Characteristics of violent behaviour in acute psychiatric in-patients: a 5-year Italian study (original) (raw)
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People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future.
Hostility and violence of acute psychiatric inpatients
Clinical Practice & Epidemiology in Mental Health, 2005
The aim of the present study was to find out the extent of hostility and violence and the factors that are associated with such hostility and violence in a psychiatric intensive care unit.
European Psychiatry, 2017
IntroductionViolence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy.Objectives or AimsThe Bolzano psychiatric department adopted a de-escalation model developed by the Institut-für-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers.MethodsIn 2015, health professionals were interviewed by using a ProDeMa® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons.ResultsA total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation fa...
Violence in a psychiatric unit
Journal of Advanced Nursing, 1978
The aim of this paper is to discuss violence in a modem purpose-built psychiatric unit, with a view to a better understanding of the associated problems of patient care and their management. The unit was built in 1965 and since then certain changes In its design have been necessary. Some modification of pliilosophy of care has also been introduced and these clunges have benefited tlie majority of patients, but a plea is made for a 'small area that is lockablc'. The paper makes a valuable contribution to the current discussions into violence in psychiatric hospitals.
International Journal of Law and Psychiatry, 2016
Available online xxxx Background: Numerous studies conducted in inpatient settings have highlighted how mental disorders are associated with an increased risk of violence, particularly during acute phases. However, to date a more limited number of studies have been performed to assess the risk of violence in outpatients, particularly in Italy. The present study aims to evaluate the prevalence of violent events in a sample of patients in charge of a community mental health center in Italy. Methods: Based on data obtained from standardized clinical records, a retrospective study was undertaken to investigate acts of violence (physical aggression only) in a total of 678 patients (Males = 308, 45.4%) in charge of a university mental health center; patients were mainly affected by anxiety disorders (30.7%), depressive disorder (17.2%), bipolar disorder (18.3%) and schizophrenia or other psychotic disorders (25.0%). Results: 27.6% of the sample had committed at least one act of violence during their lifetime, 10.5% over the previous year. 56.7% of those who committed violence acts had acted violently twice or more during their lifetime. A significant association of lifetime violence was found with gender (male), younger age, low education, unemployment, living with parents. With regard to diagnosis, a significant association was found with schizophrenia and other psychotic disorders, personality disorders, mental retardation, and comorbidity between two or more psychiatric disorders. Violence was moreover associated with early age at onset and at first psychiatric treatment, longer duration of the disorder, previous hospital admissions, previous violent events. Conclusion: Violent behavior is relatively common among outpatients.
Violence and its prediction at a psychiatric hospital
European Psychiatry, 2001
Aggressive behaviour in psychiatric inpatients was assessed before and after a training course for staff members. The Social Dysfunction Aggression Scale (SDAS) was used to report and assess aggressive behaviour over time, and the Staff Observation Aggression Scale (SOAS) to report and assess single aggressive incidents. In addition, the numbers of nursing staff members who were on sick leave because of injuries in the periods before and after the course were recorded and compared. No statistically significant reduction was found in the number of aggressive patients or in the number of staff members on sick leave. One interesting finding was a lower reporting on the SOAS of perceived aggressive incidents after the training course in comparison with the SDAS reports. Directed verbal aggressiveness and violence towards things were found to be predictors of violence.
The extent and effects of violence among psychiatric in-patients
Psychiatric Bulletin, 1995
Actual and perceived safety of male and female ¡n-patientsin an inner-city psychiatric hospital were examined. Using semi-structured interviews, 59 inpatients were asked to report on their direct experiences of physical or sexually threatening behaviour towards them during their admission. Of the sample, 75% reported unwanted physical or sexual experiences: female patients were significantly more likely than males to report sexual harassment. Most incidents were not reported to staff and both staff and patients appeared to perceive the ward environment as safe despite fairly high levels of verbal and physical aggression. Thisstudy has implications for the way that 'violent incidents' in psychiatric hospitals are defined and recorded and raises questions about the provision of women-only space in hospitals.
The antecedents of violence and aggression within psychiatric in-patient settings
Acta Psychiatrica Scandinavica, 2012
antecedents of violence and aggression within psychiatric in-patient settings. Objective: To systematically review the types and proportions of antecedents of violence and aggression within psychiatric in-patient settings. Method: Empirical articles and reports with primary data pertaining to violence and aggression within adult psychiatric in-patient settings were retrieved. For each study, prospective antecedent data were extracted. The extracted antecedent data were thematically analysed, and all higher-level themes were meta-analysed using rate data. Results: Seventy-one studies met the inclusion criteria, from which 59 distinct antecedent themes were identified and organised into nine higher-level themes. The higher-level antecedent theme Ôstaff-patient interactionÕ was the most frequent type of antecedent overall, precipitating an estimated 39% of all violent ⁄ aggressive incidents. An examination of the staff-patient interaction themes revealed that limiting patients freedoms, by either placing some sort of restriction or denying a patient request, was the most frequent precursor of incidents, accounting for an estimated 25% of all antecedents. The higher-level themes Ôpatient behavioural cuesÕ and Ôno clear causeÕ also produced other large estimates and were attributed to 38% and 33% of incidents overall. Conclusion: This review underscores the influence that staff have in making in-patient psychiatric wards safe and efficacious environments.
Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy
Journal of Nervous & Mental Disease, 2020
Workplace violence and aggression are receiving increasing attention, especially when perpetrated in at-risk services such as psychiatric and emergency departments. Many healthcare providers have been victims of verbal aggressions (VAs) and physical aggressions (PAs), as well as injuries (INs), at the hands of patients. We conducted a 1-year retrospective questionnaire-based survey to assess workplace violence and aggression experienced by staff working at the Psychiatric Service of the Health District of Bolzano-Bozen (Italy). We performed parametric statistics. Logistic regression estimated the size of the association between PA occurrence and staff characteristics. Our psychiatric service's employees were frequent victims (91.5%) of 1 or more aggression/injury in the previous year. VAs and INs showed comparable frequencies among the three sites of our service, that is, the inpatient (INP), the outpatient (OUTP), and the rehabilitation (REHAB) units, differently from PAs, whic...