Abstract
Aggressive behavior among psychiatric inpatients remains an issue of concern for staff, families and patients themselves. At the present time, studies examining prediction of aggression among psychiatric inpatients have focused mainly on diagnostic or demographic risk factors. Unfortunately little is known about specific social functioning and personality risk factors that may help identify specific individuals at risk for aggressive behavior. Given that many individuals who have engaged in violent criminal behavior have been observed to experience a combination of social isolation, depression and impulsiveness, it is possible that this same combination of traits may function as a predictor of aggression among psychiatric inpatients. The current study examines whether psychiatric inpatients with a combination of social isolation, depression and impulsivity are significantly more likely to become aggressive than other psychiatric inpatients without that combination of factors. Results indicated that impulsivity functioned as a positive predictor of aggression, whereas depression acted as a protective factor. Perceived social support did not appear to relate strongly to aggression. Further, physicians’ ratings of hostility were more predictive of aggressive incidents than were self-reports of hostility. Clinical implications of these findings are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Steinert T, Sippach T, Gebhardt R: How common is violence in schizophrenia despite neuroleptic treatment? Pharmacopsychiatry 33:98–102, 2001.
Bellus S, Vergo J, Kost P, et al: Behavioral rehabilitation and the reduction of aggressive and self-injurious behaviors with cognitively impaired, chronic psychiatric inpatients. Psychiatric Quarterly 70:27–37, 1999.
Daffern M, Howells K: Psychiatric inpatient aggression: A review of structural and functional assessment approaches. Aggression and Violent Behavior 7:477–497, 2002.
Monahan J, Steadman H: Violence risk assessment: A quarter century of research, in The Evolution of Mental Health Law. Edited by Frost L, Bonnie R. Washington DC, American Psychological Association, 2001.
Gudjonnson G, Rabe-Hesketh S, Wilson C: Violent incidents on a medium-secure unit over a 17-year period. Journal of Forensic Psychiatry 10:249–263, 1999.
Duxbury J: An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: A pluralistic design. Journal of Psychiatric and Mental Health Nursing 9:325–337, 2002.
Chou K, Lu R, Mao W: Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan. Archives of Psychiatric Nursing 16:187–195, 2002.
Cunningham J, Conner D, Miller K, et al: Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities. Aggressive Behavior 29:31–40, 2003.
Sjostrom N, Eder D, Malm U, et al: Violence and its prediction at a psychiatric hospital. European Psychiatry 16:459–465, 2001.
Hall H, Ebert R: Violence Prediction: Guidelines for the Forensic Practitioner. Springfield, Charles C. Thomas, 2002
Rasmussen K, Levander S: Violence in the mentally disordered: A differential clinical perspective. Issues in Criminology and Legal Psychology 24:127–130, 1995.
Hoptman M, Yates K, Patalinjug M, et al: Clinical prediction of assaultive behavior among male psychiatric patients at a maximum-security forensic facility. Psychiatric Services 50:1461–1466, 1999.
Mammen O, Kolko D, Pilkonis P: Negative affect and parental aggression in child physical abuse. Child Abuse & Neglect 26:407–424, 2002.
Miller R, Zadolinnyi K, Hafner R: Profiles and predictors of assaultiveness for different psychiatric ward populations. American Journal of Psychiatry 150:1368–1373, 1993.
Hodelet N: Psychosis and offending in British Columbia: Characteristics of a secure hospital population. Criminal Behavior and Mental Health 11:163–172, 2001.
Ehmann T, Ross D, Au T, et al: Aggression among patients with treatment refractory psychoses. Schizophrenia Research 24:14, 1997.
Arango C, Barba A, Gonzalez-Salvador T, et al: Violence in inpatients with schizop- hrenia: A prospective study. Schizophrenia Bulletin 25:493–503, 1999.
Wang E, Diamond P: Empirically identifying factors related to violence risk in corrections. Behavioral Sciences and the Law 17:377–389, 1999.
Stalenheim E: Relationships between attempted suicide, temperamental vulnerability and violent criminality in a Swedish forensic psychiatric population. European Psychiatry 16:386–394, 2000.
Cherek D, Moeller G, Dougherty D, et al: Studies of violent and nonviolent male parolees: II. Laboratory and psychometric measurements of impulsivity. Biological Psychiatry 41:523–529, 1997.
Dougherty D, Bjork J, Huckabee H, et al: Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Research 85:315–326, 1999.
Rubin K, Mills R: The many faces of social isolation in children. Journal of Consulting and Clinical Psychology 56:916–924, 1988.
Chen Y, Ryden M, Feldt K, et al: The relationship between social interaction and characteristics of aggressive, cognitively impaired nursing home residents. American Journal of Alzheimer’s Disease 15:10–17, 2000.
Famularo R, Fenton T, Kinscherff R, et al: Mother and child post-traumatic stress disorder in cases of child maltreatment. Child Abuse & Neglect 18:27–36, 1994.
Fava M: “Anger Attacks”: Possible variants of panic and major depressive disorders. American Journal of Psychiatry 147:867–890, 1990.
Tardiff K, Sweillam A: Assault, suicide and mental illness. Archives of General Psychiatry 37:164–169, 1980.
Berkowitz L: Toward a general theory of anger and emotional aggression: Implications of the cognitive-neoassociationistic perspective for the analysis of anger and other emotions, in Perspectives on Anger and Emotion: Perspectives in Social Cognition, 4th ed. Edited by Wyer R, Krull, T. Hillsdale, NJ, Lawrence Erlbaum & Associates, 1993.
Overall J, Gorham D: The Brief Psychiatric Rating Scale. Psychological Reports 12:578–602, 1962.
Overall J, Henry B, Markett J: Validity of an empirically derived phenomenological typology. Journal of Psychiatry Research 9:87–99, 1972.
Overall J, Woodward J: Conceptual validity of a phenomenological classification of psychiatric patients. Journal of Psychiatry Research 12:215–230, 1975.
Lachar D, Bailley S, Rhoades H, et al: New subscales for an anchored version of the Brief Psychiatric Rating Scale: Construction, reliability and validity in acute psychiatric admissions. Psychological Assessment 3:384–395, 2001.
Derogatis L, Melisaratos N: The Brief Symptom Inventory: An introductory report. Psychological Medicine 13:595–605, 1983.
Beck A, Steer R: Beck Depression Inventory: Manual. San Antonio, TX, The Psychological Corporation, 1987.
Zimet G, Dahlem N, Zimet S, et al: The multidimensional scale of perceived social support. Journal of Personality Assessment 52:30–41, 1988.
Barratt E, Stanford M: Impulsiveness, in Characteristics of the Personality Disordered. Edited by Costello C. New York, Wiley, 1995.
Patton J, Stanford M, Barratt E: Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51:768–774, 1995.
Garnefski N, Doets T: Perceived social support and dysfunctioning in “clinical” and “normal” adolescents. Journal of Adolescence 23:753–762, 2000.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ferguson, C.J., Averill, P.M., Rhoades, H. et al. Social Isolation, Impulsivity and Depression as Predictors of Aggression in a Psychiatric Inpatient Population. Psychiatr Q 76, 123–137 (2005). https://doi.org/10.1007/s11089-005-2335-1
Issue Date:
DOI: https://doi.org/10.1007/s11089-005-2335-1