Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis.
BACKGROUND
Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China.


METHODS
Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis.


RESULTS
The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies).


CONCLUSIONS
Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.
Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China.
Jian-Song
JS
Zhou
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
Bao-Liang
BL
Zhong
Faculty of Health Sciences, University of Macau, Macau, China.
Yu-Tao
YT
Xiang
Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China.
Qiongni
Q
Chen
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
Xiao-Lan
XL
Cao
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York City, NY, USA.
Christoph U
CU
Correll
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia.|Marian Centre, The University of Notre Dame Australia, Perth, WA, Australia.
Gabor S
GS
Ungvari
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
Helen F K
HF
Chiu
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
Kelly Y C
KY
Lai
Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, China.
Xiao-Ping
XP
Wang
D000374:Aggression / Q000523:psychology*; D002681:China / Q000453:epidemiology; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003702:Delusions / Q000453:epidemiology / Q000523:psychology; D006212:Hallucinations / Q000453:epidemiology* / Q000523:psychology; D006760:Hospitalization; D006791:Hostility; D006801:Humans; D007297:Inpatients; D015995:Prevalence; D012307:Risk Factors; D012559:Schizophrenia; D012562:Schizophrenia, Disorganized / Q000453:epidemiology / Q000523:psychology; D012565:Schizophrenic Psychology; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*
aggression; meta-analysis; psychiatric ward; schizophrenia