Hostility and Violent Ideation: Physical Rehabilitation Patient and Community Samples

OBJECTIVES: To assess the relative frequency of violent ideation VI in physical rehabilitation and community samples, and to identify associated factors. DESIGN: Analysis of variables from the Battery for Heath Improvement using MANOVA, ANOVA and chi(2) analyses. SETTING: Medical sites in 30 US states, and community sites in 16 US states, overall representing 36 US states. PARTICIPANTS: 527 physical rehabilitation patients suffering from both acute and chronic pain conditions, and 725 community members. Subjects from both groups were drawn from a larger pool of 2,262 subjects. INTERVENTIONS: None. OUTCOME MEASURES: The Hostility scale and a VI critical item from the Battery for Heath Improvement (BHI). RESULTS: The patient group reported significantly more violent ideation than did the community group. VI was also significantly associated with involvement in workers' compensation or personal injury insurance systems, work conditioning programs, the BHI Hostility scale, and a number of other psychosocial factors. CONCLUSIONS: Recent research supports the contention that there is a relationship between ideation, angry affect, aggressive behavior and delayed recovery. Thus the presence of VI in the patient should be a cause for concern, and has clear ramifications for those working in the clinical setting. Primary prevention should involve not only the identification of hostile patients at risk for VI and aggression, it should also involve identifying programs or systems where a higher incidence of VI is likely to be observed. As VI was found to be associated with a range of variables, including characterological disorders, mood and social conflict, a further evaluation of factors contributing to VI would be recommended prior to intervention.