Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis (original) (raw)
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2020
Aim: The objective is to identify key predictors of violent behaviour amongst patients admitted to PICUs. Methods: A literature search was carried out in five online databases using a predefined strategy with terms relevant to the setting and population. Articles were screened based on the inclusion criteria and quality assessed using the Hawker critical appraisal tool. A thematic matrix was prepared from the final articles to highlight the pivotal predictors for violent behaviour in PICUs. Results: Initial search without duplicates retrieved 152 articles, of which 120 were excluded after screening their title and abstract. The full-text of 32 articles was read of which a total of 10 studies with 4733 participants were included in the literature review. These studies had good designs and methodological quality. The key predictors of violent incidents were a longer duration of in-patient stay, higher readmission rate, non-voluntary admission to PICUs, previous history of violence and...
Psychological Medicine, 2021
Background Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions. Methods Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1–4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded. Results We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18)...
Risk factors for violence among long-stay psychiatric patients: national study
Acta Psychiatrica Scandinavica, 2007
This study identified risk factors for violence among long-stay (1 year or more) psychiatric patients in Israel (n= 2946) using data from a national re-evaluation of such patients. Patients were rated as being violent if hospital staff or patient charts indicated an incident of physical violence at least every few months. The relationship between violence and patients' functioning, living conditions, treatment, background and hospitalization history was studied. In total, 22.8% of patients were violent. Based on logistic regression analysis, the risk factors for being violent were younger age, younger age at first hospitalization, poorer self-care, having more frequent visitors, and the patient not having his or her own clothing. The data for age and lack of gender differences confirm previous findings. However, the results regarding clothing, visitors, poor self-care and age of onset are unique. The results of this study suggest that the violent behaviour of in-patients is related to both individual and environmental variables.
Incidence of violent behavior among patients in Psychiatric Intensive Care Units
European Journal of Psychiatry, 2016
Background and Objectives: Both psychiatric acute units and psychiatric intensive care units (PICUs) focus on acute treatment of behavioral disturbances such as violence and aggressive threats and acts. The aim of the present study is to describe the frequency of violent behavior; such as verbal or physical threats and physical attacks, among patients admitted to psychiatric intensive care unit (PICU). In addition the relationship between the episodes of threats and/or attacks in relation to time of the day, days of the week, and their seasonal variations was explored. Methods: All violent behavior was continuously assessed at the psychiatric emergency department. Data were collected during the period from May 2010 to May 2012. Results: Patients with only one hospitalization were less violent than those who have had two hospitalizations. There was a statistically significant difference in violence among patients without formal secondary education and those who have not formal educat...
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.
Risk of violence among patients in psychiatric treatment: results from a national census
Nordic journal of psychiatry, 2017
Adverse media coverage of isolated incidents affects the public perception of the risk of violent behavior among people with mental illness. However, the risk of violence is studied most frequently among inpatients, which falsely exaggerates the prevalence of people with mental illness because the majority of individuals receive treatment as outpatients. To estimate the prevalence of the risk of violence among inpatients and outpatients in psychiatric treatment, as well as the associations with gender, age, socio-economic status and co-morbid substance use disorders in all major diagnostic categories. We conducted a national census of patients in specialist mental health services in Norway, which included 65% of all inpatients (N = 2,358) and 60% of all outpatients (N = 23,124). The prevalence of the risk of violence was 32% among inpatients and 8% among outpatients, where 80% of the patients in specialist mental health services were outpatients. If we weight the prevalence rates ac...
Predictors of violent behavior among acute psychiatric patients: Clinical study
Psychiatry and Clinical Neurosciences, 2008
Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. Methods: The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated. Results: Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. Conclusion: A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.
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.
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.