A systematic review found that aggression in psychiatric wards was due to a combination of patient, ward, and staff factors. These results were published in PLOS One.
Researchers at Maastricht University in the Netherlands searched publication databases for studies on aggressive behavior in psychiatric departments. A total of 145 studies were included in this review.
The studies examined patient factors (n = 82), prevalence of aggression (n = 71), personnel factors (n = 55), and ward factors (n = 37).
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For the prevalence of aggression, the employees, who were 62% women, stated a prevalence of aggression between 65% and 99% and for physical aggression between 38% and 82%. The weighted prevalence of verbal and physical aggression was 54%. The patients were admitted to a psychiatric ward for a period of 11.6 days to 3 years. The involuntary uptake was between 21.5% -100%. The proportion of patients involved in aggression ranged between 7.5% and 75.9% with a weighted prevalence of 23%.
Diagnoses of a psychotic disorder were overrepresented in studies (29% -100%) and showed an increased risk of aggressive behavior. Aggression was associated with delusional thoughts (odds ratio [OR], 12.39): Sadness (OR, 11.96), suicidal thoughts (OR, 11.59), withdrawal symptoms (OR, 11.05), insertion of thoughts (OR, 5.06), being spied on (OR, 4.27 ), Anger (OR.), 3.64), restlessness (OR, 3.41), substance abuse (OR, 2.60) and current alcohol consumption (OR, 2.19). Previous admission violence was predictive of aggressiveness (OR, 1.34).
Staff-patient interactions were a major contributor to aggression. Studies have shown that poor communication or a lack of empathy and respect lead to aggressive behavior. Overall, communication contributed 38% of aggression, interaction 29%, patient refusal 21%, assistance with daily activities 8%, and medication 7%.
In 37% of the acts of aggression, no provocations or triggers were identified. Workplace stress due to aggression (OR, 1.65) and wards with high conflict rates had more unqualified staff (P <.001), temporary workers (P <.001) or staff who were absent more often (incidence rate ratio.) [IRR], 1.11).
On days when an aggressive event occurred, bed occupancy was significantly higher (P <.001) and there were more patients on the ward (P = .05). A patient excess of 10% was associated with the greatest risk of an aggressive event (OR, 2.15). Aggressive behavior occurred in hallways (14% -67%), the activity room (13% -28%), bedrooms (8.5% -21.9%), the dining room (7% -17%), offices (6, 1% -19.) On%), and outside (3.3%).
In general, there have been conflicting reports about the role of age and gender in both patients and staff in relation to aggressive acts.
This review comprised very heterogeneous studies with different definitions of aggression and there was an overall lack of controlled studies.
The authors concluded that aggressive events in inpatient mental health facilities remain a major problem. A variety of factors contributed to this behavior. Future studies should focus on prospective naturalistic research.
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Weltens I, Bak M, Verhagen S, et al. Aggression on the psychiatric ward: prevalence and risk factors. A systematic review of the literature: PLoS One. 2021; 16 (10): e0258346. doi: 10.1371 / journal.pone.0258346
This article originally appeared on Psychiatry Advisor
