Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward

Abstract

Ping-Ying Chang,1,2 Jian-Hong Chen,1– 3 Hui-Wen Cheng,1 Yen-Chin Wang4 1Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; 3Doctoral Program for Transnational Sport Management and Innovation, National Taiwan Sport University, Taoyuan, Taiwan, Republic of China; 4Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of ChinaCorrespondence: Jian-Hong Chen, Email [email protected]: Prevention, de-escalation, and management of violence in the acute psychiatric ward is essential. Few studies have focused on differences in the duration of high-violence risk between different profiles of high-violence risk. This study aimed to analyze the data of high-violence patients and duration of high-violence risk to provide a new perspective on violence prevention, de-escalation and management.Methods: This retrospective observational cohort study included 171 patients who were treated in the acute psychiatric ward of Keelung Chang Gung Memorial Hospital between January 2016 and June 2020, and who were assessed daily as having high violence risk. All patient data were collected from electronic hospital records (eg, age, gender, diagnosis, violence history, self-harm history, and admission condition (involuntary admission, discharged against medical advice). Between-group differences in disease severity, use of antipsychotics and benzodiazepine, and duration of high violence risk were analyzed using regression analysis.Results: Only patients’ age was significantly associated with duration of high-violence risk (P = 0.028), making it predictive of longer duration of high-violence risk. In patients with schizophrenia spectrum disorder or bipolar disorder, higher severity was significantly associated with longer duration of high-violence risk (P = 0.007, P = 0.001, respectively).Conclusion: Only age is a predictor of longer duration of violence risk in psychiatric patients, although higher severity is associated with higher violence risk. Study results may help management and healthcare staff better understand how quickly or slowly violence risk will decrease and may improve efficient use of healthcare resources and individualized patient-centered care.Keywords: acute psychiatric ward, predictor, risk assessment, severity, violence risk

Keywords

• acute psychiatric ward
• predictor
• risk assessment
• severity
• violence risk