Physical Violence During Mandatory Psychiatric Treatment: Prevalence and Patient Characteristics

Abstract

This study explores variables that predict physical violence in 614 (forensic) psychiatric inpatients. All violent incidents that occurred in a Dutch forensic psychiatric hospital between 2014 and 2019 (N = 3,713) were coded with the Modified Overt Aggression Scale+ based on daily hospital reports and patients’ medical records. Binary logistic regression analyses examined which patient variables could differentiate between patients with and without physical violence during treatment and between patients with single and multiple incidents of physical violence. Variables included in the analyses were gender, legal status, borderline personality disorder, antisocial personality disorder, schizophrenia spectrum disorder, psychopathy (Psychopathy Checklist–Revised [PCL-R] score), self-harm during treatment, impulsivity, intellectual disability, and length of stay. A clear association was found between self-harm and inpatient physical violence on all outcome measures and in all analyses. Adequate monitoring of self-harm is advised as a strategy to early identify patients with a high risk to threaten ward safety.

Keywords

forensic psychiatry inpatients physical violence prevalence self-injurious behavior

Get full access to this article

View all access options for this article.

References

Almvik

Woods

Rasmussen

(2000). The Brøset Violence Checklist: Sensitivity, specificity, and interrater reliability. Journal of Interpersonal Violence, 15(12), 1284–1296. https://doi.org/10.1177/088626000015012003

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Arnetz

J. E.

Hamblin

Ager

Luborsky

Upfal

M. J.

Russell

Essenmacher

(2015). Underreporting of workplace violence: Comparison of self-report and actual documentation of hospital incidents. Workplace Health & Safety, 63(5), 200–210. https://doi.org/10.1177/2165079915574684

Bader

S. M.

Evans

S. E.

(2015). Predictors of severe and repeated aggression in a maximum-security forensic psychiatric hospital. International Journal of Forensic Mental Health, 14, 110–119. https://doi.org/10.1080/14999013.2015.1045633

Abu-Akel

Kongerslev

Haahr

U. H.

Simonsen

(2011). Risk factors for violence among patients with schizophrenia. Clinical Psychology Review, 31(5), 711–726. https://doi.org/10.1016/j.cpr.2011.03.002

Bonta

Andrews

D. A.

(2017). The psychology of criminal conduct (6th ed.). Routledge.

Bowers

Stewart

Papadopoulos

Dack

Ross

Khanom

Jeffery

(2011). Inpatient violence and aggression: A literature review. Report from the Conflict and Containment Reduction Research Programme. Section of Mental Health Nursing, Health Service and Population Research, Institute of Psychiatry, Kings College.

Broderick

Azizian

Kornbluh

Warburton

(2015). Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: Patient assaults, staff assaults, and repeatedly violent patients. CNS Spectrums, 20, 319–330. https://doi.org/10.1017/S1092852915000188

10.

Cornaggia

C. M.

Beghi

Pavone

Barale

(2011). Aggression in psychiatry wards: A systematic review. Psychiatry Research, 189(1), 10–20. https://doi.org/10.1016/j.psychres.2010.12.024

11.

Crocker

A. G.

Mercier

Lachapelle

Brunet

Morin

Roy

M.-E.

(2006). Prevalence and types of aggressive behaviour among adults with intellectual disabilities. Journal of Intellectual Disability Research, 50, 652–661.

12.

Dack

Ross

Papadopoulos

Stewart

Bowers

(2013). A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatrica Scandinavica, 127, 255–268. https://doi.org/10.1111/acps.12053

13.

Daffern

Howells

Ogloff

Lee

(2005). Individual characteristics predisposing patients to aggression in a forensic psychiatric hospital. Journal of Forensic Psychiatry & Psychology, 16(4), 729–746. https://doi.org/10.1080/14789940500345595

14.

de Looff

Nijman

Didden

Embregts

. (2018). Burnout symptoms in forensic psychiatric nurses and their associations with personality, emotional intelligence and client aggression: A cross-sectional study. Journal of Psychiatric and Mental Health Nursing, 25, 506–516. https://doi.org/10.1111/jpm.12496

15.

de Vogel

de Vries Robbé

van Kalmthout

Place

. (2012). Female Additional Manual (FAM). Additional guidelines to the HCR-20 for assessing risk for violence in women. Van der Hoeven Stichting.

16.

de Vogel

Lancel

. (2016). Gender differences in the assessment and manifestation of psychopathy: Results from a multicenter study in forensic psychiatric patients. International Journal of Forensic Mental Health, 15(1), 97–110. https://doi.org/10.1080/14999013.2016.1138173

17.

de Vogel

Stam

Bouman

Y. H.

Ter Horst

Lancel

. (2016). Violent women: A multicentre study into gender differences in forensic psychiatric patients. The Journal of Forensic Psychiatry & Psychology, 27, 145–168. https://doi.org/10.1080/14789949.2015.1102312

18.

de Vries Robbé

de Vogel

Wever

Douglas

K. S.

Nijman

H. L. I

. (2016). Risk and protective factors for inpatient aggression. Criminal Justice and Behavior, 43, 1364–1385. https://doi.org/10.1177/0093854816637889

19.

Douglas

K. S.

Belfrage

(2014). Interrater reliability and concurrent validity of the HCR-20 Version 3. International Journal of Forensic Mental Health, 13, 130–139. https://doi.org/10.1080/14999013.2014.908429

20.

Douglas

K. S.

Guy

L. S.

Hart

S. D.

(2009). Psychosis as a risk factor for violence to others: A meta-analysis. Psychological Bulletin, 135(5), 679–706. https://doi.org/10.1037/a0016311

21.

Douglas

K. S.

Hart

S. D.

Webster

C. D.

Belfrage

(2013). HCR-20V3: Assessing risk of violence—User guide. Mental Health, Law, and Policy Institute, Simon Fraser University.

22.

Field

(2009). Discovering statistics using SPSS. SAGE.

23.

Gadon

Johnstone

Cooke

(2006). Situational variables and institutional violence: A systematic review of the literature. Clinical Psychology Review, 26, 515–534. https://doi.org/10.1016/j.cpr.2006.02.002

24.

Hare

R. D.

(2003). Manual for the Hare Psychopathy Checklist—Revised. Multi-Health Systems.

25.

Heilbrun

Hart

S. D.

Hare

R. D.

Gustafson

Nunez

White

A. J.

(1998). Inpatient and postdischarge aggression in mentally disordered offenders: The role of psychopathy. Journal of Interpersonal Violence, 13, 514–527. https://doi.org/10.1177/088626098013004007

26.

Hildebrand

De Ruiter

Nijman

(2004). PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital. Journal of Interpersonal Violence, 19, 13–29. https://doi.org/10.1177/0886260503259047

27.

Huitema

Verstegen

de Vogel

(2018). A study into the severity of forensic and civil inpatient aggression. Journal of Interpersonal Violence. Advance online publication. https://doi.org/10.1177/0886260518817040

28.

Jeglic

E. L.

Vanderhoff

H. A.

Donovick

P. J.

(2005). The function of self-harm behavior in a forensic population. International Journal of Offender Therapy and Comparative Criminology, 49, 131–142. https://doi.org/10.1177/0306624X04271130

29.

Kay

S. R.

Wolkenfeld

Murrill

L. M.

(1988). Profiles of aggression among psychiatric patients: I. Nature and prevalence. Journal of Nervous and Mental Disease, 176, 539–546. https://doi.org/10.1097/00005053-198809000-00007

30.

Lam

J. N.

McNiel

D. E.

Binder

R. L.

(2000). The relationship between patients’ gender and violence leading to staff injuries. Psychiatric Services, 51(9), 1167–1170. https://doi.org/10.1176/appi.ps.51.9.1167

31.

Lanctôt

Guay

(2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and Violent Behavior, 19, 492–501. https://doi.org/10.1016/j.avb.2014.07.010

32.

Landers

R. N.

(2015). Computing intraclass correlations (ICC) as estimates of interrater reliability in SPSS. The Winnower, 2, Article e143518.

33.

Leistico

A. M. R.

Salekin

R. T.

DeCoster

Rogers

(2008). A large-scale meta-analysis relating the Hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32, 28–45. https://doi.org/10.1007/s10979-007-9096-6

34.

Linhorst

D. M.

Parker Scott

(2004). Assaultive behavior in state psychiatric hospitals: Differences between forensic and nonforensic patients. Journal of Interpersonal Violence, 19, 857–874. https://doi.org/10.1177/0886260504266883

35.

Lussier

Verdun-Jones

Deslauriers-Varin

Nicholls

Brink

(2010). Chronic violent patients in an inpatient psychiatric hospital: Prevalence, description, and identification. Criminal Justice and Behavior, 37, 5–28. https://doi.org/10.1177/0093854809347738

36.

National Institute for Health and Care Excellence. (2015). Violence and aggression: Short-term management in mental health, health and community settings. NICE guideline NG10.

37.

Needham

Abderhalden

Halfens

R. J. G.

Fischer

J. E.

Dassen

(2005). Non-somatic effects of patient aggression on nurses: A systematic review. Journal of Advanced Nursing, 49, 283–296.

38.

Nicholls

T. L.

Brink

Greaves

Lussier

Verdun-Jones

(2009). Forensic psychiatric inpatients and aggression: An exploration of incidence, prevalence, severity, and interventions by gender. International Journal of Law and Psychiatry, 32(1), 23–30. https://doi.org/10.1016/j.ijlp.2008.11.007

39.

Nijman

Bowers

Oud

Jansen

(2005). Psychiatric nurses’ experiences with inpatient aggression. Aggressive Behavior, 31, 217–227. https://doi.org/10.1002/ab.20038

40.

Nijman

H. L.

Muris

Merckelbach

H. L.

Palmstierna

Wistedt

Vos

A. M.

Rixtel van

Allertz

(1999). The Staff Observation Aggression Scale–Revised (SOAS-R). Aggressive Behavior, 25(3), 197–209.

41.

O’Donnell

House

Waterman

(2015). The co-occurrence of aggression and self-harm: Systematic literature review. Journal of Affective Disorders, 175, 325–350. https://doi.org/10.1016/j.jad.2014.12.051

42.

Ogloff

J. R.

Daffern

(2006). The Dynamic Appraisal of Situational Aggression: An instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & the Law, 24(6), 799–813. https://doi.org/10.1002/bsl.741

43.

Oliver

P. C.

Crawford

M. J.

Rao

Reece

Tyrer

(2007). Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behaviour: A reliability study. Journal of Applied Research in Intellectual Disabilities, 20, 368–372.

44.

O’Shea

L. E.

Dickens

G. L.

(2014). Short-Term Assessment of Risk and Treatability (START): Systematic review and meta-analysis. Psychological Assessment, 26, 990–1002. https://doi.org/10.1037/a0036794

45.

O’Shea

L. E.

Picchioni

M. M.

Mason

F. L.

Sugarman

P. A.

Dickens

G. L.

(2014). Predictive validity of the HCR-20 for inpatient self-harm. Comprehensive Psychiatry, 55(8), 1937–1949. https://doi.org/10.1016/j.comppsych.2014.07.010

46.

Ramesh

Igoumenou

Montes

M. V.

Fazel

(2018). Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: A systematic review and meta-analysis. European Psychiatry, 52, 47–53. https://doi.org/10.1016/j.eurpsy.2018.02.007

47.

Selenius

Leppänen Östman

Strand

(2016). Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care. Nordic Journal of Psychiatry, 70(7), 554–560. https://doi.org/10.1080/08039488.2016.1183707

48.

Selenius

Strand

(2017). Experiences of self-injury and aggression among women admitted to forensic psychiatric care. Nordic Journal of Psychiatry, 71(4), 304–311. https://doi.org/10.1080/08039488.2017.1283443

49.

Tengström

Hodgins

Müller-Isberner

Jöckel

Freese

Özokyay

Sommer

(2006). Predicting violent and antisocial behavior in hospital using the HCR-20: The effect of diagnoses on predictive accuracy. International Journal of Forensic Mental Health, 5(1), 39–53. https://doi.org/10.1080/14999013.2006.10471229

50.

Tonnaer

Cima

Arntz

(2016). Modeling impulsivity in forensic patients: A three-dimensional model of impulsivity. American Journal of Psychology, 129, 429–441. https://doi.org/10.5406/amerjpsyc.129.4.0429

51.

van Dongen

J. D. M.

Buck

N. M. L.

van Marle

H. J. C

. (2012). Delusional distress partly explains the relation between persecutory ideations and inpatient aggression on the ward. Psychiatry Research, 200, 779–783. https://doi.org/10.1016/j.psychres.2012.05.016

52.

van Leeuwen

M. E.

Harte

J. M

. (2017). Violence against mental health care professionals: Prevalence, nature and consequences. The Journal of Forensic Psychiatry & Psychology, 28, 581–598. https://doi.org/10.1080/14789949.2015.1012533

53.

Verstegen

de Vogel

de Vries Robbé

Helmerhorst

(2017). Inpatient violence in a Dutch forensic psychiatric hospital. Journal of Forensic Practice, 19, 102–114. https://doi.org/10.1108/JFP-04-2016-0020

54.

Webster

C. D.

Douglas

K. S.

Eaves

Hart

S. D.

(1997). HCR-20: Assessing the risk of violence (Version 2). Simon Fraser University, Forensic Psychiatric Services Commission of British Columbia.

55.

Webster

C. D.

Martin

Brink

Nicholls

T. L.

Desmarais

S. L.

(2009). Short-Term Assessment of Risk and Treatability (START). Clinical guide for evaluation risk and recovery (Version 1.1). St. Joseph’s Healthcare Hamilton.

56.

Wong

Gordon

(1999). Manual for the Violence Risk Scale. University of Saskatchewan.