@article{ref1,
title="Incidents of aggression in German psychiatric hospitals: is there an increase?",
journal="PLoS one",
year="2021",
author="Eisele, Frank and Steinert, Tilman and Flammer, Erich",
volume="16",
number="1",
pages="e0245090-e0245090",
abstract="INTRODUCTION: In a meta-analysis of international studies, 17% of admitted patients in psychiatric hospitals had exhibited violent behavior toward others. Reported data  from studies in Germany were considerably lower until recent years. However, studies  examining only single hospitals, as well as the quality of the data itself, have  raised questions as to the validity of these findings. Indeed, a debate currently  exists as to whether there has, in fact, been an increase of violent incidents in  German mental institutions. <br><br>METHODS: In a group of 10 hospitals serving about half  the population of the Federal State of Baden-Wuerttemberg with 11 million  inhabitants, the Staff Observation Aggression Scale-Revised (SOAS-R) was introduced  into patients' electronic charts as part of routine documentation. Data recording  was strongly supported by staff councils and unions. A completed data set is now  available for the year 2019. For one hospital, data are available since 2006. Due to  some doubts with respect to fully covering self-directed aggression, we restricted  the analysis to aggression toward others and toward objects. <br><br>RESULTS: In 2019,  17,599 aggressive incidents were recorded in 64,367 admissions (1,660 staying  forensic psychiatric inpatients included). 5,084 (7.90%) of the admitted cases  showed aggressive behavior toward others. Variation between hospitals was low to  modest (SD = 1.50). The mean SOAS-R score was 11.8 (SD between hospitals 1.20%). 23%  of the incidents resulted in bodily harm. The percentage of patients showing violent  behavior was highest among patients with organic disorders (ICD-10 F0) and lowest  among patients with addictive or affective disorders (F1, F3, F4). Forensic  psychiatry had the highest proportion of cases with aggressive behavior (20.54%),  but the number of incidents per bed was lower than in general adult psychiatry and  child and adolescent psychiatry (indicating a lower risk for staff). In the hospital  with longer-term recordings available, an increase could be observed since 2010,  with considerable variation between years. <br><br>CONCLUSIONS: This is the most robust  estimate of the frequency of violent incidents in German psychiatric hospitals thus  far. The incidence is about half of what has been reported internationally, probably  due to sample selection bias in previous studies and a relatively high number of  hospital beds in Germany. Available data suggest an increase of violent incidents  over the last ten years; however, it is unclear to which extent this is due to  increased reporting.<p /> <p>Language: en</p>",
language="en",
issn="1932-6203",
doi="10.1371/journal.pone.0245090",
url="http://dx.doi.org/10.1371/journal.pone.0245090"
}