The Predictive Properties of Violence Risk Instruments May Increase by Adding Items Assessing Sleep

Abstract

Background: The psychometric instruments developed for short-term prediction of violence in psychiatric inpatients do not include variables assessing sleep. Disturbances in sleep may precede aggression in this setting. We investigated whether adding information on sleep improved the predictive properties of the Brøset Violence Checklist (BVC). Methods: The study population consists of all patients admitted to a psychiatric intensive care unit (PICU) over a 6-month period who were hospitalized for at least one night ( n = 50). Sleep observed by staff (521 nights), behavior assessed with the BVC (433 days), and aggressive incidents recorded by the Staff Observation Scale-Revised ( n = 14) were included in the analysis. Results: The ability of the BVC to predict aggressive incidents improved from AUC ROC 0.757 to AUC ROC 0.873 when a combined sleep variable including both sleep duration and night-to-night variations of sleep duration was added to the BVC recordings. The combined sleep variable did not significantly predict aggressive incidents (AUC ROC 0.653, p = 0.051). Conclusions: A sleep disturbance variable improves the predictive properties of the BVC in PICUs. Further studies of sleep duration, night-to-night variations in duration of sleep, and aggression are needed.

Anti-violence measures developed by ILO and WHO: Analysis of the prevalence of workplace violence and the effects of implementation in a general hospital in China

“…There are different tools for the assessment of WPV among HWs. Current research instruments on WPV in HWs mostly use the self-report questionnaire, a self-administered questionnaire, a short-term assessment tool, the Crisis Monitor, the Brøset Violence Checklist (BVC), the Brief Psychiatric Rating Scale (BPRS), the Perception of Aggression Scale (POAS), and the Perception of Patient Initiated Aggression Tool (POPAS) (22)(23)(24)(25)(26)(27). Currently, most of the questionnaires that are used within China are homemade, or only a part of the questionnaire is utilized (13,28,29), which indicates a lack of sufficient studies using internationally recognized survey instruments.…”

Lying awake in forensic hospitals: a multicenter, cross-sectional study on the prevalence of insomnia and contributing factors in forensic psychiatric patients

“…For example, a longitudinal investigation in patients admitted to a forensic psychiatric hospital demonstrated that overall self-rated aggression declines over one year, but increases in patients with low subjective sleep quality (Van Veen et al, 2020). Furthermore, adding information on sleep disturbances to the Brøset Violence Checklist significantly improved its power to predict next-day aggressive incidents in patients of a psychiatric intensive care unit (Langsrud et al, 2019). Both studies indicate that poor sleep contributes to the risk of problematic behavior.…”