Patient’s Experiences of Violence as Perpetrator: A Qualitative Study from Patients with Schizophrenia in Indonesia (original) (raw)
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How patients with schizophrenia “as a Victim” cope with violence in Indonesia: a qualitative study
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2021
Background There is increasing concern about the level of violence and people with schizophrenia. However, research about violence in correlation with schizophrenia mostly focuses on patients as offenders rather than victims. Phenomenology was chosen to explore experience of patients with schizophrenia as a victim coping with violence in Indonesia. Results Of the 40 interviewees, average age was 35.8 years old (range 21–43). The 40 patients with schizophrenia comprised 26 males and 14 females. Violence typically included pushing, punching, or kicking, and restrained. The patient’s coping experiences as victims of violence were categorized into three themes: submission ( n = 28), expression of anger to object ( n = 33), and positive coping strategy ( n = 23). Conclusion To shorten the evaluation required to choose coping strategies, domestic violence education/psychoeducation would be relevant.
East Asian Arch Psychiatry , 2019
Objective: This study aimed to determine the prevalence of violence and factors associated with aggressive or violent behaviour in Thai patients with schizophrenia. Methods: This cross-sectional study was conducted in all patients with schizophrenia aged ≥18 years admitted to Suan Prung Psychiatric Hospital, Thailand, between January and November 2014. Baseline interviews were conducted by a psychiatrist and psychiatric nurses. Accessibility to weapons and toxic chemicals was evaluated. Results: Of 230 patients with schizophrenia screened, 207 (162 men and 45 women) were included. Of them, only 16 (7.7%) patients had aggressive or violent behaviour, including verbal aggression (n = 7), physical aggression (n = 5), and aggression against property (n = 4). Nonetheless, only 2 (12.5%) of them had been charged by the police. The weapon score was higher in violent than non-violent patients (p < 0.05). Binary logistic regression analysis showed that the weapon score was the only significant predictor of violence. Conclusion: Patients with schizophrenia with greater access to weapons were more likely to have aggressive or violent behaviour. Routine screening for access to weapons in clinical settings and adequate treatment of psychotic symptoms may reduce the incidence of aggressive or violent behaviour and violent offences.
Violence in Inpatients With Schizophrenia: A Prospective Study
Schizophrenia Bulletin, 1999
Accurate evaluations of the dangers posed by psychiatric inpatients are necessary, although a number of studies have questioned the accuracy of violence prediction. In this prospective study, we evaluated several variables in the prediction of violence in 63 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Nurses rated violent incidents with the Overt Aggression Scale. During hospitalization, sociodemographic variables, clinical history, neurological soft signs, community alcohol or drug abuse, and electroencephalographic abnormalities did not differ between violent and nonviolent groups. Violent patients had significantly more positive symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), higher scores on the PANSS general psychopathology scale, and less insight in the different constructs assessed. A logistic regression was performed to discriminate between violent and nonviolent patients. Three variables entered the model: insight into symptoms, PANSS general psychopathology score, and violence in the previous week. The actuarial model correctly classified 84.13 percent of the sample; this result is significantly better than chance for the base rate of violence in this study. At hospital admission, clinical rather than sociodemographic variables were more predictive of violence. This finding has practical importance because clinical symptoms are amenable to therapeutic approaches. This study is the first to demonstrate that insight into psychotic symptoms is a predictor of violence in inpatients with schizophrenia.
A Journey of Hidden Outburst of Anger Shackling a Person with Schizophrenia: The Indonesian Context
The Qualitative Report, 2021
Shackling a person with schizophrenia violates human rights. This process is often carried out when the person has committed acts of violence and hostility. In this study, we focus on considering the shackling of a person with schizophrenia in Indonesia’s context. We used grounded theory (GT; Charmaz, 2011) with 23 participants located in the East Java Province, Indonesia. The participants consisted of people with schizophrenia who were shackled by their ankles, families treating people with schizophrenia, the cadre volunteers, prominent figures, and nurses. We used in-depth interviews using semi-structured questions. We identified five phases associated with the process of shackling a person with schizophrenia: (a) distress signal, (b) high demand for treatment, (c) a change of positive convictions, (d) loss of confidence and capability, and (e) restrictions. Understanding the process of shackling people with schizophrenia will help the Indonesian government prevent people with sch...
BMC Psychiatry
Background: Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. Methods: A case-control study was conducted in Bogor Regency from May-June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012-16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. Results: A total of 114 case and 136 control subjects were studied. Patient's aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52-8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09-6.9) and informal employment (AdjOR: 2.5, 95%CI: 1. 1-5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43-4.43) were associated with pasung. Patient's aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. Conclusions: Patient's aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.
Salud mental, 2021
Introduction. Schizophrenia is a mental disorder that affects 21 million people worldwide, and it brings about environments with high Expressed Emotion (EE) in the families of these individuals. High EE is characterized by negative evaluations, criticism, and overinvolvement of family members towards the person with schizophrenia. Objective. Recognize the relationship between the cultural agreement about the symptoms of schizophrenia and EE. Method. The study had a mixed design, with a cognitive anthropology method. The sample had a probabilistic estimate based on Weller and Romney proposal, with a competence higher than 50%, a confidence level of 95%, and 5% of type I error. The 40 participants were selected with a simple randomized probability sampling, conformed by relatives of patients from the Instituto Jalisciense de Salud Mental (SALME). Results. The 45% of the sample showed a high EE according to the Questionnaire for Measuring the Level of Expressed Emotion (CEEE). A single...
International Journal of Mental Health Systems
Background: The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. Objective: To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. Methods: This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. Results: Family members and society in general perceived that pasung is necessary for security reasons due to the patient's aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient's request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. Conclusion: Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.
2019
Mental nurses are health workers who are most often experiencing violence from patients because they face patients with various emotional symptoms. One in five patients in the acute psychiatric units in several countries can commit violence. Violence toward nurses has various effects that can affect their quality of work life. This study aims to explore the lived experience of nurses who get violence from patients.The method of this study is qualitative with a phenomenological approach. A total of nine participants were involved in this study with criteria having experienced violence from patients ≤ 1 year while working in a psychiatric intensive care unit and emergency unit. The process of data retrieval by in-depth interviews and analyzed with Colaizzi method. The result of this study found 4 themes namely, feeling incompetent to face violent of patients, feeling disappointed and disadvantaged by mental hospital management, tend to avoid when facing violent of patients, and realiz...
Severe non-lethal violence in psychotic illness
Background: Research about violence in psychosis has mainly considered homicide by people with mental disorder, especially schizophrenia, and violence in groups of psychiatric patients. In this study we examine the characteristics of a sample of offenders with psychotic illness who committed severe non-lethal violent offences. Method: A review of court documents from a consecutive series of cases involving violence resulting in signifi cant injury concluded in the District Court of New South Wales, Australia, in the years 2006 and 2007. Results; Of 661 people found to have committed a severe violent offence, 74 (11%, 95% confi dence interval (CI) 9 -14%) had a diagnosed psychotic illness. Of these, 16 (22%, 95% CI 12 -31%) had never received treatment with antipsychotic medication and could be regarded as being in the fi rst episode of psychosis. Offenders with psychosis were typically non-adherent to treatment, had co-morbid substance use and prior criminal convictions. Positive symptoms of psychotic illness such as hallucinations and delusional beliefs were reported to be present at the time of the offence in most of the cases. Seven of 74 (10%) psychotic offenders were found not guilty on the grounds of mental illness. Conclusions: People with psychotic illness are over-represented among those who commit violent offences resulting in signifi cant injury, confi rming the presence of an association between psychosis and severe non-lethal violence. Earlier treatment of fi rst episode psychosis, improving the adherence to treatment of known patients and treatment of co-morbid substance abuse could reduce the incidence of severe violence committed by patients with psychosis.