Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence

Abstract

a b s t r a c tBackground: Most people with mental disorders are not violent. However, the lack of specific studies in this area and recent radical changes in Italy, including the closure of six Forensic Mental Hospitals, has prompted a more detailed investigation of patients with aggressive behaviour. Aims: To compare socio-demographic, clinical and treatment-related characteristics of long-term inpatients with a lifetime history of serious violence with controls; to identify predictors of verbal and physical aggressive behaviour during 1-year follow-up. Methods: In a prospective cohort study, patients living in Residential Facilities (RFs) with a lifetime history of serious violence were assessed with a large set of standardized instruments and compared to patients with no violent history. Patients were evaluated bi-monthly with MOAS in order to monitor any aggressive behaviour. Results: The sample included 139 inpatients, 82 violent and 57 control subjects; most patients were male. The bi-monthly monitoring during the 1-year follow-up did not show any statistically significant differences in aggressive behaviour rates between the two groups. The subscale explaining most of the MOAS total score was aggression against objects, although verbal aggression was the most common pattern. Furthermore, verbal aggression was significantly associated with aggression against objects and physical aggression. Conclusions: Patients with a history of violence in RFs, where treatment and clinical supervision are available, do not show higher rates of aggressiveness compared to patients with no lifetime history of violence. Since verbal aggression is associated with more severe forms of aggression, prompt intervention is warranted to reduce the risk of escalation.

Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy

“…In the first wave of this project [15], we evaluated 139 patients living in RFs, 82 violent and 57 control subjects. We did not find any statistically significant differences in aggressive behavior rates between the two groups during the 1-year follow-up.…”

“…On the other hand, this finding is at odds with the results of the first wave of the VIORMED project, in which 82 patients living in RFs with an history of violence were compared to 57 patients with no such history. In these settings, with 24-hour cover, the difference in the frequency of aggressive and violent behavior between patients with and without a history of violence was negligibile [15]. Living in a controlled environment, with compliance granted and no possibility of substance use disorders, may have a preventive effect on aggressive and violent behavior, while life in the community, where treatment compliance is not warranted and there is a greater risk of substance use disorders, has a potential detrimental effect on the risk of recurrence.…”

“…Second, we measured aggressive or violent behavior exhibited by outpatients during a 1-year period, using a standardized tool, and analyzed a variety of risk and protective factors. An additional aim was to compare the frequency of aggressive and violent behavior (over a 1-year period) among (a) residential patients (VIORMED-1 Study) assessed in wave 1 of this project [15], (b) outpatients (VIORMED-2 Study), both with a history of violence, and (c) residential and outpatients without any history of violence.…”

Aggressive behavior and metacognitive functions: a longitudinal study on patients with mental disorders

“…Another strong predictor of aggressive behavior is a history of violence. This result is confirmed by the VIORMED project (Bulgari et al [12]; Candini et al [14]; de Girolamo et al [21]) and by several studies on patients with SMD and/or offenders (Fazel et al [25,26]; Lund et al [38]). At the same time, the present study points out that people with a history of violence are characterized more frequently by poor metacognitive functioning compared to patients without such history; this data is supported by other studies [1,2,30].…”

“…The present study is part of the Violence Risk and Mental Disorders (VIORMED) project (for further details, see [3,21] submitted). This is a prospective cohort study involving inpatients living in residential facilities (RFs) and outpatients of the Departments of Mental Health in Northern Italy.…”