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. 2023 Oct 4;62(4):190-197.
doi: 10.2478/sjph-2023-0027. eCollection 2023 Dec.

Incidence, Severity and Characteristics of Patients' Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey

Andreja Čelofiga  1 , Jure Koprivšek  1 , Hojka Gregorič Kumperščak  2 , Blanka Kores Plesničar  3
Affiliations

Incidence, Severity and Characteristics of Patients' Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey

Andreja Čelofiga et al. Zdr Varst. .

Abstract
in English, Slovenian

Aim: To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient characteristics and the incidence of recurrent aggressive behaviour.

Methods: A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases.

Results: 3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization.

Conclusion: Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.

Namen: Oceniti pojavnost, resnost in značilnosti agresivnega vedenja pri pacientih, ki so hospitalizirani v akutnih psihiatričnih oddelkih in ugotoviti povezavo med demografskimi in nekaterimi kliničnimi značilnostmi pacientov in pojavnostjo ponavljajočega se agresivnega vedenja.

Metode: V multicentrično prospektivno raziskavo so bili vključeni akutni oddelki vseh slovenskih psihiatričnih bolnišnic. V obdobju petih zaporednih mesecev so bili pridobljeni podatki o številu hospitalnih obravnav z agresivnim vedenjem in številu agresivnih incidentov, njihovi resnosti in značilnostih. Za beleženje incidentov, njihovih značilnosti in oceno resnosti, je bil uporabljen slovenski prevod opazovalne Lestvice za oceno agresivnega vedenja: angl. The Staff Observation Aggression Scale – Revised (SOAS-R). Predstavljene so incidenčne stopnje verbalne in fizične agresije na ravni hospitalnih obravnav in dogodkov. Analizirana je povezava med značilnostmi pacientov in ponavljajočimi se agresivnimi incidenti. Demografski podatki pacientov in podatki o vodilni diagnozi, komorbidnih diagnozah, protivoljni hospitalizaciji in dolžini hospitalizacije so bili pridobljeni iz bolnišnične dokumentacije. Statistična analiza podatkov je bila izvedena z uporabo statističnega programskega paketa IBM SPSS 25.

Rezultati: V 5-mesečnem obdobju je bilo vključenih 3190 hospitalnih obravnav. Agresivno vedenje je bilo prisotno pri 13,4 % obravnav, zabeleženih je bilo skupno 922 agresivnih incidentov, kar predstavlja 3,98 incidentov na 100 dni zasedenih postelj in 9,48 incidentov na posteljo na leto. 74,1 % incidentov je bilo ocenjenih kot hudi, več kot polovica incidentov je vključevala fizično agresijo. 75,5 % incidentov je bilo usmerjenih proti zdravstveno-negovalnemu osebju. Pri skoraj polovici incidentov ni bil prepoznan sprožilec agresivnega vedenja, med ugotovljenimi sprožilci pa je bila najpogosteje opisana zavrnitev pacientovih zahtev in želja. Za zaustavitev agresivnega vedenja je bilo večinoma uporabljenih več ukrepov hkrati, najpogosteje pogovor s pacientom v kombinaciji z uvedbo omejitve s pasovi ali aplikacijo zdravila. 5,9 % hospitalnih obravnav je bilo vključenih v več agresivnih incidentov. Pacienti s ponavljajočimi se agresivnimi incidenti so imeli v primerjavi s tistimi z enkratnimi incidenti v manjšem deležu prisotno vodilno diagnozo duševna motnja, povezana z uporabo psihoaktivnih snovi ter daljše povprečno trajanje hospitalizacije.

Zaključek: Agresivno vedenje pri pacientih, hospitaliziranih v akutnih psihiatričnih enotah, je pogosto povezano s poslabšanjem duševne motnje in je lahko neposreden vzrok za sprejem na oddelek. Pričakovanja, da bi lahko agresivno vedenje v takem okolju popolnoma odpravili, so najverjetneje nerealna. Zagotovo pa je smiselno spremljanje incidence in značilnosti agresivnega vedenja pacientov v psihiatričnem hospitalnem okolju, saj tako pridobljeni podatki omogočajo primerjavo z drugimi državami, še pomembneje pa je, da predstavljajo izhodišče za načrtovanje preventivnih strategij obvladovanja agresivnega vedenja in spremljanje njihove učinkovitosti.

Keywords: Acute psychiatric wards; Aggression; Incidence; Mental disorders; SOAS-R.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that no conflicts of interest exist.

Figures

Figure 1.
Figure 1.
Severity of different types of aggressive behaviour.
Figure 2.
Figure 2.
Time-of-day variations in the severity of aggressive incidents.
See this image and copyright information in PMC

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