Predicting aggressive behaviour in acute forensic mental health units: A re‐examination of the dynamic appraisal of situational aggression's predictive validity

Abstract

In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval (CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated.

Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour

“…The data set used for this study has been described in an earlier paper (Maguire et al. ), which focused on the predictive validity of DASA; however, the focus of this study is associated with nursing interventions and their impact on aggression, which has not previously been reported.…”

“…DASA items are then totalled to determine the likelihood of imminent aggression, and a final risk rating is translated into one of three risk bands, low (0), moderate (1–3) and high (4 or greater) (Maguire et al. ). The bands serve as a guide for interpreting the scores and assist in indicating the level of risk (Ogloff & Daffern, ).…”

Evaluating the impact of an electronic application of the Dynamic Appraisal of Situational Aggression with an embedded Aggression Prevention Protocol on aggression and restrictive interventions on a forensic mental health unit

“…A small number of patients are responsible for most aggressive acts within mental health units (Bowers et al 2011;Grenyer et al 2013;Maguire et al 2017;Nicholls et al 2009). Identifying the patients who are more likely to act aggressively can help clinicians dedicate resources to meet the needs of these patients, while lessening unnecessary restrictions may also be welcomed by patients presenting as low risk (Chu et al 2013).…”

“…Items are rated 0 if the item is absent or a 1 if present. The scores are then totalled (Ogloff & Daffern 2006) and the corresponding score yields a risk rating, low (0), moderate (1-3), or high (4-7) (Maguire et al 2017).…”

“…Aggression in mental health units is a significant concern for clinicians, patients, families, carers, and mental health services (Cusack et al 2003;Renwick et al 2016;Stewart & Bowers 2013). In forensic mental health settings, the number of patients reportedly engaging in aggression varies across different studies, for example Nicholls et al (2009) reported that approximately 60% of patients engaged in at least one act of aggression, whereas Maguire et al (2017) reported that 92% of patients had engaged in at least one act of aggression. Adverse outcomes for patients and staff include physical, psychological and emotional harm (Lee et al 2015;Needham et al 2005;Royal College of Psychiatrists 2007).…”