Centers for Psychiatry Suedwuerttemberg, Ravensburg, Germany.
Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany.
PLoS One. 2021 Jan 5;16(1):e0245090. doi: 10.1371/journal.pone.0245090. eCollection 2021.
In a meta-analysis of international studies, 17% of admitted patients in psychiatric hospitals had exhibited violent behavior toward others. Reported data from studies in Germany were considerably lower until recent years. However, studies examining only single hospitals, as well as the quality of the data itself, have raised questions as to the validity of these findings. Indeed, a debate currently exists as to whether there has, in fact, been an increase of violent incidents in German mental institutions.
In a group of 10 hospitals serving about half the population of the Federal State of Baden-Wuerttemberg with 11 million inhabitants, the Staff Observation Aggression Scale-Revised (SOAS-R) was introduced into patients' electronic charts as part of routine documentation. Data recording was strongly supported by staff councils and unions. A completed data set is now available for the year 2019. For one hospital, data are available since 2006. Due to some doubts with respect to fully covering self-directed aggression, we restricted the analysis to aggression toward others and toward objects.
In 2019, 17,599 aggressive incidents were recorded in 64,367 admissions (1,660 staying forensic psychiatric inpatients included). 5,084 (7.90%) of the admitted cases showed aggressive behavior toward others. Variation between hospitals was low to modest (SD = 1.50). The mean SOAS-R score was 11.8 (SD between hospitals 1.20%). 23% of the incidents resulted in bodily harm. The percentage of patients showing violent behavior was highest among patients with organic disorders (ICD-10 F0) and lowest among patients with addictive or affective disorders (F1, F3, F4). Forensic psychiatry had the highest proportion of cases with aggressive behavior (20.54%), but the number of incidents per bed was lower than in general adult psychiatry and child and adolescent psychiatry (indicating a lower risk for staff). In the hospital with longer-term recordings available, an increase could be observed since 2010, with considerable variation between years.
This is the most robust estimate of the frequency of violent incidents in German psychiatric hospitals thus far. The incidence is about half of what has been reported internationally, probably due to sample selection bias in previous studies and a relatively high number of hospital beds in Germany. Available data suggest an increase of violent incidents over the last ten years; however, it is unclear to which extent this is due to increased reporting.
在一项对国际研究的荟萃分析中，17%的住院精神病患者表现出对他人的暴力行为。直到近年来，德国研究报告的数据要低得多。然而，仅对单个医院进行的研究以及数据本身的质量，引发了对这些发现的有效性的质疑。事实上，目前确实存在关于德国精神病院暴力事件是否增加的争论。
在为巴登-符腾堡州的一半人口（拥有 1100 万居民）服务的 10 家医院组成的一组中，工作人员观察性攻击量表修订版（SOAS-R）被引入患者的电子病历中，作为常规记录的一部分。员工委员会和工会大力支持数据记录。现在已经有 2019 年的完整数据集。对于一家医院，自 2006 年以来就有数据。由于对完全涵盖自我指向性攻击存在一些疑问，我们将分析仅限于对他人和物体的攻击。
2019 年，在 64367 人次的住院治疗中记录了 17599 起攻击事件（包括 1660 名住院法医精神病患者）。5084 例（7.90%）住院患者表现出对他人的攻击行为。医院之间的差异较小（SD=1.50）。SOAS-R 平均得分为 11.8（医院间 SD 为 1.20%）。23%的事件导致身体伤害。表现出暴力行为的患者比例在器质性障碍（ICD-10 F0）患者中最高，在成瘾或情感障碍（F1、F3、F4）患者中最低。法医精神病学的攻击行为比例最高（20.54%），但每张床位的事件数量低于普通成人精神病学和儿童及青少年精神病学（表明工作人员的风险较低）。在有长期记录的医院中，自 2010 年以来可以观察到一个增加的趋势，且各年之间存在较大差异。
这是迄今为止对德国精神病院暴力事件频率的最可靠估计。发病率约为国际报告的一半，这可能是由于以前研究中的样本选择偏差以及德国相对较多的医院床位造成的。现有数据表明，过去十年中暴力事件有所增加；然而，尚不清楚这在多大程度上是由于报告的增加。
