Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland.
Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland.
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DOI：
10.1186/1745-0179-3-30
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发表时间：
2007-12-04
期刊：
影响因子：
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通讯作者：
Haug, Hans-Joachim
中科院分区：
文献类型：
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作者：
Abderhalden, Christoph;Needham, Ian;Haug, Hans-Joachim
背景：攻击和暴力及其负面后果是全球急性精神科住院患者护理中的一个主要问题。研究设计、背景、人群和数据收集方法的差异使得比较高风险环境中攻击行为的发生率变得困难。 目的：描述瑞士德语区急性精神病病房中攻击事件的频率和严重程度。 方法：我们对瑞士德语区 12 家精神病医院的 24 个急性入院病房进行了一项前瞻性多中心研究。攻击性事件通过修订后的员工观察攻击量表 (SOAS-R) 进行记录，我们检查了数据收集是否存在漏报情况。我们的样本包括 2017 名患者的 2344 次治疗事件和总共 41,560 个治疗日。结果：总共记录了 760 起攻击性事件。我们发现每 100 个治疗日的身体攻击发生率在 0.60 (95% CI 0.10-1.78) 之间，而所有攻击事件（包括纯粹的言语攻击）则在 1.83 (1.70-1.97) 之间。 22 点 SOAS-R 严重程度测量的平均严重程度为 8.80 +/- 4.88 分； 46% 的纯粹言语攻击被归类为严重（>/= 9 分）。 53%的攻击事件之后采取了强制措施，大部分是隔离或隔离并伴有药物治疗。 13% 的患者记录了 1 次以上事件，6.9% 的患者经历过 1 次以上人身攻击。非自愿入院（OR 2.2；1.6-2.9）、较长住院时间（OR 2.7；2.0-3.8）和精神分裂症诊断（ICH-10 F2）（OR 2.1；1.5-2.9）与攻击性事件的较高风险相关，但年龄和性别没有发现这种关联。 38% 的事件发生在入院后的前 7 天内。结论：急性入院病房中的攻击性事件是一个频繁且严重的问题。由于研究设计，我们认为瑞士德语区急性病房的发病率具有稳健性和代表性，因此可作为比较和介入研究的参考。对临床实践的影响包括建议将系统风险评估延长到入院后的第一天之后。该研究证实了在报告和比较发病率数据时区分攻击行为类型的必要性。
BACKGROUND: Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.OBJECTIVE: To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.METHODS: We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days.RESULTS: A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10-1.78) for physical attacks and 1.83 (1.70-1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 +/- 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (>/= 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6-2.9), longer length of stay (OR 2.7; 2.0-3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5-2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.CONCLUSION: Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.