Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives

Abstract

Background: When the people hospitalized in psychiatric units demonstrate aggression, it harms individuals and creates legal and financial issues for hospitals. Aggression has been linked to inpatient, clinician and environmental characteristics. However, previous work primarily accessed clinicians’ perspectives or administrative data and rarely incorporated inpatients’ insights. This limits validity of findings and impedes comparisons of inpatient and clinician perspectives.

Aims: This study explored and compared inpatient and clinician perspectives on the factors affecting verbal and physical aggression by psychiatric inpatients.

Methods: This study used an interpretive theoretical framework. Fourteen inpatients and 10 clinicians were purposefully sampled and completed semi-structured interviews. Data were analyzed using inductive thematic analysis.

Results: Six themes were identified at personal and organizational levels. The three person-level themes were major life stressors, experience of illness and interpersonal connections with clinicians. The three organization-level themes were physical confinement, behavioural restrictions and disengagement from treatment decisions.

Conclusions: Aggression is perceived to have a wide range of origins spanning personal experiences and organizational policies, suggesting that a wide range of prevention strategies are needed.

Keywords:

• Aggression
• inpatients
• qualitative
• involuntary hospital admission
• certification
• conflict
• restraint

Declaration of interest

This study was supported by St. Michael's Hospital and the Ontario Ministry of Health and Long-Term Care’s Applied Health Research Questions and Innovations Fund grants.