Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T13:01:38.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Aggression patterns and clinical predictors of inpatient aggressionin a mental health low secure unit population

Published online by Cambridge University Press:  01 December 2008

Anandamurugan Muthukumaraswamy ,
M Dominic Beer  and
Kalaanithi Ratnajothy
Anandamurugan Muthukumaraswamy
Affiliation:
Specialist Registrar, Bracton Centre, Oxleas NHS Foundation Trust
M Dominic Beer*
Affiliation:
Consultant Psychiatrist, Oxleas NHS Foundation Trust and Honorary Senior Lecturer Institute of Psychiatry, University of London
Kalaanithi Ratnajothy
Affiliation:
Research and Development Manager, Oxleas NHS Foundation Trust
*
Correspondence to: Dr Dominic Beer, Bracton Centre, Oxleas NHS Trust, Bracton Lane, Dartford, Kent, DA2 7AF. E-mail: Dominic.Beer@oxleas.nhs.uk
Get access

Abstract

Aims: To describe the pattern of aggressive incidents, compare clinical characteristics of aggressive and non aggressive inpatients and determine predictors of inpatient aggressive behaviours in a low secure mental health unit population.

Method: Clinical data were extracted from inpatient records and a critical incident database for a low secure unit population. Clinical variables between those with inpatient aggressive behaviours (inpatient aggressors) and those without inpatient aggressive behaviours (inpatient non aggressors) were compared. Statistical analysis was carried out on the differences to establish predictors of inpatient aggression.

Results: 80 admissions resulted from 78 patients during a 6½ year period. 44% of patients presented with inpatient aggressive incidents. 64% of aggressive incidents resulted from 15% of patients. 54% of aggressive incidents were directed towards staff, 16% towards property and 15% towards other patients. 8% and 4% contributed to disturbed behaviour (non-directed aggression) and sexually inappropriate behaviour respectively. Most aggressive incidents are perpetrated by males and directed towards staff though a larger proportion of females (compared to males) were aggressive. On univariate analysis, clinical variables of more than one previous psychiatric admission, auditory hallucinations and delusions of control and persecution were significantly higher in patients displaying inpatient aggression. Logistic regression analysis identified the former two as predictors of inpatient aggression.

Conclusion: In a low secure inpatient population, the majority of aggressive incidents are perpetrated by a minority of patients. Clinical variables such as history of more than one previous psychiatric admission and psychopathological symptoms such as presence of auditory hallucinations and delusions of control and persecution can influence inpatient aggression.

Keywords

Aggressioninpatient aggressioninpatient violenceviolencelow secure unitrisk predictorsmental health
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 4 , Issue 1-2 , December 2008 , pp. 9 - 16
Copyright
Copyright © NAPICU 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abeyasinghe, R. and Jayasekera, R. (2003) Violence in a general hospital psychiatry unit for men. Ceylon Medical Journal. 48(2): 45–47.Google Scholar
Agarwal, M. and Roberts, M. (1996) Violence among psychiatric in-patients at an Interim Secure Unit: Changes in pattern over a two-year period. Medicine Science and Law. 36(1): 31–36.Google Scholar
Arango, C., Calcedo Barba, A., Gonzalez-Salvador, T. and Calcedo Ordonez, A. (1999) Violence in inpatients with schizophrenia: A prospective study. Schizophrenia Bulletin. 25(3): 493–503.Google Scholar
Arboleda-Florez, J. (1998) Mental illness and violence: An epidemiological appraisal of the evidence. Canadian Journal of Psychiatry. 43(10): 989–996.Google Scholar
Barlow, K., Grenyer, B. and Ilkiw-Lavalle, O. (2000) Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry. 34(6): 967–974.Google Scholar
Benjaminsen, S.E. and Kjaerbo, T. (1997) [The staff's experience of patient violence in a psychiatric department] [Article in Danish]. Ugeskr Laeger. 159(12): 1768–1773.Google Scholar
Chou, K.R., Lu, R.B. and Mao, W.C. (2002) Factors relevant to patient assaultive behaviour and assault in acute inpatient psychiatric units in Taiwan. Archives of Psychiatric Nursing. 16(4): 187–195.Google Scholar
Coldwell, J.B. and Naismith, L.J. (1989) Violent incidents on special care wards in a special hospital. Medicine Science and Law. 29(2): 116–123.CrossRefGoogle Scholar
Cooper, S.J., Browne, F.W., McClean, K.J. and King, D.J. (1983) Aggressive behaviour in a psychiatric observation ward. Acta Psychiatrica Scandinavica. 68(5): 386–393.Google Scholar
Eaton, S., Ghannam, M. and Hunt, N. (2000) Prediction of violence on a psychiatric intensive care unit. Medicine Science and Law. 40(2): 143–146.CrossRefGoogle ScholarPubMed
Fottrell, E. (1980) A study of violent behaviour among patients in psychiatric hospitals. British Journal of Psychiatry. 136: 216–221.CrossRefGoogle ScholarPubMed
Grassi, L., Peron, L., Marangoni, C., Zanchi, P. and Vanni, A. (2001) Characteristics of violent behaviour in acute psychiatric in-patients: A 5-year Italian study. Acta Psychiatrica Scandinavica. 104(4): 273–279.Google Scholar
James, D.V., Fineberg, N.A., Shah, A.K. and Priest, R.G. (1990) An increase in violence on an acute psychiatric ward. A study of associated factors. British Journal of Psychiatry. 156: 846–852.CrossRefGoogle Scholar
Kennedy, J., Harrison, J., Hillis, T. and Bluglass, R. (1995) Analysis of violent incidents in a regional secure unit. Medicine Science and Law. 35(3): 255–260.CrossRefGoogle Scholar
Kraus, J.E. and Sheitman, B.B. (2004) Characteristics of violent behaviour in a large state psychiatric hospital. Psychiatric Services. 55(2): 183–185.Google Scholar
Lanza, M.L., Kayne, H.L., Hicks, C. and Milner, J. (1991) Nursing staff characteristics related to patient assault. Issues in Mental Health Nursing. 12(3): 253–265.Google Scholar
Larkin, E., Murtagh, S. and Jones, S. (1988) A preliminary study of violent incidents in a special hospital (Rampton). British Journal of Psychiatry. 153: 226–231.CrossRefGoogle Scholar
MacPhail, S. and Beck-Sander, A. (1999) Cost analysis of untoward incidents in a medium secure unit. Medicine Science and Law. 39(4): 302–312.Google Scholar
Ng, B., Kumar, S., Ranclaud, M. and Robinson, E. (2001) Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatric Services. 52(4): 521–525.CrossRefGoogle Scholar
Noble, P. and Rodger, S. (1989) Violence by psychiatric in-patients. British Journal of Psychiatry. 155: 384–390.CrossRefGoogle ScholarPubMed
Owen, C., Tarantello, C., Jones, M. and Tennant, C. (1998a) Violence and aggression in psychiatric units. Psychiatric Services. 49(11): 1452–1457.CrossRefGoogle ScholarPubMed
Owen, C., Tarantello, C., Jones, M. and Tennant, C. (1998b) Repetitively violent patients in psychiatric units. Psychiatric Services. 49(11): 1458–1461.CrossRefGoogle ScholarPubMed
Palmstierna, T., Huitfeldt, B. and Wistedt, B. (1991) The relationship of crowding and aggressive behaviour on a psychiatric intensive care unit. Hospital Community Psychiatry. 42(12): 1237–1240.Google Scholar
Palmstierna, T., Lassenius, R. and Wistedt, B. (1989) Evaluation of the Brief Psychopathological Rating Scale in relation to aggressive behaviour by acute involuntarily admitted patients. Acta Psychiatrica Scandinavica. 79(4): 313–316.Google Scholar
Pearson, M., Wilmot, E. and Padi, M. (1986) A study of violent behaviour among in-patients in a psychiatric hospital. British Journal of Psychiatry. 149: 232–235.Google Scholar
Pereira, S., Dawson, P. and Sarsam, M. (2006) The National Survey of PICU and Low Secure Services: 1. Patient characteristics. Journal of Psychiatric Intensive Care. 2: 7–12.Google Scholar
Rix, G. and Seymour, D. (1988) Violent incidents on a regional secure unit. Journal of Advanced Nursing. 13(6): 746–751.Google Scholar
Schanda, H., Gruber, K. and Habeler, A. (2000) [Aggressive behaviour of mentally incompetent psychiatrically ill criminals during inpatient treatment] [Article in German]. Psychiatrische Praxis. 27(6): 263–269.Google Scholar
Soliman, A.E. and Reza, H. (2001) Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatric Services. 52(1): 75–80.Google Scholar
Steinert, T. (2002) [Violent behaviour of patients in institutions] [Article in German]. Psychiatrische Praxis. 29(2): 61–67.Google Scholar
Swanson, J., Borum, R., Swartz, M. and Monahan, J. (1996) Psychotic symptoms and disorders and the risk of violent behaviour in the community. Criminal Behaviour and Mental Health. 6(4): 309–329.Google Scholar
Tam, E., Engelsmann, F. and Fugere, R. (1996) Patterns of violent incidents by patients in a general hospital psychiatric facility. Psychiatric Services. 47(1): 86–88.Google Scholar
Walker, Z. and Seifert, R. (1994) Violent incidents in a psychiatric intensive care unit. British Journal of Psychiatry. 164(6): 826–828.CrossRefGoogle Scholar
Whittington, R. and Wykes, T. (1994) Violence in psychiatric hospitals: Are certain staff prone to being assaulted? Journal of Advanced Nursing. 19(2): 219–225.Google Scholar