title: The violence triad and common single precipitants to psychiatric patient assaults on staff: 16-year analysis of the Assaulted Staff Action Program.
abstract: Psychiatric patient assaults are a serious community health hazard. Risk management strategies to identify common single precipitants have had limited value and this limitation has resulted in the emergence of multiple determinant studies. This 16-year retrospective study of assault precipitants in one, public sector mental health-care system assessed single common, immediate precipitants; the multiple clinical precipitants of history of violence, personal victimization, and substance use disorder (the violence triad); and both combined. Denial of services, acute psychoses, and excess sensory stimulation were the most common single precipitants. The multicomponent violence triad yielded greater association with subsequent assault than single precipitants. The combination of the violence triad and single precipitants did not yield statistically significant greater associations. Discussion of the clinical risk management implication, and methodological issues are presented.
authors.affiliation: Worcester State Hospital, Massachusetts Department of Mental Health, Worcester, MA, USA. raymond_flannery@hms.harvard.edu
authors.forename: Raymond B
authors.initials: RB
authors.lastname: Flannery
authors.forename: Andrea
authors.initials: A
authors.lastname: Staffieri
authors.forename: Susan
authors.initials: S
authors.lastname: Hildum
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Walker
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D019548:Crime Victims / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000150:complications / Q000523:psychology*; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D014754:Violence / Q000523:psychology*