Exploration of Aggression/Violence Among Adult Patients Admitted for Short-term, Acute-care Mental Health Services

The purpose of the study was to explore and describe: (a) the prevalence of incidents of aggression and violence among patients, including frequency, kinds and severity of incidents of among patients; target of the aggression; (b) situational factors including time of location and time of event; and (c) staff interventions. We describe the relationships among variables to answer the following research questions: (1) What factors are associated with incidents of aggression and violence, and (2) are factors modifiable?

The exploratory descriptive study used data collected by retrospective chart review over a three-year period; the dates of January 1, 2011 to December 31, 2013. A medical record was included if it met the following criteria: 1) person ages 18-75years; 2) admitted to the psychiatric mental care unit (PMCU) during the designated time frame; 3) the length of stay was up to 7days; and 4) during this time the person made a verbal threat of violence or exhibited violent behavior towards property, self, another patient, or a member of the hospital staff. We examined data for a relationship among score on risk assessment items, sociodemographic factors, and outcome variables. We employed a variety of statistical analytic approaches to describe our data and uncover relationships among variables.

There were 132 incidents of aggression/violence between January 1, 2011 and December 31, 2013Of the 93 patients, 68% (n=63) were male and 32% (n=30) were female. Their ages ranged from 20 to 57years with a mean age of 37 for females and 39 for males. Significant associations were found between type of intervention and patients' admitting diagnoses: Χ² (5, N=97)=11.603, p=0.004. Significant associations were also found with regard to drug history, Χ²(1, n=96)=4.673, p=0.03 and history of violence, Χ²(1, N=91)=7.618, p=0.006. Key variables were target (the staff) and location (the hallway). Multiple factor analysis yielded inconclusive results, as numerous factors were identified and variable loadings were weak possibly due to the small sample size and high number of relevant variables.

Findings from this study can be used to improve high quality care for hospitalized patients with acute mental health problems. All incidents of aggression/violence cannot realistically be prevented. Staff must stay vigilant for self-safety. The hallway may be modified to reduce visual and auditory stimuli.