Identifying key factors associated with aggression on acute inpatient psychiatric wards

Len Bowers, Teresa Allan, Alan Simpson, Julia Jones, Marie Van der Merwe, Debra Jeffery

Research output: Contribution to journalArticlepeer-review

91 Citations (Scopus)


Aggressive behaviour is a critical issue for modern acute psychiatric services, not just because of the adverse impact it has on patients and staff, but also because it puts a financial strain on service providers. The aim of this study was to assess the relationship of patient violence to other variables: patient characteristics, features of the service and physical environment, patient routines, staff factors, the use of containment methods, and other patient behaviours. A multivariate cross sectional design was utilised. Data were collected for a six month period on 136 acute psychiatric wards in 26 NHS Trusts in England. Multilevel modelling was conducted to ascertain those factors most strongly associated with verbal aggression, aggression toward objects, and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Insufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence.

Original languageEnglish
Pages (from-to)260-71
Number of pages12
JournalIssues in Mental Health Nursing
Issue number4
Publication statusPublished - 9 Jul 2009


  • Aggression
  • Alcohol Drinking
  • Attitude of Health Personnel
  • Attitude to Health
  • Commitment of Mentally Ill
  • Cross-Sectional Studies
  • England
  • Hospital Units
  • Humans
  • Inpatients
  • Mental Disorders
  • Multivariate Analysis
  • Nursing Staff, Hospital
  • Occupational Health
  • Psychiatric Nursing
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Statistics, Nonparametric
  • Verbal Behavior
  • Violence
  • Journal Article


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