Skip to main content

Advertisement

Log in

Violence in psychiatric units

A 7-year Italian study of persistently assaultive patients

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

The problem of violence and aggressive behaviour among patients with psychiatric disorders need careful assessment to improve the quality of psychiatric care. The aim of this paper is to describe the characteristics of repeated episodes of violence among patients admitted to an Italian psychiatric ward.

Methods

All violent behaviours, which occurred in a 15-bed psychiatric inpatient unit over a 7-year period, were assessed by using the Staff Observation Aggression scale (SOAS).

Results

Of a total of 3.507 admissions, 409 aggressive episodes were recorded by 160 patients (rate per admission 11.6%). A total of 65 patients exhibited two or more episodes and 95 patients showed a single episode. Repeatedly violent patients had a higher length of stay in the unit, a higher number of previous admissions and a higher number of previous violent episodes. No difference was found in terms of psychiatric diagnosis, socio-demographic variables, type of admission (voluntary versus involuntary), ward overcrowding and characteristics of violent episodes (means, aims and consequence).

Conclusions

In spite of the low prevalence of violent incidents among Italian psychiatric inpatients, careful monitoring of clinical variables associated with repeated violent episodes may help physicians recognise and prevent violence episodes among acute psychiatric inpatients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Angenmeyer MC (2000) Schizophrenia and violence. Acta Psychiatr Scand, Suppl 102:63–7

    Article  Google Scholar 

  • Arango C, et al. (1999) Violence in inpatients with schizophrenia: a prospective study. Schizophrenia Bull 25:493–503

    CAS  Google Scholar 

  • Barlow K, et al. (2000) Prevalence and precipitants of aggression in psychiatric inpatient units. Aust N Z J Psychiatry 34:967–74

    Article  PubMed  CAS  Google Scholar 

  • Chang JC, Lee CS (2004) Risk factors for aggressive behavior among psychiatric inpatients. Psychiatr Serv 55:1305–1307

    Article  PubMed  Google Scholar 

  • Chou KR, et al. (2001) Assaultive behavior by psychiatric in- patients and its related factors. J Nurs Res 9:139–51

    PubMed  CAS  Google Scholar 

  • Davis S (1991) Violence by psychiatric inpatients: a review. Hosp Comm Psychiatry 42:585–590

    CAS  Google Scholar 

  • De Girolamo G, Cozza M (2000) The Italian psychiatric reform. A 20-year perspective. Int J Law Psychiatry 23:197–211

    Article  PubMed  Google Scholar 

  • Dhossche DM (1999) Aggression and recent substance abuse: absence of association in psychiatric emergency room patients. Compr Psychiatry 40:343–6

    Article  PubMed  CAS  Google Scholar 

  • Eronen M, et al. (1998) The psychiatric epidemiology of violent behavior. Soc Psychiatry Psychiatr Epidemiol 33:S13–S23

    Article  PubMed  Google Scholar 

  • Fioritti A, et al. (1997) Reform said or done? The case of Emilia-Romagna within the Italian psychiatric context. Am J Psychiatry 154:94–98

    PubMed  CAS  Google Scholar 

  • Flannery RB (2002) Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP). J Forensic Sci 47:558–561

    PubMed  Google Scholar 

  • Fulwiler C, Ruthazer R (1999) Premorbid risk factors for violence in adult mental illness. Compr Psychiatry 40:96–100

    Article  PubMed  CAS  Google Scholar 

  • Grassi L, et al. (2001) A five-year Italian survey of violent behavior in acute psychiatric in-patients. Acta Psichiatr Scand 104:273–279

    Article  CAS  Google Scholar 

  • Haim R, et al. (2002) Predictions made by psychiatrists and psychiatric nurses of violence by patients. Psychiatr Serv 53:622–624

    Article  PubMed  Google Scholar 

  • Harris GT, Rice ME (1997) Risk appraisal and management of violent behavior. Hosp Comm Psychiatry 48:1168–1176

    CAS  Google Scholar 

  • Hillbrand M (1995) Aggression against self and aggression against others in violent psychiatric patients. J Consulting Clin Psychol 63:668–671

    Article  CAS  Google Scholar 

  • Krakowski M, et al. (1986) Psychopathology and violence: a review of literature. Compr Psychiatry 27:131–148

    Article  PubMed  CAS  Google Scholar 

  • Krakowski M, Czobor P (1994) Clinical symptoms, neurological impairment, and prediction of violence in psychiatric inpatents. Hosp Community Psychiatry 45:700–705

    PubMed  CAS  Google Scholar 

  • Krakowski M, et al. (1999) Course of violence in patients with schizophrenia: relationship to clinical symptoms. Schizophrenia Bull 25:505–517

    CAS  Google Scholar 

  • Lowenstein ML, et al. (1990) The relationship between admission symptoms and hospital assaults. Hosp Commun Psychiatry 41:311–313

    CAS  Google Scholar 

  • McNiel DE, Binder RL (1994) The relationship between acute psychiatric symptoms, diagnosis, and short-term risk of violence. Hosp Community Psychiatry 45:133–137

    PubMed  CAS  Google Scholar 

  • Mulvey EP (1994) Assessing the evidence of a link between mental illness and violence. Hosp Comm Psychiatry 45:663–668

    CAS  Google Scholar 

  • Nestor PG (2002) Mental disorder and violence: personality dimensions and clinical features. Am J Psychiatry 159:1973–1978

    Article  PubMed  Google Scholar 

  • Nijman HLI, et al. (1999) The Staff Observation Aggression Scale-Revised (SOS-R). Aggress Behav 25:197–209

    Article  Google Scholar 

  • Nijman HLI, Rector G (1999) Crowding and aggression on inpatient psychiatric wards. Psychiatr Serv 50:830–831

    PubMed  CAS  Google Scholar 

  • Nijman HLI, et al. (2002) Assessing aggression severity with the revised staff observation aggression scale. J Nerv Ment Dis 190:198–200

    Article  PubMed  Google Scholar 

  • Nijman HLI, et al. (2005) Fifteen years of research with the Staff Observation Aggression Scale: a review. Acta Psychiatr Scand 111:12–21

    Article  PubMed  CAS  Google Scholar 

  • Norusis MJ (1990) Statistical Package for the Social Sciences (SPSS) Professional Statistics-6.1. SPSS Inc. Chicago

    Google Scholar 

  • Owen C, et al. (1998a) Violence and aggression in psychiatric units. Psychiatr Serv 49:1452–1457

    PubMed  CAS  Google Scholar 

  • Owen C, et al. (1998b) Repetitively violent patients in psychiatric units. Psychiatr Serv 49:1458–1461

    PubMed  CAS  Google Scholar 

  • Palmstierna T, Wistedt B (1987) Staff observation aggression scale, SOAS: presentation and evaluation. Acta Psychiatr Scand 76:657–673

    PubMed  CAS  Google Scholar 

  • Palmstierna T, et al. (1991) The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. Hosp Commun Psychiatry 42:1237–1240

    CAS  Google Scholar 

  • Palmstierna T, Wistedt B (1995) Changes in the pattern of aggressive behaviour among inpatients with changes ward organization. Acta Psychiatr Scand 91:32–35

    PubMed  CAS  Google Scholar 

  • Perris C, Kemali D (1985) Focus on the Italian psychiatric reform. Acta Psychiatr Scand 71(Suppl 316):1–157

    Google Scholar 

  • Piccinelli M, et al. (2002) Focus on psychiatry in Italy. Br J Psychiatry 181:538–544

    Article  PubMed  Google Scholar 

  • Raja M, et al. (1997) Aggressive and violent behavior in a population of psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 32:428–434

    PubMed  CAS  Google Scholar 

  • Serper MR, et al. (2005) Predictors of aggression on the psychiatric inpatient service. Compr Psychiatry 46:121–127

    Article  PubMed  Google Scholar 

  • Soliman AE, Reza H (2001) Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatr Serv 52:75–80

    Article  PubMed  CAS  Google Scholar 

  • Steinert T, et al. (1999) Aggressive behavior against self and others among first-admission patients with schizophrenia. Psychiatr Serv 50:85–90

    PubMed  CAS  Google Scholar 

  • Steinert T, et al. (2000) Measurement of violence during in-patient treatment and association with psychopathology. Acta Psychiatr Scand 102:107–112

    Article  PubMed  CAS  Google Scholar 

  • Tansella M, Williams P (1987) The Italian experience and its implications. Psychol Med 17:283–289

    Article  PubMed  CAS  Google Scholar 

  • Tardiff K, et al. (1997) Violence by patients admitted to private psychiatric hospital. Am J Psychiatry 154:88–93

    PubMed  CAS  Google Scholar 

  • Taylor PH, et al. (1998) Mental disorder and violence. Br J Psychiatry 172:218–226

    Article  PubMed  CAS  Google Scholar 

  • Walsh E, et al. (2002) Violence and schizophrenia: examining the evidence. Br J Psychiatry 180:490–495

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The Authors are indebted to the staff for their cooperation in the study and to Paul Packer, PhD, for his professional help in revising the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luigi Grassi MD.

Additional information

The authors report no financial affiliation and other relationship relevant to the subject matter of this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grassi, L., Biancosino, B., Marmai, L. et al. Violence in psychiatric units. Soc Psychiat Epidemiol 41, 698–703 (2006). https://doi.org/10.1007/s00127-006-0088-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-006-0088-5

Keywords

Navigation