Simmons Melanie L, Maguire Tessa, Ogloff James R P, Gabriel Jessica, Daffern Michael
Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia.
Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia.
J Psychiatr Ment Health Nurs. 2023 Oct;30(5):942-951. doi: 10.1111/jpm.12913. Epub 2023 Mar 30.
Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units. Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive.
While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration. Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated.
There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score.
INTRODUCTION: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk.
Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively.
Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review.
The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient-to-patient aggression; high-risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores.
It is possible that there were more nursing interventions and/or patients engaged in greater self-regulation on unsettled units, thus reducing aggression.
Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk.
研究表明，情境性攻击动态评估（DASA）是一种有用的风险评估工具，可用于识别精神科住院单元中可能存在攻击风险的个体。尽管风险评估研究通常侧重于个体的攻击风险，但最近的研究已开始探索DASA是否可用于评估一组患者发生攻击行为的可能性。
虽然DASA有助于评估个体是否可能具有攻击性，但一旦考虑个体的DASA评分，群体平均评分对于攻击可能性而言并非有用指标。出乎意料的是，与未稳定单元（包括其他风险升高的个体）相比，在DASA上被评估为高风险的患者在稳定单元上更有可能具有攻击性。
没有足够的证据表明群体DASA平均值在识别攻击性方面比个体DASA评分更具优势。
引言：情境性攻击动态评估（DASA）是一种住院患者攻击风险评估工具。最近，有研究探讨了以单元平均DASA评分表示的单元氛围是否与住院患者攻击风险相关，但未对个体风险进行控制。
调查DASA单元平均评分或单元平均值与个体患者DASA评分之间的相互作用是否与个体发生攻击行为的可能性相关。
采用重复评估和复发事件的Cox回归分析，通过回顾性文件审查收集的113名住院患者的11243次DASA风险评估。
单元DASA平均评分与对工作人员的攻击行为无关。在识别患者之间的攻击行为时，个体和单元DASA平均评分之间存在负向相互作用；与DASA平均评分较低的单元相比，当单元平均值升高时，高风险患者的攻击行为较少。
在未稳定单元可能有更多的护理干预措施和/或患者进行了更强的自我调节，从而减少了攻击行为。
目前，没有足够的证据表明应使用单元平均评分来补充个体DASA评分以识别攻击风险。
