Risk of violence among patients in psychiatric treatment: results from a national census

Figures & data

Table 1. Descriptive statistics and risk of violence among inpatients.

	% of patients
	No risk	Low/moderate risk	High risk	Very high risk	Sum	Of all patients	(N)
All patients	67.6	26.8	4.4	1.2	100	100.0	2240
Male	52.2	38.7	6.8	2.3	100	47.6	1041
Female	81.9	15.7	2.3	0.2	100	52.4	1147
Age
18–23 years old	68.9	26.3	3.0	1.8	100	15.3	334
24–29 years old	62.3	29.8	6.0	1.8	100	15.2	332
30–39 years old	56.0	36.6	5.5	1.9	100	21.5	470
40–49 years old	64.4	27.4	7.4	0.8	100	17.3	379
50–59 years old	74.4	22.4	3.2	0.0	100	14.3	313
60–69 years old	83.5	15.4	0.5	0.5	100	8.3	182
70 years and older	83.8	15.6	0.6	0.0	100	8.2	179
ICD-10 diagnoses
F01–F09 Mental disorders due to known physiological conditions	72.2	24.1	0.0	3.7	100	2.6	54
F10–F19 Mental and behavioral disorders due to psychoactive substance use	56.8	36.9	5.4	0.9	100	5.4	111
F20–F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders	48.5	42.0	7.4	2.1	100	39.8	819
F30–F39 Mood [affective] disorders	83.5	14.8	1.6	0.0	100	26.5	546
F40–F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders	91.3	7.8	0.4	0.4	100	11.2	231
F50–F59 Behavioural syndromes associated with physiological disturbances and physical factors	93.0	7.0	0.0	0.0	100	3.4	71
F60–F69 Disorders of adult personality and behavior	64.0	27.9	7.0	1.2	100	4.2	86
F70–F79 Intellectual disabilities	42.9	42.9	14.3	0.0	100	0.7	14
F80–F89 Pervasive and specific developmental disorders	41.4	41.4	10.3	6.9	100	1.4	29
F90–F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	60.9	34.8	4.3	0.0	100	1.1	23
F99–F99 Unspecified mental disorder	66.7	33.3	0.0	0.0	100	0.1	3
Z-diagnosis as main diagnosis: factors influencing health status and contact with health services	90.0	10.0	0.0	0.0	100	1.5	30
Other diagnoses	69.8	27.9	2.3	0.0	100	2.1	43
Socio-economic status
Income
Income from labor	82.9	15.3	1.8	0.0	100	9.9	222
Health-related benefits	63.4	30.3	4.9	1.4	100	65.1	1459
Other economic support from national insurance	72.6	22.2	4.3	0.9	100	25.0	559
Education
High education (completed lower or higher university degree)	83.9	14.9	1.2	0.0	100	15.0	335
Medium education (completed upper secondary school)	75.1	21.1	3.3	0.5	100	37.0	828
Low education (did not complete upper secondary school)	56.8	34.8	6.3	2.0	100	48.1	1077
Other
No fixed address	40.3	45.9	9.7	4.1	100	12.9	290
Refugee	34.3	45.7	11.4	8.6	100	1.6	35
Born outside Norway	51.4	36.3	9.6	2.8	100	11.2	251
Suicide attempt (last 4 weeks)	81.8	15.5	2.7	0.0	100	4.9	110
Living in one of the five regional cities	59.7	33.6	5.2	1.4	100	24.8	556
Unit
Hospital ward	60.1	31.8	6.4	1.8	100	63.1	1414
District psychiatric center	83.2	15.6	1.1	0.1	100	32.9	737
Other institutions	58.4	40.4	1.1	0.0	100	4.0	89
Referral formality
Voluntarily committed	81.5	16.8	1.5	0.2	100	65.8	1474
Involuntarily committed	41.0	46.0	10.1	3.0	100	34.2	766

Table 2. Descriptive statistics and risk of violence among outpatients.

	% of patients in risk group
	No risk	Low/moderate risk	High risk	Very high risk	Sum	Of all patients	(N)
All patients	92.3	6.8	0.6	0.2	100	100.0	20,329
Male	86.5	11.8	1.2	0.4	100	37.1	7469
Female	95.8	3.8	0.3	0.1	100	62.9	12,681
Age
18–23 years old	90.1	8.7	0.8	0.3	100	16.3	3199
24–29 years old	91.3	7.5	0.8	0.3	100	18.0	3537
30–39 years old	92.2	7.1	0.5	0.2	100	25.3	4977
40–49 years old	92.7	6.3	0.7	0.3	100	21.1	4144
50–59 years old	94.1	5.2	0.6	0.1	100	11.8	2321
60–69 years old	96.5	3.1	0.4	0.0	100	4.2	833
70 years and older	94.8	4.7	0.5	0.0	100	3.4	659
ICD-10 diagnoses
F01–F09 Mental disorders due to known physiological conditions	94.0	6.0	0.0	0.0	100	0.3	50
F10–F19 Mental and behavioral disorders due to psychoactive substance use	77.1	19.2	2.7	0.9	100	2.8	546
F20–F29 Schizophrenia, schizotypal, delusional and other non-mood psychotic disorders	84.8	13.4	1.3	0.6	100	12.1	2327
F30–F39 Mood [affective] disorders	95.4	4.2	0.3	0.1	100	32.2	6191
F40–F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders	95.5	4.1	0.3	0.1	100	26.5	5099
F50–F59 Behavioural syndromes associated with physiological disturbances and physical factors	98.2	1.8	0.0	0.0	100	3.8	733
F60–F69 Disorders of adult personality and behavior	89.8	9.1	0.8	0.3	100	8.8	1693
F70–F79 Intellectual disabilities	79.3	14.4	3.6	2.7	100	0.6	111
F80–F89 Pervasive and specific developmental disorders	88.9	9.4	1.7	0.0	100	1.2	235
F90–F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	90.0	9.2	0.7	0.1	100	4.8	921
F99–F99 Unspecified mental disorder	90.4	8.7	0.0	0.9	100	0.6	115
Z-diagnosis as main diagnosis: factors influencing health status and contact with health services	89.8	9.2	0.8	0.2	100	5.0	968
Other diagnoses	93.9	4.8	0.9	0.4	100	1.2	229
Socio-economic status
Income
Income from labor	94.6	5.0	0.3	0.1	100	26.8	5441
Health-related benefits	91.5	7.4	0.8	0.3	100	53.0	10,783
Other economic support from national insurance	91.5	7.4	0.7	0.4	100	20.2	4105
Education
High education (completed lower or higher university degree)	97.0	2.9	0.1	0.0	100	20.7	4203
Medium education (completed upper secondary school)	93.7	5.6	0.5	0.2	100	44.0	8944
Low education (did not complete upper secondary school)	87.9	10.5	1.1	0.4	100	35.3	7182
Other
No fixed address	77.8	19.1	3.1	0.0	100	1.4	288
Refugee	83.3	14.6	1.6	0.6	100	3.4	699
Born outside Norway	88.3	10.4	1.1	0.2	100	12.2	2476
Suicide attempt (last 4 weeks)	77.9	15.4	3.7	2.9	100	0.7	136
Living in one of the five regional cities	90.9	8.2	0.6	0.3	100	23.2	4725
Unit
Psychiatric outpatient clinics	93.6	5.7	0.5	0.2	100	83.3	16,933
Substance abuse treatment teams	83.1	15.3	1.0	0.6	100	2.4	491
Crises resolution teams	84.8	13.6	1.3	0.4	100	2.7	552
Day treatment units	92.1	7.7	0.2	0.0	100	2.3	466
Inpatient units	92.1	7.9	0.0	0.0	100	0.8	164
Assertive community treatment teams	80.6	16.1	2.0	1.2	100	4.3	881
Other units	89.5	9.3	0.8	0.4	100	4.1	842
Referral formality
Voluntarily committed to outpatient treatment	93.1	6.2	0.5	0.2	100	96.7	19,666
Involuntarily committed to outpatient treatment	69.4	24.4	3.8	2.4	100	3.3	663

Table 3. Regression results, coefficients and ordered probit with risk of violence (no risk, low/moderate risk, high risk or very high risk) as dependent variable (statistically significant associations only).

	Inpatients						Outpatients
	All patients		With substance use disorder		Without substance use disorder		All patients		With substance use disorder		Without substance use disorder
	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2
Base: F20–F29 Schizophrenia, schizotypal, delusional and other non-mood psychotic disorders
F01–F09 Mental disorders due to known physiological conditions	−0.56*** (−3.12)	−0.16 (−0.78)	1.01 (1.56)	1.28* (1.90)	−0.59*** (−3.07)	−0.30 (−1.37)	−0.54* (−1.91)	−0.17 (−0.59)	–	–	−0.42 (−1.46)	−0.093 (−0.32)
F10–F19 Mental and behavioral disorders due to psychoactive substance use	−0.21* (−1.77)	−0.11 (−0.90)	−0.68*** (−4.79)	−0.49*** (−3.02)	–	–	0.28*** (4.30)	0.22*** (3.27)	−0.32*** (−3.45)	−0.22** (−2.16)	–	–
F30–F39 Mood [affective] disorders	−0.99*** (−13.20)	−0.58*** (−6.82)	−1.06*** (−4.94)	−0.72*** (−2.99)	−0.90*** (−11.10)	−0.54*** (−5.81)	−0.65*** (−15.70)	−0.45*** (−9.84)	−0.85*** (−5.25)	−0.60*** (−3.43)	−0.54*** (−12.0)	−0.37*** (−7.52)
F40–F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders	−1.36*** (−11.10)	−1.16*** (−8.54)	−1.91*** (−5.01)	−1.79*** (−4.27)	−1.22*** (−9.39)	−1.03*** (−7.17)	−0.66*** (−15.20)	−0.53*** (−11.0)	−0.65*** (−3.77)	−0.54*** (−2.80)	−0.55*** (−11.80)	−0.45*** (−8.82)
F50–F59 Behavioural syndromes associated with physiological disturbances and physical factors	−1.51*** (−6.59)	−1.03*** (−4.15)	−1.03 (−1.40)	−0.85 (−1.06)	−1.46*** (−5.90)	−0.99*** (−3.70)	−1.08*** (−9.29)	−0.80*** (−6.37)	−4.23 (−0.058)	−4.00 (−0.024)	−0.95*** (−8.10)	−0.71*** (−5.65)
F60–F69 Disorders of adult personality and behavior	−0.33** (−2.39)	−0.040 (−0.27)	−0.46 (−1.39)	−0.44 (−1.29)	−0.26* (−1.75)	0.048 (0.29)	−0.24*** (−4.71)	−0.058 (−1.05)	−0.32* (−1.75)	−0.093 (−0.46)	−0.14*** (−2.62)	0.015 (0.25)
F70–F79 Intellectual disabilities	0.14 (0.45)	0.034 (0.11)	−5.12 (−0.037)	−4.40 (−0.042)	0.34 (1.10)	0.23 (0.71)	0.28** (2.10)	0.27** (1.97)	1.22 (1.52)	−4.61 (−0.014)	0.37*** (2.69)	0.38*** (2.72)
F80–F89 Pervasive and specific developmental disorders	0.27 (1.27)	0.10 (0.46)	−0.19 (−0.34)	−0.41 (−0.69)	0.39* (1.73)	0.25 (1.03)	−0.19* (−1.68)	−0.22* (−1.90)	−0.12 (−0.16)	−0.22 (−0.30)	−0.075 (−0.66)	−0.12 (−0.99)
F90–F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence	−0.33 (−1.31)	−0.28 (−1.02)	0.65 (1.03)	0.89 (1.36)	−0.48* (−1.66)	−0.49 (−1.55)	−0.26*** (−4.08)	−0.21*** (−3.06)	−0.026 (−0.12)	−0.036 (−0.16)	−0.20*** (−2.88)	−0.17** (−2.25)
Other diagnoses	−0.80*** (−4.94)	−0.53*** (−3.06)	−0.34 (−0.52)	−0.41 (−0.57)	−0.72*** (−4.27)	−0.46** (−2.56)	−0.28*** (−4.93)	−0.17*** (−2.74)	−0.12 (−0.16)	−0.0076 (−0.010)	−0.16*** (−2.65)	−0.083 (−1.29)
Men	–	0.58*** (8.91)	–	0.77*** (4.93)	–	0.49*** (6.74)	–	0.49*** (16.1)	–	0.58*** (5.82)	–	0.46*** (14.3)
Age	–	−0.005** (−2.48)	–	−0.0075 (−1.40)	–	−0.0027 (−1.18)	–	−0.007*** (−6.75)	–	−0.001*** (−2.72)	–	−0.01*** (−5.95)
Health-related benefits (b: labor)	–	0.35*** (2.71)	–	0.25 (0.78)	–	0.35** (2.37)	–	−0.00011 (−0.0029)	–	0.43*** (2.60)	–	−0.043 (−1.05)
Other economic support from national insurance (b: labor)	–	0.24* (1.70)	–	0.30 (0.88)	–	0.21 (1.31)	–	0.055 (1.21)	–	0.48*** (2.66)	–	0.030 (0.63)
Medium education (b: high)	–	−0.038 (−0.35)	–	0.098 (0.26)	–	−0.089 (−0.77)	–	0.25*** (5.10)	–	0.13 (0.71)	–	0.26*** (5.06)
Low education (b: high)	–	0.34*** (3.19)	–	0.36 (0.95)	–	0.31*** (2.78)	–	0.48*** (9.68)	–	0.37** (1.98)	–	0.48*** (9.14)
No fixed address	–	0.49*** (5.99)	–	0.35** (2.09)	–	0.53*** (5.49)	–	0.26*** (2.75)	–	0.37** (2.27)	–	0.081 (0.68)
Refugee	–	0.38* (1.82)	–	−0.12 (−0.24)	–	0.51** (2.23)	–	0.19** (2.50)	–	0.17 (0.66)	–	0.20** (2.57)
Born outside Norway	–	0.24** (2.51)	–	0.44** (1.99)	–	0.22** (2.05)	–	0.18*** (3.77)	–	0.14 (0.86)	–	0.20*** (4.02)
Suicide attempt last 4 weeks	–	−0.29* (−1.85)	–	−0.92* (−1.73)	–	−0.17 (−1.02)	–	0.59*** (4.56)		0.66** (2.32)	–	0.57*** (3.90)
Living in one of the five regional cities	–	0.023 (0.33)	–	−0.16 (−1.05)	–	0.085 (1.07)	–	0.10*** (3.14)	–	0.10 (1.12)	–	0.086** (2.39)
Observations	2060	1978	383	369	1677	1609	19,218	18,512	1181	1147	18,037	17,365
Pseudo R2	0.098	0.17	0.093	0.17	0.094	0.16	0.049	0.10	0.029	0.087	0.032	0.084

z-Statistics in parentheses.

*** p < 0.01.

** p < 0.05.

* p < 0.1.

Table 4. Days since first admitted to the unit (inpatients) and days since first consultation (outpatients), showing the mean and median.

	Days since first admitted to the unit (inpatients)		Days since first consultation (outpatients)
	Mean	Median	Mean	Median
No risk	91	26	502	226
Low/moderate risk	382	42	479	187
High risk	416	89	503	189
Very high risk	935	423	781	548