Aggressive Event Incidence using the Staff Observation of Aggression Scale-Revised (SOAS-R): A Longitudinal Study

Abstract

The aim of this study was to identify aggressive event incidence rates in the inpatient psychiatric setting, describe characteristics of events and differences based on aggression target and type (verbal vs. physical). A longitudinal study was carried out of aggressive events identified by workers in four inpatient psychiatric units using the Staff Observation of Aggression Scale-Revised (SOAS-R) over 6weeks. A total of 113 aggressive events were recorded resulting in a rate of 13.27 events per bed per year. Verbal aggression was demonstrated in 86% and physical aggression in 57% of events. Most events (70.8%, n=81) targeted a worker. Compared to other targets, workers were 3.4 times more likely to feel threatened (95% CI 1.2-9.6, χ2=5.08, p=0.0242), and less likely to have a visible injury (OR 0.15, 95% CI 0.04-0.6; χ2=7.1, p=0.0078). Event severity ranged from 0 to 21 with a mean of 9.5(SD=5.1), with 20% considered severe. Verbal events had lower mean severity of 6.5(SD=3.8) versus physical events with a severity of 11.8(SD=4.8; t=6.5, df=111, p<0.0001). In 57.5% of events there was no consequence to the victim. For most events (76%) resolution included workers talking to the patient, while 54% involved use of medication. Restrictive measures (physical hold, seclusion or physical restraint) were involved in 24.8% of events. Aggression incidence was similar to incidence found in other studies. Workers were the target of most aggressive events and many were identified as having no understandable provocation. Further understanding of event characteristics will promote more effective prevention and management of aggressive events.