Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model
<p><strong>Background</strong> Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions.</p> <p><strong>Methods</...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Cambridge University Press
2021
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| _version_ | 1826309759840550912 |
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| author | Fazel, S Toynbee, M Ryland, H Vazquez-Montes, M Al-Taiar, H Wolf, A Aziz, O Khosla, V Gulati, G Fanshawe, T |
| author_facet | Fazel, S Toynbee, M Ryland, H Vazquez-Montes, M Al-Taiar, H Wolf, A Aziz, O Khosla, V Gulati, G Fanshawe, T |
| author_sort | Fazel, S |
| collection | OXFORD |
| description | <p><strong>Background</strong>
Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions.</p>
<p><strong>Methods</strong>
Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1–4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded.</p>
<p><strong>Results</strong>
We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25–9.20), 10-year increase in age (OR 0.67, 0.47–0.96), and female sex (OR 2.78, 1.04–7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20–1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72–0.82) and 0.75 (0.70–0.80) when the dynamic score was excluded.</p>
<p><strong>Conclusions</strong>
In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.</p> |
| first_indexed | 2024-03-07T07:40:33Z |
| format | Journal article |
| id | oxford-uuid:332d5382-4e30-41fd-82ec-7b858e836732 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:40:33Z |
| publishDate | 2021 |
| publisher | Cambridge University Press |
| record_format | dspace |
| spelling | oxford-uuid:332d5382-4e30-41fd-82ec-7b858e8367322023-04-27T09:16:30ZModifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction modelJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:332d5382-4e30-41fd-82ec-7b858e836732EnglishSymplectic ElementsCambridge University Press2021Fazel, SToynbee, MRyland, HVazquez-Montes, MAl-Taiar, HWolf, AAziz, OKhosla, VGulati, GFanshawe, T<p><strong>Background</strong> Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions.</p> <p><strong>Methods</strong> Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1–4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded.</p> <p><strong>Results</strong> We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25–9.20), 10-year increase in age (OR 0.67, 0.47–0.96), and female sex (OR 2.78, 1.04–7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20–1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72–0.82) and 0.75 (0.70–0.80) when the dynamic score was excluded.</p> <p><strong>Conclusions</strong> In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.</p> |
| spellingShingle | Fazel, S Toynbee, M Ryland, H Vazquez-Montes, M Al-Taiar, H Wolf, A Aziz, O Khosla, V Gulati, G Fanshawe, T Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title | Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title_full | Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title_fullStr | Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title_full_unstemmed | Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title_short | Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model |
| title_sort | modifiable risk factors for inpatient violence in psychiatric hospital prospective study and prediction model |
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