid of criticism or blame. Narrative descriptions of emergency interventions, including what was learned from debriefings with patients and staff involved, provide data about factors that may contribute to the use of seclusion or restraint. This forum provides visible administrative and clinical support that promotes creative thinking, collaborative problem solving, and the exploration of new ideas recommended by those directly involved in providing patient care. It has fostered exploration and development of strategies that have minimized episodes of aggressive behavior as well as seclusion and restraint.
Collapse
|
21
|
Abstract
Nursing is a demanding and stressful occupation. Nursing staff is required and expected to develop an interpersonal style that conveys concern for mentally ill patients. This study is aimed at investigating whether staff attitudes and behaviours are related to assaults on nurses in psychiatric settings. One hundred, sixty-two nurses working in psychiatric hospitals participated in this descriptive and analytical study. The data were gathered with an Interview Form and The Interpersonal Style Inventory. The statistical analysis shows that nurses who are less social and less tolerant are more exposed to physical assaults from patients, however nurses who are more help-seeking are more exposed to verbal assaults and have a concern of being assaulted. The findings of this research suggest that nurses' interpersonal styles may contribute to aggressive behaviours of patients/relatives.
Collapse
Affiliation(s)
- Hülya Bilgin
- Florence Nightingale School of Nursing, Istanbul University, Istanbul, Turkey.
| |
Collapse
|
22
|
Aggression patterns and clinical predictors of inpatient aggression in a mental health low secure unit population. ACTA ACUST UNITED AC 2008. [DOI: 10.1017/s1742646408001283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
23
|
Larson TC, Sheitman BB, Kraus JE, Mayo J, Leidy L. Managing treatment resistant violent adolescents: a step forward by substituting seclusion for mechanical restraint? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 35:198-203. [PMID: 18058220 DOI: 10.1007/s10488-007-0156-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 11/16/2007] [Indexed: 11/30/2022]
Abstract
Despite a growing consensus that seclusion or restraint should never be used with children or adolescents, there are a few patients who are resistant to treatment, and are persistently violent. The purpose of this study was to measure the efficacy of installing a padded seclusion room to decrease the use of mechanical restraints, a potentially more emotionally traumatic and dangerous intervention than seclusion. After padded room installation, the number of monthly mechanical restraint events per 1000 patient days decreased by 93.7%, from 21.2 to 1.3. A padded seclusion room may offer a safer, albeit a less than desirable alternative to mechanical restraint.
Collapse
Affiliation(s)
- Thomas C Larson
- Child and Adolescent Psychiatry, Dorothea Dix Hospital, 3601 MSC Center, Raleigh, NC 27699, USA.
| | | | | | | | | |
Collapse
|
24
|
Abderhalden C, Needham I, Dassen T, Halfens R, Fischer JE, Haug HJ. Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland. Clin Pract Epidemiol Ment Health 2007; 3:30. [PMID: 18053203 PMCID: PMC2231349 DOI: 10.1186/1745-0179-3-30] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 12/04/2007] [Indexed: 11/17/2022]
Abstract
Background Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult. Objective To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland. Methods We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days. Results A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78) for physical attacks and 1.83 (1.70–1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9), longer length of stay (OR 2.7; 2.0–3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5–2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission. Conclusion Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.
Collapse
Affiliation(s)
- Christoph Abderhalden
- Nursing and Social Education Research Unit, University Bern Psychiatric Services, Berne, Switzerland.
| | | | | | | | | | | |
Collapse
|
25
|
Ketelsen R, Zechert C, Driessen M, Schulz M. Characteristics of aggression in a German psychiatric hospital and predictors of patients at risk. J Psychiatr Ment Health Nurs 2007; 14:92-9. [PMID: 17244011 DOI: 10.1111/j.1365-2850.2007.01049.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the aggressive behaviour of all mentally ill patients within a whole psychiatric hospital with a catchment area of 325 000 inhabitants over a 1-year period (i) to assess the 1-year prevalence and characteristics of aggressive episodes and index inpatients, and (ii) to identify predictors of patients at risk by a multivariate approach. Staff Observation of Aggression Scale was used to assess aggressive behaviour. Characteristics of index inpatients were compared with those of non-index inpatients. Logistic regression analysis was applied to identify risk factors. A total of 171 out of 2210 admitted patients (7.7%) exhibited 441 aggressive incidents (1.7 incidents per bed per year). Logistic regression analyses revealed as major risk factors of aggression: diagnoses (organic brain syndromes OR = 3.6, schizophrenia OR = 2.9), poor psychosocial living conditions (OR = 2.2), and critical behaviour leading to involuntary admission (OR = 3.3). Predictors of aggressive behaviour can be useful to identify inpatients at risk. Nevertheless, additional situational determinants have to be recognized. Training for professionals should include preventive and de-escalating strategies to reduce the incidence of aggressive behaviour in psychiatric hospitals. The application of de-escalating interventions prior to admission might be effective in preventing aggressive behaviour during inpatient treatment especially for patients with severe mental disorders.
Collapse
Affiliation(s)
- R Ketelsen
- Department of Psychiatry and Psychotherapy, Ev. Hospital Bielefeld, Bethel, Remterweg 69-71, D-33617 Bielefeld, Germany.
| | | | | | | |
Collapse
|
26
|
Waldheter EJ, Jones NT, Johnson ER, Penn DL. Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness. J Nerv Ment Dis 2005; 193:609-18. [PMID: 16131944 DOI: 10.1097/01.nmd.0000177788.25357.de] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study was to assess the utility of social cognition and insight in the prediction of violence in a psychiatric inpatient sample. Violence history, demographic information, symptomatology, neuropsychological functioning, social cognition (i.e., attributional style), and insight were assessed in 29 inpatients with severe mental illness. Greater posttest violence was associated with greater pretest violence, less education, greater psychiatric distress, neuropsychological impairment, and hostile attributional and personalizing biases. Hierarchical multiple regression analyses showed that history of violence contributed the most variance to posttest violence. Hostile attributional and personalizing biases were also uniquely associated with posttest violence. Overall, this study supported the modest utility of attributional style measures in the prediction of inpatient violence. The predictive value of insight in this context appears limited.
Collapse
Affiliation(s)
- Evan J Waldheter
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-3270, USA
| | | | | | | |
Collapse
|