A coercive interactional style as an antecedent to aggression in psychiatric patients

Abstract

As with society at large, violence in psychiatric settings is a serious clinical problem. Despite a great deal of attention, however, very little is currently known about the underlying theory or interventions to reduce aggression and violence in hospital settings. In this study, some psychiatric patients were viewed as having a general, aggressive, interactional style, motivated by the traits of Intimidation and Interpersonal Control, which when combined were labeled Coercion. A causal model in which violence and aggression were hypothesized to be predicted by a coercive interpersonal style and negatively predicted by an accommodating interpersonal style was tested. These interpersonal styles were proposed to mediate antecedent variables, that is, history of violence, psychiatric diagnoses, and length of hospitalization. Data were collected in two hospitals on psychiatric patients (N = 156) and analyzed using multiple regression techniques. The results of theoretical model testing suggested that 60% of the variance in Aggression was explained by four model variables: (a) Intimidation and Interpersonal Control (Coercion) (beta = .44), (b) Length of Hospitalization (beta = .26), (c) History of Violence (beta = .27), and (d) Bipolar Affective Syndrome (beta = .21). The implications for clinical care are discussed.

Precipitants to psychiatric patient assaults on staff: review of empirical findings, 1990–2003, and risk management implications

“…The studies to date demonstrate that patient assaults appear to be a worldwide occupational hazard in a variety of different health care settings (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Although these first studies' results must be considered preliminary in nature, there appear to be some commonalties of precipitants across the studies that should warrant future research consideration.…”

“…Strategies that address facility access, ongoing surveillance, warning signs of potential conflicts, and the like not only serve to enhance general facility safety but also include strategies that may serve to reduce the risk of patient assault and to contain its aftermath, when it does occur (3,17). Based on the findings reviewed here (11)(12)(13)(14)(15)(16) facilities may want to consider the following specific patient and patient/staff interaction variables as additional opportunities to reduce the risk of violence.…”

“…The clinical triad of violence toward others, substance use disorder, and personal victimization have all been associated with subsequent assaultive behavior (11)(12)(13)(14)(15)(16). The risk for these assaultive precipitants may be addressed directly by clinical interventions.…”

“…The research on assaultive patients (11)(12)(13)(14)(15)(16) suggests additional clinical risk management strategies for consideration. The clinical triad of violence toward others, substance use disorder, and personal victimization have all been associated with subsequent assaultive behavior (11)(12)(13)(14)(15)(16).…”

“…Utilizing data gathered from 156 incidents in a private and a state psychiatric hospital in the Midwest of the United States, Morrison performed a multiple regression analysis to test a theoretical model of patient aggression (12). Chart reviews of past violence and scales for interpersonal control, intimidation, accommodation, violence, and social desirability were among the several measures that were completed after interviewing each assaultive patient.…”