Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis

Abstract

BackgroundViolence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards.ObjectivesTo use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators).MethodSystematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries.ResultsOf the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14–20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence.ConclusionThe findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

“…In contrast to other large studies (Keski-Valkama et al 2010;Noorthoorn et al 2015), patient diagnosis was largely unrelated to either PICU transfer or seclusion with the exception that patients with bipolar disorder were twice as likely to be transferred to PICU compared with patients with schizophrenia. The fact that we adjusted for behaviours and traits commonly associated with this diagnosis (i.e., manic, agitated, demanding and irritable behaviour), implies that bipolar disorder patients may present with other behaviours which cause them to be viewed by clinical staff as needing PICU treatment.…”

“…These findings are unsurprising given that younger age is a well-established risk factor for violence in psychiatric inpatient settings (Cornaggia et al 2011;Dack et al 2013;Iozzino et al 2015). However, the fact that we adjusted for multiple behavioural precursors suggests that this finding is not entirely explained by the fact that younger patients are more likely to be aggressive.…”

“…Whilst a recent review found that secluded patients are also likely to be young, legally detained and diagnosed with schizophrenia, bipolar disorder and personality disorder, seclusion was not consistently associated with either patient sex or ethnicity (Van Der Merwe et al 2009). Nationwide studies conducted in the Netherlands (Noorthoorn et al 2015) and Finland (Keski-Valkama et al 2010) indicate that both patients with schizophrenia and substance use disorders are at greater risk of seclusion after adjusting for other demographic/clinical factors. With regard to behavioural precursors, aggressive, disruptive and chaotic behaviour, acute psychosis, absconsion and self-harm are all strongly associated with both PICU and seclusion (Bowers, 2006;Van Der Merwe et al 2009).…”

Risks Factors of Violence Among Psychiatric Inpatients: Focusing on Substance Abuse and Environmental Violence

“…The factors which seem more significantly linked to inpatient violence are the diagnosis of schizophrenia and affective disorder, the low degree of insight, the intensity of the thought disturbances, the delusions or the hallucinations. The previous histories of violence (either committed or subjected to) also appear to be a significant variable associated with violence [1][2][3][4][5][6]10,16]. Concerning the substance abuse, it is a well-established factor of violence in the severely mentally ill patients [7,18].…”

“…Concerning the substance abuse, it is a well-established factor of violence in the severely mentally ill patients [7,18]. However, the nature of the link is complex: it may be mediated by psychiatric symptoms or social factors [18] or associated with male gender [10]. This short commentary aims at reviewing the risk factors of violence among psychiatric patients during their hospitalizations.…”