Miller R J, Zadolinnyj K, Hafner R J
Dibden Research Unit, Glenside Hospital, Eastwood, South Australia.
Am J Psychiatry. 1993 Sep;150(9):1368-73. doi: 10.1176/ajp.150.9.1368.
The authors examined associations between patient-related characteristics and assaultiveness on six different psychiatric wards to determine 1) the relative contributions of demographic, disorder-related, and diagnostic variables to prediction of assaultiveness and 2) how ward composition and type of victim affect prediction of assaultiveness.
Hospital records of 1,025 inpatients residing in psychiatric wards within a 6-month time frame were reviewed for evidence of assaultiveness. Data on all 260 assaultive patients and a sample of 136 of the nonassaultive patients were analyzed with multiple regression to predict assaultiveness scores for each ward and each victim category.
The findings indicated high rates of assaultive patients and assaults on fellow patients. Multiple regression results produced different predictors of assaultiveness for different wards but not for different categories of assault victim within each ward. Overall, age and sex consistently failed to predict assaultiveness, whereas greater assaultiveness was significantly associated with a greater proportion of time hospitalized since first admission. The most powerful unique predictors of assaultiveness scores were diagnostic distinctions derived from data on coexistent diagnoses. The most assaults were by acute patients whose diagnoses excluded organic mental disorder but included either bipolar disorder or personality disorder and longer-stay patients whose exclusive diagnosis was organic mental disorder.
This identification, albeit modest, of risk factors for assaultiveness on different wards nevertheless provides information fundamental to the management policies of psychiatric institutions. The findings caution against aggregating different ward populations for research on assaultiveness and endorse the usefulness of coexistent diagnoses for predicting assaultiveness.
作者研究了六个不同精神科病房中与患者相关的特征和攻击性之间的关联，以确定：1）人口统计学、疾病相关和诊断变量对攻击性预测的相对贡献；2）病房构成和受害者类型如何影响攻击性预测。
回顾了6个月时间内居住在精神科病房的1025名住院患者的医院记录，以寻找攻击性的证据。对所有260名有攻击行为的患者以及136名无攻击行为患者的样本数据进行多元回归分析，以预测每个病房和每个受害者类别的攻击性得分。
研究结果表明有攻击行为的患者比例较高，且存在患者之间相互攻击的情况。多元回归结果显示，不同病房有不同的攻击性预测因素，但同一病房内不同类别的攻击受害者的预测因素并无差异。总体而言，年龄和性别始终无法预测攻击性，而自首次入院以来住院时间越长，攻击性越强。攻击性得分最有力的独立预测因素是来自并存诊断数据的诊断差异。攻击行为最多的是急性患者，其诊断不包括器质性精神障碍，但包括双相情感障碍或人格障碍，以及长期住院患者，其唯一诊断为器质性精神障碍。
尽管对不同病房攻击性风险因素的识别有限，但仍为精神病院的管理政策提供了重要信息。研究结果提醒不要将不同病房的人群合并进行攻击性研究，并认可并存诊断对预测攻击性的有用性。
