Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;53(2):590-596.
doi: 10.1017/S0033291721002063. Epub 2021 May 24.

Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model

Seena Fazel  1   2 , Mark Toynbee  1   2 , Howard Ryland  1   2 , Maria Vazquez-Montes  1   2 , Hasanen Al-Taiar  1   2 , Achim Wolf  1   2 , Omar Aziz  1   2 , Vivek Khosla  1   2 , Gautam Gulati  1   2 , Thomas Fanshawe  1   2
Affiliations

Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model

Seena Fazel et al. Psychol Med. 2023 Jan.

Abstract

Background: Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions.

Methods: Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1-4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded.

Results: We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25-9.20), 10-year increase in age (OR 0.67, 0.47-0.96), and female sex (OR 2.78, 1.04-7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20-1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72-0.82) and 0.75 (0.70-0.80) when the dynamic score was excluded.

Conclusions: In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.

Keywords: Inpatients; prediction; psychosis; risk assessment; violence.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
ROC curve of the main model predicting inpatient violence: predictions incorporating random effects. Note: AUC 0.87 (95% CI 0.84–0.91).
Fig. 2.
Fig. 2.
ROC curve of the main model predicting inpatient violence: predictions not incorporating random effects. Note: AUC 0.77 (95% CI 0.72–0.91).
See this image and copyright information in PMC

References

    1. Abderhalden, C., Needham, I., Dassen, T., Halfens, R., Haug, H., & Fischer, J. (2008). Structured risk assessment and violence in acute psychiatric wards: Randomised controlled trial. British Journal of Psychiatry, 193, 44–50. doi: 10.1192/bjp.bp.107.045534 - DOI - PubMed
    1. Bowers, L., Allan, T., Simpson, A., Jones, J., Van Der Merwe, M., & Jeffery, D. (2009). Identifying key factors associated with aggression on acute inpatient psychiatric wards. Issues in Mental Health Nursing, 30, 260–271. doi: 10.1080/01612840802710829 - DOI - PubMed
    1. Bowers, L., Stewart, D., Papadopoulos, C., Dack, C., Ross, J., Khanom, H., … Jeffery, D. (2011). Inpatient violence and aggression: A literature review. London: Section of Mental Health Nursing Health, Service and Population Research, Institute of Psychiatry, King's College London. Retrieved from https://pdfs.semanticscholar.org/b98f/4ff17c264fd919542dcc14905b280c8776....
    1. Cornaggia, C., Beghi, M., Pavone, F., & Barale, F. (2011). Aggression in psychiatry wards: A systematic review. Psychiatry Research, 189, 10–20. doi: 10.1016/j.psychres.2010.12.024 - DOI - PubMed
    1. Cullen, A. E., Clarke, A. Y., Kuipers, E., Hodgins, S., Dean, K., & Fahy, T. (2012). A multi-site randomized controlled trial of a cognitive skills programme for male mentally disordered offenders: Social–cognitive outcomes. Psychological Medicine, 42, 557–569. doi: 10.1017/S0033291711001553 - DOI - PubMed

Publication types