Gender differences in aggressive behavior at admission to a psychiatric hospital

Abstract

As aggressive behavior has a negative impact in general psychiatry, its influence specifically from a gender-related point of view in an in-patient population of a psychiatric clinic was assessed at the time of admission. A group of 521 successively admitted psychiatric in-patients was investigated at admission with the help of the "Social Dysfunction and Aggression Scale". A slightly higher frequency and intensity of "verbal aggressive behavior" was observed in males. Within the other categories of aggressive behavior ("tension", "physical violence to things", and "assaults"), however, the percentages and intensities of gender-related aggressive behavior did not differ significantly. Furthermore, under the covarying impact of various psychiatric diagnoses, the gender-related differences concerning the intensity of "verbal aggressive behavior" disappeared. When comparing male and female subgroups, it was notable that male schizophrenic patients were younger than female patients when displaying comparable risks of showing at least one kind of aggressive behavior. In addition, in the female subgroup, "self-injurious behavior" was more strongly correlated to the category "tension" than in the male subgroup. Although there are some methodological shortcomings, the present results show that there are small qualitative differences in gender-related aggressive behavior in addition to minimal quantitative differences in the frequency and intensity of "verbal aggressive behavior" at admission.

Characteristics of Assaultive Psychiatric Patients: 20-Year Analysis of the Assaultive Staff Action Program (ASAP)

“…Physical assaults were the most prevalent. These findings in concert with earlier published findings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] continue to document that patient assaults on staff are a worldwide, occupational health hazard [3]. These characteristics have remained stable over time, even as the present health care system (DMH), like others worldwide, has adjusted to facility closures; downsizings; privatizing of inpatient and community services; several reductions in force; the addition of child and forensic patients; various advances in medications and rehabilitation services; the development of flexible community response systems for more complicated, multidiagnostic individuals; a major restraint-free policy initiative, and a wide array of advocacy groups.…”

“…The findings from the present 20-year study, which appears to be the longest, continuous study of patient assault characteristics in the published literature, are consistent with previous cross-sectional and longitudinal studies in public and private settings during a forty-year period [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] and are also essentially similar to the 10-, and 15-year studies from this same public sector health care system [1,16]. Older male patients with diagnoses of schizophrenic illness and/or other neurological abnormality and histories of violence toward others and substance use disorder and younger, male/female patients with diagnoses of personality disorders and histories of violence toward others, personal victimization, and substance use disorder were more likely to be assaultive.…”

“…This was true at 10-, 15-, and 20-year periods. Specific clinical findings with regard to forensic patients, the violence triad, and victimization of women as well as methodological issues were discussed and the implications noted.Psychiatric patient assaults on health care staff are a serious and continuing occupational hazard [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In 1995, Bjorkley and his colleagues estimated that 15-30% of hospitalized patients engaged in assaults and that the prevalence of aggressive behavior ranged from 0.15 assaults per bed year to as high as 88.8 incidents per bed year in some high security units [2].…”

“…Common precipitants included acute psychotic disorganization, organic impairment, denial of services, excessive sensory overload, and provocation by others [3]. Since 2005, there have been twelve additional studies of over 6,200 assault incidents that empirically document the remarkable consistency of these assault characteristics across sites [4][5][6][7][8][9][10][11][12][13][14][15].…”

Vulnerable long-term psychiatric inpatients need screening for physicalhealth problems: An audit of regular hospital statistics and clinical files

“…7 More specifically, research on gender-related risk of aggressive behaviour has yielded contradictory findings: The balance of evidence suggests that male psychiatric in-patients tend to have more aggressive behaviour, especially a higher frequency and intensity of verbal aggressive behaviour. [28][29][30] Aggressive behaviour has also been found to be associated with involuntary admission and closed wards, or the locking of ward doors -in acute psychiatric in-patients. 31,32 One interpretation is that the imposition of restrictions on patients exacerbates the problem of violence but, on the other hand, patients end up in closed wards because of their aggression.…”