The antecedents of violence and aggression within psychiatric in-patient settings

Acta Psychiatr Scand. 2012 Jun;125(6):425-39. doi: 10.1111/j.1600-0447.2012.01827.x. Epub 2012 Jan 23.


Objective: To systematically review the types and proportions of antecedents of violence and aggression within psychiatric in-patient settings.

Method: Empirical articles and reports with primary data pertaining to violence and aggression within adult psychiatric in-patient settings were retrieved. For each study, prospective antecedent data were extracted. The extracted antecedent data were thematically analysed, and all higher-level themes were meta-analysed using rate data.

Results: Seventy-one studies met the inclusion criteria, from which 59 distinct antecedent themes were identified and organised into nine higher-level themes. The higher-level antecedent theme 'staff-patient interaction' was the most frequent type of antecedent overall, precipitating an estimated 39% of all violent/aggressive incidents. An examination of the staff-patient interaction themes revealed that limiting patients freedoms, by either placing some sort of restriction or denying a patient request, was the most frequent precursor of incidents, accounting for an estimated 25% of all antecedents. The higher-level themes 'patient behavioural cues' and 'no clear cause' also produced other large estimates and were attributed to 38% and 33% of incidents overall.

Conclusion: This review underscores the influence that staff have in making in-patient psychiatric wards safe and efficacious environments.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aggression / psychology*
  • Hospitals, Psychiatric
  • Humans
  • Inpatients / psychology*
  • Psychiatric Department, Hospital
  • Violence / psychology*