title: Temporal trends in self harm and aggression on a paediatric mental health ward.
abstract: OBJECTIVE
  The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends.
  
  
  METHODS
  This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses.
  
  
  RESULTS
  Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion.
  
  
  CONCLUSIONS
  Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.
authors.affiliation: The Vrije Universiteit, Boelelaan 1117, 1058HV Amsterdam, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Berntsen
authors.forename: Jean
authors.initials: J
authors.lastname: Starling
authors.forename: Earle
authors.initials: E
authors.lastname: Durheim
authors.forename: Cassandra
authors.initials: C
authors.lastname: Hainsworth
authors.forename: Liselotte
authors.initials: L
authors.lastname: de Kloet
authors.forename: Lucy
authors.initials: L
authors.lastname: Chapman
authors.forename: Karen
authors.initials: K
authors.lastname: Hancock
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D001521:Behavior Therapy; D002648:Child; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D010564:Personnel, Hospital; D011567:Psychiatric Department, Hospital; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology*; D012919:Social Behavior; D013997:Time Factors; D000078329:Workforce