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Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: Systematic Review and Meta-Analysis—A 2019 Update

  • Ester di Giacomo
  • Laura Iozzino
  • Clarissa Ferrari
  • Cosmo Strozza
  • Matthew Large
  • Olav Nielssen
  • Giovanni de GirolamoEmail author
Chapter
Part of the Comprehensive Approach to Psychiatry book series (CAP, volume 1)

Abstract

Violence by patients in acute psychiatric wards affects both patients and staff. This study updates a 2015 meta-analysis of the prevalence of violent patients in acute psychiatric wards. Forty-two studies conducted in high-income countries were located in searches of the electronic databases PubMed, Scopus, and CINAHL. The pooled prevalence of reported acts of violence by patients was 18% (95% CI), although with very high heterogeneity (I2 = 98.7%, Q = 1735.3, p < 0.0001). Analysis of moderator variables found that 17.9% of the between-study heterogeneity was explained by the proportion of males (p = 0.0035), 16.4% by ward size (p = 0.0217), 12.8% by the proportion of involuntary patients (p = 0.0225), and 36.1% by the proportion of patients with alcohol-use disorder (p = 0.0007). The proportion of patients with other diagnoses, including psychotic illness, was not a source of heterogeneity.

The continued high rate of violence confirms the need for improvement in the identification and containment of violent behavior in psychiatric wards in order to provide safer and more therapeutic environments.

Keywords

Violence Aggression Acute psychiatric ward Psychiatric admission Psychiatric inpatients 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ester di Giacomo
    • 1
    • 2
  • Laura Iozzino
    • 3
  • Clarissa Ferrari
    • 4
  • Cosmo Strozza
    • 5
    • 6
  • Matthew Large
    • 7
    • 8
  • Olav Nielssen
    • 9
  • Giovanni de Girolamo
    • 3
    Email author
  1. 1.School of Medicine and Surgery, University of Milan-BicoccaMonzaItaly
  2. 2.Department of Mental Health and AddictionASST MonzaMonzaItaly
  3. 3.Unit of Epidemiological and Evaluation PsychiatryIRCCS Centro San Giovanni di Dio FatebenefratelliBresciaItaly
  4. 4.Unit of StatisticsIRCCS Centro San Giovanni di Dio FatebenefratelliBresciaItaly
  5. 5.Department of Statistical Science‘La Sapienza’ UniversityRomeItaly
  6. 6.Interdisciplinary Centre on Population Dynamics (CPOP)Southern Denmark UniversityOdenseDenmark
  7. 7.Prince of Wales Hospital SydneySydneyAustralia
  8. 8.University of New South WalesSydneyAustralia
  9. 9.Faculty of Medicine and Health Science, Macquarie UniversitySydneyAustralia

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