title: Aggression on inpatient units: Clinical characteristics and consequences.
abstract: Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.|School of Nursing, Midwifery Social Work, University of Manchester, Manchester, UK.
authors.forename: Laoise
authors.identifier: http://orcid.org/0000-0001-7060-4537
authors.initials: L
authors.lastname: Renwick
authors.affiliation: School of Psychology, Social Work and Human Sciences, University of West London.
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Department of Childhood, Families and Health, Institute of Education, University College London, London.
authors.forename: Michelle
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
authors.forename: Mary
authors.initials: M
authors.lastname: Lavelle
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
authors.forename: Karen
authors.initials: K
authors.lastname: James
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
authors.forename: Claire
authors.initials: C
authors.lastname: Hardy
authors.affiliation: School of Nursing, Midwifery Social Work, University of Manchester, Manchester, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Price
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
mesh_terms: D000328:Adult; D000374:Aggression; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000523:psychology; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data
keywords: acute psychiatric setting; aggression; violence