title: Assessment and determinants of aggression in a forensic psychiatric institution in Hong Kong, China.
abstract: Institutional aggression in forensic psychiatric setting is an under-researched subject, despite the magnitude of the problem. No studies have been conducted on the assessment of risk and the examination of predictors of aggression among the Chinese forensic psychiatric population. Our study aimed to examine the determinants of aggression in the only forensic psychiatric institution in Hong Kong, and to test the psychometric properties of a risk-assessment instrument, the Dynamic Appraisal of Situational Aggression (DASA). We recruited a representative sample of 530 consecutively admitted detainees. Qualified nurses completed two risk-assessment instruments, the DASA and the Brøset Violence Checklist (BVC), once daily during the participants׳ first 14 days of admission. Aggressive incidents were recorded using the revised Staff Observation Aggression Scale (SOAS-R), and participants׳ data were collected for multivariate analyses. We showed that female gender, diagnoses of personality disorder and substance-related disorder, and admission at other correctional institutions were associated with institutional aggression. Aggression was perpetrated by 17.7% of the participants, and the DASA was demonstrated to have good psychometric properties in assessing and predicting aggressive incidents. Our findings preliminarily support the use of daily in-patient risk-assessment and affirm the role of dynamic factors in institutional aggression.
authors.affiliation: Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong. Electronic address: co258@ha.org.hk.
authors.forename: Oliver
authors.initials: O
authors.lastname: Chan
authors.affiliation: Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong.
authors.forename: Kavin Kit-wan
authors.initials: KK
authors.lastname: Chow
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D057189:Checklist; D005260:Female; D005555:Forensic Psychiatry; D006723:Hong Kong; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000523:psychology; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000523:psychology; D014754:Violence / Q000523:psychology
keywords: Chinese; Forensic psychiatry; Institutional aggression; Risk-assessment; Validation