Self-harm behaviour and externally-directed aggression in psychiatric outpatients: a multicentre, prospective study (viormed-2 study)

Scocco, Paolo; Macis, Ambra; Ferrari, Clarissa; Bava, Mattia; Bianconi, Giorgio; Bulgari, Viola; Candini, Valentina; Carrà, Giuseppe; Cavalera, Cesare; Clerici, Massimo; Conte, Giovanni; Cricelli, Marta; Ferla, Maria Teresa; Iozzino, Laura; Stefana, Alberto; Girolamo, Giovanni de

doi:10.1038/s41598-019-53993-7

Cited by 3 publications

(5 citation statements)

References 43 publications

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“…Our findings of an association between self‐harm and the enactment of violence demonstrate that trauma‐informed care is crucial not just for those who exhibit more “care‐seeking” behaviour such as self‐harm, but for those who enact violence too. Self‐harm and externally direct violence share many of the same risk factors, notably exposure to neglect or trauma during childhood (Scocco et al, 2019). This strongly points to the enactment of violence and self‐harm as different manifestations of severe distress.…”

Section: Discussionmentioning

confidence: 99%

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Associations between violence, self‐harm and acute psychiatric service use: Implications for inpatient care

McIvor

Payne-Gill

Beck

2022

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self‐esteem and lead to feelings of shame. Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward. It is important to gain a sound understanding of violence in order to help reduce it. What the paper adds to existing knowledge? Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward. We identified several new factors associated with violent behaviour, such as engaging in self‐harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team. Implications for practice For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma‐informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma‐informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions. Abstract Introduction Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence. Aim We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self‐harm and being the target of violence. We also included seldom used service metrics. Method Data were extracted on admissions to acute adult wards and PICUs 2017–2020 within South London and Maudsley NHS Foundation Trust. A zero‐inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence. Results Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self‐harm, being the target of violence and referral to a Psychiatric Liaison Team. Discussion The novel associations found between enacting violence, self‐harm and being the target of violence indicate trauma‐informed care is crucial to reduce violent presentations of distress. Implications for practice System level interventions are crucial to ensure mental health nurses are supported to provide trauma‐informed care.

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Section: Discussionmentioning

confidence: 99%

“…Self-harm and externally direct violence share many of the same risk factors, notably exposure to neglect or trauma during childhood (Scocco et al, 2019). This strongly points to the enactment of violence and self-harm as different manifestations of severe distress.…”

Section: Novel Findings: the Association Between Violence Enactment S...mentioning

confidence: 99%

Associations between violence, self‐harm and acute psychiatric service use: Implications for inpatient care

McIvor

Payne-Gill

Beck

2022

Psychiatric Ment Health Nurs

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“…In contrast to our findings, previous research, in both studies of dual harm in non-clinical settings (Richmond-Rakerd et al, 2019 ) and in a clinical population (Plutchik et al, 1989 ; Richmond-Rakerd et al, 2019 ), has not identified higher risks of depression among people engaging in dual harm compared to single harm. One study of psychiatric outpatients with severe mental disorder (Scocco et al, 2019 ) reported higher depression scores among the dual harm group compared to the group engaging solely in violence towards others (though not compared to the self-harm only group). However, we found a greater risk of dual harm than both single harm outcomes among adolescents reporting clinically significant levels of depression at age 13 years, a novel finding that merits further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…In general population settings, prevalence of dual harm is around 2–5% (Harford, Chen, Kerridge, & Grant, 2018 ; Harford, Yi, & Grant, 2013 ; Richmond-Rakerd et al, 2019 ). Prevalence of dual harm in prison settings has been reported as 11% (Slade, Forrester, & Baguley, 2020 ), and in clinical settings it varies from 13% among psychiatric outpatients (Scocco et al, 2019 ) to between 28 and 50% in inpatient settings (Boxer, 2010 ; Plutchik, Vanpraag, & Conte, 1989 ).…”

Section: Introductionmentioning

confidence: 99%

Childhood predictors of self-harm, externalised violence and transitioning to dual harm in a cohort of adolescents and young adults

et al. 2023

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Background The aetiology of dual harm (co-occurring self-harm and violence towards others) is poorly understood because most studies have investigated self-harm and violence separately. We aimed to examine childhood risk factors for self-harm, violence, and dual harm, including the transition from engaging in single harm to dual harm. Methods Data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort study, were used to estimate prevalence of self-reported engagement in self-harm, violence, and dual harm at ages 16 and 22 years. Risk ratios were calculated to indicate associations across various self-reported childhood risk factors and risks of single and dual harm, including the transition from single harm at age 16 years to dual harm at age 22. Results At age 16 years, 18.1% of the 4176 cohort members had harmed themselves, 21.1% had engaged in violence towards others and 3.7% reported dual harm. At age 22 the equivalent prevalence estimates increased to 24.2, 25.8 and 6.8%, respectively. Depression and other mental health difficulties, drug and alcohol use, witnessing self-harm and being a victim of, or witnessing, violence were associated with higher risks of transitioning from self-harm or violence at age 16 to dual harm by age 22. Conclusions Prevalence of dual harm doubled from age 16 to 22 years, highlighting the importance of early identification and intervention during this high-risk period. Several childhood psychosocial risk factors associated specifically with dual harm at age 16 and with the transition to dual harm by age 22 have been identified.

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“…Data in the international literature pertain mainly to male patients and in a few investigations conducted on new forensic facilities in Italy ( De Girolamo et al, 2016 ; Scocco et al, 2019 ; Carpiniello et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study

Rossetto¹,

Clerici

Franconi³

et al. 2021

Front. Psychol.

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The main objective of this study was to compare readmitted (RW) and non-readmitted (NRW) female psychiatric patients after being conditionally or unconditionally released from Italian inpatient forensic psychiatry services, in order to identify variables that were significantly linked with readmission. This study included all patients who were discharged from the female Residences for the Execution of the Security Measure (REMS) of Castiglione delle Stiviere from January 2008 to June 2015 who were not readmitted until December 31, 2018 (48). In addition, data were collected on female patients who were discharged from the same REMS before 2008 and readmitted from January 2008 to December 2018 (42). A key finding of our study was that the readmission into a female REMS was positively associated with the presence of substance use disorders (SUD) and a primary diagnosis on Axis II. To a lesser extent, younger age, being unconditionally discharged when first released, having had a shorter length of inpatient stay and having committed a crime against property for the first REMS admission was also variables that were apparently linked with readmission. The present research continues the previous research on gender-specific mentally ill offenders. Hence, the decision to proceed separately with a sample of men only and one of women only. For all these reasons, young female patients with personality disorder and SUD perhaps should remain longer in REMS and be released with conditions. In most European countries, the length of stay depends on the clinical condition and risk assessment, with some exceptions where the courts set a maximum length of stay at the outset, as in Italy. All the factors listed above influence the risk assessment. Finally, from integrating these findings into the increasing international literature on conditional release and considering the recent changes in the Italian forensic treatment model, we recommend continuing research on individual risk and protective factors as well as risk assessment instruments on conditionally and unconditionally released inpatients with genders studied separately.

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Self-harm behaviour and externally-directed aggression in psychiatric outpatients: a multicentre, prospective study (viormed-2 study)

Cited by 3 publications

References 43 publications

Associations between violence, self‐harm and acute psychiatric service use: Implications for inpatient care

Associations between violence, self‐harm and acute psychiatric service use: Implications for inpatient care

Childhood predictors of self-harm, externalised violence and transitioning to dual harm in a cohort of adolescents and young adults

Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study

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