Risk of aggression among patients admitted in a psychiatric unit of a tertiary hospital, Kochi, Kerala

Abstract

Introduction: Patient aggression in psychiatric units is an important negative outcome, which threatens the safety of patients and the staff and its prediction and prevention are among the top priorities in psychiatric care. The current study was done with the objectives of determining the risk of aggression among patients admitted to the psychiatric unit of a selected tertiary hospital and also finding the associated factors for the risk of aggression.

Methods: This study adopted a descriptive cross-sectional design and was conducted in the psychiatric open inpatient unit of a tertiary hospital in Kochi, Kerala. The sample constituted 100 admitted mentally ill patients aged above 18 years who were selected on the day of admission by consecutive sampling. Data collection instruments were the patient information schedule and the Dynamic Appraisal of Situational Aggression (DASA) which is a standardized structured tool for assessing risk for aggression for the upcoming 24 hours. The investigators received a short training in using the DASA and after the ethical procedures, rated the participants’ risk of aggression during three shifts of the first 24 hours of their admission in the unit.

Results: The sample consisted of both males (61%) and females (39%) with a mean age of 34.4 years (SD 12.15). The risk of aggression was found to be moderate in 76%, high in 20%, and low in four percent of the participants. The risk of physical aggression against people was shown by 23% of the subjects and that of verbal aggression and physical aggression against objects were found in 34% and 40% respectively. Factors like age (p=0.039), economic status (p=0.016), history of aggressive behavior (p=0.042), history of non-adherence with medications (p=0.006), and number of hospital admissions (p=0.006) were found to be associated with high risk of aggression in the patients.

Conclusion: A considerable proportion of patients were found to have a high risk of aggression in the initial days of their admission. This study throws light to the need for mental health carers, especially the nurses to identify and predict aggressive behavior in their clients and to take up preventive strategies so that they can ensure the safety of the patients, other staff in the unit, and their safety as well.