Background: Aggression and challenging behaviours are common in inpatient psychiatry units. They may threaten the safety of patients and staff and interfere with therapeutic milieu. Understanding triggers may assist in development of preventive approaches.
Aim: To examine patterns and correlates of aggressive behaviour in a child and adolescent psychiatric inpatient unit.
Method: Incidents of aggression between October 2004 and December 2005 were collected at the time of the incident by clinical staff in a designated register incorporating nature of the incident, time, location, and response.
Results: Data was collected from 213 admissions for 134 patients. 23% of admissions were associated with aggression. The majority of incidents involved oppositional behaviour and verbal abuse and were most likely to occur in the mornings before school and after dinner in the evenings. Positive predictors of aggression were male gender, younger age, diagnosis of pervasive developmental disorder, mental retardation or ADHD. Past history of aggression predicted future aggression. Aggression was most frequently managed with Time Out.
Conclusions: A substantial minority of admissions were associated with aggressive incidents. Understanding predictors and triggers for aggression may enable preventative strategies to be implemented prior to admission for those patients at high risk of aggression. In turn, this may lead to a safer and more therapeutic ward environment.
