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.
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Acknowledgments
We thank Lawrence Scahill PhD, Susan Busch PhD, and Len Bowers PhD for their guidance with the Aggression Exposure Study; Meghan Parmenter, Lauren Fiola, Rachel Mauro, Hannah de Long for their contributions as Research Assistants; Hospital and Nursing Administrators, Pamela Mathews, and the workers who assisted and participated in the Aggression Exposure Study. This publication was made possible by Clinical and Translational Science Award Grant Number UL1 RR024139 and KL2 RR024138 from the Yale Center for Clinical Investigation and the National Center for Research Resources and the National Center for Advancing Translational Science, components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
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Joanne Iennaco, Robin Whittemore, Jane Dixon have declared that they have no conflicts to report.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Iennaco, J.D., Whittemore, R. & Dixon, J. Aggressive Event Incidence using the Staff Observation of Aggression Scale-Revised (SOAS-R): A Longitudinal Study. Psychiatr Q 88, 485–499 (2017). https://doi.org/10.1007/s11126-016-9462-y
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DOI: https://doi.org/10.1007/s11126-016-9462-y