Predictors of Severe and Repeated Aggression in a Maximum-Security Forensic Psychiatric Hospital

Abstract

Institutional aggression within forensic psychiatric facilities is a common problem that has not been adequately researched. Several studies have shown that a relatively small portion of the at-risk patient population is responsible for the majority of inpatient aggression. The present study compared a sample of forensic inpatients who engaged in repeated and severe aggression towards staff or peers with a sample of non-aggressive inpatients that were matched for age, gender, legal commitment type, and hospital length of stay. The discriminant model correctly predicted 74.2% of those classified as perpetrating severe and repeated aggression and 87.1% of those classified as non-aggressive within the institution. The model accounted for 51% of the variance. The predictors included variables traditionally associated with violence risk, such as the presence of a personality disorder. However, the model also included suicide attempts and psychiatric hospitalization as a juvenile; two predictors that have not been commonly included in community violence measures. These findings identify unique predictors of highly aggressive patients who cause serious injuries to other patients and staff. The early identification and management of individuals with increased risk for severe and repeated aggression is an important consideration for triaging inpatients at risk for this type of aggression.