Prevalence and precipitants of aggression in psychiatric inpatient units

Aggression is a significant clinical problem in psychiatric facilities. The present study reviews data on aggression collected from psychiatric inpatient units in order to determine prevalence and causal factors.

Data on aggressive incidents were gathered from four adult psychiatric units in the Illawarra, Australia. Information obtained included diagnosis, causal factors and patient sociodemographic characteristics.

During the 18-month period, a total of 1269 psychiatric patients were admitted and 174 patients (13.7%) were recorded as being aggressive. Patients with bipolar affective disorder and schizophrenia had a 2.81 and 1.96 significantly increased risk of aggression, respectively, while depression and adjustment disorder conferred a significantly lower risk. Aggression was most likely to occur within 2 days of admission and length of stay was greater for aggressive than non-aggressive patients. The greater number of incidents occurred on day shift. Most patients who displayed aggression did so on one occasion, but a small proportion of total patients (6.0%) accounted for a large number of incidents (71.0%). High-risk patients were identified as those who were under 32 years of age, were actively psychotic, detained and known to have a history of aggression and substance misuse. The most frequent form of aggression was physical and staff were most often the victims.

These results have important implications for predicting and thereby reducing inpatient aggression. Organisations need to ensure aggression management strategies are in place and periodically identify and assess the level of risk for workers.