Self- and Other-Directed Aggressive Behavior and Safety Measures in an Acute Psychiatric Ward

Background: Aggression in hospital settings, particularly in acute psychiatric wards, is a significant and frequent phenomenon. Objectives: This study analyzes self- and other-directed aggressive behavior and highlights risk factors, prevention and management actions. Methods: We divided hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena over a year based on the presence or absence of aggressive behavior. Socio-demographic and clinical variables, aggression risk assessment, modality of aggression management, Incident Reports, and harmful consequences were analyzed. The data were statistically analyzed. Results: The sample consisted of 411 hospitalizations and 370 inpatients, of whom 29.2% (n = 108) exhibited aggression: 3.0% (n = 11) self-directed, 23.2% (n = 86) other-directed, and 3.0% (n = 11) both types of aggression. Risk levels were found to be highly predictive of aggressive behavior. Males engaged in other-directed aggressive behavior more frequently than females, who presented more prevalent self-directed aggression (Pearson Chi2 = 13.73; p = 0.003). Adolescents more frequently engaged in both self- and other-directed aggression. Other-directed aggressive behavior occurred more frequently in unmarried people (p = 0.014), with no children (p = 0.019), in involuntary hospitalizations (p = 0.000), in longer hospitalizations (p = 0.0001), and in acute psychosis (p < 0.001), during the first days of hospitalization. The Brøset Violence Checklist showed good discrimination with high sensitivity and negative predictive value. Conclusions: Assessing the level of self- and other-directed aggression risk at admission is essential for adopting appropriate preventive and management measures for patient and staff safety in a ward, avoiding coercive measures to contain aggression.