Ball E M, Young D, Dotson L A, Brothers L T, Robbins D
Department of Psychiatry, University of Colorado Health Sciences Center, Denver, USA.
Bull Am Acad Psychiatry Law. 1994;22(4):605-20.
This study was designed to identify risk factors associated with violence within a forensic inpatient hospital setting. The primary purpose was to develop a screening tool to aid in the rapid identification of patients requiring high versus low security ward placement. Subjects included 232 consecutive admissions during a five-month period to a 300-bed forensic division within a public-sector psychiatric hospital. Demographic, historical, and current clinical variables were collected, and dangerous behaviors were documented by nursing staff on a daily basis. The associations between dangerous outcomes and various risk factors were examined using chi-square or t tests, as appropriate. Stepwise logistic regression analysis was performed to assess the contribution of each risk factor significantly associated with violent behavior. A strong association was found between 10 risk factors and the incidence of violence in our forensic population. These factors included current clinical factors (grossly inappropriate behavior observed on the ward, an assessment of current escape risk); historical factors (psychiatric hospitalization history, criminal history variables, and a self-report of prior violence); and one demographic variable (length of stay). Of the 10 risk factors then included in the stepwise regression analysis, four contributed significantly to the final predictive model. Grossly inappropriate behavior, patient self-report of prior violence, history of psychiatric hospitalization, and a history of 10 or more prior psychiatric hospitalizations were most predictive of a violent outcome. Although situational and environmental variables also must be incorporated into final assessments and decisions, the identified significant variables can provide an additional tool in the rapid assessment of violence potential.
本研究旨在确定法医住院医院环境中与暴力相关的风险因素。主要目的是开发一种筛查工具，以帮助快速识别需要安置在高安全级别病房还是低安全级别病房的患者。研究对象包括在五个月期间连续入住一家公立精神病医院拥有300张床位的法医科的232名患者。收集了人口统计学、病史和当前临床变量，护理人员每天记录危险行为。根据情况，使用卡方检验或t检验来检查危险结果与各种风险因素之间的关联。进行逐步逻辑回归分析，以评估与暴力行为显著相关的每个风险因素的作用。在我们的法医人群中，发现10个风险因素与暴力发生率之间存在密切关联。这些因素包括当前临床因素（在病房观察到的严重不当行为、对当前逃跑风险的评估）；病史因素（精神科住院史、犯罪史变量以及先前暴力行为的自我报告）；以及一个人口统计学变量（住院时间）。在逐步回归分析中纳入的10个风险因素中，有4个对最终预测模型有显著贡献。严重不当行为、患者先前暴力行为的自我报告、精神科住院史以及10次或更多次先前精神科住院史对暴力结果的预测性最强。尽管情境和环境变量也必须纳入最终评估和决策中，但所确定的显著变量可以为快速评估暴力可能性提供额外的工具。
