Anger Predictors of Aggressive Behavior on an Acute Inpatient Psychiatric Unit

Violent behavior by patients on psychiatric units is a topic that has received considerable attention, particularly with regard to its consequences for nursing staff. While studies have sought to identify predictors of violence by inpatients, there is a dearth of research on dynamic risk factors, particularly anger.

The present study investigates the viability of assessing anger among patients on an acute civil commitment psychiatric hospital unit and to examine its association with aggressive behavior.

We evaluated the psychometric properties of several patient-rated anger assessment instruments and tested whether anger was predictive of subsequent patient-rated and nurse-rated aggressive behavior during the hospital stay of 42 patients. A brief, semi-structured diagnostic interview and measures of depression, early trauma, and coping were also used.

Patients' self-ratings of anger, across all the psychometric scales, had high internal consistency and high concurrent validity, along with convergent and discriminant validity. Patient-rated anger was associated with patient-reported physical and verbal aggression and was prospectively predictive of aggressive behavior observed by psychiatric nurses, controlling for age, gender, and depression.

Patients on an acute psychiatric unit can self-report anger that bears on their risk for short-term aggressive behavior. The value of nurse involvement in monitoring patients' anger on inpatient psychiatric units is discussed, along with nurse-supported anger treatment programs.