BackgroundAggressive behaviour is common in mental health inpatient units, and can cause physical and psychological harm, low work satisfaction among staff and be disruptive to the clinical care of patients. Identification of static and dynamic variables associated with inpatient aggression may help identify opportunities for intervention to reduce such incidents.MethodWe carried out a two-year retrospective study of consecutive admissions to the Centre for Addiction and Mental Health, the largest mental health facility in Canada. We created a multivariable model of risk factors associated with aggression, which included static and dynamic variables, as well as the Dynamic Appraisal of Situational Aggression (DASA), which was measured daily.ResultsWe included 4419 consecutive admissions comprising 88,124 patient-days. We found that High and Medium DASA scores were strongly associated with subsequent aggression (HR = 9.64, 95% CI = 7.75-11.99, and HR = 3.51, 95% CI = 2.82-4.37, respectively) after controlling for other variables. Other variables associated with aggression included the Aggressive Behaviour Scale of the Resident Assessment Instrument-Mental Health (RAI-ABS), male gender, younger age, ethnicity, PRN (as needed medication) administration, unit type, involuntary admission, medication refusal and self-harm. However, these variables were more weakly associated with subsequent aggression as compared to the DASA score categories.ConclusionsHigher DASA scores are strongly associated with aggression after controlling for a range of other patient variables. Frequent structured measurement of dynamic variables using the DASA may help identify patients most at risk of aggression and assist clinical staff in directing interventions to where they are most needed to reduce aggression on inpatient units.
Contexte: Les comportements agressifs sont fréquents sur les unités d’hospitalisation en santé mentale et peuvent causer des dommages physiques et psychologiques, réduire la satisfaction au travail des employés et nuire aux soins cliniques des patients. L’identification de variables statiques et dynamiques associées au comportement agressif des patients hospitalisés peut aider à déterminer les possibilités d’intervention afin de réduire la fréquence de ces incidents.
Méthodes: Nous avons mené une étude rétrospective de deux ans portant sur des admissions consécutives au Centre de toxicomanie et de santé mentale, le plus grand établissement de santé mentale au Canada. Nous avons créé un modèle d’analyse multivariable des facteurs de risque associés au comportement agressif, comprenant des variables statiques et dynamiques ainsi que le résultat de la grille DASA (Dynamic Appraisal of Situational Aggression) pour la détection du potentiel de comportement agressif des patients, qui était remplie quotidiennement.
Résultats: Nous avons inclus 4419 admissions consécutives représentant 88 124 jours-patient. Nous avons constaté que les scores DASA moyen et élevé étaient fortement associés au comportement agressif subséquent (RR : 9,64 [IC à 95 % : 7,75 à 11,99] et RR : 3,51 [IC à 95 % : 2,82 à 4,37], respectivement) après la prise en compte des autres variables. Parmi les autres variables associées au comportement agressif, mentionnons le résultat de l’échelle des comportements agressifs de l’Instrument d’évaluation pour les résidents – Santé mentale (RAI-ABS), le sexe masculin, le jeune âge, l’origine ethnique, l’administration de médicaments au besoin (PRN), le type d’unité, l’admission en cure obligatoire, le refus de médication et l’automutilation. Toutefois, ces variables étaient plus faiblement associées au comportement agressif subséquent comparativement aux catégories de score DASA.
Conclusions: Les scores DASA élevés sont fortement associés au comportement agressif après la prise en compte d’un éventail d’autres variables liées aux patients. L’évaluation fréquente des variables dynamiques de façon structurée à l’aide de la grille DASA peut contribuer à déterminer quels patients présentent un risque accru de comportement agressif et aider le personnel clinique à mieux orienter les interventions nécessaires pour réduire les comportements agressifs sur les unités d’hospitalisation.
Keywords: aggression; behaviour problems; inpatient psychiatry; risk factor.
What Factors Are Linked to Aggression in Mental Health Hospitals? A Two-Year StudyPlain Language SummaryAggression in mental health hospitals is a serious concern. It can lead to injuries for staff and patients, cause emotional stress, and interfere with patient care. Being able to predict when aggression might happen can help staff take steps to prevent it. This study looked at over 4,400 patient admissions to Canada’s largest mental health hospital over two years. We analyzed more than 88,000 days of patient care to understand what factors were linked to aggression. We used a tool called the Dynamic Appraisal of Situational Aggression (DASA), which staff complete daily to assess how likely a patient is to become aggressive. We also looked at other factors, such as age, gender, use of â€oeas needed†medication, whether a patient was admitted involuntarily, and if they had refused medication or engaged in self-harm. The results showed that high or medium DASA scores were strongly linked to aggressive incidents, even when considering other factors. While things like age, gender, and previous behavior were also related to aggression, they were not as strongly predictive as DASA scores. This suggests that tracking day-to-day changes in behavior using tools like the DASA can help staff identify which patients are most at risk of becoming aggressive. This allows them to take early action, such as adjusting care or support, to help reduce aggression and keep the ward safer for everyone.