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Patient overcrowding and violent assaults by patients are two major
problems in psychiatric healthcare. However, evidence of an association
between overcrowding and aggressive behaviour among patients is mixed and
limited to small-scale studies.
This study examined the association between ward overcrowding and violent
physical assaults in acute-care psychiatric in-patient hospital
Longitudinal study using ward-level monthly records of bed occupancy and
staff reports of the timing of violent acts during a 5-month period in 90
in-patient wards in 13 acute psychiatric hospitals in Finland. In total
1098 employees (physicians, ward head nurses, registered nurses, licensed
practical nurses) participated in the study. The outcome measure was
staff reports of the timing of physical assaults on both themselves and
We found that 46% of hospital staff were working in overcrowded wards, as
indicated by >10 percentage units of excess bed occupancy, whereas
only 30% of hospital personnel were working in a ward with no excess
occupancy. An excess bed occupancy rate of >10 percentage units at the
time of an event was associated with violent assaults towards employees
(odds ratio (OR) = 1.72, 95% CI 1.05–2.80; OR = 3.04, 95% CI 1.51–6.13 in
adult wards) after adjustment for confounding factors. No association was
found with assaults on ward property (OR = 1.06, 95% CI 0.75–1.50).
These findings suggest that patient overcrowding is highly prevalent in
psychiatric hospitals and, importantly, may increase the risk of violence
directed at staff.
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