title: The antecedents of violence and aggression within psychiatric in-patient settings.
abstract: OBJECTIVE
  To systematically review the types and proportions of antecedents of violence and aggression within psychiatric in-patient settings.
  
  
  METHODS
  Empirical articles and reports with primary data pertaining to violence and aggression within adult psychiatric in-patient settings were retrieved. For each study, prospective antecedent data were extracted. The extracted antecedent data were thematically analysed, and all higher-level themes were meta-analysed using rate data.
  
  
  RESULTS
  Seventy-one studies met the inclusion criteria, from which 59 distinct antecedent themes were identified and organised into nine higher-level themes. The higher-level antecedent theme 'staff-patient interaction' was the most frequent type of antecedent overall, precipitating an estimated 39% of all violent/aggressive incidents. An examination of the staff-patient interaction themes revealed that limiting patients freedoms, by either placing some sort of restriction or denying a patient request, was the most frequent precursor of incidents, accounting for an estimated 25% of all antecedents. The higher-level themes 'patient behavioural cues' and 'no clear cause' also produced other large estimates and were attributed to 38% and 33% of incidents overall.
  
  
  CONCLUSIONS
  This review underscores the influence that staff have in making in-patient psychiatric wards safe and efficacious environments.
authors.affiliation: Institute for Health Research, University of Bedfordshire, UK. chris.papadopoulos@beds.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: J
authors.initials: J
authors.lastname: Ross
authors.forename: D
authors.initials: D
authors.lastname: Stewart
authors.forename: C
authors.initials: C
authors.lastname: Dack
authors.forename: K
authors.initials: K
authors.lastname: James
authors.forename: L
authors.initials: L
authors.lastname: Bowers
mesh_terms: D000374:Aggression / Q000523:psychology*; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D011567:Psychiatric Department, Hospital; D014754:Violence / Q000523:psychology*