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Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: Patient assaults, staff assaults, and repeatedly violent patients

Published online by Cambridge University Press:  04 May 2015

Charles Broderick ,
Allen Azizian ,
Rebecca Kornbluh  and
Katherine Warburton
Charles Broderick*
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Allen Azizian
Affiliation:
Coalinga State Hospital, Coalinga, California, USA Department of Criminology, California State University, Fresno, California, USA
Rebecca Kornbluh
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Katherine Warburton
Affiliation:
California Department of State Hospitals, Sacramento, California, USA Division of Psychiatry and the Law, University of California, Davis, California, USA
*
*Address for correspondence: Charles Broderick, PhD, California Department of State Hospitals, Clinical Operations Division, 1600 9th Street, Room 400, Sacramento, CA 95814, USA. (Email: charles.broderick@dsh.ca.gov)
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Abstract

Introduction

We examined physical violence in a large, multihospital state psychiatric system during 2011–2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety.

Method

Acts of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011–2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios.

Results

Overall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization.

Discussion

Implications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.

Keywords

Aggressionassaultforensichospitalinpatientmental illnesspsychiatricschizoaffectiveschizophreniaviolence
Type
Original Research
Information
CNS Spectrums , Volume 20 , Special Issue 3: Violence in the Psychiatric Setting , June 2015 , pp. 319 - 330
Copyright
© Cambridge University Press 2015 

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Footnotes

The authors wish to thank our Data Management Office, and especially Ms. Pat Young, for her support and dedication in providing us with the data necessary to complete our work. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the California Department of State Hospitals.

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