Broderick Charles, Azizian Allen, Kornbluh Rebecca, Warburton Katherine
1California Department of State Hospitals,Sacramento,California,USA.
2Coalinga State Hospital,Coalinga,California,USA.
CNS Spectr. 2015 Jun;20(3):319-30. doi: 10.1017/S1092852915000188. Epub 2015 May 4.
Introduction We examined physical violence in a large, multihospital state psychiatric system during 2011-2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety.
Acts of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011-2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios.
Overall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization. Discussion Implications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.
引言 我们研究了2011 - 2013年期间一个大型的、多医院的州立精神病系统中的身体暴力情况，并分析了暴力患者的相关人口统计学和临床特征，以更好地了解患者和工作人员的安全问题。
收集并分析了2011 - 2013年期间住院患者对其他患者（n = 10958）或工作人员（n = 8429）实施的身体暴力行为，以得出患病率和相关的优势比。
总体而言，31.4%的患者在住院期间至少实施了1次暴力攻击。在患者对患者和患者对工作人员的攻击中发现了不同的风险因素模式。年龄较小与患者对患者和患者对工作人员攻击的较高患病率相关，非法医法律身份也是如此。女性对工作人员攻击的患病率高于对患者攻击的患病率。不同种族在患者对患者攻击的发生率上有所不同，但在对工作人员攻击方面没有显著差异。与被诊断为精神分裂症的患者相比，分裂情感性障碍与患者对患者（优势比1.244，95%可信区间1.131至1.370）和患者对工作人员（优势比1.346，95%可信区间1.202至1.507）攻击的较高患病率和优势相关。大多数人格障碍诊断也有较高的身体暴力患病率和优势。1%的患者占所有攻击行为的28.7%。此外，暴力患者的住院时间明显更长。讨论 讨论了这些发现对提高患者安全以及为未来减少暴力努力提供信息的意义，包括结合使用暴力风险评估进行新治疗的必要性。
